What does the body of a 6-year-old girl look like after a Bushmaster AR-15 assault rifle’s high-velocity bullets rip through her? The average 6-year-old girl weighs about 44 pounds and stands around 3 feet 9 inches tall. The size of her organs and the diameters of her arteries and veins, bowel, and bones are much smaller than an adult’s. But a 6-year-old girl is not a miniature adult; her organs are more vulnerable and less protected by bones. So when a high-velocity projectile like a .223-caliber bullet, traveling at approximately 2,000 miles per hour, from an assault weapon like a Bushmaster AR-15, enters her body, all hell breaks loose. If that bullet pierces her chest wall into her heart, it will cause her heart to explode, and if it passes within 3 inches of her aorta, the shockwaves will tear it open. If it slices into her arm, it will shatter her humerus into so many fragments that it will no longer be recognizable as a bone. If it spirals into her brain, the cavity and damage the bullet causes will be so extensive that her head will break apart.
Guns kill kids. In 2010, according to the Centers for Disease Control and Prevention, 2,694 children and teens in the United States died because of a firearm. Another 15,578 children and teens were injured. Every 30 minutes, a child is killed or injured by a gun. The American Academy of Pediatrics (AAP), the largest organization of pediatricians, recommends that conversations about guns and gun safety start during a prenatal visit and be repeated every year as part of anticipatory guidance. Those conversations start with a question: “Do you own a gun?”
One Tuesday in the summer of 2010, at Children’s Health of Ocala, Fla., a pediatrician named Chris Okonkwo asked the mother of a 7-year-old patient, “Do you have guns in the home?”
Her response was unexpected: “None of your business!”
Okonkwo tried to explain why he was asking the question. He told the mother he routinely asked questions about safety regarding firearms, swimming pools, and bike helmets, to name just a few. He told her that if there was a gun in her home, it should be locked and any ammunition also locked and kept separately.
Instead she continued to yell at him, “Didn’t you hear what I said? None of your damn business!”
Okonkwo finished the rest of the physical exam, administered immunizations, and then informed the mother she had 30 days to find another doctor. He felt they were unable to establish a “relationship of trust,” given her refusal to answer questions about basic safety.
What happened in that pediatric office led an NRA lobbyist to sponsor legislation in the Florida State House. “Privacy of Firearm Owners” was signed by Gov. Rick Scott and passed into law on June 2, 2011. This law prohibits doctors from “making written inquiry or asking questions concerning the ownership of a firearm or ammunition by the patient or by a family member of the patient.” It also prohibits doctors from “unnecessarily harassing a patient about firearm ownership during an examination.” But this law does not define what “unnecessarily harassing” means. The question Okonkwo asked could be construed as “unnecessarily harassing” if that mother filed a complaint with the Florida Board of Medicine. And Okonkwo could be censured and his license to practice medicine revoked, as well as fined up to $10,000. But this was a watered-down version of the law. The original bill called for more Draconian measures: a third-degree felony punishable by a fine of up to $5 million and a maximum of five years in prison. All for simply asking the question, “Do you have guns in the home?”
Days after the law passed, three physicians, Bernd Wollschlaeger, Judy Schaechter, and Tommy Schechtman, along with the Florida chapter of the AAP and other medical societies, filed a suit to block enforcement of the law. They sued Rick Scott, in his official capacity as governor of Florida, on grounds that the law violated the First Amendment right to freedom of speech for physicians and also violated the First Amendment right of patients to hear that speech.
Wollschlaeger is a family practitioner who makes house calls. Before he became a naturalized citizen of the United States, he served in the Israeli army and is intimately familiar with firearms. He owns guns and is a concealed-weapons permit holder. He used his personal knowledge of guns to relate to his patients who are gun owners to counsel them on gun safety. But the Florida Physician Gag Law, as the plaintiffs refer to it in their suit, changed his practice. He stopped talking about guns. Wollschlaeger used to be a member of the NRA. Now he feels the NRA has “metastasized into a lobby for the gun industry.” And the law, which was “all NRA proposed, all NRA sponsored, all NRA supported,” was a form of intimidation. Wollschlaeger doesn’t like to be intimidated. He volunteered to be a named plaintiff in the suit because “our voices and our words matter. We have to stand up for what is right.”
Schaechter is an expert on childhood injury and violence. She has practiced Adolescent Medicine for 16 years and is much too familiar with gun violence and teens. Most teens use guns in homicide and suicide, the second and third leading causes of death in older teenagers. Schaechter felt that the lawsuit was a way “to serve the nation” because it was an “opportunity to stand up for constitutional freedom.”
Schechtman echoes his fellow plaintiffs in his desire to do “the right thing” in bringing this suit. He is a pediatrician who has been involved in child advocacy throughout his career. He recalled an incident in his exam room when the mother of a patient denied the presence of guns in her home. “Yes, there is,” her teenage son interrupted. Unbeknownst to her, the father was keeping a loaded gun in the house. Schechtman counseled the mother on the safe storage of guns. He may have averted an episode of needless gun violence in his patient’s home. After the law passed, he did not stop asking the question, “Do you have guns in the home?” To him, “missing a child at risk for gun violence” outweighs “the risk of being censured.”
On Sept. 14, 2011, Justice Marcia Cooke granted a preliminary injunction in favor of the physicians and blocked the state of Florida from enforcing the gag law, and on June 29, 2012, she issued a permanent injunction. In her orders, she wrote, “The State has attempted to inveigle this Court to cast this matter as a Second Amendment case. Despite the State’s insistence that the right to ‘keep arms’ is the primary constitutional right at issue in this litigation, a plain reading of the statute reveals that this law in no way affects such rights. … What is curious about this law—and what makes it different from so many other laws involving practitioners’ speech—is that it aims to restrict a practitioner’s ability to provide truthful, non-misleading information to a patient. …” The state is appealing the decision to the U.S. Court of Appeals for the 11th Circuit, where oral arguments await. Gov. Rick Scott in a press release said, “I signed this legislation into law because I believe it is constitutional, and I will continue to defend it.”
The NRA has proposed physician gag laws like the one that passed in Florida in several other states. In 2011, it sponsored legislation in Alabama, North Carolina, West Virginia, Minnesota, and Oklahoma. In 2012, the NRA was responsible for bringing to the Oklahoma senate floor a bill that required doctors to first obtain “informed consent” to ask about guns in the home before they could even ask questions about guns in the home. In Tennessee a house bill prohibited doctors from making a written or verbal inquiry about gun ownership. And in West Virginia, a house bill sought to amend the West Virginia Medical Practice Act so that doctors asking about guns would be the equivalent of “professional incompetence” and “gross negligence” and punishable by a fine of up to $10,000 and the revocation of the doctor’s license to practice.
Gun violence is a public health issue. And the NRA has been disturbingly influential in public health policy. Since the 1990s, it has suppressed research in gun violence by targeting the sources of funding. In 1996, pro-gun members of Congress tried to eliminate the CDC’s National Center for Injury Prevention and Control. They failed in getting rid of the center, but the House of Representatives cut $2.6 million from the CDC’s budget—the exact amount the agency had spent on firearm injury research the previous year. And they added restrictive language on any appropriation to the CDC: “none of the funds available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” In 2011, Congress extended the restriction to include all Department of Health and Human Services agencies, including the National Institutes of Health, the nation’s leading medical research agency.
Astoundingly, the NRA was also responsible for a provision in the Affordable Care Act. Into this landmark health care law, NRA-backed legislators quietly inserted “Protection of Second Amendment Gun Rights.” This section bans doctors, health care programs, and insurers from “collection of any information relating to the presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property of an individual.” This provision stifles research in gun violence, and it is so vaguely worded it could be interpreted to prohibit doctors from asking patients about guns. This provision was so alarming to the AAP and other child-advocacy groups that they wrote a letter to the Department of Health and Human Services “vehemently” rejecting this provision in the ACA and urging the department to “craft policy” to “limit the harmful impact of this section of the Act.”
Since the Newtown, Conn., massacre, it appears as though the NRA is weaker than it has been in decades, and gun control is finally being debated seriously. President Obama has issued 23 executive actions on gun control. But the NRA, through its friends in Congress, has many ways to block meaningful action.
Among Obama’s executive actions, No. 16 states, “Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes.” This clarification confirms that doctors should continue to practice preventive medicine. But it does not specifically lift the moratorium on data collection of gun ownership in the ACA, which directly affects research on gun violence.
Another executive action, No. 14 directs the CDC to “research the causes and prevention of gun violence,” which is intended to overturn the restrictive language on research-funding agencies. However, Congress needs to provide funding for gun violence research or it will not be supported. If the NRA continues to be influential with members of Congress, it will continue to affect public health policy.
Despite a permanent injunction blocking enforcement of the physician gag law, doctors in Florida remain wary. Okonkwo, the pediatrician involved in the circumstance leading to the gag law, says the permanent injunction may not be enough. He knows there is an appeal in progress. He counsels patients and their families about the safe storage of guns. But he does not ask the question: “Do you have guns in the home?”