Physicians, gun owners tangle over Florida "don't ask" gun bill

Physicians and Florida gun ownership advocates are battling over a state bill that would fine and imprison physicians who ask if their patients have guns.

State Rep. Jason Brodeur, a Republican, introduced the bill, which could send doctors to jail for up to five years and fine them up to $5 million for asking about patients' gun ownership, refusing to treat patients who won't answer such questions or entering gun ownership information into any record. The bill has the support of the National Rifle Assn. State Sen. Greg Evers, also a Republican, introduced an identical bill in the state Senate.

The measure is partly a reaction to American Academy of Pediatrics guidelines encouraging physicians to talk to parents about protecting children from preventable accidents. This includes the use of booster seats in cars, swimming pool safety and proper gun storage.

"We're not against guns, per se. What we're concerned about is proper storage and handling of firearms," said Louis St. Petery, MD, executive vice president of the Florida chapter of the American Academy of Pediatrics.

The Florida AAP chapter and the Florida Medical Assn. oppose the bill. "As written, the bill is absolutely unacceptable, and we will fight it," said FMA general counsel Jeff Scott.

But gun-rights advocates said physician questions regarding gun ownership are inappropriate privacy violations. Physicians should stick to diagnosing illnesses, said Marion Hammer, former NRA president and executive director of the Unified Sportsmen of Florida, the NRA's state legislative affiliate.

"This is a constitutionally protected right that has nothing to do with health care," she said.

Legislators in Virginia and West Virginia have introduced similar bills in recent years, but neither received significant support.

The Florida bill was prompted in part by a July 2010 exchange between Ocala, Fla., pediatrician Chris Okonkwo, MD, and the 26-year-old mother of a 4-month-old patient. Dr. Okonkwo asked the mother if she owned a gun, but she refused to answer. For that reason, the physician gave her 30 days to find a new pediatrician, according to the Ocala Star-Banner. Dr. Okonkwo declined to speak to American Medical News for this article.

Pediatricians and other physicians sometimes end patient relationships when there's lack of trust between the doctor and the patient, Dr. St. Petery said. Typically, the physician will provide two weeks' notice to allow the patient to find a new doctor.

Pediatricians have good reasons to ask patients about gun ownership and storage, said Robert Sege, MD, PhD, chief of ambulatory pediatrics at Boston Medical Center. For example, households with unlocked firearms are more likely to experience a suicide or other fatal gun injury than those with locked and stored guns, according to a study published in the Feb. 9, 2005, Journal of the American Medical Association.

Dr. Sege helped develop the AAP's Connected Kids clinical guide, which advises physicians to begin talking about safe gun storage to parents of 6- to 9-month-old children. The AAP also advises parents with guns to store them unloaded and locked, with a separate lock on the trigger.

Hammer said she has been receiving complaints from her members about pediatricians and nurses asking questions about guns and entering the responses into laptop computers and other records. These parents wonder if the government will be able to access this information, she said.

Hammer said patient privacy protections in the Health Insurance Portability and Accountability Act of 1996 are not strong enough, and HIPAA violations occur all the time. "You can't un-ring a bell," she said.

Hammer also took issue with an AAP policy that says the most effective way to prevent firearm-related injury to children is to keep guns out of homes and communities. The policy also says, "We believe that handguns, deadly air guns and assault weapons should be banned."

"That's politics," Hammer said. "They are pushing their anti-gun politics on families who own firearms."

Dr. Sege said parents should understand that AAP public stances are not the same as the association's guidelines for advising parents on safety.

Hammer said the threat from gun-related injuries is overblown compared with other causes. For example, 1,229 people age 10 to 14 died of unintentional injuries in 2007, according to the Centers for Disease Control and Prevention. Firearms were the seventh leading cause of these injuries, but only 26 fatal injuries -- or 2.1% of the total -- were tied to guns. The No. 1 cause -- motor vehicle crashes -- was linked to 54.4% of injuries.

Hammer said the bill's penalties are stiff to discourage physicians from violating its provisions. "How much is your privacy worth? How much is your right to keep and bear arms worth?" she asked. She also dismissed concerns about the bill violating physicians' constitutionally protected right to free speech. "It does not give you the right to interrogate people."

American Medical Association policy on gun ownership supports the storage of unloaded firearms in locked cabinets with trigger locks. AMA policy also supports legislation to hold gun owners legally responsible for injuries or deaths caused by a child gaining unsupervised access to a gun, unless reasonable precautions were taken by the owner.