• Background
  • The Investigation
  • The Notes
  • The Law
  • Repercussions?
  • Vanderbilt and Gender Ideology
  • Why It Matters

Leaked investigative documents from the Metro Nashville Police Department (MNPD) indicate Vanderbilt Psychiatric Hospital (VPH) knew about Nashville school shooter Audrey Hale’s homicidal fantasies before she committed murder.

If true, VPH could face civil penalties for failing to alert law enforcement.


Hale shot six people — including three nine-year-olds — at Covenant Christian School on March 27, 2023, before being killed by police.

The MNPD refuses to release Hale’s extensive writings due to an “ongoing investigation” into the attack. Considering Hale died at the scene, the target of this investigation has remained unclear — until now.

Documents leaked to The Tennessee Star earlier this month show the MNPD wanted to find out whether Hale’s psychologists knew about her mental state prior to the attack.

Hale began treatment at VPH in 2001 when she was just six years old. She completed the hospital’s young adults Intensive Outpatient Program in 2019 after a local therapist recommend she be involuntarily committed.

Hale was still receiving treatment from VPH at the time of the shooting. She had bottles of Lexapro, buspirone and hydroxyzine — common medication to treat anxiety and depression — prescribed by the hospital in her medicine cabinet.

The Investigation

Police discovered Hale’s connection to VPH on the day of the shooting during an interview with her parents.

On May 13, 2023, the MNPD subpoenaed all of Hale’s psychological and medical records from VPH to “determine Audrey Hale’s mental state before the incident and at the time of the incident.”

On June 1, the MNPD requested a search warrant for these same records, explaining they “would assist in confirming or denying if any Vanderbilt Psychiatric Hospital Staff knew of the mental state of Audrey Hale.”

The affidavit continues:

It is not uncommon for patients to confide to their therapist or psychologist. Your affiant believes there is a strong possibility that Audrey Hale confided to a Vanderbilt Psychiatric Hospital Staff Member since she has been receiving care there since 2001.

The request not only confirms MNPD’s interest in what VPH knew about Hale’s homicidal thoughts, but, according to Star reporter Tom Pappert, suggests VPH didn’t produce the appropriate records when subpoenaed.

Police conducted the search in June 2023, yielding at least 75 pages of notes from Hale’s therapy sessions.

The Notes

A police officer’s analysis of the therapy notes seized from VPH show Hale’s psychologists documented her homicidal ideation, including her desire to shoot up a school.

The Daily Citizen has included a replication of the original document, published and authenticated by the Star, below. All abbreviations have been spelled out in parentheses for added clarity.

The Law

Tennessee Code 33-3-206 requires mental health professionals and behavioral analysts to report if a patient became homicidal or suicidal and shared a plan to carry it out.

At the time of the shooting, however, the law didn’t require psychologists report the threat to law enforcement — only to the patients intended victim.

State Representative Jason Zachary helped close this loophole directly after Hale’s attack on Covenant Christian, making psychologists in Tennessee report threats of violence to law enforcement.


The Star’s sources claim MNPD Chief John Drake himself acknowledged VPH could be sued for failing to warn potential victims of Hale’s homicidal fantasies. Drake has since denied making this statement.

Regardless, the penalties for violating Tennessee Code 33-3-206 are relatively light. VPH would face no criminal charges. A civil suit could be brought against them, which could result in it paying a fine. An additional Tennessee Code noted by the Star, however, suggests the statute of limitations on such a suit may have already expired.

VPH officially declined to comment on Hale’s treatment on June 20, 2024.

Vanderbilt and Gender Ideology

VPH is part of Vanderbilt University Medical Center (VUMC), the group Matt Walsh accused of performing “gender-affirming surgeries” for profit in September 2022.

The Daily Wire journalist’s damaging Twitter thread included video of Dr. Shayne Taylor calling “the “gender transition game” a “big money-maker.” As the Daily Citizen previously reported:

Dr. Taylor shared that performing double mastectomies on young girls who want to appear more masculine “can bring in $40,000” while prescribing opposite-sex hormones “can bring in several thousand dollars.”

The doctor says that female to male “bottom surgeries,” which consists of the removal of a girl’s uterus and ovaries, followed by the construction of a faux penis, is a “huge money maker” and can bring in up to $100,000.

Adjusting for inflation, these procedures would be worth more than $50,000 and $125,000 today, respectively.

Dr. Taylor remains in the medical center as an Assistant Professor of Internal Medicine and Pediatric and a physician at the CUMC Clinic for Transgender Health.

Another video of the same event showed Dr. Ellen Clayton warning staff against “problematic conscientious objections.” Walsh sums up:

Anyone who decides not to be involved in transition surgeries due to “religious beliefs” will face “consequences.”

Dr. Clayton also remains at VUMC in the Center for Biomedical Ethics and Society, where she teaches pediatrics and health policy. She also teaches law at Vanderbilt’s law school.

Additional evidence published by Walsh showed that, between 2018 and 2022, Vanderbilt prescribed opposite-sex hormones to children as young as thirteen and performed double-mastectomies on adolescents.

VUMC “paused gender-affirmation surgeries” shortly after Walsh’s expose. It continues to embrace gender ideology in medicine.

At this point, there is no evidence to suggest VPH contributed to Hale’s gender confusion in any way.

We do know, however, that Hale entered an Intensive Outpatient Program at the Hospital in 2019 — one year after VUMC “got into the gender transition game.”

Hale revealed her gender confusion to her parents sometime after she turned 25 in March 2020.

Why It Matters

Audrey Hale repeatedly told VPH doctors that she was homicidal — including multiple mentions of her desire to commit a school shooting. If MNPD finds the hospital truly did not communicate this danger, it should be held legally accountable.

Given the rapid adoption of gender ideology in medical institutions, the public has a right to know how these ideas affect children’s treatment — especially if it makes them worse. VPH should be more forthcoming about any “gender-affirming treatment” Hale received, when it began, and whether her mental state subsequently declined.

Additional Articles and Resources

Nashville Shooter’s Journal Reveals Destructive Power of Gender Ideology

Five Things You Need to Know About the Nashville Shooter’s Manifesto

Tennessee Considering Legislation Banning ‘Sex-Change’ Procedures on Minors After Vanderbilt Scandal

New Gender Research Confirms Previous Findings: Most Gender Confused Kids Desist

Texas Children’s Hospital Embroiled in Fraud Scandal as Haim Case Kicks Off

Pediatrics Organization Urgers Their Peers to Cease Harming Children

Judge Up for Promotion Moved Serial Rapist and Pedophile into Female Prison

U.K.’s Review of Child Gender Policy Reveals Profound Failures That U.S. Still Defends