There Is A Way To Keep Guns Out Of The Wrong Hands. Let Doctors Decide.

NRA Headquarters, Fairfax Virginia USA

NRA Headquarters, Fairfax Virginia USA (Photo credit: Wikipedia)

As we approach the Newtown anniversary everyone’s going to weigh in with their thoughts about gun control, so here’s mine.  I believe the NRA is more right than wrong in questioning the motives of many of the proponents of more gun control.  They are correct when they say that just about all gun owners are responsible, law-abiding citizens who don’t need to jump through yet more legal hoops in order to buy or own guns.

At the same time, the NRA should stop diluting the force of their argument and keep their nose out of places where it doesn’t belong.  And one place they don’t belong is challenging the right of physicians to talk to their patients about guns.  Their attempt to criminalize such efforts by physicians (‘Docs versus Glocks’) is both stupid and wrong.  And here are the reasons why.

Every day in Emergency Rooms all over the country, people wander in complaining of various degrees of mental distress.  Unless they present a “clear and present danger” to themselves or anyone else, they are free to leave and, if we follow the argument of the NRA, they can walk out into the street even if they walked into the ER with a gun.  Physicians can restrain a person in the ER who is drunk and might, if released, drive off in his car.  But unless an individual actually threatens someone with his gun, the physician who even asks the patient whether he has a gun is, according to the NRA, trampling on the guy’s 2nd Amendment rights, and should be prosecuted to the full extent of the law.

In 2004 a woman in Indianapolis called the police and reported that her 24-year old son was exhibiting dangerous signs of mental distress.  The cops found the kid in possession of multiple guns and ammunition, briefly took the guns away but within several days let the young man reclaim ownership of his guns.  Eight months later the young man, Kenneth Anderson, shot and killed his mother, a police officer, and then was shot and killed by the police.

I don’t know whether in the intervening period this troubled young man ever saw a physician or other medical professional even though he was clearly at risk.  But I do know that even if he had been seen by a physician, the NRA’s position would be that the doctor would not have been able to ask him about his guns.  The NRA is trying to have it both ways.  On the one hand, they say that the mental health system needs to be ‘fixed.’  On the other hand, they don’t want physicians to be able to close a gap in mental health treatment simply through asking appropriate questions and using common sense.

If you walk into a doctor’s office and you’re obese, the physician would be violating the Hippocratic Oath if he or she didn’t tell you to lose some weight. Not everyone who weighs too much is going to live a shortened life, but the physician isn’t violating your privacy by telling you that your weight is putting you at risk.  If someone walks into an ER or a doctor’s office and exhibits symptoms of emotional distress, anyone who would deny that gun ownership by that individual constitutes a risk, has no business engaging in a rational discussion or debate about guns.

The 2nd Amendment gives us the right to arm and protect ourselves from the bad guys in our midst.  It doesn’t give anyone the right to prevent physicians from finding out whether someone’s behavior might turn them into a bad guy whether they meant to be bad or not.

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Think Doctors Shouldn’t Ask Patients About Guns? Think Again.

English: A roadside sign at Santa Clara Valley...

English: A roadside sign at Santa Clara Valley Medical Center in San Jose. This sign is an example of how the U.S. state of California requires all hospitals with emergency rooms to include text like “Comprehensive Emergency Medical Service” and “Physician On Duty.” (Photo credit: Wikipedia)

There’s been a lot of talk in and out of gun circles about the attempt by Florida to criminalize physicians who ask patients whether or not they own guns.  The law, passed in 2011, was  overturned in Federal Court but now is headed for another hearing in the 11th Circuit.  At issue is whether physicians can inquire about the ownership of guns, even if no clear threat to health is perceived. Supporters of the law insist that because most physicians are anti-gun, what they are really trying to do is disarm law-abiding Americans.  To quote the NRA-sycophant Dr. Timothy Wheeler:  “doctors are following a hidden agenda laid out for them years ago by the American Academy of Pediatrics — an agenda that would take guns away from Floridians.”

But the question is not whether physicians are following some hidden agenda.  The real question is whether they are following federal law.  And the law I am referring to is the law that covers all hospitals and physicians delivering medical services covered by Medicaid and Medicare, which in the case of hospitals basically covers every hospital treatment facility in the United States.  This law is regulated by an agency known as the CMS, whose treatment manuals define medical care.  And here is what the CMS has to say about what a physician must do when a patient walks into an Emergency Department and requests care: “In such a case, the hospital has incurred an obligation to provide an appropriate medical screening examination (MSE) for the individual and stabilizing treatment or an appropriate transfer. The purpose of the MSE is to determine whether or not an emergency medical condition exits.”

Notice that I say “walked” into the emergency room.  Obviously if someone is wheeled into the emergency room bleeding from a gunshot wound, the attending physicians don’t have to figure out whether an emergency medical condition exists.  But most people who visit emergency departments don’t present such obvious symptoms of distress.  Rather, they show up because they “don’t feel good,” or have a pain here or a pain there.  Many are suffering from mental distress, others have been victims of domestic violence that, if left untreated, might get much worse.

How many of these patients are caught in a vortex of physical or mental deterioration that could wind up in a gun being shot off?  According to Megan Ranney, an emergency room physician in Providence, patients who are treated for gun wounds have a one-in-five chance of returning with another gunshot wound within five years. Wouldn’t there be a good possibility that many of these patients would re-appear in an emergency room in the intervening period and shouldn’t an attending physician need to know whether that individual had access to a gun?

Let me quote a little further from the CMS: “Individuals coming to the emergency department must be provided an MSE appropriate to the individuals’ presenting signs and symptoms, as well as the capability and capacity of the hospital. Depending on the individual’s presenting signs and symptoms, an appropriate MSE can involve a wide spectrum of actions….” So what should a doctor do when a patient says that he or she feels “depressed” or “upset,” or reports some other sign of mental distress.  Should the attending physician ignore all the data that indicates a clear correlation between household gun ownership and successful suicide attempts?

It’s time to set aside all the nonsense about how physicians have some kind of secret agenda to take away the guns.  Let’s remember that it was the CDC’s announcement in a 1981 morbidity report regarding deaths from an “unknown” lung infection that eventually led to treatments for AIDS.  If the NRA wants to pretend that 31,000 annual deaths and 75,000 injuries don’t constitute a health issue that’s fine.  But I’ll close this post with a quote from the novelist Walter Mosely: “If you carry a gun, it’s bound to go off sooner or later.”  Physicians need to figure out if the gun is going to go off, and when it does, what to do about it. That’s not a secret agenda, that’s the law.

 

 

 

 

Where Do All The Shooting Victims Go?

 

 

 

 

 

 

 

The Urban Institute just published an important report on the costs of gun violence.  Titled, “The Hospital Costs of Firearm Assaults,” it attempts to calculate the costs associated with hospitalizations due to shootings based on reports from hospital admitting units and emergency rooms.  Not surprisingly, the report found that more than 50% of gun-shot victims either had no insurance or were covered by public plans supported by taxpayer revenues. Since the total cost for all gunshot admissions was slightly short of $630 million, this means that Uncle Sam Taxpayer got stuck with at least half the bill.

Unfortunately, there’s only one problem with this report.  The data covers one year – 2010.  During that year, roughly 50,000 people were admitted to hospital in-patient and emergency units with gun shot wounds.  But according to the Department of Justice and the CDC, there were over 100,000 gun shootings that resulted in death or injuries in 2010.  So where did the other 50,000 go?  Maybe we can eliminate most of the 19,000 suicides that resulted from using guns because most of those folks went to the morgue.  But if that’s true, it still leaves another 30,000 men, women and children who got shot but found some other way to deal with their wounds besides going to the hospital. Maybe they went to a local clinic, or maybe there’s some over-the-counter remedy now available that takes care of the common gun shot the way that Ibuprofen takes care of the common cold.

Or maybe someone ought to get their data straight.

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