Saturday, March 19, 2011

Doctors to Go to Jail for Asking Patients About Guns in the Home

Imagine the scenario where you are an ER physician, nurse, or social worker and a person is brought to the hospital by the police for making a suicidal threat.
"I want to die. My wife left me and our house is in foreclosure."--"Do you have any plans to harm yourself?""My dad shot himself when I was little. That's how I would do it."--"Do you have any firearms at home?""OFFICER! Can you arrest this social worker? He just asked me if I have guns at home."[officer]: "Come with me sir. You have the right to remain silent..."
This is the scenario that could actually happen if Senate Bill 432 passes in Florida. The bill makes it a felony to inquire about firearms access or to include any information about firearms access in the medical record, punishable by up to 5 years in jail and/or a $5 million fine. Excuse my French, but WTF?!

An article in the Psychiatric News by Bob Guldin explains that the bill was introduced in both the House and Senate at the suggestion of the National Rifle Association (NRA) to prevent intrusion into the constitutionally protected right to bear arms.

It has been shown that removal of firearms from the home reduces the risk of a completed suicide. So you'd think such a bill would get laughed out of the legislature? Florida child psychiatrist and APA Assembly recorder said, "This bill is not a stunt... the financial power of the NRA in Florida will make it very difficult for sensible legislators to vote against this bill."

I note that a second version of the bill has been proposed, one that reduces the fine to a minimum of $10,000 for the first offense and a minimum of $100,000 for the third offense. It also reduces the offense from a felony to a "noncriminal violation" and compels the states attorney to pursue a possible violation or face professional misconduct charges. This version does permit certain health care providers to ask the question only in certain specific situations (e.g., an emergency "mental health or psychotic episode") but cannot tell anyone else other than the police. Apparently, a similar bill passed one house in Virginia five years ago before dying.

Next will be a bill that outlaws common sense.


Clink comments: We've talked about issues related to guns before here, in Dinah's post "Guns and the Mentally Ill" and again when I mentioned a poster session that talked about gun ownership laws nationally. At my last American Academy of Psychiatry and Law conference I mentioned that 27 states have statutes with lifetime restrictions on gun ownership for people with mental illness. Other states have time limited restrictions on ownership, and some allow restoration of full rights contingent on a physician's documentation of recovery.

So now we have a dilemma: in states where you need a physician's certificate to buy a gun, how can that same physician then be banned from asking about ownership?? I can imagine the session in which a patient comes in to be "cleared" to buy a weapon.

MD: "Well, you're taking your medicine and your symptoms are all under control. You tell me you're feeling well and you'd like to buy that awesome weapon you've been dreaming about."

Gun buyer: "Yeah! I've done the research and I know exactly what I want."

MD: "I need to know whether you have cognitive skills and emotional stability to handle a responsibility like that. Tell me, have you ever owned a gun before?"

Gun buyer: "Awesome!! Now I can sue you for infliction of emotional distress for violating my Second Amendment rights. Those triple damages will really help me stock up my arsenal."

Bottom line: The NRA can't have it both ways. If they involve psychiatrists in restoration of gun rights, they can't ban them for asking questions about ownership.


moviedoc said...

The last thing health care professionals need is another easy and unintentional route to prison, but we should consider how this may have come about: 1) Extreme polarization of the whole gun debate. 2) Health care professionals using their position to push their own political agenda.

Sarebear said...

These bills are legislative stupidity, and the legislators who put their name on them as authors should be embarrassed to be so in the pocket of the NRA. It's like they are puppets, because it's not like anyone would come up with this THEMSELVES. GEEZ.

Roy said...

I found what got this started in Florida. Read this analysis, which mentions a pediatrician who asked about guns in the home. The mother refused to answer the question and the pediatrician refused to treat the family. There was recent press about the situation in the Ocala news.

moviedoc said...

"the pediatrician refused to treat the family" Not exactly. The analysis says he gave them 30 days notice. The story reminds me of when I visited a pediatrician's office in Brooklyn soon after moving my practice there ~1981. He had revolver tucked in his belt, barely hidden by his white coat. He explained that he was recently mugged in his own office.

A patient should have the right to refuse to answer any question they deem to constitute invasion of privacy, but I would oppose any restriction on a physician's choice of whom to treat, except perhaps in an emergency.

Anonymous said...

I changed PCPs this year. Part of her routine history taking was to ask if I had any guns in the house or a fire extinguisher (strange bedfellows, I know).

Anonymous said...

I don't get it. What about my first amendment right to free speech? It's illegal to ask certain questions?

Patient says "Doc, I feel like shooting myself and everyone else." I can't ask if he has a gun oR access to one? And how stupid do we all want to feel when he leaves and shoots schoolchildren or college students or congress members?

Anonymous said...

you have to read the other section, too:

Certain mental health care professionals as statutorily defined, and physicians, nurses, and other
medical personnel are exempted from the provisions in the bill in cases where inquiries are
reasonably necessary under emergency circumstances such as where the patient is exhibiting
conduct that indicates the patient could pose an imminent threat to himself, herself, or others.
The patient’s response is private and shall not be disclosed to a third party, other than law
enforcement conducting an active investigation, under the provisions of the bill.

So, you can ask and put it in the med record if mental health is involved, but you can't share the info.

Personally, I think legislating that is a waste of resources and opens the question of intruding on physician's rights. Plus, if someone feels the need to lecture me on everything, and i think it's an invasion of my privacy, maybe I just need to find another physician with whom I have a better fit.

Unknown said...

Anon - I think that's precisely the time when you could ask. The bill has an exception for mental health practitioners when patients are at risk. The bill is misguided, but I do think that when a doctor has 15 minutes with a patient, he shouldn't spend it asking whether the house has guns or a swimming pool. He'd be better off asking whether the kid eats vegetables and exercises, or asking questions to determine whether the kid is being abused.

Fat Bastardo said...

Everybody is nuts. Look at the the reasons we are fighting wars now. There are people in this world armed with AK-47s who follow the teachings of a murderer, rapist and pedophile named Mohammad and his "religion of peace."

They say the most dangerous thing in the world is a shrink with a prescription pad.and they may be right because over 118 million Americans are on an anti-depressant. I'd rather face the barrel of a gun than today's medications and the pushers that sell them.

The leading cause of death and injury in the US is not guns. It's the medical industry.

cyndi said...

so i'm a psychiatric home health nurse and i'm going to weigh in- in the article with the pediatrician he said that the American academy of pediatricians suggested people include this in their safety assessment. I live in florida and i read the law and there is no exemption for mental health - it does say all bet are off if someone is harmful to themselves or others which a person may state but for the most part we need to do a suicide assessment - so the person may or may not be harmful to others but we really don't know this yet until we have asked the question. then you have some er nurse who has a concern may not even ask the question because they are afraid of the ramifications. not only is this bad for patients and really bad for all of us -i can see malpractice carriers using this as a reason to increase out rates. all around stupidity over a simple question on something we all do every day as medical and mental health practitioners- assess safety and council. do the legilators not know that peoples records are protected by privacy laws??