Obama Sides With Physicians in Fray Over Gun Questions

January 16, 2013

As part of his new initiative against gun violence, President Barack Obama today announced an executive action to protect the right of clinicians to talk to their patients about gun safety.

In doing so, the president jumped squarely into a fray between organized medicine and the National Rifle Association (NRA).

The executive action, one of 23 unveiled at a White House event, has a limited scope. It states that the administration will issue guidance clarifying that the Affordable Care Act (ACA), contrary to what some believe, does not prohibit or regulate communication about firearms between clinicians and patients.

The rationale for taking this minor action — as stated in a White House press release — nevertheless provides broad support for physicians who have taken the state of Florida to court over a 2011 law that prohibits them from asking patients if they own a gun. Florida lawmakers and the NRA view such a question as a threat to the Second Amendment right to bear arms. Organized medicine counters that the question is only a prelude — when the answer is affirmative — to discussing safe gun storage and other practices, lest a 4-year-old discover a loaded pistol in a desk drawer.

Obama is siding with the physicians.

"Doctors and other healthcare providers...need to be able to ask about firearms in their patients' homes and safe storage of those firearms," the administration said in the press release, "especially if their patients show signs of certain mental illnesses, or if they have a young child or mentally ill family members at home."

The administration noted that "medical groups continue to fight against state laws attempting to ban doctors from asking these questions."

Medical Societies Applaud Obama's Stance on Gun Question

In the Florida lawsuit, organized medicine so far is winning the fight for free medical speech about guns.

State chapters of the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP), along with several individual physicians, sued the state of Florida in a federal district court in Miami to overturn what they called a gag law on gun questions. US District Judge Marcia Cooke struck down the law as unconstitutional, saying it had nothing to do with the Second Amendment but everything to do with the First Amendment and its guarantee of free speech.

The law technically permits inquiries about gun ownership if a physician believes they are relevant to the health or safety of the patient or others. However, Cooke agreed with the plaintiffs that this exception is too vaguely worded to offer any assurance to clinicians that they could pose the gun question and not risk getting in trouble with the state medical board.

The state of Florida appealed the case to a federal appellate court in Atlanta, Georgia, where it is pending. In a friend-of-the-court brief filed last fall, the NRA voiced support for the Florida law. It accused the AAP of harboring a nonmedical agenda of removing guns from the home. The society's anti-gun bias, the NRA asserted, is evidenced by its current support for a ban on semiautomatic assault weapons — a pillar of the president's initiative against gun violence — and its past support for banning handguns.

The Florida law, said the NRA, rightfully "exhorts doctors to stick to practicing medicine...rather than pushing their own political agendas, and it protects patients from doctors who refuse to do so."

Soon after, the AAP, AMA, AAFP, and 4 other medical societies filed their own friend-of-the-court brief with the appellate court. They said the Florida law abridged the free speech of physicians and intruded into their relationship with patients. Their explanation of why a physician might want to discuss gun ownership in the exam room foreshadowed the mass shooting perpetuated by a troubled young man at Sandy Hook Elementary School in Newtown, Connecticut, on December 14, 2012.

"A physician is well positioned to warn a parent...that a teenager who shows symptoms of depression or impulsivity could harm himself or others if given access to a firearm," the medical societies wrote.

Obama's defense of the right of physicians to ask the gun question was singled out by the presidents of the AAP and ACP in statements they issued today in overall support of the president's gun-violence plan.

"State governments must also do their part, by not imposing restrictions on engaging in such discussions with their patients, as some state legislatures have attempted to do," said ACP President David Bronson, MD.

For its part, the NRA decried the president's position on the gun question.

"I think the action that President Obama is taking with regard to doctors and interrogations of firearms owners is a classic example of why states need to protect gun owners from overzealous doctors who ask questions simply because they want to make political statements against gun ownership," said Marion Hammer, a past NRA president and a current board member who represents the group in Florida, in an interview with Medscape Medical News.

ACA's Second Amendment Provisions

To protect physician free speech, the Obama administration intends to issue a clarification of heretofore obscure provisions of the ACA about firearms. The Title X section of the law titled "Strengthening Quality, Affordable Health Care for All Americans" states that wellness and prevention programs implemented under the law may not require "the disclosure or collection of any information relating to the presence or storage of a lawfully possessed firearm or ammunition" in someone's home or "the lawful use, possession, or storage of a firearm or ammunition." This prohibition extends to any data collection activity authorized under the law.

In addition, a health insurer may not increase someone's premium, deny him or her coverage, or withhold or reduce a discount for participating in a wellness program based on gun ownership or use.

All these provisions come under the subhead of "Protection of Second Amendment Gun Rights."

In its press release today, the White House said that "some have incorrectly claimed that the language in the [ACA] prohibits doctors from asking their patients about guns and guns safety."