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Primarily a research and teaching hospital affiliated with Indiana University, the first patients were admitted in July 1952. The hospital continues in operation. A total of 17975 patients had been admitted as of June 2008. Information about patients and their records is accessible through the hospital, which has preserved nearly all of its medical records.
Opened in 1890 as the Southern Indiana Hospital for the Insane, the facility, known as “Woodmere,” was located on 879 lushly wooded acres. It served primarily counties in southwestern Indiana. A disastrous fire in 1943 forced closure of the hospital for two years. The records were lost, but “ heroic action” by staff saved nearly all the 1100 patients. After rebuilding, Evansville reopened in 1945 and is still in operation. Through June 2008, 23749 patients had been admitted. For information on patients admitted before the fire, contact the Indiana State Archives. Contact the hospital for information on patients admitted after 1945.
Indiana’s second oldest mental health facility opened in 1879 at Knightstown. It was relocated to Fort Wayne in 1890. The first patient admitted that year was an eleven year old boy from Ossian, Wells County. It served mentally retarded children from throughout Indiana until 1939, when its service area was reduced to the northern half of the state. Its mission was expanded to include patients of all ages with other developmental disabilities. Before closure in 2007 the facility had admitted 12162 patients. The center’s admission registers, card index, and a nearly complete set of medical records on microfilm, are at the Indiana State Archives.
The Indiana Hospital for Insane Criminals was authorized by the Indiana General Assembly in 1909 and opened on the grounds of the Indiana State Prison at Michigan City on October 19, 1912. It housed convicted criminals who were adjudged insane and persons indicted or acquitted because of insanity. The criminally insane from the entire state were incarcerated here. The inmates were transferred in 1954 to the newly opened Maximum Security Division of the Dr. Norman M. Beatty Memorial Hospital at Westville, Indiana.
The 1335 acre campus of the Northern Indiana Hospital for the Insane opened in 1888 on a high bluff over the Wabash River, hence its popular name “Longcliff.” It serves primarily counties in northern and west central Indiana. The institution is still in operation, admitting patients with mental illnesses and criminally involved or “forensic” individuals not committed to the Department of Correction. Logansport had admitted 38498 patients as of June 2008. The hospital maintains a complete admission index. The first inmate register (1888-1905), case history books through 1919, microfilmed patient records from the 1950s and 1960, and a sample of records from other years are at the Indiana State Archives.
The 585 acre campus opened in 1910 as the Southeastern Hospital for the Insane. Situated on a bluff overlooking the Ohio River, it was appropriately called “Cragmont.” It was built to serve patients living in southeastern Indiana. Still in operation, the hospital had admitted 47106 inpatients as of June 2008. The hospital’s complete medical records through 1987 are at the Indiana State Archives. A master admission register is maintained by the hospital.
This facility opened in 1920 on 1813 acres near Butlerville in Jennings County. Known originally as the Indiana Farm Colony for the Feeble-Minded, it became a separate institution for mentally retarded children in 1937. Legislation in 1939 limited its service area to the southern half of the state. Its role too expanded over the years to include individuals of all ages with other developmental disabilities. Prior to closure in 2005 Muscatatuck had admitted 8117 patients. The Indiana State Archives has the hospital’s two admission registers. Only a sample of the early medical records survive. Records for patients discharged after 1972 were saved and transferred to the State Archives.
This facility opened in 1907 on 1300 acres in rural Henry County as the Indiana Village for Epileptics. It was one of only seven facilities in the world built especially to care for persons with convulsive disorders. Prior to New Castle’s opening many epileptics had been housed in county jails and poor asylums. Its mission expanded in 1955 to include treatment of the neurologically disabled. It was an important center for anticonvulsant drug research in the 1960s and 1970s. Prior to its closure in 1996 New Castle had admitted 6461 patients. The State Archives has the master card index, two admission registers, a sample of the early medical records, and complete records for patients discharged from 1988-1998.
This hospital, popularly known as “Easthaven,” opened in 1890 on a 1000 acre campus near Richmond in Wayne County. It serves counties in east central Indiana. Richmond is still in operation. As of June 2008 it had admitted 42251 patients. The hospital maintains a complete admission index. A sample of the medical records has been sent to the State Archives; the remaining records were destroyed.
Besides the records of the individual state hospital, researchers should be familiar with a number of related collections in the Indiana State Archives and in local court houses.
Index to Patients Discharged from State Hospitals, 1890-1986
From its creation in 1889 the Board of State Charities systematically collected information on all aspects of public welfare in Indiana, including persons in state hospitals and correctional facilities. Entry of information into the state hospital index continued until 1986. Virtually every patient discharged from a state hospital has a card. Information on these cards includes dates of admission and discharge, hospital name, patient hospital number, diagnosis, county of residence, and date and place of birth. Many cards give the names of parents and siblings. The card index is the only source of information on patients admitted to Evansville State Hospital before the 1943 fire. Access to this essential search tool, which is on microfilm, is restricted to State Archives’ staff for reasons of confidentiality.
State Archives’ Insanity Inquest Collection
An Act of 1818 empowered circuit courts in Indiana to conduct inquests into cases of suspected insanity and to appoint guardians for individuals adjudged insane. Later acts gave courts the power to commit such persons to state hospitals. Over time inquest paperwork became increasingly detailed, with long lists of questions about the individuals accused of insanity and detailed statements by examining physicians. One copy of the inquest was sent to the state hospital. Another copy was kept by the county clerk or the information transcribed into so-called “Insane Books.”
When Central State Hospital closed in 1994 the State Archives found over 25000 inquests for patients committed there. These documents have been arranged and a database of names prepared. Volunteers at the State Archives are presently searching through county court records at the State Archives for additional commitment papers and adding these to the database. These papers include commitments to hospital other than Central State. Information in “Insane Books” transferred to the State Archives will be added too. For reasons of confidentiality, the database is not online.
For commitment information not found at the State Archives, check with clerks of court in the various Indiana counties. Some clerks still have their copies of old inquests for insanity or the so-called “Insane Books.”
These elements must be protected regardless of where they are found—in a patient’s medical record, an admission register, financial records, operational records such as meeting minutes and contracts.
How health information providers in each state safeguard PHI is determined by a preemptive analysis. If state confidentiality statutes are more restrictive, they preempt HIPAA. Conversely, HIPAA standards prevail if they are more restrictive. In some cases the outcome is a blend of state and federal law.
In Indiana’s case, state laws on access to confidential mental health records were determined in most instances to be more restrictive, so they prevail. Briefly, a patient’s mental health record is confidential and cannot be disclosed without the consent of the patient. In the case of minors or person incapable of giving consent, a parent, a guardian, or a health care representative may exercise the patient’s right. In the absence of consent, state law provides a mechanism for court ordered disclosure of a mental health record following a hearing, but this process is mainly limited to situations in which there is pending litigation.
The big issue for most family historians is access to decedents’ records. Here again, Indiana Code governs. Basically, consent to the release of a deceased patient’s records may be given by the personal representative of the patient’s estate, then by a spouse, and, finally, by “a responsible member of the patient’s family.” For purposes of access, the State Archives defines a “responsible member of the patient’s family” as someone related to the patient. Along with a signed Consent to Release Information, the State Archives requires proof that the patient is deceased and evidence of relationship. In practice this means copies of documents showing relationship to the deceased patient, such as birth, death, marriage certificates, census records, obituaries, and more.
For Indiana, the big change wrought by HIPAA involves the terminal date of confidentiality. Indiana Code opens most records to public access after seventy-five years. HIPAA provides no time limitation on confidentiality, so it is more restrictive. As a result, Indiana mental health records presently are confidential in perpetuity. Amending HIPAA to impose a time limit on restrictions to decedent health information will take a determined lobbying effort by genealogists.
The time limitation issue aside, HIPAA is not a blanket prohibition on access to mental health records. Researchers need to determine how HIPAA affects confidentiality statutes in their respective states before requesting confidential information and then work with health information providers in order to access the wealth of information on family members found in state hospital records. Indiana is fortunate indeed that so much of its institutional heritage has been preserved for future generations by the Indiana State Archives.
Alan January is Director of Patron Services at the Indiana State Archives. He holds a Ph.D. in American History from the University of Iowa. Versions of this article were delivered previously at the Midwest Archives Conference Annual Meeting in 2007 and the Midwestern Roots Family History and Genealogy Conference in 2008.
The author would like to thank Katherine G. Gregory, J.D., Deputy Chief Counsel in the Office of General Counsel, Indiana Family and Social Services Administration, for commenting on this article.