The missing pieces of the mental health records of Virginia Tech shooter Seung-Hui Cho were made public today by the university, offering the first glimpse at the medical evaluations Cho underwent prior to committing the deadliest school shooting in U.S. history.
The records chronicle two telephone conversations and one in-person visit between Cho and mental health professionals at the Cook Counseling Center, the university's student mental health services provider, in the winter of 2005, the only instances in which the student ever interacted with the center, according to authorities.
Throughout his visits with mental health professionals, Cho denied having any homicidal or suicidal thoughts, according to documents.
The in-person consultation at the center followed Cho's release from the psych ward at Carilion St. Albans hospital on Dec. 14, 2005. According to the documents, Cho had been admitted overnight to the hospital after his roommate became concerned when Cho threatened to take his own life.
"I met with student for about 30 minutes," wrote triage counselor Sherry Lynch Conrad on a Post-It note stuck to Cho's file dated Dec. 14, 2005, the day after his release. "He denied any suicidal or homicidal ideation. Said the comment he made was a joke. Says he has no reason to harm self and would never do it."
Even so, Conrad drew an "X" through the portion of the medical chart that assesses a patient's mental health, instead writing, "Did not assess -- student has had two previous triages in past two weeks -- last two days ago."
Conrad wrote that she provided Cho with emergency numbers should he begin to have "suicidal or homicidal thoughts" over winter break, but she did not schedule a follow-up appointment because Cho didn't "know his schedule."
Cho first made contact with the center on Nov. 30, 2005, when he was referred by a professor.
In the records from his initial telephone conversation, another triage counselor checked off "Troubled: Further contact within 2 weeks" under the portion of the form that rates the severity of the patient's disposition.
An in-person appointment was scheduled for Cho on Dec. 12, 2005, but when he failed to show up, another telephone consultation took place.
According to the documents, Cho indicated in the second phone conversation that his symptoms of depression and anxiety had persisted. He also said that he was having trouble concentrating.
That counselor's notes indicate that Cho said that "he did not want to come in at this time," despite his symptoms.
This is the first time the public has seen the notes of three separate therapists who counseled Cho.
On April 16, 2007, Cho killed 32 people and then himself on the Virginia Tech campus in Blacksburg, Va., making the school the site of the deadliest shooting in U.S. history and the focal point for a renewed debate over gun control and mental health services.
In a written statement released in conjunction with the medical records, Virginia Tech released a statement saying the university believes the center's counselors acted "appropriately in their evaluation of Cho."
"The absence and belated discovery of these missing files have caused pain, further grief, and anxiety for families of the April 16 victims and survivors, as well as for the Cook Counseling Center professionals who interacted with Cho and created and maintained appropriate departmental records," reads the statement.
"With release of these records, Virginia Tech seeks to provide those deeply affected by the horrible events of April 2007 with as much information as is known about Cho's interactions with the mental health system 15-16 months prior to the tragedy."
Just two weeks after the shootings, Virginia Gov. Timothy Kaine signed an executive order that required anyone court-ordered to receive mental health treatment be added to a state database of people prohibited from buying guns.
A year after the shooting, Sen. Jim Webb, D-Va., introduced legislation that would amend the Family Educational Rights and Privacy Act, which determines how much of a student's mental health records can be disclosed by a university. Webb argued that the Virginia Tech massacre may have been prevented had the policy been more clear on when information about a mentally ill student can be shared by a university .
The records released today were discovered to be missing during a Virginia panel's August 2007 investigation -- four-and-a-half months after the massacre.
The notes were recovered last month from the home of Dr. Robert Miller, the former director of the counseling center, who says he inadvertently packed Cho's file into boxes of personal belongings when he left the center in February 2006. Until the July 2009 discovery of the documents, Miller said he had no idea he had the records.
Miller has since been let go from the university.
Cho, born in 1984 in Seoul, South Korea, was a naturalized U.S. citizen and had lived in the Washington, D.C., area since age 8.
In the days and weeks following the massacre, it became clear that Cho had not been a happy child. Even his grandfather told ABCNews.com after the massacre that his grandson Cho had "never hugged."
The documents released today make no reference to any mental health diagnoses prior to Cho's time as a Virginia Tech student. After the shooting it was reported that Cho had been diagnosed and had received treatment as a young adult for an anxiety disorder.
Four months after the shootings, Gov. Kaine released a report that harshly criticized the university for its handling of the incident, primarily in the failure to notify students promptly about the shootings, as well as the failure to notice warning signs that he says may have prevented the incident altogether.
University officials have cited privacy laws as the reason they did not exchange information on Cho's mental health history or contact his parents about problems he was having on campus.
The Virginia Tech massacre occurred over a span of several hours, beginning in the early morning of April 16, when Cho claimed his first victims -- students Emily Hilscher, 19, and Ryan Clark, 22 -- as they sat in Hilscher's fourth-floor dorm room.
Cho is then believed to have returned to his own dorm room, where he collected more ammunition and firearms before preparing a lengthy note in which he wrote, "You caused me to do this."
Meanwhile, campus police were just then receiving a call about an incident in the dorm room.
At approximately 9:01 a.m., Cho went to the Blacksburg Post Office where he mailed photos, a letter and video clips of himself reciting an angry rant to NBC. The multimedia manifesto included 27 video clips with 10 minutes worth of Cho's chilling, personal rantings.
"You had 100 billion chances and ways to avoid today. But you decided to spill my blood," Cho said on the video in the package. "You forced me into a corner and gave me only one option. The decision was yours. Now you have blood on your hands that will never wash off."
Included with the video clips was a 1,800-word diatribe in which he professed admiration for Columbine killers Dylan Klebold and Eric Harris; Cho carried out his rampage on the same week as the Columbine murders were committed in 1999.
Forty-three still photos, 10 of which showed Cho holding handguns, were also included in the package sent to NBC.
Cho then headed to Virginia Tech's engineering building, Norris Hall, where he shot and killed 30 people before taking his own life. Cho fired more than 170 rounds, a shot every three seconds, inside the building where he had once attended class.
In all, Cho's shooting rampage inside the building lasted nine minutes. It took police three minutes to respond to the scene and another five minutes to break through chains that Cho had used to lock the building's three public entrances.
Police heard a final gunshot -- presumably Cho's suicide shot -- before entering one of the four classrooms he targeted and discovering his corpse among some of his 30 Norris Hall victims.
Two handguns were retrieved near Cho's body: a .22 caliber model that was purchased in February from a Wisconsin dealer, the same one that 48-year-old George Sodini got his guns from for use in the Aug. 4 fitness club killings near Pittsburgh. Cho also purchased a 9 mm model at a Roanoke gun shop.