WATERLOO - Questions persist about why law enforcement agencies were not notified Tuesday when Mark Becker was released from Covenant Medical Center.

Becker was taken to Covenant early Sunday for medical treatment after leading law officers on a high-speed chase across three counties. According to court documents, the chase began when a witness saw Becker at about 9 p.m. Saturday vandalizing a house in Cedar Falls. The pursuit ended six miles north of Parkersburg on Iowa Highway 14 when Becker hit a deer going 90 mph.

In a statement Thursday, the Butler County Sheriff's Office said authorities had asked the county's mental health coordinator, known as a "central point coordinator," to contact them when Becker was discharged. A central point coordinator is responsible for the administration and funding of mental health services in the county.

"An emergency detention order was signed by a Black Hawk County Judicial Magistrate on June 21st to hold Becker for evaluation. Law enforcement officials were not notified upon Mark Becker's release on June 23rd," the statement said.

The next day, Becker showed up at the Aplington-Parkersburg High School and allegedly shot football coach Ed Thomas multiple times. Thomas later died at Covenant.

The sheriff department's statement clarified earlier reports that authorities requested notification from the hospital about Becker's release.

Bob Lincoln, who oversees Butler County's mental health services, said he couldn't comment on the sheriff's statement because of federal privacy regulations. Lincoln also oversees mental health services for four other counties, including Black Hawk.

Covenant Medical Center officials said in a release that they were never asked to notify anyone about Becker's release.

"Our review shows no evidence of this request, so notification was not made," according to the hospital's prepared statement. "It is always our goal to work cooperatively with law enforcement and carry out requests for notification as we have done many times before."

Covenant said a "third party" picked Becker up from its facility in Waterloo but could not identify them except to say it was not a family member or police.

Hospital officials also said Becker was not officially under arrest while at their facility. Had he been, Covenant officials said a deputy would have to be posted while Becker was a patient. That did not happen.

Cedar Falls Police Chief Jeff Olson said his department usually holds off on making an arrest if medical attention is required.

"Typically, if we're going to the hospital, we're not going to arrest them until the (hospitalization) is all over," Olson said.

If the case is important enough, Olson said, police can get a court order requiring hospital officials to tell them when the patient is discharged.

Olson said his department intended to charge Becker for the vandalism after Butler County finished its booking procedures.

The incident highlights difficulties hospital and law enforcement officials have coping with complex federal, state and local regulations related to mental health.

Area mental health officials say having a magistrate sign an order for emergency detention is standard and necessary when dealing with people who have mental health or substance abuse problems.

"There really needs to be that legal enforcement," said Kristina Tripp, director of mental health services for Allen Hospital.

Tripp said the order is important because it in effect waives federal privacy requirements under the Health Insurance Portability and Accountability Act, which oversees most medical information. The order also allows hospital officials to release a patient into police custody.

"There is responsibility of the police department to make sure all that paperwork is in order so we can discharge them into police custody without a HIPAA violation," Tripp said.

Legally, a hospital can hold a person for mental health concerns for no more than 48 hours before further legal action is taken. If more time is needed, Tripp said physicians or psychiatrists can begin involuntary committal proceedings.

Taking that step can gain as much as five days for further examination before a court hearing is scheduled, said Diane Larsen, a mental health referee for Black Hawk County. Larsen works with committal cases on a regular basis.

Among the reasons for committal are signs the person poses a danger to themselves or the public. Larsen said the system relies on opinions of mental health professionals to make that determination, which can be difficult at times.

"They'll all tell you, you can't predict the future with great accuracy," she said.

The majority of times, patients do not commit crimes after being released, though they do get help later on. In Becker's case, no paperwork was filed for further examination.

Hospital and county health officials did not comment on whether Becker had sought treatment previously for mental health issues.