I’ve previously noted a Florida law that prohibited doctors from inquiring whether there was a gun in a patient’s home. In my opinion, the Firearm Owners ‘ Privacy Act was, and is, a terrible law, and interferes with health care professionals’ attempts to routinely screen for environmental factors that may, at some point, become a safety risk for the patient or others. The law made an exception for health care professionals inquiring if there was a specific concern, but otherwise, the law tried to tie healthcare professioanls’ hands from inquiring and recording such information.
The law was put on hold last year by a federal court, and now in the wake of the Newtown tragedy, there’s an attempt to repeal it altogether. Michael Peltier reports:
A 2011 law restricting how doctors can talk to patients about guns would be repealed under a bill filed in the state Senate.
Sen. Oscar Braynon, D-Miami Gardens, filed the measure (SB 314) Tuesday to repeal the 2011 “Firearm Owners’ Privacy Act,” which isn’t currently being enforced because a federal judge threw it out in July.
The state, however, is appealing that ruling.
The law prevents doctors from asking patients questions about whether they have guns in their house.
“It’s an unnecessary statute,” Braynon said. “When doctors are asking these questions, they’re asking for safety reasons. It’s like asking if you have dogs in the house, do you have knives.”
Read more on The Ledger.
In a recent discussion with a friend of mine who is very concerned about gun ownership privacy and who interpreted President Obama’s recent memoranda to suggest new obligations on health care professionals to share information, he raised the question of what happens with returning veterans who might need mental health care. Would they avoid seeking help, he asks, if they knew mental health professionals might be asking them if they own guns and would be recording the information in their chart? And will they avoid seeking help if they think that healthcare professionals are under some new duty to report or share that information?
Those are fair questions, and I tried to explain to him that there was really nothing new in what the President had said, although perhaps some mental health professionals may not have understood their obligations correctly until now. In response to the President’s call for clarification, HHS sent out this letter to major health organizations.
The issue, though, as Deborah Peel points out, is not our obligations but how any such disclosures might also be used beyond their intended purpose. If our disclosures are compiled in a federal database relating to gun ownership or the right to purchase guns, would that dissuade those in need in care from seeking care? If we do notify police, do they then forward/input that report to a federal database? The short answer is that our reports do not necessarily result in a person being prohibited from purchasing a gun legally unless our report results in the patient being involuntarily committed or a restraining order against them. The Law Center to Prevent Gun Violence has a summary of the federal law on this point with links to state laws. Our reports are not the equivalent of “adjudicating” someone as a “mental defective” for purposes of the law.
I don’t treat veterans in my practice, and I don’t routinely screen for the presence of guns in my patients’ homes (although there are situations in which I have certainly asked because of a perceived risk), but if I did treat veterans, I would be routinely inquiring/screening for substance or alcohol abuse, suicidal thoughts, and the presence of any weapons in the home. But I would also be reminding/assuring the patients of the confidentiality requirements of both HIPAA and state law. And as I do with all my patients, I’d be explaining under what limited circumstances I might have to breach confidentiality.
So as I tried to explain to my friend, there is really nothing new about what President Obama said. I don’t know the laws in every state, but in most cases, health care professionals already have a duty to warn or share information with family or others if we have reason to believe that our patient intends to harm themselves or others. We also have a duty to protect the safety of our patients, which includes protecting them from themselves, at times.
Putting gun owners’ privacy above the needs to keep patients and others safe is not an argument I can or would support. Indeed, to the contrary, should the gun owners’ lobby ever get laws enacted that might interfere with my responsibility to keep my patients safe, I would knowingly break such laws in a heartbeat, even if it meant risking losing my license. I suspect I am not alone in that position.
The Newtown tragedy and other recent events have put the spotlight on mental health issues and gun violence. This is a time for the mental health profession to engage in a thoughtful discussion of what we need to do and can do to promote greater public safety while serving our patients. It is not a time for attempts to stifle or hamstring our ability to care for our patients by imposing “Don’t Ask, Don’t Tell” obligations.