A Psychiatrist’s Perspective on a Potentially Explosive Issue

Had the National Rifle Association(NRA) had its way and Bill 432 had been voted into law in Florida, physicians in that state would have been prohibited from asking their patients whether they have access to firearms.¹ That bill—the details of which can be read at www.flsenate.gov/session/bill/2011/0432/BillText/Filed/HTML—would have made it a felony to ask about access to guns or even to include details about such access in a patient’s medical record. Doctors found guilty of doing so could have been imprisoned for up to 5 years and/or fined up to $5 million.

According to Psychiatric News, the NRA introduced Bill 432 into the Florida House and Senate in an effort to “prevent intrusion” into the constitutional right to bear arms.²

An article that appeared in the March 29, 2011, Sunshine News (http://www.sunshinestatenews.com/print/2524846) reports that a compromise has been reached between the backers of the bill and the Florida Medical Association (FMA), which strongly opposed it. Under that compromise, questions about gun ownership would generally be permissible—as long as the physician doesn’t “harass” the patient and doesn’t include information about guns in the medical record without “good reason.” According to that article, both the FMA and the NRA now support the measure.

The NRA appears to be maneuvering similar bills in other states, so the issue may become one of national importance. It is a legislative battle that could affect all physicians—but it has serious forensic and liability implications for psychiatrists in particular.

Psychiatric Times editor in chief emeritus, Ronald Pies, MD, offers his thoughts on this issue. Dr Pies is professor in the psychiatry departments of SUNY Upstate Medical University, Syracuse, NY, and Tufts University School of Medicine, Boston.

“It is the physician’s moral, legal, and clinical responsibility to inquire into all relevant risk factors related to a patient’s safety, both with respect to self-harm and potential harm to others. The possession of firearms in the home—legal or otherwise—markedly increases the risk of both gun-related suicide and homicide, as well as unintentional gun-related harm to others.

“The constitutionality of legal possession of firearms is emphatically not the issue here. The issue is the physician’s professional right and duty to inquire into risk factors for harm to self or others, including but not limited to possession of firearms. Indeed, failure to so inquire—particularly in cases involving suicidal or homicidal individuals seen in emergency department settings—would pose a serious threat to the safety and well-being of both the patient and, potentially, society. It would also expose the physician to tremendous liability in the event a patient with violent tendencies left the medical setting and inflicted harm on himself or herself or others.

“No law that has a chilling effect on pertinent medical assessment of risk factors for violence should be tolerated by any state or any citizen. I would urge all legislators to ensure that any law written to protect the privacy of patients includes language stating that ‘nothing in this legislation shall be construed as restricting a physician’s right and duty to carry out a thorough and professional assessment of the patient’s safety vis-a-vis self and others. No liability shall be attached to a physician’s inquiries re: firearms possession, when such inquiry occurs in the course of the professional medical assessment of a patient’s safety.’”