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Kids, guns and doctors' rights

Physicians say firearms safety is a matter of public health; the NRA says it’s a privacy issue

By Chelsea Conaboy
Globe Staff / June 13, 2011

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Pediatricians regularly give parents advice about how to keep their children safe at home: Stash toxic cleaners where young children cannot get to them, fence the backyard swimming pool, require bike helmets, and keep any firearms unloaded and locked away.

Physicians call this kind of preventive care “anticipatory guidance.’’ When it comes to guns, the National Rifle Association calls it an invasion of privacy.

Governor Rick Scott this month signed a law making Florida the first state to limit a physician’s ability to ask patients or their parents whether they own a gun. Those who do would be subject to discipline by the state medical board. Similar proposals now being considered by several other states have enraged many doctors who say the law impinges on their ability to deliver critical information to families.

“This is not an even-steven discussion,’’ said Dr. Joel Alpert, a pediatrician and assistant dean at Boston University School of Medicine, who is past president of the American Academy of Pediatrics. “This is child health against a paranoid fear about guns being taken away from someone.’’

At the heart of the issue is whether guns are a matter of public health. Supporters of the law say that they are not.

“For a doctor to be able to do his or her job, they don’t need to know whether a person owns a firearm or not,’’ said NRA spokesman Andrew Arulanandam.

The idea that firearms are out of bounds for doctors, who are committed to preventing illness and injury, is preposterous, opponents said. Between 2003 and 2007, the most recent years for which data are available, 152,519 people were killed by firearms, including more than 15,000 children and teenagers, according to a US Centers for Disease Control and Prevention database that collects information from death certificates. In the same period, 138 Massachusetts children and teenagers were killed by firearms, the bulk of which were homicides. That’s more than twice the number killed while riding in a motor vehicle.

The American Academy of Pediatrics recommends that doctors talk with families about the safe storage of guns, which can include storing ammunition separately and using a gun safe or a trigger lock. Several physicians interviewed for this story said they have supported or helped to organize programs to hand out free locks or buy back guns.

“It would almost be malpractice if the doctor didn’t talk about guns,’’ said David Hemenway, director of the Harvard Injury Control Research Center, and author of the book “Private Guns, Public Health.’’

The Florida law sets a bad precedent of allowing government to reach into the exam room to tell doctors, “for clearly political reasons,’’ what they can and can’t talk about, Hemenway said.

This is not the first time this issue has been debated by lawmakers. Legislators in Virginia and West Virginia voted against similar laws in 2006. West Virginia is considering the proposal again, along with North Carolina and Minnesota. Alabama postponed a vote in April.

Represented by the Washington, D.C., office of Ropes & Gray and the Brady Center to Prevent Gun Violence, the Florida chapters of several physician groups have filed a lawsuit asking that the state’s law be thrown out. The suit claims the law is unconstitutional and could result in “grievous harm’’ to families and children denied information about gun safety.

The Florida Medical Association is not a party to the suit. The association negotiated with sponsors to tone down the original bill, which called for steep financial penalties and jail time, and supported the measure in the end. The final version includes broad language allowing doctors to talk with patients about guns when considered medically necessary or when physicians are concerned about patient safety.

But Dr. Louis St. Petery, executive vice president of the Florida chapter of the American Academy of Pediatrics, said the law will have a chilling effect, and it opens the door for other states to enact similar measures. Plus, he said, a referral to the board of medicine is not something doctors take lightly.

Though no such proposal has been introduced here, the Massachusetts Medical Society last month took preemptive action at its annual meeting. Members passed a resolution saying they oppose any legislative interference in their ability to take a person’s medical history or to talk with families about guns. The resolution also requested that the American Medical Association take a strong stance against such limits.

The resolution was put forward by Dr. Michael Hirsh, head surgeon at UMass Memorial Children’s Medical Center. Hirsh became interested in gun control in 1981, when his best friend and fellow resident at New York-Presbyterian Hospital was shot and killed on the street. Since then, Hirsh has helped organize gun buy-back programs in Worcester and other cities

On the Florida law, he said, “I just don’t want to see this wave of stupidity come anywhere where sane people might understand this is going to affect kids.’’

He pointed to the recent death of a 3-year-old South Carolina girl who reportedly picked up her mother’s loaded handgun from a windowsill and was killed when it fired. Those are the kinds of tragedies that doctors try to prevent, he said.

But Arulanandam said doctors have no formal gun safety program like the one that the NRA offers. Its Eddie Eagle program taught at least 1 million children about gun safety last year, he said. Its primary message to kids: If you see a gun, leave it alone and tell an adult.

Jim Wallace, executive director of the Gun Owners’ Action League, a Massachusetts affiliate of the NRA, said the questioning from doctors is invasive and “doesn’t lead to trust.’’ He said he did not know of any efforts to bring the issue up before Massachusetts legislators, who historically have supported strict gun control. But he said his group could raise the matter if it heard from members that the questioning from doctors had become “overly intrusive.’’

Arulanandam did not answer questions about how those families that the Eddie Eagle program does not reach should learn about gun safety or whether people other than doctors also should be prohibited from asking whether a person owns a gun.

“Our simple point is this: This is a privacy issue, doctors don’t need to know this information to provide the care that they give, and certainly people should be entitled to their privacy,’’ he said.

When asked why the NRA does not simply counsel its members not to answer doctors’ questions if they feel uncomfortable, he said, “Why not make sure that people don’t ask the question to begin with?’’

He went on to say that the NRA cares about the First Amendment as much as it cares about the Second. But several doctors said they are concerned about what other conversations — those about birth control or sexual behavior, for example — conservative groups might aim to limit if this law stands.

“They’re putting government into the doctor’s office,’’ BU’s Alpert said.

Chelsea Conaboy can be reached at cconaboy@boston.com.

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Out of harm’s way

Just like seat belts and bike helmets, guns are a child-safety issue, said physicians interviewed for this story. Here are some tips that Dr. Eileen Costello, a pediatrician at Southern Jamaica Plain Health Center, offers to families of her patients:

IF YOU HAVE GUNS AT HOME:

Consider the risk. “It’s better not to have them, because if you have them you’re more likely to use them, and terrible things happen when people use guns,’’ she said. She pointed to US Centers for Disease Control and Prevention literature that shows that many guns used in school shootings come from the shooters’ homes. In a study published in February in the American Journal of Lifestyle Medicine, David Hemenway of the Harvard Injury Control Research Center reviewed literature on gun usage and found that the costs outweigh the benefits.

Keep guns unloaded and stored in a locked cabinet.

Evaluate the risk to your children. Costello said adolescent boys are particularly interested in guns. Others interviewed for this story said parents of children with mental health concerns should think twice about keeping guns in the home.

If the gun is necessary for a parent’s job, Costello suggests storing it in the workplace instead of at home.

IF YOU ARE CONCERNED ABOUT GUNS IN THE HOMES OF FRIENDS OF FAMILY:

Talk about it. Costello said parents should not be afraid to ask about how the guns are stored. One approach she suggested: “I know I’m a nervous mom, but I just want to know that if you have guns in your house that they are in a really safe or locked cabinet.’’

Think about this as another safety issue. People often talk with other parents about their child’s food allergies, for example. Tact is important, but parents should not be afraid to bring up gun safety, Costello said.

CHELSEA CONABOY

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