Harvard's University Health Services (UHS) does not promise students anonymity. But it does promise doctor-patient confidentiality.

When UHS admits a student, the nurse on call releases the student's name to a senior tutor or assistant dean of freshmen. But policy requires that UHS reveal no other information.

The policy is designed, in part, to ensure that underage students will seek medical attention for alcohol abuse when they need it--and not worry about possible disciplinary action.

But it is not unusual for administrators to find out why students were admitted.

Harvard University Police Department (HUPD) reports--which are faxed to administrators whenever HUPD transports students to UHS--sometimes indicate if incidents are alcohol-related, says HUPD spokesperson Peggy McNamara

And--in violation of official UHS policy--medical staff at UHS have informed administrators that students have been admitted for alcohol abuse.

Two former assistant deans of freshmen say administrators will often call and ask students why they were admitted to UHS, and students, hesitant to refuse to give the information or lie, will often tell them.

And if an incident attracts a lot of attention--if the student is ill enough to require an ambulance, for example-- administrators sometimes find out what happened simply by word-of-mouth, says Harry R. Lewis '68, dean of the College.

Lewis says it is not surprising that administrators sometimes find out if a student goes to UHS for an alcohol-related illness. But this is not necessarily undesirable, he writes in an e-mail, as it allows administrators to intervene if the incident is symptomatic of a larger problem.

"Though of course no one is happy when students publicly embarrass themselves, I am not sure that it is a bad thing when word gets around--we may be able to intervene to get a student some counseling help," he writes. "College is not a bad place to learn that one's standing in the community can be affected by one's drinking behavior."

Besides, Lewis says, the College also promises that students will not be disciplined by the College's Administrative Board when they seek medical attention for alcohol-related illnesses--even if administrators find out.

Ill Communication

If nothing else, a significant portion of the campus is confused about an alcohol policy that promises confidentiality at UHS in some matters--but not in others.

Nearly 50 percent of undergraduates believe that senior tutors or assistant deans will not find out if they seek medical treatment at UHS, even though it is UHS policy to always inform administrators when a student is admitted to Stillman Infirmary or any other hospital.

And more than a quarter of the undergraduate population believes that a student brought to UHS for an alcohol-related illness is "likely" or "very likely" to be disciplined by college administrators.

It is unclear how well UHS policy is understood by those who must enforce it on a day-to-day basis.

One senior tutor incorrectly believed that it was UHS policy to notify senior tutors of both the admittance and the reason should one of their students be admitted for alcohol-related problems.

One nurse said it was up to the discretion of the nurse on call whether or not to notify administrators--even though UHS policy requires they be notified unless the student expressly forbids them from doing so.

Students say this kind of confusion reduces the likelihood that they will seek help at UHS when they need it, or that others will seek it on their behalf.

"No one wants to bring the guy passed out on the floor to UHS--not because they care about him getting in trouble, but because they don't want to get in trouble themselves for having the party or for buying the alcohol," says Alexis M. Craig '02.

Craig says she would take an inebriated friend to any hospital but UHS.

"Only if I had a friend who had alcohol poisoning, and I thought they might die in five seconds, would I maybe take them to UHS," Craig says.

But Lewis and UHS Director David S. Rosenthal '59 say they are not worried that nearly three in 10 undergraduates believe they would face disciplinary action as a result of going to UHS.

"I am a 'glass half-full' kind of guy, and I actually am impressed that almost three-quarters of our students know that a behavior which is clearly illegal under state law and contrary to College rules will ordinarily not result in disciplinary action," Lewis writes in an e-mail.

Applying The Pressure

Part of the confusion may arise from the fact that while the College's Administrative Board does not discipline students for seeking medical attention at UHS after alcohol-related incidents, they may be required to attend counseling or speak with assistant deans or senior tutors about their drinking.

A Kirkland House sophomore, who asked to remain anonymous, drank too much in a friend's room last spring and was taken by ambulance to UHS's urgent-care facility.

When she returned to the Yard the next day, both her proctor and Assistant Dean of Freshmen Wendy E. Torrance asked to meet with her.

"I was given the impression that there would be some undesirable consequence to my Harvard status if I didn't tell them everything I knew about where I had gotten the alcohol," the student says.

"My friends' names were given under duress," she says. "I just felt really bad about dragging my friends into it, but I knew that I would be causing problems if I didn't tell them everything I remembered."

The student says the assistant dean then contacted her friends.

"The administration has now heard of their names in conjunction with alcohol, based on my going to UHS," the student says. "I would not characterize this experience as anonymous or confidential in any way."

Two former assistant deans, who spoke on condition of anonymity, described similar incidents.

Dean of Freshmen Elizabeth Studley "Ibby" Nathans would not comment on the specifics of any individual case, but says that as long as the College takes no disciplinary action against a student, broad questioning is a reasonable follow-up measure to an alcohol-related UHS admittance.

As a result, a first-year's meeting with an assistant dean "may include a conversation about where and how the student obtained the alcohol," Nathans writes in an e-mail.

Rosenthal says he is surprised to hear of an incident in which a student felt compelled to reveal the names of her friends.

This is not what UHS visits are intended to accomplish, he says.

"I don't think students [who have gone to UHS] are required to respond to any of this sort of administrative questioning," he says.

The Proctor Lottery

Not all first-years are questioned in this way.

A first-year student who went to UHS earlier this fall after drinking says that her meeting with her proctor and Assistant Dean Philip A. Bean was relatively low-key.

She says her comfortable relationship with her proctor kept the meeting casual.

"They were really cool about it," says the student, who asked to remain anonymous. "They just wanted to make sure that I was all right and that there was no real history to be worried about."

The student says she was not asked about where and with whom she was drinking--even though her proctor ran into her friends when he came to visit her at the hospital.

The FDO does not intend conversations with students to follow a disciplinary line of questioning, says Noah S. Selsby '95, a senior proctor of the Ivy Yard.

"The usual questions should ask why the student drank, rather than how," Selsby says.

Beyond the Yard, House residents say that enforcement of alcohol policy does not result in extensive questioning by administrators.

An Eliot House senior who went to UHS after drinking last fall says his tutor wrote him an e-mail asking if he was all right after the incident.

The student says he thanked the tutor for her concern, and the incident was never mentioned again.

"I had expected more hassle, but all I got was this one e-mail from the tutor, who didn't even know why I had gone to UHS," the student says.

The student says his experience actually made him trust UHS "marginally" more.

He says that when his roommates initially tried to take him to UHS, he sat down in the middle of Mass. Ave. and refused to budge.

"Before the incident, I never would've taken my roommate to UHS, unless they were near death," the student says.

The student says he found his own brief interaction with UHS personnel and senior tutor heartening.

"I trust [UHS] a little bit more on the side of anonymity than I did before," the student says.

A Matter Of Discretion

Lewis says administrators must know when students are admitted to UHS--for the students' own well-being.

"We can't have a parent call looking for their child and have us in the dark about where the student is, when the University itself has been involved in hospitalizing the student," Lewis wrote in an e-mail.

But even then, UHS informs administrators inconsistently.

Susan W. Stern, a UHS nurse practitioner, says the decision to contact the Freshmen Dean's Office (FDO) or a senior tutor is actually left to the discretion of the nurse on call.

"We do things by the individual," she says. "We look at how long the person has been at the University, to see whether drinking is a problem or a one-time thing."

She says no firm guidelines exist on whether or not administrators are notified.

"There is no blanket policy," she says. "We try to be as sensitive to the person's needs as possible."

Because of a revision to UHS policy instituted last year, nurses will honor a student's explicit request not to contact Harvard administrators, according to after-hours care physician Donald H. Perlo '83.

"It turns out that if a student comes into Stillman and doesn't want anyone to know, that request would have to be honored," Perlo says. "We don't want the notification issue to get in the way of someone getting medical care."

Some students are never contacted about their visits to UHS.

An Eliot senior who was taken to UHS as a first-year returned to the hospital after drinking too much as a sophomore.

No College administrator contacted him after either UHS visit.

The lack of mandatory notification comes as a surprise to Yard proctors who say they rely on UHS to know whether one of their students has had a problem with alcohol.

In Selsby's six years as a proctor, he remembers only one case in which UHS did not notify him that a student was admitted.

"The fact that everything isn't being reported is more than a little bit concerning," Selsby says. "This is not the policy they present to us."

With one policy in place and others in practice, who knows what--and how they know it--is constantly in flux.