A gag order cannot halt a passionate child advocate

Florida politicians will not change pediatrician resolve to advocate for and protect children. There’s no question that a gag order cannot halt a passionate child advocate. I’d call the recent Florida ruling a dull tool taken to a very sharp crowd. Consider this post an open letter to Florida politicians.

I live as far away from Florida as any continental American (you do the math) yet Florida politics affect pediatricians and families everywhere. In my opinion, every parent should tune in and follow this case. Florida just restricted physician free speech and hindered a physician’s ability to help your neighbors, your relatives, and your family create a safe environment for children.

Guns in your home? Do you ask about guns at playdate drop off? Have you seen the Moms Demand Action For Gun Sense In America online presence (and progress) or follow their feed on Facebook?

Florida may have gotten this wrong thinking that restricting a pediatrician’s words and inquiry about safely storing firearms meant that pediatricians were trying to take away guns. Not so fast.

The Florida physician gag order law

Recently, The 11th Circuit Court of Appeals in Florida upheld the “physician gag law” in Florida, a law that violates the First Amendment rights of pediatricians and family doctors and threatens their ability to counsel parents about how to protect children from unintentional injury and death. This started way back in 2011. Then the law was appealed. Now the appeal is overturned. This ping-ponging is just politics but the waste here is distraction from protecting children. In 2011 I explained the gag order for pediatricians – basically it’s this: Florida says it’s illegal for pediatricians to ask about how families and guardians store firearms in their home even though we know about 4,000 American children die every year from firearm injuries.

Relevant firearm statistics

  • Guns are in about 1/3 to 1/2 of American households (data I reviewed varied). For the parents that don’t have guns, research finds that over 1/2 have never talked to their children about gun safety. Since more than a 1/3 of all accidental shootings of children take place in the homes friends, neighbors, or relatives gun in your home or not, guns are a safety issue for all children. Another reason the Florida legislation matters to us all.
  • One in every twenty-five admissions to pediatric trauma centers in the United States is due to gunshot wounds. See information about handguns in the home and ways to protect children.
  • Storing guns separately from ammunition and in a locked container reduce likelihood of accidental injuries.

The American Academy of Pediatrics condemned the Florida ruling this morning in a statement that strongly goes against the ruling and delicately lays out the facts for why:

Research has shown that physician counseling about gun locks and safe storage, tailored to a child’s specific age and development, increases the likelihood a family will take the steps to store their firearms safely. Pediatricians routinely counsel families about firearm safety just as they offer guidance on seat belt use, helmets and parental tobacco use to reduce the risk of injury to children where they live and play

Limiting a physician’s right to inquire about a child’s home, including safe storage of firearms, remains an impediment and outrageous threat to safety. It’s not just our own homes, but the homes our children visit that must be safe. This is why Florida legislation matters for most of us.

Dr. James Perrin sums it up beautifully: “Parents who own firearms must keep them locked, with the ammunition locked away separately. In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming – young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility.”

This law (if it is upheld again) won’t save lives. These antics waste state and federal money, distract politicians from governing and re-direct research dollars. Good thing is I know who we’re dealing with; I met pediatricians formally as teachers and mentors back in August of 1998 when I started medical school. In fact the very first lecture I heard at med school was given by Dr. Ken Ginsburg an adolescent expert. He gave a talk on firearms, adolescents, risk and responsibility. And although I don’t remember the numbers shared in that talk nearly 16 years ago, I remember the intent he inspired in me.

The efforts and goals to protect children are pre-conditions when living on earth for parents and pediatricians. Antics like gagging pediatricians will not deter advocacy and there is no question what my 16 years in the community of medicine has taught me: this will not change pediatrician resolve to protect children’s lives. Inquiring and learning about a child’s environment while providing tips for safety for those who protect children will always be a part of that, gun-safety included. Florida politicians or not. The AAP notes that since 2011, 10 other states have attempted (and failed) to enact similar legislation.

See here what other pediatricians and advocates have said about this ruling on Twitter:

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc. She is the author of Mama Doc Medicine: Finding Calm and Confidence in Parenting, Child Health, and Work-Life Balance.

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  • doc99

    Here’s an issue that should unite all physicians across the entire political spectrum – Get The Government Out of the Exam Room. Period.

  • Hexanchus

    Personally, I think the 11th Circuit hit the nail on the head.

    As they clearly stated there is nothing in the act to prevent physicians from providing firearm safety information to patients across the board. If they were to do so, there would be absolutely no need to ask the patient anything or record their response – just note in the record that the information was provided. I’m sure the AAP or AMA could come up with an appropriate brochure – they probably already have one.

    From the patient’s standpoint, rather than get into a potential confrontation with a provider, the easiest solution when asked a question about firearm ownership or any other subject they feel is none of the providers business is to lie to them – just tell them “no” or whatever the “politically correct” answer would be and be done with it.

    I wonder how much outcry would be heard from physicians if those patients who were adversely affected for refusing to answer exercised their free speech rights by widely publicizing what occurred and naming names.

    • Eric Strong

      How exactly would a parent who refused to answer a question about firearms be adversely affected by that refusal? The only way I can see is if, in response, the pediatrician asked for them to find another doctor. If that was the case, it suggests that the pediatrician and parent are unlikely to be well matched, and the parent is probably better off finding a different doctor for their child anyway, which ultimately is to the parent/patient’s benefit and not detriment.

  • Dave

    While I hope this terrible law gets overturned, until then doctors in Florida can take some refuge in the loophole in the law that allows you to ask if it’s relevant to the patient’s medical care or safety. Considering that guns kill more children each year than Polio did even at the height of the pre-Salk epidemic, the safety loophole is a no brainer.

  • JR DNR

    I don’t think providers should be asking if patients have guns and writing it down in their notes. I also don’t like the legislation of health care matters.

    I don’t see a problem with educating patients about gun safety if the physician is that passionate about the issue. You don’t need to ask in order to do that.

  • http://intellectualfollies.blogspot.com/ Vamsi Aribindi

    The Florida law has a loophole big enough to drive all the questions you want right through it. If the doctor “honestly” believes that a question about gun ownership is “medically relevant”, they can ask all the questions about it they want.

    The ONLY thing a doctor can’t do per the new law is:

    1) Ask about guns, and if the patient responds no or declines to answer
    2) Immediately order the patient out of the office.

    Even there- all the doctor has to do is wait one visit and say “I don’t think we’re getting along. Go see this other doctor.” Seriously, the law is silly beyond all belief and doesn’t infringe on anyone’s 1st Amendment rights because it’s just a FAIL- and probably an intentional one.

  • Eric W Thompson

    I don’t like legislating health care. Neither this nor the ACA. What else kills children? Are they being asked about automobiles? Swimming?

  • cherterra

    I think physicians should have the right to ask any questions they deem in the best interest of their patients health or safety. The fact is… people don’t have to answer anything they don’t want to. People have a tendency to lie or omit information all the time. This is no different so attempting to legislate what can or cannot be said in the privacy of a physicians office is absurd.

  • Dr Dave

    There is no reason we can’t advise and inform without asking about possession and habits. Do it in general terms just like we do about drugs and other sensitive issues. It is none of the Gov business what happens in my exam room. I don’t talk about guns UNLESS it is related to care I am rendering. Discussing it as a hypothetical is simply out of the scope of Medicine. I don’t ask if they have bomb making equipment either or if they safe guard the keys to the family car so Jr doesn’t get at them and kills someone on a joy ride. IF however I need the patient to refrain from firing a weapon post surgery for Medical reasons then we have that chat actually in great detail. If not let the AMA make a poster discussing the proper ways to protect about gun mishaps and it will go on the wall for all to read but I am not the agent of the gun lobby folks one way or another. Dr D

  • http://intellectualfollies.blogspot.com/ Vamsi Aribindi

    ..?
    The supposed point of the law is to protect 2nd Amendment rights, though it doesn’t do that very well.

    I’m saying that it does not seriously infringe on anyone’s 1st Amendment rights because it is ineffective.