Wednesday, May 25, 2011

Florida Don't-Ask-Don't-Tell Gun Law Modified

Here's a follow-up to my March post about the Florida bill to outlaw physicians from asking their patients about access to firearms. Dinah later posted about the effects of the bill on pediatricians. The bill passed, though it was amended to remove the jail time and the potential $5M fine (a bit excessive?).

The Florida Medical Association originally opposed the bill, but now has expressed satisfaction with the compromise language. In March, Asher Gorelik, M.D., president of the Florida Psychiatric Society (FPS), expressed to Psychiatric News his membership's opposition to the bill, particularly “a great deal of concern about how this law would interfere with the ability of the psychiatrist to properly assess a patient.” But in a recent follow-up interview, Gorelik stated that the new language in the bill “no longer interferes with the ability of a psychiatrist to perform a risk assessment.
~Psychiatric Times


Rob Lindeman said...

"...a great deal of concern about how this law would interfere with the ability of the psychiatrist to properly assess a patient"

IOW, how can a psychiatrist know whether he can get away with incarcerating a person against his will unless he can ask him about guns?

jesse said...

"provides that unless information is relevant to patient's medical care or safety or safety of others, inquiries regarding firearm ownership or possession should not be made"

What is totally unnerving about this is that the physician would have to demonstrate relevancy of an inquiry. This provision places the burden on the doctor to prove relevancy. It means that although the patient or family does not have to answer a question, the physician can be penalized severely for having asked it.

moviedoc said...

On the positive side this law seems bound to make it harder to hold a physician responsible for the violent acts of another person. Maybe FL docs will have more time for, of all things, diagnosing and treating illness.

Roy said...

Moviedoc has a good point. Folks like Flea complain about withholding a person's liberty when she threatens to kill herself with a gun (for which courts have held physicians responsible for assessing risk by asking things like Do you have access to a firearm?).

Wondering what these same people will say when we no longer ask about firearm access and the person goes and shoots up their local politicians or schools.

Damned if you do and damned if you don't.

Rob Lindeman said...

"Wondering what these same people will say when we no longer ask about firearm access and the person goes and shoots up their local politicians or schools."

I guess this was addressed to me, although you can call me by my real name, as I've been outed.

I'm not a cop, but if I were, I believe I'd be obliged to say something like "You have the right to remain silent". And Roy, it is hubris, to say the least, that a psychiatrist or anybody can prevent homicide. In a free society, pre-emptive incarceration to prevent murder is out of the question. I liked the movie "Minority Report" but I don't care to live in that world.

jesse said...

Unfortunately, Roy, they won't say anything, just as they are not saying anything about purchasing firearms. But for us, we will still be in trouble as after the fact it is easy to show that we should have asked in that instance. Perilous to to be a psychiatrist in Florida...

moviedoc said...

Perilous to be a psychiatrist in any state.

Anonymous said...

Patients should learn about where their information goes before they open their mouths. I suppose if you don't mind your insurance company knowing if you have a gun or not, then I guess share away. But, it's not the kind of information I would want in my medical record.


Roy said...

@Rob: finally, something we can agree on ;-)
Psychiatrists have been saying for years that we cannot predict violence (though there are validated risk factors) with much certainty. Nonetheless, judges and juries make liability judgments against us for failing to do so. So, we can't just ignore it. If you see a way out of this cycle, do speak up. The Florida law may turn out to be a piece of it; we'll have to see.

Dinah said...

Everyone is so focused on the details of whether it's useful for a doc to ask a patient if they have a gun, and if this actually promotes safety.

Why isn't anyone focused on the bigger issue here: the concept of making it a crime for a physician to ask a patient a question? Any question? Where are the lines drawn? One guy can walk up to a stranger on a street and ask a question, why can't a doc ask a patient that same question? Since when do we make it a crime to ask questions? That's the issue here, not the content of the question.

Rob Lindeman said...

Roy, with respect, I may speak up but who will listen? Psychiatrists, singly or in groups ought to do (at least) two things in this regard:

1) Stop insisting that one can predict another man's future dangerousness to self or others.

2) Start insisting that future homicide (and suicide) can be prevented.

To paraphrase Henry Kissinger, both these assertions have the benefit of being true.

Rob Lindeman said...

Cr*p!!! That should be future homicide / suicide CAN'T, as in CAN NOT be prevented!!!

Rob Lindeman said...


I'm not taking it seriously because it is a silly law that cannot be enforced. It was designed to make a political statement about guns and pediatricians. This pediatrician is not impressed.

moviedoc said...

Dinah, the issue to me is that we docs already commit crimes every day. If your patient crosses the state line into Virginia, and you talk to her over the phone, you are practicing without a license according to an attorney at the VA licensing board. We don't need anymore laws to break.

Rob and Roy, of course we cannot predict the future, but what gets us in such lawsuits is related instead to standard of care in assessing risk. But we figure out pretty quick that we avoid liability by trying to control someone else's behavior, which we cannot do, whether its homicide, suicide, drug abuse or cutting. Furthermore, when we try to do all the right things it interferes with our ability to do what we should be doing: treating the patient's illness, which is hard enough to do already.

My solution? We use all that data on risk assessment to avoid treating high risk patients until society figures out how to deal with the problem without holding us responsible.

jesse said...

"I'm not taking it seriously because it is a silly law that cannot be enforced." That may be true, but would you like to pay for your defense when you are accused of breaking it?

Dinah's point is the one that should outrage everyone. It is against the law to ask a specific question. It is against the law to put the answer in a medical record. Unless there were reasonable grounds for having asked or documented.

What will be considered reasonable grounds? The psychiatrist puts himself at risk whether he asks or doesn't ask.

This is not the situation we were thinking of when we answered Exalya's question in "To Shrink or Not to Shrink."