The XX Factor

At Universities, Students’ Medical Records are Open Territory

A university facing a Title IX investigation turned over notes from a student’s private therapy sessions.


When it comes to legal rights, colleges often operate as independent territories. Some crimes committed on college campuses get sorted out through labyrinthine internal justice systems rather than involving the local police or courts. And as two accounts published today on ProPublica detail, a student who matriculates at a university doesn’t have the same rights to privacy as her unenrolled neighbor.

At issue are the stories of two college students whose medical records were viewed and used by their universities without their consent. One, a former Yale student named Andrea, was hospitalized against her will when she began abusing alcohol and considered suicide after being treated on campus for depression and anxiety. Though the medical professionals who treated Andrea knew that she and her parents were not on good terms—they knew nothing of her mental health treatment—the campus health center notified them when she was admitted to the hospital.

University health facilities are not covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which keeps most medical records confidential without the patient’s consent. Instead, college students’ health records fall under the Family Educational Rights and Privacy Act, which gives parents the right to inspect their children’s records at an educational institution. ProPublica explains the dilemma schools face when it comes to viewing and disclosing their students’ medical records:

Universities walk a fine line when providing that treatment or mental-health services to students. If campus officials don’t know what’s going on or disclose too little, they risk being blamed if a student harms himself, herself, or others. If they pry too deeply, they may be accused of invading privacy, thereby discouraging students from seeking treatment.

But in Andrea’s case, Yale’s parental notification caused real harm. Andrea says she would have rather moved in with a friend or a friend’s family than back with her parents, who refused her access to continued psychiatric help once they took her home. In order to graduate with her class, which she did, Andrea had to come back to campus—but Yale only let her return with her parents as an escort. 

The other student profiled in the ProPublica series, Laura Hanson, filed a claim against the University of Oregon after being raped in 2013 by a fellow student. After several months of investigation, the university “concluded that the student who she accused of the assault was responsible for sexual misconduct” and placed him on probation. Hanson’s lawyer asked the university to send over her medical records, since she’d been tested for pregnancy and sexually transmitted infections after the assault.

There was one set of records the university didn’t send: the notes from the private counseling sessions where Hanson confronted her rape trauma. “I found out months later that every single meeting I had with a therapist, she took detailed notes on, and the University of Oregon had read these notes before I had even seen them,” Hanson told ProPublica. According to the school’s general counsel, this practice is totally kosher for a university facing allegations of Title IX violations or other instances of negligence or misconduct.

Viewing medical records for medical reasons could help a university protect a student at risk of harm. But the University of Oregon’s meddling into Hanson’s private account of her rape would have only helped the university protect itself. The value of therapy lies in the patient’s expectation of confidentiality; if a student thinks her private exchanges with a doctor could resurface in the office of a university administrator, helping her heal will be much harder. A therapist’s office can be one of the only safe spaces available to a rape survivor on a college campus. Exploiting that trust to try to avoid paying a legal settlement is a cynical maneuver that can only exacerbate an already-low rape reporting rate.