Medical Billing Forum

General Category => General Questions => Topic started by: PMRNC on January 22, 2013, 12:53:20 PM

Title: Asking about guns on Patient Information Sheet
Post by: PMRNC on January 22, 2013, 12:53:20 PM
Without getting into a political discussion and/or rant..  I've had two clients so far ask me about them HAVING to include the question on their patient information sheets about gun ownership/possession.  One of those clients is insisting it passed as a law that doctors HAVE to ask? Both are in NY.   Anyone have a confirmed source of reference for this? If so what happens if a physician refuses (this ONE of the two is insisting he will NOT put it on even if they come take him away) :)
Title: Re: Asking about guns on Patient Information Sheet
Post by: RichardP on January 22, 2013, 03:36:59 PM
From the perspective of a caring physician who may think someone is depressed or prone to violence, asking about gun ownership can be a useful tool to become alert to someone who may become a threat to self or others.  There is a legitimate medicinal use for that type of doctor / patient interaction.

However, there are no Federal requirements to query patients about gun ownership.  If there are state requirements, they are overridden by the ACA.  The NRA got language into the ACA to discourage such queries.

If a suicidal or homicidal person has access to guns, they are more likely to use that implement to initiate their violent act. This is why we are trained to ask that question.

One of the best methods to defuse potential violence is heartfelt conversation. By openly questioning each other in a non-judgmental manner, we can often discover a person’s pain, motives, and ability to act. Unfortunately, the gun rights lobby, mostly funded by the National Rifle Association, has time and time again inserted their hand in attempting to shut down that conversation.

In the Affordable Care Act, the gun lobby’s section is in Title X, starting on page 2,037, line 23.  “Protection of Second Amendment Gun Rights” contains five provisions mostly dedicated to shutting down conversation about guns in medicine.  What do these sections contain?


Continue at the first link.  And for those who have nurses asking about gun ownership and writing it in the notes, note this provision at the first link:  The next provision states we can’t collect data related to owning or using firearms.

http://www.forbes.com/sites/carolynmcclanahan/2012/07/23/gun-owner-rights-and-obamacare-yes-it-is-in-the-law/

http://www.forbes.com/sites/paulhsieh/2013/01/22/why-doctors-should-not-ask-their-patients-about-guns/

http://www.snopes.com/politics/guns/medicare.asp

Some thought these provisions could tie the hands of doctors who want to report someone that might be prone to violence, so we have this follow-up from the following link:

http://www.foxnews.com/politics/2013/01/17/does-white-house-plan-enlist-doctors-in-gun-control-fight/

One of the 23 executive actions Obama approved Wednesday was to "clarify" that the federal health care overhaul "does not prohibit doctors asking their patients about gun in their homes."   ...  An overview of the plan said "we should never ask doctors and other health care providers to turn a blind eye to the risks posed by guns in the wrong hands."  ... Coupled with the language on asking patients about guns was a decision to "clarify" that no federal law prevents doctors from warning law enforcement about "direct and credible threats of violence."
Title: Re: Asking about guns on Patient Information Sheet
Post by: PMRNC on January 22, 2013, 05:06:10 PM
Wow that's a lot of information, I already knew about the ACA on this issue, this one client was pretty adamant it was a NY law but I think he was referencing an email he got which is probably another one of "those" emails.   I think he was also reacting to NY's new gun control regs and the propaganda and mis information floating around cyberspace.   Doesn't help he needs to stay off facebook!! He gets mad when his patient's "google" their condition too  :o :o :o ::) ::) :-\

Thanks again!!

Title: Re: Asking about guns on Patient Information Sheet
Post by: RichardP on January 22, 2013, 06:16:33 PM
Your welcome.  With the attention this issue seems to be getting, I thought it would be a good idea to be comprehensive with the response.

Re. your client and N.Y. law.  In one of the links I gave, there is reference to N.Y recently passing a law about doctors and getting gun info - so I think your client is referring to something legitimate, and not something like the e-mail presented at the Snopes link.  It's probable that the anti-gun-check provisions of the ACA will override whatever N.Y. state law your client is referring to.  Although, as has recently been clarified, ... no federal law prevents doctors from warning law enforcement about "direct and credible threats of violence.

[Edit]  From here:  http://www.nytimes.com/2013/01/16/opinion/new-york-leads-on-gun-control.html?_r=0#p

The broad gun control bill approved Tuesday (1-15-13?) by the New York Legislature substantially strengthens the state’s gun control laws ... Some sections of the law, however, were not fully vetted in the rush. One provision asks health care professionals — physicians, psychologists, registered nurses or licensed clinical social workers — to report to local health care officials when they have reason to believe that patients could harm themselves or others. Such a report, after wending its way through other bureaucratic layers, and after crosschecking against a database of gun owners, could eventually authorize police to confiscate firearms owned by a dangerous patient.

See here also:  http://www.huffingtonpost.com/2013/01/15/mental-health-experts-new-york-gun-law_n_2480508.html

Lots of stuff if you Google on "new york" + doctor + gun  [/Edit]
Title: Re: Asking about guns on Patient Information Sheet
Post by: PMRNC on January 23, 2013, 12:09:20 PM
Again.. wow and thank you. 

Quote
It's probable that the anti-gun-check provisions of the ACA will override whatever N.Y. state law your client is referring to.  Although, as has recently been clarified, ... no federal law prevents doctors from warning law enforcement about "direct and credible threats of violence.

I was on phone with my attorney when reading this to him. He said that IF a state law is stricter than a federal law it will supersede believe it or not. He's going to dig a bit deeper and call this client for me as they are friends anyway. 

I have such a headache over this ACA.. how they can even use the word "affordable" in there is beyond me.  Affordable to WHO?
Title: Re: Asking about guns on Patient Information Sheet
Post by: RichardP on January 23, 2013, 12:42:37 PM
You are welcome.

He said that IF a state law is stricter than a federal law ...

In a contest between state and Federal law, the stricter law is the one that is allowed to carry the day - on any issue where there are both state and Federal regulations concerning the issue.  I made this same point recently here: http://www.medicalbillinglive.com/members/index.php?topic=7070.msg21194#msg21194

However, this gun reporting issue will be interesting - with respect to which issue gets the stricter test applied to it - the strongly encourage you to report or the strongly discourage you from reporting.  Since the ACA prohibits the collection of data related to owning or using firearms, it may fall out that doctors can be strongly encourage to report things that get their attention, but are prohibited from storing any information related to that concern.  We'll see.
Title: Re: Asking about guns on Patient Information Sheet
Post by: DMK on January 23, 2013, 12:45:12 PM
I have to say from the provider's side.  There has always been the DUTY to inform law enforcement when there is violence or the viable threat of violence (child abuse, spousal abuse, elder abuse, etc.).  We live in a VERY gun totin' community and "Do you have guns in the house?" is a question that will not be asked unless the doctor has reason to worry or assume there's a problem.
Title: Re: Asking about guns on Patient Information Sheet
Post by: RichardP on January 23, 2013, 12:55:50 PM
Understood.  But the New York fellow, and quite a few folks on the internet, are/were concerned that the new New York law just implemented might require (rather than simply allow) medical personnel to ask every patient about gun ownership.  The question being discussed here is can a state law require that?  The answer is not quite clear yet, in light of the NRA provisions that were inserted into the Federal ACA.  The answer will no doubt be determined in the courts.
Title: Re: Asking about guns on Patient Information Sheet
Post by: DMK on January 23, 2013, 03:55:24 PM
It will be even more interesting if the patient has to answer!
Title: Re: Asking about guns on Patient Information Sheet
Post by: PMRNC on January 23, 2013, 04:14:34 PM
Quote
It will be even more interesting if the patient has to answer!

That's why I'm not going to dig further, this is an issue for the client and his attorney to fight over.  That wouldn't effect my job unless suddenly we had to report it on our CMS 1500 forms. LOL   (I know I shouldn't laugh, soon we will get a bill weekly for oxygen)   Anyhooooo  They can lead the horse to water but they won't be able to make them drink. Patient's will either NOT answer or lie so really what's difference?    doctors have mandatory reporting as it is and should continue on with those regs.   I have to put this headache away. I'm passing the buck to the lawyer .. <sigh>
Title: Re: Asking about guns on Patient Information Sheet
Post by: RichardP on January 23, 2013, 06:14:43 PM
DMK said It will be even more interesting if the patient has to answer!

I think we are not even close to doctors being required to ask their patients about guns at the moment.  In the New York law, there is no requirement for the doctors to ask the patients if they have guns.  And there is no such requirement in the ACA.  The following statements quoted below are what is actually happening - compared to what the internet is speculating about.  The new New York law only asks physicians to do what they mostly already do - report someone they think might be a danger to themselves or others.  And I see no evidence that this request to report, in the New York law, is confined to reporting only on those who have admitted to having guns at home.  It applies to everyone, gun owner or not.

From the links I provided above:

One provision [of the New York law] asks health care professionals — physicians, psychologists, registered nurses or licensed clinical social workers — to report to local health care officials when they have reason to believe that patients could harm themselves or others.

The next provision [of the ACA] states we can’t collect data related to owning or using firearms.

Must have been a slow news week for the internet to get worked up over this.