Should doctors ask patients about guns? Forum airs the debate
Published: Wednesday, February 6, 2013 at 10:24 p.m.
Last Modified: Wednesday, February 6, 2013 at 10:24 p.m.
Psychologist Steve Pittman posed a hypothetical situation to University of Florida law students at a forum Wednesday: If Pittman were to ask a psychotic patient whether he owned firearms, the question alone — not to mention recording the answer in the patient's medical records — would constitute a third-degree felony that could put Pittman in prison, with fines of up to $5 million.
At the moment, that situation is a moot point, but in 2011, a Florida law known as Privacy of Firearm Owners Bill was passed, making it a crime for doctors to ask patients about guns and record that information in their medical records.
Florida physicians and organizations including the American Academy of Pediatrics filed suit against the law, which they dubbed the "Physicians' Gag Law," and it was struck down in federal court.
The state has since appealed that decision, and in the wake of national and local incidents of gun violence, the issue of privacy versus protection — and the physician's role — has emerged.
"For me, (gun ownership) is vital information," said Pittman, who is executive vice president and chief operating officer of Meridian Behavioral Healthcare. "That (law) would be a huge constraint on me, not just for patients in crisis, but those with a history of being unstable."
But the National Rifle Association and other groups say guns shouldn't be singled out.
"Probably more kids die in swimming pools than by guns in Florida," said Sandra Froman, an attorney and past president of the NRA who is on its board of directors.
Froman also spoke at Wednesday's forum at the UF law school.
"I think people ought to have the right to say it's none of the doctor's business," Froman said.
Furthermore, gun ownership information on patients' electronic health records serves as "a defacto gun registry," Froman said.
Docs vs. Glocks
Shortly after the law was passed, Florida physicians filed a suit against it. According to Dr. Bernd Wollschlaeger, a family practice doctor in Miami and one of the doctors who filed the suit, "We don't consider ourselves fringe physicians like the governor likes to say. We are mainstream physicians who want to uphold safety."
"Politicians have to be mindful that the average American citizens are not radicals, but law-abiding citizens who love safety and security. What we claim with our lawsuit makes sense for all law-abiding citizens. If you have a gun, keep it away from your children. Love your children more than your gun," Wollschlaeger continued.
And part of working on behalf of safety is allowing physicians to ask about guns, along with other potential risks such as household poisons and swimming pools, Wollschlaeger said. "We ask about a lot of things that people may find offensive, like sexual behavior."
Dr. Mobeen H. Rathore, the president of the Florida Chapter of the American Academy of Pediatrics, who also was part of the suit, said doctors "are in a unique position to provide guidance to our families and children and protect them from any number of things. We talk to them about prevention or protection — not whether they can have firearms or not. That's not our role."
But openly discussing risky situations is, Rathore continued, which made the law an infringement of both patients' and physicians' First Amendment rights. Rathore was one of the authors of a recent editorial in the Journal of the American Medical Association about the law, which underlies physicians' role in protecting kids from gun violence.
"Screening for child and adolescent access to firearms is an essential component of injury prevention," the editorial said.
But Marion Hammer, another NRA past president, argued that since the Second Amendment protects a person's right to bear arms, doctors shouldn't have the right to ask about it.
"Firearms are protected by the Constitution. Swimming pools are not. Poisons are not," Hammer said. "If safety is (doctors') concern, then providing information is important, without asking what you do or do not do."
Hammer said some doctors have a political agenda to encourage patients to dispense with guns or not get them in the first place. She recalled a doctor who once asked her about guns at her granddaughter's appointment.
"First the doctor asked me if I would leave the room. And I refused. Then she asked whether or not we had guns in the home, and I told her I wouldn't answer."
"She didn't ask about any other measures. She asked about guns period."
Where mental illness fits in
But if physicians like Pittman and Wollschlaeger couldn't ask their patients about guns, they would be doing these patients — and society — a disservice, they said.
"As a physician who is board-certified in mental health, I am very much in favor of a mental health registry ... to know that they don't have access to medications or guns that they can abuse … that patients must be cross-checked," Wollschlaeger said.
Although most mentally ill people don't commit acts of violence, there is a greater tendency for them to do so compared to the general population, Pittman said.
He added that the Florida Department of Corrections is the state's largest single mental health provider, and 18 percent of the total incarcerated population is seen for mental health disorders, which rises to nearly 50 percent among women.
Pittman said treating the mentally ill is one piece of the country's gun violence puzzle, but that mental health facilities and providers need more funding to function. Florida is 49th out of all states for mental health spending, and it spends less on mental health than it did in the 1950s, Pittman said.
"If we expect the mental health system to play a crucial role, which it can, we have to decide to fund it," Pittman said.
Furthermore, psychologists and psychiatrists do a good job of predicting short- but not long-term violence, he added. In other words, they can spot a person who is likely to commit an act of violence within 48 hours, but not in three years.
Forensic assessments can determine long-term risks, but they are generally available only for previously incarcerated individuals, not people off the street, like those who have been responsible for the recent outbursts of gun violence, Pittman said.
Self-protection and the Second Amendment
Allowing people to protect themselves from random acts of violence is what the NRA stands for, Froman told the law school forum.
"As a law-abiding citizen, I want to have the same right to protect myself as the police," Froman said, pointing out that police are not generally at the scene of violent crime as it occurs because "criminals go where they know there are unarmed victims."
She added, "A handgun is a defensive weapon and is there to stop the attack."
Women in particular have a responsibility to protect themselves, she said, and women trained to use firearms are less likely to be raped or injured.
"If you are a woman at home alone with your two kids, it's about you and your two kids," Froman said. "It's not about whether everyone is better off because the city doesn't allow firearms."
Contact Kristine Crane at 338-3119 or firstname.lastname@example.org.