Dr. Lynne Fenton sounded the alarm that alleged theater shooter James Holmes was a threat to others.

Friends and acquaintances say they would expect nothing less from the University of Colorado Denver psychiatrist who is a central figure in the murder case being built against the former neuroscience student accused of killing 12 people and injuring 58 others in an Aurora movie theater.

On Thursday, attorneys will debate about access to a notebook Holmes mailed to Fenton — a crucial piece of evidence in the case against Holmes, who is charged with 24 counts of first-degree murder and 116 counts of attempted murder.

News reports, citing anonymous sources, say the notebook contains details of Holmes’ murderous plans.

Defense attorneys say the notebook is protected by doctor-patient confidentiality and should be returned to Holmes.

Prosecutors say the notebook’s content is not privileged and should be admitted as evidence.

To determine who is right, 18th Judicial District Chief Judge William Sylvester will consider when Holmes, 24, started visiting Fenton; when the treatment relationship ended, if it did; and whether Holmes did anything that would have waived the usual doctor-patient privilege.

So far, information about Fenton and her connection to Holmes has been a tightly held secret, protected by the judge’s gag order.

Sources say Fenton, who is skilled at recognizing trouble and who in 2010 helped create the campus’ Behavioral Evaluation and Threat Assessment team, alerted team members in early June about her concerns regarding Holmes.

For her to take her concerns outside of her office, Fenton must have seen something worrisome.

Mental-health professionals have a duty under federal guidelines called the “Tarasoff Rule” to protect or warn a third party only if the therapist believes or predicts that the patient poses a serious risk to a reasonably identifiable victim.

Colorado law gives further direction, saying a psychiatrist cannot be held liable for failing to warn about a mental-health patient’s behavior, except where the patient has communicated to a mental-health-care provider a “serious threat of imminent physical violence against a specific person.”

Specific threat

According to courtroom discussion and documents released Friday, Holmes made a specific threat that was brought to the attention of campus police.

Those documents say Holmes told a fellow student in March that he wanted to kill people. The documents also say he made threats to a professor sometime before June 12, when he withdrew from the graduate program.

Fenton’s friends and colleagues say she would have known exactly the right thing to do in any situation.

Fenton, 51, has not responded to requests for an interview.

Her friends and ex-colleagues described her as a highly intelligent physician with an easy ability to connect with her patients.

“You don’t meet people quite as brilliant and amazing and caring and thorough as her,” said Dr. Ellen Price of Grand Junction, who worked with Fenton in the early 1990s. “I am sure she did everything completely the right way. I am sure of it.

“Her history shows that is what she does. She is ethical, caring and brilliant.”

Fenton earned a bachelor’s degree in genetics from the University of California at Davis in 1982, then earned her medical degree at Chicago Medical School in 1986 and completed her residency at Northwestern University Medical Center.

She began her career as a physiatrist, specializing in rehabilitation of injuries or illnesses that affect a person’s movement. Her first job was as chief physician at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio.

Not long after, she relocated to Colorado, where she worked for Colorado Rehabilitation and Occupational Medicine in Aurora and eventually started her own practice, the Merlin Medical Institute.

She began to use acupuncture as a way to treat pain.

A 1998 Denver Post article also showed that she had begun looking into ways to use acupuncture to increase women’s breast sizes.

In the article, Fenton said she knew some people, including fellow doctors, “will say this (is) silly.”

“But I’m glad to have this procedure to offer to women who like this idea but wouldn’t want to have (implant) surgery,” she said. “It’s a big self-esteem issue for a lot of women.”

Disciplined by board

Her career record is not pristine.

Around the same time as The Post article, the state medical board disciplined Fenton after the U.S. Drug Enforcement Agency found that she had improperly prescribed medicine to herself, her husband and two staff members.

The discovery came after Fenton alerted the DEA about a bogus prescription order from a staff member, whom she promptly fired.

The DEA found the employee had obtained multiple illegal prescriptions through Fenton’s office and conducted a complete investigation — discovering Fenton in violation of drug laws.

She had prescribed Ambien and Claritin (then not an over-the-counter drug) to her husband; Lorazepam and Vicodin to an employee who was suffering from chronic headaches; and Xanax to another employee who was nervous about flying. Also, she took three tablets of Xanax herself during a time when her mother was dying.

The investigation concluded she had failed to maintain required medical charts, and she agreed to never again prescribe drugs for family members or employees. She voluntarily completed 50 hours of continuing medical education in pain management.

The discipline did not seem to derail her career.

Along with her private practice, she became the medical acupuncturist at the Mile High Spine and Rehabilitation Center in Greenwood Village, where she worked with Dr. Jennifer Burns.

“We took care of people who were in pain, and most of those patients are depressed and anxious,” said Burns, who added that she noticed Fenton becoming more intrigued with the counseling aspect of the work.

Fenton’s husband at the time, Steffen Andrews, said she began to realize it wasn’t just the needles that were helping people recover.

“She started to begin to think that there was something in the one-on-one, the direct doctor-patient interaction beyond just the needles that may have been having a therapeutic effect,” he said. “That led her to think, ‘Maybe it’s the dialogue that I am having.’ “

Career change

In 2005, she entered the residency program for psychiatry at CU Denver. Friends were not surprised when Fenton decided to change careers.

“Most people do one residency. Not Lynne. She does two,” said Price, the Grand Junction doctor.

Each year, residents take the Psychiatry Resident In-Training Exam. Fenton’s scores were among the nation’s highest, said Andrews, who was divorced from Fenton in 2002 but remains her friend. The university could not confirm her scores in relation to others in the nation.

“The wonderful part about her is that she is brilliant and great in social situations,” Andrews said. “She has these wonderful interpersonal skills. That’s why her colleagues like her and loved her. That is why she always had wonderful relationships with her patients.”

The best and brightest usually end up as the chief resident.

Fenton was chief resident in the CU psychiatry department, and Andrews said she held the same position during her residency at Northwestern.

In 2009, Fenton became medical director of the Anschutz Medical Campus student mental-health service. A year later, CU hired her as an associate professor of psychiatry. She is paid about $150,000 per year.

She supervised residents, taught courses and was a research fellow with the Veterans Administration. She wrote papers, gave presentations and continued research projects. One of her specialties was schizophrenia, and her “particular research interest is the neurobiology of psychotherapy, what happens in the brain with psychotherapy, and why does it work,” she wrote in her online biography.

In August 2009, she helped coordinate sessions on how to train students to recognize the signals of common mental- health problems — and what they should do when they saw them. Within a year, she was leading an effort to create a campuswide Behavioral Evaluation and Threat Assessment — or BETA — team, a collection of ad hoc administrators who can help provide support, information and referrals to those dealing with threatening or disruptive situations.

Name in the news

An avid gardener and lover of the outdoors, Fenton was described by a neighbor as apparently comfortable in her career and life.

“We love her as a neighbor and a person,” said Marie Mos-sett, who lives near Fenton in the Mayfair neighborhood. “We think it is terrible what (the media) is doing to her.”

In the minutes after a court document revealed Fenton was Holmes’ psychiatrist, the psychiatrist’s name and photo were splashed around the world as people searched for a motive behind the shooting.

The university immediately disabled her online biography and refused to comment about her, citing the gag order. It hired an attorney to represent her.

Even limited data found on the Web about Fenton made news, including an agenda from a May 30 presentation to the psychiatry department called “World of Warcraft: The Use of Archetypes in Psychotherapy” — a discussion that Fenton participated in about a multiplayer role-playing video game that Holmes had reportedly played.

Later, after open-records requests from The Post, CU released limited information about Fenton, including employment agreements and her yearly performance evaluations for 2010 and 2011 that rated her as “outstanding” and that she “far exceeds performance expectations.”

Why and when Fenton began to see Holmes have not been publicly discussed. According to a CBS report, Holmes also was seen by three mental health professionals at the campus clinic.

Prosecutors say sometime in the spring, Holmes began to struggle in the rigorous neuroscience graduate program on the Anschutz campus — failing in his labs, prompting a professor to suggest another vocation. On June 7, he performed poorly on his oral exams. That day, he bought the second of two Glock pistols he would bring to the Century Aurora 16 on July 20.

The prosecution clearly is laying out its courtroom strategy: Holmes reacted to his academic failure with the shooting.

Questions remain: What did Fenton know? Did she do enough to stop the massacre?

“I feel so badly for her,” said Price, who moved to Grand Junction in 1995 but still considers Fenton a friend. “It is not fair for one person to have the burden of this on their shoulders. No doctor can be responsible for this guy’s actions.

“He was smart, and he probably didn’t tell her much. People don’t know her, and they are looking for someone to blame. But she is not God.”

Staff writer Charles Minshew contributed to this report.

Jeremy P. Meyer: 303-954-1367, jpmeyer@denverpost.com or twitter.com/jpmeyerdpost