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In November Doctors for Responsible Gun Ownership’s Robert Young, MD was invited to attend a meeting in Dallas of the American Medical Association’s Litigation Committee. This AMA management committee assembled to discuss the ongoing litigation aimed at overturning Florida’s Firearm Owners’ Privacy Act (FOPA), also known as the Docs vs. GLOCKs law. DRGO has been involved in this case since before FOPA was enacted, having written editorials on the subject and weighing in through an amicus curiae brief in the federal Court of Appeals case Wollschlaeger v. Governor of State of Florida. Dr. Young presents here the remarks he gave as an invited guest representing Doctors for Responsible Gun Ownership. His own comments are included before and after the transcript . . .

Presentation Supporting the Florida Firearms Owners Privacy Act
Presented at AMA Litigation Center Open Meeting
Sunday, November 9, 2014 — 3:00-5:00 pm, Hilton Anatole, Dallas TX

[Ref. article: Docs, GLOCKs & Patients]

The Litigation Committee of the American Medical Association (AMA), which determines legal actions in support of AMA positions, decided for its fall 2014 meeting’s educational presentation to discuss the litigation (along with other medical specialty associations, such as the Florida branches of the American Academy of Pediatrics, or AAP, and the American Academy of Family Practice, or AAFP) seeking to overturn the Florida Firearms Owners Privacy Act (FOPA). This law, passed in 2011, prohibits physicians in Florida from routinely inquiring about patients’ gun ownership, even under the rationale of wanting to advise on general gun safety. It expressly permits inquiries whenever there is documented clinical justification (e.g., suspected dangerousness).

In Wollschlaeger, et al vs. Frank Farmer, et al [i.e., Governor, State of Florida], the AAP, AMA etc. contested the law based on physicians’ 1st Amendment rights. That succeeded in the U.S. District Court of Southern Florida in 2012. On appeal by defendants to the U.S. 11th Circuit Court of Appeals in 2014, that ruling was overturned, finding by a 2 to 1 majority that there was no infringement of plaintiffs’ rights to free speech and that the state of Florida had the right to set expectations for professional practice in this way as in others. The decision to overturn the law is currently enjoined pending appeal by plaintiffs for en banc review, so FOPA is not currently in effect. However, physicians across Florida have changed their practice based on a reasonable expectation that it will be upheld.

I was asked to conclude the panel presentations by discussing the reasons for FOPA, so that attendees could understand both sides of the issue. There were several hundred attendees, mostly physician members from local, state and the national organizations but also a number of interested lawyers. The discussion began with Leonard Nelson, the AMA’s General Counsel and Director of the Litigation Center, who organized the session, introducing Litigation Committee Chair, Jo Bryson, MD.

The first panelist was Jeff Scott, General Counsel of the Florida Medical Association (FMA). He’d been surprised by the unexpected but widely supported, rather punitive proposal that was the original FOPA draft endorsed by the National Rifle Association (NRA), which was instrumental in Florida in promoting this law. He was surprised and pleased that NRA readily agreed to consequences of licensure discipline only, dropping language requiring jail and fines. He described how Florida’s licensure oversight body has said it will act only on complaints of blatant promotion of political agendas or of haranguing patients. He doubted that discipline would ever result from the Act as it is now understood, since physicians are already being more careful. He hadn’t thought of it but agreed with a questioner that if the law had been stricter, it might more likely have been voided as a result of AMA and other plaintiffs seeking that.

Judith Schaechter, MD (Interim Chair of Pediatrics at the University of Miami and one of the named plaintiffs opposing FOPA) spoke next, explaining that she felt so strongly about this as an important health and safety issue that she could not have failed to pursue overturning the law for her patients’ sakes.

Douglas Hallward-Driemeier, the plaintiffs’ lead attorney spoke third. Though certainly an advocate for the plaintiffs, he mostly discussed legal rationales in the case from both sides, what levels of scrutiny regarding potential infringement on physicians’ right to free speech that should be applied (believing this should be higher than “rational”), the reasons that an en banc review by the entire 11th Circuit Court of Appeals is being sought (which could be based on the fact that one judge of the 2 to 1 panel majority upholding FOPA was not from that Circuit). He explained how the current decision reversed the overturning of the law “facially” (i.e. generally), though perhaps not in the plaintiffs’ precise circumstances, which might also become a reason for further judicial review. If their appeal is denied, plaintiffs intend to seek a U.S. Supreme Court hearing.
My remarks, minimally edited to make better sense being read, follow:

It’s a privilege to offer a counterpoint to the AMA’s position on FOPA. The belief of the dissenting Judge Wilson in the unanimity of the medical community on what to counsel regarding gun ownership is true only of the official positions of our professional associations, which actually represent only the minority of physicians who belong (and obviously not all of us), on any particular issue. So it’s always important to keep both sides of an issue in mind. That now includes Missouri, which in September enacted similar provisions in SB 656, and comparable legislation that has been proposed in at least 12 other states.

I belong to the AMA & the NRA for similar reasons. Were it not for the AMA, our ability to care effectively for our patients would be far more restricted. Without the NRA, one of our Constitutional rights would be, too. Both make invaluable contributions to the well-being of our nation.

Doctors for Responsible Gun Ownership (DRGO), which I particularly represent today, is a nationwide network of physicians and health care scientists and professionals who are knowledgeable about firearm safety, skills and policy. DRGO supports the long-standing American tradition of responsible, capable and safe firearm ownership. All of us, in this room, in our practices and in our communities, are equally concerned about keeping people safe from firearm injury. The difference is that DRGO promotes gun education to achieve that, not restriction.

The underlying question is whether individual and family firearm possession is necessarily dangerous and ill-advised. “Gun violence” and “gun safety” are phrases that are often misused, with implications that guns are inherently unsafe and that guns are a cause of violence, something like pathological organisms whose transmission needs to be stopped and that ought to be exterminated.
The phrase “gun violence” risks discounting people’s responsibility for the harm they cause, and can imply that other means of harm are somehow of lesser import. Neither notion is correct, of course. And it’s simple to be safe with a gun: Point it only where you are willing to shoot, and don’t touch the trigger until you choose to.

Statistical arguments justifying blanket advice not to own guns have misrepresented facts about youth and gun access, and have exaggerated the risks from guns. They can inform, but not substitute for, the patient-centered clinical thinking that should characterize any advice we give. For example, advice only to store guns and ammunition in separate locked locations ignores other responsible ways to secure them, depending on why and where one needs them, and who else should have access and who should not. Nor does the “public health” perspective on firearms include, as it should, the harm reduction played by guns used legally for protection.

We know that as gun ownership has grown across the United States, violent crime of all kinds has decreased, whatever other factors may have contributed. There are as many guns as people in the United States, and gun owners are very resistant to registering or surrendering their firearms. So there will always be guns around. “Gun safety” can only be achieved by teaching people, beginning with children, the rules of safe gun handling.

Gun access is an important issue in suicide, since it can provide an immediate, lethal means to someone vulnerable to a self-destructive impulse. The surest way to reduce this, as with all firearm tragedies, lies with responsible owners securing their weapons and using good judgment. At the same time, many good people are working to find ways to suspend access temporarily to firearms, with due process, from those who are at acute risk.

So, why was FOPA enacted in Florida? Too many Floridians had bad experiences with physicians telling them to get rid of their guns, when many patients who own and use guns knew that wasn’t right. Concern also grew that physicians were using their authority to prejudice less informed patients. As the 11th Circuit Court of Appeals majority later judged, these were appropriate concerns of the state in its “legitimate regulation of physician conduct … intended to protect patient privacy and curtail abuses of the physician-patient relationship.” The Court recognized that “the Act codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient’s care.” My hope is that the result is a clearer focus by physicians on the actual medical issues patients present.

Many gun owners also fear the creation of databases of gun ownership, because that could be a step toward confiscation someday. The absence of such a database becomes a safeguard against that and so resistance to entering it is understandable. Whatever we physicians intend, documenting patients’ gun ownership, especially in searchable EMRs, is going to raise that specter. Whether or not someone owns a gun is no one else’s business unless he or she chooses to share that, and many consider it rude to be asked.

The Court determined that “Any burden the Act places on physician speech is thus entirely incidental”. It only prohibits our taking advantage of the imbalanced doctor-patient relationship to require information from patients regarding their gun possession or to push a politicized position like “no one should have guns at home” (or, for that matter, that “everyone should have guns”). That would be unethical, like telling patients how they must vote.
Only “unreasonable inquiries” are banned, which is a bit vague but flexible. Anything related to actual clinical concern (such as suspected dangerousness) is fine. Yet even being a psychiatrist, I rarely need to inquire about weapons. We can still promote our beliefs about firearms or anything else, like every other American, by speaking out or writing, making videos or mounting a soapbox—even by joining a forum like this. We can still inform all our patients about the risks of guns—which we should also do regarding cars, bathtubs, swimming pools, iatrogenic complications and nosocomial infections, all greater hazards.

Mostly, I’m saddened by all this, which I see largely as a cultural conflict. I resent the government telling me how I must practice, even if it seems necessary to others, as in this case. But as another panelist explained, it’s not a bad law as it turns out. Unfortunately, our adversarial legal system has become a common means to settle disagreements, which in this case I think is an indignity we inflicted on ourselves. I’m sympathetic to Judge Wilson’s comment “That we have a right to do something does not mean we have a right to be free from questioning about that right”—but only if the questioning is respectful of that right.

I wish the NRA and the FMA could have worked together. But this wouldn’t have happened if we physicians had made more effort to understand the meaning of gun ownership to the vast number of Americans for whom it is a statement of autonomy, a healthy exercise of fundamental human rights and an individual American constitutional right. We need to recognize that it is perfectly normal to live with and use firearms, and that this is done quite safely by over 99% of all legal firearm owners. Educating physicians about these realities is the answer.

Our present generation of physicians is probably less familiar with firearms than were previous ones, as our nation has become more urbanized. But we have also learned to become more sensitive to those of differing gender, ethnic, racial, religious, political, linguistic, socioeconomic, and sexual preference identities. We need to offer the same respect to Americans who may “cling to their … guns”, but who do so as a vital part of their lives and identities. We should not assume the worst about them.

My talk, like those of the other panelists, seemed well-received. About half the questions and comments were directed to me, all supporting the AMA’s positions but the audience generally seemed to appreciate my participation. I encouraged them, perhaps ironically, not to give up on their professional organizations just because they were mistaken on this issue. But following the event I was thanked by several physicians from the audience who expressed their support of my position.

It’s worth noting that only about 20% of U.S. physicians belong to the AMA, with comparable participation in specialty societies. So an official position of the AMA such as this, which it presents as representing American medicine, is not necessarily a majority view of the profession. As a member of the AMA myself, I served as an example of that reality.

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  1. My gun ownership status is not my doctor’s business. Period. End of. My doctor has never asked me about firearms, and if he did, I would get a new doctor. If all doctors did I would avoid doctors or lie. Doctors need be be concerned with their own job, which is NOT household or gun safety. It’s treating actual ILLNESSES.

    • As someone who is getting ready to graduate from medical school I wholeheartedly agree with your comment. Ive never understood why some people think docs should ask about firearm ownership, my school doesn’t teach it nor would I ever do it. Someone telling me they have guns in their household is about as helpful as knowing what kind of car they drive. I might not be an attending yet but that information is useless to the diagnosis of any disease I’ve heard of or learned about.

  2. Since Doctors nationwide are estimated to cause needless deaths at a rate as much as ten times higher than all gun deaths each year, we damn sure need to be asking doctors more questions about their safety record before answering their silly ass inquiries! If they ask about guns in our houses, the answer is: “Every american has guns in their house, it’s their constitutional duty to be prepared as part of the well regulated militia!”.

    • At least half the homes where I live have guns. So that might be why my doctor doesn’t ask such foolishness. Any doctor here who asked such a question would be making it pretty clear that they “aren’t from around here” and are completely out of touch with the locals.

    • You would be surprised, Don. I live in a state that probably gets a solid F rating from all the gun grabber organizations and some school districts are actually closed on the first day of the firearm deer hunting season. I was stunned at a revelation in a middle school class in my district. As part of history and law, the local police liaison visited a class of 35+ students to review the role of police in law enforcement. When the police officer asked the class how many students had ever seen a firearm before, only 5 students raised their hands. When he asked them how many had actually handled a firearm, the number shrunk to three. And when officer friendly asked the children if anyone knew what was special about a certain date in November, only one student new that date was the opening day of the firearm deer hunting season.

      Less than 20% of the students had ever even seen a firearm and less than 10% had ever handled a firearm. And less than 3% knew the start date for firearm deer season. I am having a hard time wrapping my brain around that. Apparently there are areas where firearm ownership is extremely low even in firearm friendly states.

      • “Less than 20% of the students had ever even seen a firearm and less than 10% had ever handled a firearm.”

        In a few years when they start playing first person shooters that will change…

  3. I’m as likely to take gun advice from a doctor as I am from a politician. Medical school does not grant tactical ability, nor does the treatment of gunshot wounds. And politicians with bodyguards are equally inept at advising me how to best provide for my safety. Politicians and doctors alike have an unfortunate propensity to tell me how to live my life. I find that vexing.

    With that being said, I appreciate the doctors who are on the side of freedom, particularly as it pertains to firearms.

  4. If my doctor asked me if I had guns, I swear I would tell him that it’s none of his business. I would end that conversation right then and there. If there was a problem after that, fu–you very much, smell you later.
    I’d walk out the door. Eat sh–, die, bark at the moon. There are thing you don’t ask that being one of them. Guns don’t kill enough people, although the mainstream media would like us to think they do, to have a doctor question me about possessing firearms.

    Now if my Aimpoint T1 along with the front site off my AK is stuck up my ass, ok fair question.

    • I don’t think I would feel a need to go that far. If my doc asked me about my gun ownership, I would probably just draw my gun (which activates the laser) and ask, “you mean like this one? Of course I do. Don’t you?” If he carries the questioning / control attempt further, I would refuse to pay the bill for that day, and never go back. We have lots of doctors, many of them unable to support themselves. Whatever the govt says they should do, when it costs them money they will stop. I have already done that once, when my doctor insisted that whatever was my complaint, including a stubbed toe, it was because I smoked. Ruined an expensive vacation once, he did not get another chance.

      • Well I’m way past the point of leaning over backwards to sugar-coat my comments because someone might get offended. Maybe I should clarify my comment. I would tell the doctor politely that it was none of his business.
        Should the subject get pressed, then I most certainly would tell them where to go and what to do. What’s going to happen, get a spanking? Have to find another doctor? Have someone think I’m an asshole? Get in line.

        There are a few places I wouldn’t carry my weapon and leave it in the car. Going to the doctor is one of them. I see a doctor every two years for my medical certificate for my pilots license. It’s my opinion that carrying a concealed weapon to a physical borderlines stupid, especially for a flight physical.

        I prefer to keep my business, MY business. That’s why I don’t have my facebook accounts, or my name, age and picture on Google, Yahoo etc.
        I don’t like being questioned and to no surprise, I don’t open carry.

  5. I don’t know, perhaps a polite refusal if asked by a Dr. Or “none of your (insert expletive) business, works wonders and leave with a complete copy of your medical file.

    In FL, this was also a tactic to hold Dr’s accountable, as there were instances where doctors asked “children”, remember, it’s for the children, if Mommy or Daddy owned firearms, especially tweens and teens that didn’t want Mom or Dad in the exam room. I defer to my opening sentence.

  6. “That we have a right to do something does not mean we have a right to be free from questioning about that right”

    Actually, yes, it does mean that! And, Mr Doctor, please note that none of these proposed rules require me to retain your services past one second after you ask a question which is outside your expertise and demonstrably none of your damn business. If you can see that asking such questions will add more patients than it would lose, you go right ahead. I suspect it would behoove you to research openings at Burger King before you do. We are overloaded with doctors, and lawyers, we do not need you. Think about it, and consider the source of your arrogance!

  7. Half the time I am embarrassed to say I am a physician, because of F@cktards like this. I will not ask my patients questions about guns in the home. None of my freaking business. My doctor does ask me about firearms, but he is my younger brother and my usual range partner.

  8. “It’s worth noting that only about 20% of U.S. physicians belong to the AMA, with comparable participation in specialty societies.”

    Actually, it is less than 15%. Most of us recognize the AMA for what it is.

    • Haha your name makes me think general surgeon

      Echoing a lot of what has been said, there are pro and anti gun docs. Interestingly the progun docs seem to usually be very progun

  9. Just remember, if the doctor asks the question, any answer other than “no” is a “yes”. As soon as you say “Pardon me but that is none of your business” the doctor immediately jots down “gun owner” in your file.

    • Yep.

      If a doc asks me that question, I’m planning on looking aghast and recoiling in horror at the very mention of a gun…

      • You may have intended a bit of exaggeration in your post, but I would advise to not overdo it. As Nancy Reagan suggested (for those of us old enough to remember) I’m going to “just say no”. 🙂

    • I was thinking along those lines myself. Given what a paper trail people leave about themselves and their leanings all over the interwebz with things like facebook and such, I wonder if it might not be wise to do a little bit of online snooping before selecting a doctor. Knowing a doctor is likely to be pro-gun due to various hints and tells in his social media (People give themselves away more than they know), it could help avoid interaction with doctors who could be dangerous to your freedoms in the future.

    • I am glad I’m in Florida. However, I would have to ask if they were a certified safety instructor or a licensed gun smith. I don’t go to a gunsmith to get my heart checked out. I don’t go to the Doc for gunsmithing issues.

  10. As a nationally certified pistol and rifle instructor and a State Police certified safety instructor, a certified CRSO and RSO and an FFL, I’m going to give medical advice to my clients.

    I know more about medicine than docs do about guns, so it’s fair, no?

  11. Never been questioned by Doctors or Staff about guns. My own take about strangers asking about if I have guns is that of the U.S. Military regarding if certain ships and aircraft are carrying nuclear weapons.

  12. It is not a good idea to see my doctor the week before turkey season. He sure as hell is not thinking about me.

    He has a slide show on one of his examination room computers. It shows him and his wife on a caribou hunt in upper Canada.

    No worries for me.

  13. The truth is docs can discuss gun safety without asking about gun ownership, period, full stop.

    This does not limit their freedom of speech, it only forces them to be apolitical, which they should be in the first place.

  14. My dentist is an avid turkey hunter, so we talk guns now & then. My doctor I don’t know the status of, but given he’s with the VA, it’s not a discussion I care to have.

  15. Rarely are our physicians educated or knowledgeable about diet. Patients sit right in front of them with complaints aches and pains caused by diet and these docs rarely speak about what folks should eat and not eat.

    This kills far more people and/or guarantees a life pharma purchases and medical procedures.

    Why change my diet when I can get a quad bypass? Steroid shots instead of reducing inflammation by eating less wheat gluten. Weight loss? Quit the high fructose corn syrup. Hard it’s in everything. We’d feel so much better, all of us.

  16. My doctor is too overworked to take the time to ask.

    If it was billable separately, the clerks would likely add it to the questionnaire they have you fill-in at the start of your visit (to make sure it gets billed – every dollar counts). Gun Owner, Diagnostic Code xxxx.y, Non-Gun Owner, Diagnostic Code xxxx.n.

    They wouldn’t care if it was yes or no, just that they got paid.

  17. I live in north Florida and during my annual this fall my doctor asked me what I was doing for exercise. I told him I bike regularly and that I was doing USPSA. He asked me what range we shot at and then we discussed his wife’s and his experience with their CCW class. He said he’d like to get in more practice, and I told him he could be my guest at the range anytime. I have no problem discussing guns with my doctor. But I understand not all of them are as sensible.

  18. Geepers, back when I still lived in NJ, my doctor was occasionally written about in Field & Stream. He sometimes had his hunting dog sleeping in the waiting room, which had the walls covered in art showing the hunting of wildlife. He has since retired and I have since moved out of the state. My current doc hunts a little, but has never asked me about gun ownership beyond “do you go hunting at all?” My dentist also hunts.

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