A Physician’s Perspective: the Public Health Challenge of Gun Safety

health.usnews.com ^ | 1/28/2016 | Michael Rabovsky, M.D.

[rktman]

There are 90 deaths due to firearms every day in the U.S., or more than 33,000 deaths a year.

[elcid1970]

Never been impressed by any VA physician. Thank goodness I don’t have to go there. Went there to `register’ after I retired and it was pitiful to see busloads of vets being brought in from the projects; VA was all they had.

VA is getting into the gungrabbing racket, too.

[baltimorepoet]

CDC says about 100,000 people a year die from HAIs (hospital-acquired infections). In other words, unclean hospitals needlessly kill you.

The same kind of arrogant God-complex b@st@rds (who, us Gods wash our hands?) that drove Ignaz Semmelweis to mental breakdown and death. Semmelweis is proof of the dangers of being right when surrounded by ignorant fools.

[MNJohnnie]

There are 90 deaths due to firearms every day in the U.S., or more than 33,000 deaths a year.

Total population of 318.9 million in the USA A hysteric rant about a statistically insignificant problem. Like ranting we need to ban cars because of traffic accidents.

[DPMD]

Let’s explore the public health challenge of physicians who are not addicted to drugs, stealing from their pharmacies, molesting children, beating their spouses, botching surgeries, sending victims of their botched abortions to ER’s, contributing to liberal politicians, pushing unnecessary drugs as payoffs to their drug company sponsors, and running victim/patients through their offices in speed diagnosis flurries. And so on.

[marktwain]

Doctor Rabovsky states the following:

“40 percent of all guns in the U.S. are purchased through the public sector”

That is simply and completely false. Military and police only purchase a small fraction of firearms in the United States. In 2015, about 17 million firearms were sold outside the military in the U.S. There are only about 700,000 total federal state and local law enforcement in the United States. They might get new guns once a decade. It is likely less, on average. That would be about 70,000 guns a year, or about half of one percent of the firearms in the United States.

Guns that come to the civilian population from the military are a very small fraction of that.

[FBRhawk]

I have lost two friends to suicide by gun. In high school a friend who was only 14 used a .270 rifle under his chin on Christmas eve. That was 40 years ago and his family still bears the scars.

More recently an adult friend and father of two little girls drove to a secluded park and shot himself with a .38. Both were know to be suffering from depression or Bi-polar disorder.

Pills often don’t work, other methods are less common and may give the person a chance to back out. Pulling a trigger takes only a second and is usually fatal.

I don’t think doctors should constantly screen for depression and reporting any of your health information to the government is an invasion of privacy and a step on the road to tyranny.

However -if you have friends or family that are clinically depressed or bi-polar it is only prudent to limit their access to firearms until they are well. This is no more radical than taking the car keys from a drunk friend on a Saturday night. Friends don’t let friends drive drunk, and friends don’t leave depressed friends alone in a room with a loaded gun.

[IC Ken]

The infections are huge in hospitals. I was starting to import an air cleaner made in Finland that with NO Hepa filters could clean air to 1 nana meter. That is 300 times smaller than a virus. I though with Staph running rampant at the time it could be a big money maker.

Couldn't sell one to save my soul.

[goodnesswins]

I’d stay away from this doctor....not mentally qualified to practice medicine, IMHO

[Skepolitic]

I used to think it was always immoral to lie. However, I now think an exception applies when one is coerced to make a statement, explicitly or implicitly, by an agent of a state that intends to violate one’s natural rights.

In 1943, it was not immoral to lie to a national socialist if he were to ask whether you harbored any Jews or knew anybody who did.

In 2016, it is not immoral to lie to a socialist if he were to ask whether you possessed any firearms.

An answer of “nunya business” in either case is tantamount to a confession. However, I do like the idea of responding with a nosy question about his income. Then you could say his refusal to answer implies that he’s in the 1%, and shame him for enriching himself at the expense of poor people, and thereby violating American social justice principles. That would simultaneously establish your socialist credibility with the creep and cause him discomfort.

[Stanwood_Dave]

PART - 1

Risk Management Advice to Physicians
and their Insurers:
Don't Borrow Trouble

By Joe Horn

Since retiring and leaving Law Enforcement, I have been active in Risk Management consulting, a field that has grown rapidly throughout every industry over the past 20 years. Some of the companies I have consulted to for risk management include IBM, Gates Lear jet, National Semiconductor, and Pinkerton International Protection Services.

One of the best games in town is litigation, and litigating against physicians is even more popular than suing gun manufacturers. Physicians and their malpractice insurance carriers are well aware that litigators are constantly looking for new opportunities to sue. Let's talk about one of those new areas of exposure.

Nowadays, many physicians and other health care providers are engaging in the very risky, well intentioned, but naive and politically inspired business of asking their patients about ownership, maintenance and storage of firearms in the home. Some could argue that this is a "boundary violation," and it probably is, but there is another very valid reason why these professionals should NOT engage in this practice -- MASSIVE LIABILITY.

Physicians are licensed and certified in the practice of medicine, the treatment of illnesses and injuries, and in preventative activities. They may advise or answer questions about those issues. However, when physicians give advice about firearms safety in the home, without certification in that field, and without physically INSPECTING that particular home and those particular firearms, they are functioning outside the practice of medicine. Furthermore, if they fail to review the gamut of safety issues in the home, such as those relating to electricity, drains, disposals, compactors, garage doors, driveway safety, pool safety, pool fence codes and special locks for pool gates, auto safety, gas, broken glass, stored cleaning chemicals, buckets, toilets, sharp objects, garden tools, home tools, power tools, lawnmowers, lawn chemicals, scissors, needles, forks, knives, and on and on, well, you get the drift. A litigator could easily accuse that physician of being NEGLIGENT for not covering whichever one of those things that ultimately led to the death or injury of a child or any one in the family or even a visitor to the patient's home.

To engage in Home Safety Counseling without certification, license or formal training in Risk Management and to concentrate on one small politically correct area, i.e., firearms to the neglect of ALL of the other safety issues in the modern home, is to invite a lawsuit because the safety counselor Knew, Could have known or SHOULD have known that there were other dangers to the occupants of that house more immediate than firearms. Things like swimming pools, buckets of water, and chemicals in homes are involved in the death or injury of many more children than accidental firearms discharge [ Source: CDC.] Firearms are a statistically small, nearly negligible fraction of the items involved in home injuries. Physicians SHOULD know that. So, why all of a sudden do some physicians consider themselves to be firearms safety experts? Where is their concern for all the other safety issues that they DON'T cover with their patients?

Once physicians start down this path of home safety counseling, they are completely on their own. A review of their medical malpractice insurance will reveal that if they engage in an activity for which they are not certified, the carrier will not cover them if (or when) they get sued.

Consider a physician asking the following questions of his or her malpractice insurance carrier:

1. One of my patients is suing me for NOT warning them
that furniture polish was poisonous and their child
drank it and died. I only warned them about firearms,
drugs and alcohol. Am I covered for counseling patients
about firearms safety while not mentioning and
giving preventative advice about all the other
dangers in the home, and doing so without formal
training or certification in any aspect of home
safety risk management? You know their answer.

2. How much training and certification do I need to become
a Home Safety Expert Doctor? They will tell you
that you are either a pediatrician or you are the
National Safety Council. But, you don't have
certification to do the National Safety Council's job
for them.

Homeowners and parents are civilly or criminally responsible for the safety or lack thereof in their homes. My advice to physicians is to not borrow trouble by presuming to be able to dispense safety advice outside your area of expertise: the practice of medicine. Your insurance carrier will love you if you simply treat injuries and illnesses, dispense advice on how to care for sick or injured persons, manage sanitation problems and try to prevent disease, but stay out of the Risk Management business unless you are trained and certified to do it.

Joe Horn 6th Mesa Risk Management, Los Angeles County Sheriff's Department, Retired

Physicians, Don't borrow trouble, Part II

by Joe Horn

Last time (Part I) we discussed:

the Risk Management issues involved in counseling patients about firearms home safety, and the liability issues involved with lack of certification and training of Physicians in Home Safety or Firearms Safety.

Now we'll discuss:

the very serious issues involving the lawful possession and use of firearms in the home, and the danger and liabilities associated with advising patients to severely encumber the firearm(s) with locked storage, or advising the patient to remove them entirely.

Patient X is told by Doctor Y to remove or lock up a firearm so it is not accessible. Patient X, does as counseled and has no firearm available at close-hand. Subsequently, patient is then the victim of a home invasion and calls 911, but the police are buried in calls and don't arrive for 20 minutes during which time Patient X is raped, robbed and murdered. Anyone can see the liability issue here, particularly Risk Management specialists and liability insurance carriers.

It's just a matter of when and not if this will happen, God forbid, but it will - if a home invasion takes place and Patient X takes Doctor Y's advice.

Now, imagine what follows this horrendous event. Who is to blame? The perpetrator is long gone, and even so, the Plaintiff's litigator will state that the perpetrator could have been neutralized by the appropriate defensive use of a firearm, which was no longer available to the deceased/injured because he/she followed a Physician's advice to render him/herself defenseless against violent crime.

The Litigator will further argue that the Physician Knew, Could have known, Should have known that removing a firearm from use for home defense would result in harm to the patient if and when a crime was committed against the patient in the home.

Physicians are already under incredible pressure from Liability and Malpractice carriers to limit their exposure, and Malpractice rates are staggeringly high. So, why borrow trouble?

If one acknowledges the already dangerous general liability of home safety counseling and then adds the very risky practice of advising patients to disarm themselves in the face of the reality of violent crime daily perpetrated against home owners and apartment tenants, it is apparent that the Physician is placing him/herself in a very risky position for suit.

It is my strong recommendation to Malpractice Carriers and those Physicians they insure to strictly avoid this high risk practice and reserve counseling for the area of expertise in which they are certified: Medicine. In my professional opinion, this is an emotionally charged political issue that Physicians and their Carriers should not be manipulated for whatever well-intentioned reason into taking the risk, which is considerable......

Physicians in doubt of the veracity of what I've said are encouraged to call their carriers and ask them what they currently cover, and to ask if this new counseling policy is covered under the existing policy. We already know what they will say: Don't borrow trouble.

Joe Horn, Sixth Mesa Risk Management, Los Angeles County Sheriff's Department, Retired. (c) 2000 Permission is granted to reproduce this article if left intact and complete.
crowtalk@theriver.com

[Harpotoo]

There are like 44K deaths each years from autos. Maybe that’s why the push for self driving cars. Maybe they can come out with self shooting guns.

[rktman]

Thus, if you’re not thoroughly immersed in the subject, best to avoid it. Kind of like the overweight doc telling you you need to lose a few pounds right? Mrs. rktman had a cardio appt last week and was asked by the overweight doc about her weight and what was she doing to shed some of it. Mrs. rkman asked that doc what did she do? LOL!

[Nailbiter]

My home does not have throw rugs, poor lighting or slippery bathrooms?

I live in cardboard box with my dog- if he did not have fleas he would be a better companion. Next question

[rktman]

Well guns, apparently, do have a life of their own. At least the way the press addresses the “issue”.

[thorvaldr]

The US doesn’t have a particularly higher suicide rate than any other industrialized country. Guns are a blatantly obviously fatal and anyone choosing them is making a serious attempt. People in Japan, Russia, and jail, regularly commit suicide without access to a gun. If you are concerned that someone is suicidal taking away their gun and pretending everything is ok would be stupid.

[ctdonath2]

I had a doctor that would make gently disparaging comments about firearms ownership.
Until 9/11.
Then he asked what he should buy.

[Arm_Bears]

How many people are killed in automobile accidents every day, doc?

Why isn’t that a public health challenge?

[Stanwood_Dave]

A Form to have your Liberal Doctor fill out. (Don't worry s/he won't.)

FIREARMS SAFETY COUNSELING REPRESENTATION: PHYSICIAN QUALIFICATIONS AND LIABILITY

Part One: Qualifications
I affirm that I am certified to offer (Name of Patient:_____________________), hereinafter referred to as "the Patient", qualified advice about firearms safety in the home, having received:
Specify Course(s) of Study: ____________________________
from:
Specify Institution(s):_________________________________
on:
Specify Course Completion Date(s):______________________
resulting in:
Specify Accreditation(s), Certification(s), License(s) etc.:
________________________________________________________
________________________________________________________
Check one, as appropriate:

_______________I represent that I have reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership. I further represent that I have reviewed all other relevant home safety issues with the Patient, including those relating to electricity, drains, disposals, compactors, garage doors, driveway safety, pool safety, pool fence codes and special locks for pool gates, auto safety, gas, broken glass, stored cleaning chemicals, buckets, toilets, sharp objects, garden tools, home tools, power tools, lawnmowers, lawn chemicals, scissors, needles, forks, knives, etc. I also acknowledge, by receiving this document, I have been made aware that, in his inaugural address before the American Medical Association on June 20, 2001, new president Richard Corlin, MD, admitted "What we don't know about violence and guns is literally killing us ... researchers do not have the data to tell how kids get guns, if trigger locks work, what the warning signs of violence in schools and at the workplace are and other critical questions due to lack of research funding." (UPI). In spite of this admission, I represent that I have sufficient data and expertise to provide expert and clinically sound advice to patients regarding firearms in the home.

OR

__________I am knowingly engaging in Home/Firearms Safety Counseling without certification, license or formal training in Risk Management, and; I have not reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership.

Part Two: Liability
I have determined, from a review of my medical malpractice insurance, that if I engage in an activity for which I am not certified, such as Firearms Safety Counseling, the carrier (check one, as appropriate):

____________will
____________will not

cover lawsuits resulting from neglect, lack of qualification, etc.

Insurance Carrier name, address and policy number insuring me for firearms safety expertise:
________________________________________________________

____________I further warrant that, should the Patient follow my firearm safety counseling and remove from the home and/or disable firearms with trigger locks or other mechanisms, and if the patient or a family member, friend or visitor is subsequently injured or killed as a result of said removal or disabling, that my malpractice insurance and/or personal assets will cover all actual and punitive damages resulting from a lawsuit initiated by the patient, the patient's legal representative, or the patient's survivors.

Signature of attesting physician and date:_____________ ___/___/20__

Name of attesting physician (please print):___________________________________________________

Signature of patient and date:____________________________ ___/___/20__

Name of patient (please print):_________________________

Patient: Indicate if physician "REFUSED TO SIGN." Have physician place a copy in your chart/medical record.

[DoughtyOne]

[stockpirate]

The next thing to watch for in the gun debate is the new reporting methods being employed concerning weekend shootings in the cities.

In the past they were reported based on the number of victims in each event. For instance 1 person shots three people, but over the weekend there was 22 dead in 16 separate shootings. Now they will all be lumped in to one mass shooting. So, it would say 22 dead in ONE shooting.