A bill at the General Assembly would limit physicians’ questions to their patients about firearms.
By Rose Hoban
Physicians and physicians’ organizations scrambled Wednesday to react to an omnibus gun-rights bill that appeared Tuesday afternoon at the General Assembly.
The bill would forbid any health care provider – from doctors to dental hygienists to hospital workers – from asking a patient about their ownership or storage of firearms. Further, the bill would create a mechanism to fine doctors who did.
“That goes against he code of medical ethics,” said Adam Goldstein, a pediatrician who works in family medicine at UNC-Chapel Hill and who has written on the health implications of widespread gun ownership. “It goes against what we vow to uphold, to be able to ask questions that might be related to improve outcomes for our patients.”
The bill, which was introduced by Rep. Jacqueline Schaffer (R-Charlotte), purports to affirm the Second Amendment. It was originally filed in early April and was run through a judiciary committee Tuesday.
Almost immediately, the medical community swung into action, sending out press releases, buttonholing lawmakers in hallways and calling reporters.
“Doctors routinely speak with their patients about potential health threats including dangerous chemicals, car seats, water safety, tobacco and guns,” wrote N.C. Medical Society spokeswoman Elaine Ellis in a press release Wednesday afternoon. She said the Medical Society was opposed to legislation that would “deprive physicians of the information they need to assess those health risks.”
“I routinely ask patients and their families if they have firearms,” said Laura Willing, who was in the Legislative Building for the weekly “White Coat Wednesday” event that features physicians talking to lawmakers.
Willing, an adolescent and child psychiatrist at UNC-Chapel Hill’s residency program, said asking about firearms is “a safety issue for children.”
“Anytime I meet a new patient, that’s a standard question, undertaking a thorough social history and doing a safety-risk assessment,” she said, noting that impulsive adolescents who attempt suicide are significantly more likely to be successful at killing themselves if a firearm is handy.
If someone who is potentially suicidal is being discharged from the hospital, Willing said, she might recommend locking up weapons, “Just as we would for medications or knives or anything else that you could use to hurt yourself or somebody else.”
She also said that she sometimes has to notify law enforcement if someone expresses a desire to hurt another person, but that more often she notifies family that there’s a risk.
N.C. Hospital Association lobbyist Cody Hand sent a notice to lawmakers stating that the bill could put doctors and hospitals into a bind.
“You are forcing providers to choose between breaking the law or alerting law enforcement of potential deadly actions,” Hand wrote, noting there is no exception for the injunction against physicians asking about firearms except in the case of “imminent deadly harm.”
Schaffer argued the language did not prohibit health care providers from communicating orally with patients, if they want to talk to patients about gun safety. But they are prohibited from putting things in writing, such as on a standard patient questionnaire.
“If they were to do that, under the language, they could not turn that [written document] over to a government official,” she said.
“Some individuals are being asked these questions and they feel that its violating their privacy,” Schaffer said, in explanation of the bill. “We’re trying to balance the interests of patients’ rights to have this information private.”
Goldstein also reacted to the fact that the bill would make the issuance of concealed-carry permits automatic within 90 days if a sheriff doesn’t hear back from a doctor who has been sent the permit for review. To get a medical clearance for a permit, an applicant provides his or her physician’s name and contact information. Sheriffs can send off the application to the doctor for approval.
Goldstein has written in the New England Journal of Medicine about the role of physicians in the concealed-carry permitting process.
“It’s … difficult to assess mental competence and current or future risk for violence. Even with drug testing, it’s often difficult to detect clinically whether a person is abusing illegal substances, controlled prescription drugs or alcohol,” he wrote in the article.
He’s called for lawmakers to clarify the role and responsibilities of physicians in the process.
In an interview Wednesday, Goldstein said he was disappointed the concealed-carry language had been included in the bill.
“Is the sheriff supposed to know what to do once the patient has Parkinson’s disease or Alzheimer’s or PTSD?” he asked. “I have no faith that a sheriff can made a medical determination without guidance or standards.”
Public health risk
Duke University researcher Jeffrey Swanson took issue with a statement in the bill that “lawfully possessed, stored, and used firearms and ammunition are not a threat to the public health.”
“There’s excellent research showing that household gun possession and having guns in the home significantly increases the risk of gun-related suicide,” said Swanson, who has published widely on mental illness and policies to reduce gun violence.
“Your brain doesn’t care who fired the bullet; it’s just as destructive if you do it to yourself,” he said.
Swanson recounted that at a recent national meeting, researchers agreed the evidence is strong enough to warrant a surgeon general’s warning on guns, similar to that issued about cigarettes in the 1960s.
He also pointed to his most recent publication, which found that about 9 percent of the U.S population has a history of angry, impulsive behavior and also has access to firearms.
“People who engage in violent behavior are more likely to do it again in the future,” Swanson said. “If you add a gun to that mix, that can be a bad thing.”
His research also found that people who own more than six firearms are much more likely to be in that “group of concern.”
Swanson pointed to Craig Steven Hicks, who was in possession of more than a dozen firearms when he killed three Muslim-American students in Chapel Hill in February. Hicks also had a history of aggression toward his neighbors.
“He’s the poster person for that study,” Swanson said.
The bill was sent to the House Rules committee Wednesday where it had a small appropriation added to it. The addition of money in the bill means it will not be subject a legislative deadline Thursday and can be held for discussion later this spring or summer.