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How the NRA prevents doctors in Florida from connecting the dots between guns and public health

Silence is deadly

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Patty Sheehan is angry.

The Orlando City Commissioner has been fuming since June 12, in between grieving and helping a community patch itself up. Her blue eyes harden when she remembers what Attorney General Pam Bondi told her while Orange Avenue was still stained with blood from victims who were dragged from the gay nightclub Pulse to the Orlando Regional Medical Center. The ire from that moment has fueled her to attend multiple gun control rallies in Orlando, always with a rainbow ribbon pinned to her chest, a permanent badge that many Orlandoans took to wearing after the shooting.

"I asked if we were going to talk about guns, and nobody would listen," she says. "Some of the first words out of Pam Bondi's mouth to me: 'We're not going to talk about guns today.'"

Sheehan was baffled. How could state officials refuse to talk about the weapon used to kill 49 people and injure countless others? When a CNN anchor asked Florida Gov. Rick Scott if the state's gun laws, which make it easier to buy an AR-15 than a pistol, played a part in the massacre, why did he ask instead for a conversation on stopping "radical Islam"?

"They don't want to say a hate-filled person targeted the LGBTQ community with a high-powered assault weapon that should have never been in his hands to begin with," she says. "Instead it's ISIS and terrorism. They want to make it about anything other than what it was."

Sheehan and Scott's disagreement about what really spurred the Pulse massacre might seem like a classic clash between the way Democrats and Republicans view the world. But beneath that is a more insidious effort on the part of the gun lobby to silence any and all conversations on firearms, despite the fact that more than 33,000 Americans die from gun violence every year and most of those victims don't perish in mass shootings.

And surprisingly, the industry's main targets aren't elected officials like Sheehan, or the state representatives who asked their colleagues in the Florida Legislature for a special session after Pulse, or even the Democratic members of Congress who staged a sit-in last June asking for a vote on several gun control measures. No, it's doctors and scientists.

After the tragic events at Pulse, conservatives in the United States Congress are still beating back efforts to repeal a longstanding ban on federally funded gun-violence research. In Florida, meanwhile, the state is still defending a law that forbids doctors from even asking patients about their guns, a fight that could head to the U.S. Supreme Court. The most prominent lobbyist for the National Rifle Association in Florida says asking for a re-examination of any existing legislation on gun control is "dumb."

In the wake of disaster, inertia reigns as those in charge of the public's welfare struggle to inform Americans about why they're dying.

Dr. Mohsin Jaffer still wonders what would have happened if he knew his friend wanted to die.

Jaffer, a South Florida gerontologist, says his friend was a "Robin Williams type" – jolly and jocular on the outside, deeply depressed in private. After he heard some (undisclosed) bad news, Jaffer's friend killed himself with a gun.

Jaffer still thinks about what would have happened if he'd asked the questions he asks all his depressed patients: Do you have a gun in your home? Is it secure? Can you give it to someone else to hold for you?

"If somebody becomes depressed and wants to take their life, they'll have a higher success rate with a gun," he says. "It's a lethal combination, which is why I ask. I don't care if you like guns or not, all I want to know is if my patient is a danger to himself or not."

Jaffer owns a gun. He says he used to be a member of the National Rifle Association. But he quit years ago after the NRA ushered several pieces of legislation, including Florida's Firearms Owners Privacy Act, into law. FOPA uses the threat of severe penalties to prevent physicians from asking their patients direct questions about guns in their homes. The law's original backers wanted to prevent doctors from asking their patients about guns in the home because they felt it was a violation of privacy.

FOPA has been blocked under a temporary injunction since 2011, the same year it passed, but that hasn't stopped the chilling effect it's had on physicians in the state, says Dr. Consuelo Beck-Sagué. The law is not being enforced as it's litigated through the courts, but the fact that it was passed was enough to strike fear in the hearts of some doctors, who now refuse to ask their patients about the guns they own.

Before accepting her current job as an assistant professor at Florida International University, Beck-Sagué worked as a pediatrician. The first time she heard about the FOPA, she thought it was a hoax: How could it be possible that the state could take away her medical license or fine her for asking patients if there were guns in their homes and if so, how they were stored?

"What physician is going to take a chance like that?" she says. "Everybody I knew wimped out. The practice of pediatrics changed in Florida because everybody was so risk-averse to asking that question. This law was very much against the concept of preventative medicine."

Beck-Sagué says she didn't only ask the parents of her patients about guns. She also asked about swimming-pool safety, smoking and whether pillows were being placed in cribs. But she was interested in preventing the parents of toddlers from leaving loaded guns unlocked and within reach of tiny hands. Last year, 265 children shot someone by accident; in 83 of those cases, the results were fatal, according to data from the gun control group Everytown for Gun Safety.

Beck-Sagué says she also worried about suicidal teens. "It can be something impulsive, like a breakup or not making the team," she says. "What normally is a very little thing is huge when you're depressed, and if you have a way of ending it all suddenly with a highly lethal weapon, that's a tremendous influence."

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Beck-Sagué's logic was probably similar to that of Dr. Chris Okonkwo, an Ocala doctor who in 2010 asked 26-year-old mother Amber Ullman whether she owned any guns before he examined her baby. As he later relayed the story to the Ocala Star-Banner, Ullman told Okonkwo it was none of his business. He told her to find another pediatrician.

After that story, the NRA took notice, ginning up outrage among gun-rights enthusiasts. In 2011, Marion Hammer, writing for the Institute for Legislative Action of the NRA, said the law would stop "anti-gun doctors from asking children and parents if they own guns and then telling them to get rid of their guns."

"Doctors need to treat illness, not guns," Hammer wrote. "Pediatricians and other physicians, in growing numbers, are prying into our personal lives, invading our privacy and straying from issues relating to disease and medicine by questioning children or their parents about gun ownership."

Eventually, the idea that doctors asking about guns was problematic found a champion in state Rep. Jason Brodeur, R-Sanford.

"What we don't want to do is have law-abiding firearm owners worried that the information is going to be recorded and then sent to their insurance company," Brodeur told the Fort Myers News-Press in 2011.

As Politifact pointed out, the Affordable Care Act, which became law in 2010, specifically prohibits the federal government from using the health care law to collect data on gun owners. It also prohibits insurance companies from adjusting rates because someone is a gun owner.

Brodeur pressed on regardless; in January 2011, he introduced HB 155, which threatened to jail doctors who discussed firearms with their patients. Doctors could also be fined up to $5 million.

Even in the GOP-controlled Legislature, that was a bridge too far; over months, the bill was tempered some, but the heart of it remained. The law that passed that April said that health care practitioners "shall respect a patient's right to privacy and should refrain from making a written inquiry or asking questions concerning the ownership of a firearm or ammunition by the patient or by a family member of the patient, or the presence of a firearm in a private home or other domicile of the patient or a family member of the patient." Legislators also reduced the penalties to lesser fines and the threat of losing a medical license, adding a vague clause saying physicians could make an exception if guns were "relevant to the patient's medical care or safety."

After Gov. Rick Scott signed it into law, doctors, medical organizations and the American Civil Liberties Union teamed up to challenge the mandate in federal court. Commonly referred to as "Docs v. Glocks," the lawsuit argued that the ban violated doctors' free speech rights. A federal judge in Miami agreed and blocked it the same year it was passed.

In the five years since, a three-judge panel of the 11th U.S. Circuit Court of Appeals reversed that federal judge and upheld the law. The physicians appealed to the entire appellate court; in July, the judges heard arguments for both sides of the issue. Ed Mullens, an attorney for the plaintiffs, says he expects the decision to be handed down sometime this year. From there, this case is likely destined for the U.S. Supreme Court after the loser appeals.

Brodeur tells Orlando Weekly he sponsored the law after doctors in the state program were refusing to see kids because their parents owned a firearm. He made the analogy that it would be just as unfair as if a woman walked in with food stamps to a grocery store and was asked by her cashier whether she exercised her right to vote as a condition of sale.

Brodeur adds that the media have gotten the law twisted: Doctors and paramedics can still make a "good-faith inquiry" about a patient's guns if they believe patients are an imminent danger to themselves or others. When OW asked how a doctor could determine that for certain, the state representative says doctors are professionals who could base it off their medical opinion.

"It's a civil right to be able to own a firearm," he says. "Physicians can still have the conversation about guns and the proper way to store them, but they should pose it as a question, not a condition of treatment. They should say, 'If you have a gun, you can do this,' not ask 'Do you have a gun?' I've heard from a number of parents who thanked me for this bill, saying it was a violation of privacy."

Howard Simon, executive director of the Florida ACLU, says the case is not about the Second Amendment, but rather the First.

"I thought this lawsuit was silly in a tragic way," he says. "It's absurd. We should be arguing about what regulation of guns is consistent with the Second Amendment. With this law, it's not even permissible to talk about gun safety. This law is a restriction on speech for one group of people on one subject that's disfavored by the Legislature. That's unconstitutional."

The state's defense, which is prepared by lawyers from Attorney General Pam Bondi's office, says the law barring doctors from asking about patients' guns "passes muster under any level of First Amendment review."

"By shielding gun-owning patients and families from discrimination, unnecessary harassment, and bad-faith, irrelevant inquiries and record-keeping, the act narrowly advances the state's compelling interests in protecting the fundamental right to keep and bear arms from private encumbrances, safeguarding patient privacy, eliminating barriers to health care, and preventing discrimination and harassment in the provision of health care services," a state brief in the case says. "The act represents the most modest of all professional regulations – a requirement that doctors stick to practicing medicine – and it accomplishes its compelling goals without interfering with doctors' professional judgment or otherwise burdening more speech than necessary."

Marion Hammer, the first female president of the NRA (who now lobbies for gun rights in Florida), agrees with the state. She asserts that gun ownership is a private matter unrelated to health concerns.

"It's like going to a mechanic to get your car fixed, and he tries to sell you a dress because he didn't like your pants," Hammer says. "It's completely irrelevant, and none of their business."

The American Medical Association would beg to differ. Two days after 49 people were shot dead at Pulse, the AMA declared gun violence a "public health crisis" and said it would actively lobby Congress to overturn legislation preventing research.

"Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries," said Steven Stack, president of the AMA, in a statement.

Hammer is only one voice in the chorus of gun lobbyists denouncing what they view as invasive inquiries by doctors. She and the NRA view the law as a protective measure, aimed at preventing the collection of data on gun ownership that will only lead to discriminatory practices by insurance companies. For her, the entire issue is nothing more than propaganda aimed at banning guns entirely.

Dr. Bernd Wollschlaeger, the lead plaintiff in the case against the state, is a family doctor. He's also a gun owner.

Wollschlaeger says he's continued to ask his patients questions about guns in their homes with mostly positive response, despite what he calls "the NRA's attempt to muzzle physicians."

"This law benefits nobody," he says. "I'm not an anti-gun vigilante. The NRA and the gun lobby only want to sell guns. They're not taking part in any rational debate on the adverse effects of gun violence. The Second Amendment is not only a right. It's also a responsibility."

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In the five years Wollschlaeger and his co-plaintiffs have spent fighting in court, there's been mass shooting after mass shooting, and sadly, the physician says the Pulse shooting in Orlando has already turned into just another statistic. After the world collectively turned away from the City Beautiful to the next tragedy, someone has killed someone else with a gun every few days in Orange County. From June 10 to Aug. 25, 20 other people in Orange County lost their lives to gun violence. Unlike the Pulse victims, national TV crews weren't clamoring outside their relatives' homes to learn more about them. But they too left questions unanswered, beds empty and dreams deferred.

"We have to stop being a reactive society that wrings our hands and cries in front of the camera," he says. "We're so numb, so conditioned to the onslaught of this news, we don't pay attention anymore. "If the murder and slaughter of children doesn't change our minds, why should Orlando be different?"

At the national level, the ban on funding research into gun violence persists in the face of so much tragedy because conservative lawmakers are convinced that research will inexorably lead to regulation.

At least one local doctor is trying to change that response. On June 12, Dr. Michael Cheatham and the Orlando Regional Medical Center staff were on the front lines of the Pulse crisis, doing surgery after surgery on victims.

After the city calmed down, Cheatham pushed for more federal money to research gun violence and traveled with other trauma surgeons to speak with members of Congress about what could be done to reduce gun violence, according to the Orlando Sentinel.

"There were the cries of anguish, screams, doors slamming, family members punching the wall when they realized their loved one's name had not been read off of the list of survivors," Cheatham told the Sentinel. "I will never forget that. I don't want to ever see so many families so devastated again."

There hasn't been research from the federal government on gun violence since a 1993 study by the New England Journal of Medicine. Funded by the Centers for Disease Control and Prevention, the study found that "keeping a gun in the home was strongly and independently associated with an increased risk of homicide," according to the American Psychological Association. Incensed, the NRA persuaded members of Congress in 1996 to strip the CDC's funding for gun violence research – $2.6 million. Later, Congress forbade the CDC from using any funds "to advocate or promote gun control." While the laws didn't technically ban gun research, CDC directors have avoided studying guns. Even after President Obama ordered the CDC to "conduct or sponsor research into the causes of gun violence and the ways to prevent it" following the Sandy Hook carnage, the federal agency hasn't budged, citing a continued lack of funding from Congress.

The data we do have on gun deaths is pretty startling. In 2013, firearms accounted for 33,636 deaths in the United States. More than 11,000 of those were classified as homicides. Compounding that, 21,175 people committed suicide using a gun.

Florida, meanwhile, has about 1.38 million concealed carry permits, more than any other state. Firearms were responsible for about 18 percent (2,375) of Florida's fatal injuries in 2014, according to data from the state Department of Health. Out of those fatalities, 63 percent were suicides.

As some physicians have pointed out, research on guns may not lead to a ban on firearms or support solutions that gun control advocates have called for. But it would let Americans make their own informed opinions about what causes gun violence.

For her part, Hammer rejects a connection between guns and public health, calling it an "anti-gun" agenda, and wouldn't discuss a possible compromise between the two camps. When asked if she believed the NRA would ever be open to the idea of re-examining existing legislation on firearms, Hammer was clear about her opinion.

"That is the dumbest question I have been asked in 40 years," she told us.

At a rally Aug. 17 at the Hammered Lamb for the Pride Fund, a political action committee focused on electing pro-LGBTQ candidates who support sensible gun control, commissioner Patty Sheehan says she's still in crisis mode, as if the mass shooting that robbed 49 people of the rest of their lives had happened just yesterday. Whether you agree with her or not about guns, she wants to talk.

"This is the worst mass shooting in America, and you don't want to talk about guns?" Sheehan says, clapping vehemently between words. "That's insane."

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