Colorado Shootings Put Docs vs. Glocks Law in Spotlight

Should doctors warn patients about the risks of guns in the home?

In Florida, physicians who did just that could have lost their medical licenses—until recently.

Weeks before one of the worst gun violence incidents in U.S. history, a group of physicians won a court victory in a little-noticed case against a Florida law that threatened to strip doctors of their medical licenses if they warned patients about the risks of guns in the home.

Florida politicians, citing Second Amendment rights, were adamant that docs weren't in the gun-counseling business, and passed a statute to thwart such discussions. The physicians, however, prevailed in federal court to halt the measure.

It made me ask: How wrong can it be for physicians to raise questions about the presence of a gun in their patients' homes? And how far should physicians go with that discourse?

Of course, a constant drumbeat about the inanity of our gun laws mount as disclosures reveal how James E. Holmes, the suspected shooter in the Colorado movie theater massacre, stockpiled weapons, and bought 6,000 rounds of ammo in the weeks before he allegedly gunned down 70 innocent people July 20, killing at least 12.  Included in the arsenal was a .40-caliber Glock handgun, a Remington 870 shotgun, an AR-15 assault rifle, and a high-capacity ammunition clip. 

It's almost appallingly predictable how the gun law debate ebbs and flows with each tragic incident that haunts the country.  And possibly no physician in the world could have counseled Holmes to steer him away from the madness. (According to media reports,  Holmes allegedly mailed a notebook "full of details about how was going to kill people" to a University of Colorado psychiatrist before the attack.)

But the Florida legal action, which has been dubbed "Docs vs. Glocks" by the press, puts a twist on the gun debate, by showing how some docs want to get into the heads of their patients, and advise them to get guns out of their houses, if need be.  Some of those discussions focus on whether kids are around the guns, or if a family member may have psychological issues that many believe should rule out having a weapon around.

Bernard Wollschlaeger, MD, FAAFP, a family practice physician in Miami, who is among the group of physicians who sued to successfully halt the Florida law, says he has counseled patients about gun use. As Wollschlaeger sees it, such conversations are important, not to clash with a person's privacy rights, but as an opportunity to improve a patient's health.

"It's about our right as physicians to ask questions. We often ask questions that can be intimate and very personal," Wollschlaeger told HealthLeaders Media. "As a patient, you have a right to refuse or not (when asked the question about guns)." Families with children are particularly impacted, he says.  "If there are children in the household, we ask the question if you have a gun. Children disproportionately suffer accidental injuries from guns that are stored in the home, and the results can be tragic."

Wollschlagger, who also works in addiction medicine, says he counsels patients who have "psychiatric background issues" about the dangers of guns in the house.

Wollschlagger says his patients have reacted positively to his comments that may include questions about guns in their houses.  "I never had a patient who reacted aggressively or was opposed to the fact I asked this question," he adds. "It doesn't trigger a negative reaction, as claimed by many gun advocates, who say that physicians should stay out of it."  Some patients who may not have safeguarded weapons in their homes have told him "it's good you told me about it," Wollschlagger says.

The physicians' entanglement with Florida over the gun issue began last year after the Florida legislature passed The Privacy of Firearms Owners Act, (signed by Florida Gov. Rick Scott), which would have restricted physicians, nurses, and medical staff from asking a patient and patients' parents about firearms. Physicians accused of violating the law would have been sent before the Florida Board of Medicine for disciplinary action.

Woolschlaeger and other physicians disagreed, saying they were only doing their jobs to enhance patient care. The Florida chapters of the American Academy of Pediatric Physicians, the American Academy of Family Physicians, and the American College of Physicians joined Wollschlaegger and other physicians in the lawsuit.

Their collective contention was that the Florida law significantly curtailed their First Amendment rights to exchange information with patients about gun safety. The Brady Center to Prevent Gun Violence filed the suit, saying it represented 11,000 physicians in Florida.

The physicians first won a temporary restraining order, then a permanent injunction on June 29 after a judged ruled that Florida law violates the First Amendment about "truthful speech" concerning the dangers of easy access to guns.

U.S. District Court Judge Marcia Cooke found that the Florida legislature relied not on facts, but on anecdotal information about physicians asking patients about firearm ownership. That information included allegations that physicians misrepresented themselves by saying Medicaid would not pay claims if patients did not answer questions about firearms, or that doctors were refusing to examine patients who refused to answer questions about firearms ownership. Cooke also found that the law illegally "impairs the provision of medical care and may ultimately harm the patient."

Not all physicians are upset with the Florida law. Timothy W. Wheeler, MD, founder and director of Doctors for Responsible Gun Ownership, strongly questions whether doctors should ask about guns in a home. "It's wrong for a doctor to misuse the doctor-patient relationships to try to advocate for gun control in the doctors' office," Wheeler, a retired doctor in California, told HealthLeaders Media. "That's professional misconduct, and that is the reason the Florida law was enacted."

Physicians who specifically need to raise the gun issue do have a reason, however, if there is a "suspicion of mental illness, or homicidal or suicidal" tendencies, he adds.

Wollschlagger, a former military officer in the Israeli army, says he has a concealed weapon permit and enjoys shooting guns on a range.  He characterizes America's gun laws as "absolutely insane." The country's laws concerning assault rifles, are "crazy," and, he says, illustrate how important it is for docs to keep on eye on patients and families when it comes to guns in a household.

"There is no rational way to allow an average citizen without any involvement in security or tbe military to carry an assault rifle, it's absolutely insane," Wollschlagger says. " If somebody purchased 6,000 bullets for a high-powered assault rifle, for crying out loud, is he going to war?"

The federal assault weapons ban expired in the fall of 2004, but gun control advocates such as the Brady Campaign have supported banning military style semi-automatic assault weapons along with high capacity ammunition magazines.

While the gun debate accelerates, physicians in Florida will continue to have discussions with patients about guns, Wollschlagger says.  "We don't know if the state will continue the battle," Wollschlagger says, referring to possible state appeals of the court ruling.

Already, there are rumblings that the Florida Department of Health will appeal the court's ruling. Florida is the only state that has enacted legislation restricting physician speech on firearms safety counseling, but Alabama, Minnesota, North Carolina, Oklahoma, Tennessee and West Virginia have introduced similar bills in recent years.