Primary care organizations are booing a July 25 ruling by the 11th Circuit Court of Appeals to uphold a Florida law that prevents physicians from asking patients about firearms in the home.
The 2-1 ruling reverses a June 2012 decision by U.S. District Court Judge Marcia Cooke of the Southern District of Florida-Miami, who ruled in favor of the Florida chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians and individual plaintiff physicians who sought an injunction to prevent the enforcement of the 2011 Florida law.
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Under the law, physicians and other providers cannot record information on firearms in patients' medical records.
The plaintiffs will seek a rehearing by the full 11th Circuit Court of Appeals. The injunction against the law’s enforcement remains in place until the court renders a decision on rehearing the case.
"This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients," Dr. Mobeen H. Rathore, president of the Florida chapter of the American Academy of Pediatrics, said in a statement.
Florida Gov. Rick Scott (R) signed the law that forbids licensed health care providers from asking about gun ownership unless he or she believes "in good faith" that the information is relevant to patients’ and family members’ medical care or safety. Under the law, physicians and other providers cannot record information on firearms in patients’ medical records.
In the ruling, Circuit Court Judge Gerald B. Tjoflat wrote that the original law "seeks to protect patient’s privacy by restricting irrelevant inquiry and record-keeping by physicians regarding firearms. The act recognizes that when a patient enters a physician’s examination room, the patient is in a position of relative powerlessness. The patient must place his or her trust in the physician’s guidance, and submit to the physician’s authority. In order to protect patients, physicians have for millennia been subject to codes of conduct that define the practice of good medicine and affirm the responsibility physicians bear. In keeping with these traditional codes of conduct – which almost universally mandate respect for patient privacy – the Act simply acknowledges that the practice of good medicine does not require interrogation about irrelevant, private matters. As such, we find that the Act is a legitimate regulation of professional conduct."
The AAP called the decision a violation of pediatricians’ First Amendment rights and said that it "threatens their ability to counsel parents about how best to protect children from unintentional injury and death."
"This law has a chilling effect on life-saving conversations that take place in the physician’s office," Dr. James Perrin, AAP president, said in a statement. "More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with ammunition locked away separately. In this case, a simple conversation can prevent a tragedy."
In a statement, ACP President Dr. David Fleming called the ruling "destructive to the patient-physician relationship. Many doctors ask about gun ownership as a normal part of screening patients, including it on a long list of health questions about drug and alcohol use, smoking, exercise, and eating habits."
Dr. Fleming also noted a broader problem with the ruling, calling it "much bigger than guns. We believe it addresses whether the government or any other body should be allowed to tell physicians what they can and can’t discuss with their patients, consistent with evidence-based standards of care."
AAFP President Dr. Reid Blackwelder echoed those comments: "Make no mistake – this issue is much bigger than guns or gun ownership. This is about governmental intrusion on the patient/physician relationship. Laws that infringe on this relationship put the patient and their family’s health at risk. Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors that may negatively impact their health."