Should doctors be able to ask their patients about guns in the home?


Courts and legislators consider the right of physicians and insurers to ask about firearms in the home. (iStockphoto)
November 26, 2012

Should doctors be able to ask their patients or patients’ parents whether they own a gun? What about health insurers, employers or health-care officials implementing the Affordable Care Act?

The issue is playing out in Florida, where a federal judge in July issued a permanent injunction against enforcement of a law that would have prohibited doctors from asking patients about gun ownership in many instances, saying the prohibition impinged on doctors’ First Amendment right to speak with their patients about gun safety.

The law would have allowed physicians to ask about guns if it seemed relevant to a patient’s medical care or safety — for example, if a patient was severely depressed or experiencing violence in the home. Florida is appealing the judge’s ruling.

Six other states — Alabama, Minnesota, North Carolina, Oklahoma, Tennessee and West Virginia — have considered similar legislation in recent years, according to the Law Center to Prevent Gun Violence, though none of them has approved such a law.

The Affordable Care Act doesn’t prevent doctors from asking patients about guns, but it does prohibit insurers, employers and Department of Health and Human Services officials from asking about gun ownership in many instances, and it prohibits HHS from collecting such data.

Employer-sponsored wellness programs, for example, are prohibited from asking people about gun use or storage. Such questions might be posed as part of a questionnaire that asks about risky health behavior such as smoking and inadequate exercise. Likewise, health insurers can’t use gun ownership, use or storage as criteria for setting premiums or denying coverage.

Even without the new restrictions, such questions are rarely asked or acted on, say experts. “We don’t have any data or industry information on [this subject], but it isn’t something that we’ve heard about or seen companies do,” says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry trade group.

Physicians say that asking whether there are guns in the home and how they’re stored should be part of routine discussions doctors have about hazards in the home, just as they ask about poisonous cleaning materials or fencing around outdoor pools. In most instances, those conversations take place between pediatricians and parents of young children

In 2009, one in five deaths caused by injuries to people younger than 20 were related to firearms, according to the American Academy of Pediatrics’ revised policy statement on gun-related injuries released in October.

“It’s inconceivable to me that I wouldn’t be able to have a conversation about something that might harm the child,” says Robert Sege, director of the division of family and child advocacy at Boston Medical Center. Sometimes parents have declined to answer when he asks if they have guns at home, he says, and in those cases he doesn’t push for answers but does provide gun-safety pointers.

But gun-rights advocates say information about gun ownership is no one’s business but their own. They say it’s up to the individual to abide by laws related to gun ownership and safe storage.

“We take our children to the doctor because they’re sick or need health care,” says Marion Hammer, a former National Rifle Association president who is the executive director of United Sportsmen of Florida, the NRA’s legislative affiliate for the state. “We don’t take them there for political dialogue or for pediatricians to ask us not to exercise a constitutional right.”

This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: questions@kaiserhealthnews.org.

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