FL Primary Care Docs Battle 'Gun Gag' Law

Primary care physicians' associations in Florida have filed a federal lawsuit to strike down a new "physician gun gag" law that they say hinders them from talking about firearms hazards with patients.

"This is not about guns. It has nothing to do with the Second Amendment right to bear arms but it infringes upon the First Amendment right to discuss firearms safety," Lisa A. Cosgrove, MD, president of the Florida Pediatric Society/Florida Chapter of the American Academy of Pediatrics, told HealthLeaders Media.

"The bottom line is it is interfering with our right to talk to our patients. Inside of my exam room, that is private territory. It is already protected under HIPAA laws. There should be nothing that interferes with that and this does."

The legislation, HB 155 – was signed into law this month by Florida Gov. Rick Scott. Lane Wright, Scott's press secretary, defended the bill. "I think that last part is what some people miss—'if the information is not relevant to the patient's medical care or safety, or the safety of others,'" Wright said in an email to HealthLeaders Media. "The law ensures respect for a patient's right to own or possess a firearm and protects them from potential discrimination and harassment in cases where it is not relevant to the patient's medical care or safety, or the safety of anyone else in the home."

Marion Hammer, the National Rifle Association representative in Florida, said she felt compelled to bring the bill to the Florida Legislature after hearing complaints for several years that gun owners were being harassed by their physicians about their firearms.

"So, we sought sponsors for legislation that would prevent doctors from invading the privacy rights of their patients and bringing their gun ban politics into examining rooms," Hammer said. "People take their children to pediatricians for medical care, not to be lectured to get rid of their guns, not to be asked if they own guns, how many, where they are stored. Those are questions that no doctor has a right to ask unless he or she fears the patient may be a danger to him or herself or others, or unless they feel someone in the home may be a danger to the patient or others."

The Centers for Disease Control and Prevention reports that there were 31,224 firearms-related fatalities in the United States in 2007. That includes 2,251 firearms-related deaths of children ages 18 and younger – more than six youth fatalities each day. CDC estimates that there were 69,863 firearms-related injuries, including 12,371 firearms-related injuries of children ages 18 or younger in 2007.

The Florida Medical Association dropped its opposition to the bill when the NRA agreed to remove penalties that included up to five years in prison and up to a $5 million fine. Now a physician accused of violating the law will be required to go before a physician review board, and could face loss of license if they're found guilty, Cosgrove says. 

Even with the weaker penalties, Cosgrove says the law goes against the practice of preventive care. "Physicians play a key role in counseling patients regarding the risk of accidental or intentional injury," she says. "It is a major health hazard facing adults and children. It is best practice to minimize those risks. As part of preventive care, doctors routinely ask about potential risks such as 'does your pool have a fence around it? Do you put up your chemicals away from your kids? Is your child buckled in a seat belt?' This is just another part of the preventive care we do."

Hammer rejects suggestions that the law chills free speech, or interferes with the patient-physician relationship. "They can consult with their patients on medical care and issues that directly affect the medical care and the health and safety of the patients," she says. "They don't get to ask anything and everything they want to ask. They have no business asking a patient how much money they have in their checking account. They have no business asking if they have expensive jewelry or what cars they drive. Your personal private property is nobody else's business. If they want to ask about seat belts they certainly can. Seat belts are not protected by the constitution."

Hammer says Florida pediatricians are following an anti-gun agenda laid down by the American Academy of Pediatrics, and pushed by groups like the Brady Center to Prevent Gun Violence, which is assisting the plaintiffs in the suit.

"The American Academy of Pediatrics had on their web site for years that they support banning guns and they encouraged pediatricians to ask families if they own guns, and if they do to tell them to get rid of their guns, and if they don't to tell them not to buy guns," Hammer says. "That is not medicine and that is not appropriate and that is what the law is designed to stop."

If physicians are concerned about public safety issues, Hammer says, they should concentrate on the preventable medical errors that The Institute of Medicine has estimated kill more than 100,000 people each year. "If they want to save lives they need to clean up their own act before they go after gun owners," Hammer says.

Cosgrove says there is no way to make the law palatable for primary care physicians. "From our standpoint as the pediatric society, we said there doesn't need to be a law or anything that regulates the physician-patient relationship and nothing that interferes with what we say to our patients."

"To have a law that gags us, you start with guns, and where do you end up," she says. "Next time do you tell me I can't talk to my patients about their sexual activity, or their drug use. Where does it stop?"