The transgender-identifying shooter who killed six at a Christian school last year confessed her homicidal urges to personnel at Vanderbilt University Medical Center, but personnel there may not have taken steps to prevent the tragedy, according to a new report.

The Tennessee Star reported Wednesday that it has obtained a file called “Vandy Psych” consisting of notes taken by a police officer who reviewed documents from the Vanderbilt Psychiatric Hospital about the shooter’s treatment after the tragedy. The patient was reportedly seen by mental health doctors at Vanderbilt for 22 years.

“Thoughts of killing Dad in and struggles with mental health,” the document says. “Recent thoughts of going into a school and shooting a bunch of people… Homicidal thoughts with a plan. Misunderstood and felt like she needed to prove a point.”

Tennessee State Code 33-3-206 requires mental health professionals to “warn of, or take precautions to protect the identified victim from the service recipient’s violent behavior” if “a service recipient has communicated to a qualified mental health professional or behavior analyst an actual threat of bodily harm against a clearly identified victim” and is “likely to carry out the threat.”

The specificity of the shooter’s admissions was not clear from the reported sections of the document. The Star said a source told it that Metro Nashville Police Department Chief John Drake privately said he believes a violation occurred.

The Tennessee statute at the time carried no criminal penalty, but victims could seek money from the healthcare providers in court — except that the statute of limitations may have already passed, The Star said. Tennessee has since passed a stricter law requiring mental health personnel to alert police of threats.

Drake broke a promise to release the transgender killer’s manifesto as the FBI pressured it to conceal it, according to an FBI memo also obtained by The Star. Meanwhile, officials said the shooter — who The Daily Wire is not naming — was not politically motivated, and the FBI did not consider it domestic terrorism.

“The Covenant matters remains under investigation and detectives are working to bring it to a conclusion,” a police spokeswoman told The Daily Wire on Thursday.

The Daily Wire obtained portions of the manifesto that undercut those claims, suggesting she was motivated by grievances about transgenderism and laws passed by Republicans. The writings even said she’d “kill” to obtain puberty blockers.

Vanderbilt University Medical Center (VUMC) figures prominently into the debate over transgender treatments for Tennessee youngsters.

In a 2018 video exposed by The Daily Wire in 2022, VUMC Clinic for Transgender Health’s Dr. Shayne Sebold Taylor told young doctors “female-to-male bottom surgeries” were “huge money makers” that could bring in “up to $100,000” for the hospital, while health law expert and pediatrician Ellen Wright Clayton said “If you don’t want to do this kind of work, don’t work at Vanderbilt.”

Tennessee lawmakers banned sex-change treatments for minors in response, but federal judge Eli Richardson issued an injunction partially pausing enforcement.

In his ruling, he noted that “Dr. Pinson, the Deputy Chief Executive Officer and Chief Health System Officer at VUMC, has testified that ‘[s]hould enforcement of [SB1’s] provisions prohibiting Hormone Therapy be deferred, delayed, or enjoined, VUMC would continue to provide Hormone Therapy consistent with the prevailing standards of care for persons with gender dysphoria to those minor patients of VUMC.’”

However, an appeals court then undid Richardson’s ruling.

John Howser, a spokesman for VUMC, told The Daily Wire that “under federal (HIPAA) and state privacy rules and regulations, without permission, VUMC is not in a position to confirm or deny that any particular individual presently receives or previously received health care from VUMC.”

“Additionally, VUMC follows all applicable state and federal laws and regulations. Under Tennessee law, gender-affirming care involving puberty-blocking drugs, hormone therapy, and surgical gender transition is prohibited for any patients under age 18,” he added.

In 2023, Tennessee Attorney General Jonathan Skrmetti’s office was investigating potential medical billing fraud in relation to transgender treatment by the hospital.