Arming doctors with a tool to save lives

Extreme Risk Protection Orders have shown to be effective in reducing gun-related homicides and suicides

It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation” – Rudolf Virchow, MD

OVER THE COURSE of 1,000 days spanning 2014 to 2016, our state was home to 618 shootings. During that period, 19 children were shot. Worse, not a single perpetrator was arrested in any of these incidents. Our police are outnumbered and, at times, outgunned, by the violence that plagues Massachusetts. Despite having the lowest gun death rate in the nation, we still hear the same kind of tragic stories all too often:

A 14 year old shot three times watching fireworks in Boston.

                A 23 year old shot and killed arguing over a pet’s behavior in Springfield.

Alexander Pomerantz

Yet the most sobering statistic is perhaps the one that is least mentioned: 140 people committed suicide with a firearm in Massachusetts in 2016. With the highest rate of firearm suicides on Cape Cod, it is readily apparent that this issue is not just an urban one; it’s a statewide threat.

In the past, when our nation and our Commonwealth have tackled societal problems by viewing them through a public health lens, we have been tremendously successful. Take the case of drunken driving. In the 1970s, more than 60 percent of traffic fatalities involved alcohol. After years of research, we responded with evidence-based policies – increasing the legal drinking age and treating alcohol addiction over the span of an entire lifetime – and we soon began to see the benefits of treating a major cause of death as a public health concern. Since the early 1980s, the rate of traffic deaths involving alcohol has been cut in half. The concerted effort to tackle drunken driving is one of many classic success stories of evidence-based policies reducing deaths. So why not do the same with firearm reform?

Suhas Gondi

Massachusetts has time and again led the nation in political action on pressing issues, most recently serving as the model for national healthcare reform. We now face the opportunity to continue that trend by treating gun violence like the public health crisis it is.

Although the critical research needed to inform evidence-based legislation in gun violence is limited, one type of policy does offer us a chance to move the needle.

Extreme Risk Protection Orders (ERPOs) are a means for physicians or family members to petition civil courts to temporarily withdraw a person’s access to guns if he or she poses an imminent danger to oneself or others. Currently, in Massachusetts, a physician can accomplish this only by seeking intervention from local police. In doing so, a physician may violate laws governing patient confidentiality and may face legal ramifications, discouraging them from looking out for their patients and the public.

Further, even if the physician decides to take the risk, they are left hoping that the police chief agrees with their assessment and decides to take action. The police chief’s action often culminates in a home visit because the tools available to the police department are similarly limited.

As we’ve seen in other states, this ad hoc method has failed: in both the 2011 shooting of US Rep. Gabrielle Giffords and the 2014 Isla Vista, California, shooting, each aggressor’s family was unsuccessful in their attempts to work with the medical community and law enforcement to remove weapons from their sons’ possessions. While the Isla Vista and Giffords incidents resulted in national press, countless other attempts to stop suicide have failed because physicians, family members, police chiefs, and the courts could not collaborate effectively.

We have become habituated to these failures, which represent a significant public safety risk. Luckily, this risk is amenable to policy change. Risk protection orders have proven effective in one of our neighboring states. Connecticut implemented the orders in 1999, and peer-reviewed research has shown that for every 10 to 20 firearm interventions, in which a physician (and possibly a family member) was able to effectively collaborate with civil court and police without risking their licensure, one life has been saved. Learning from Connecticut’s success, two states (Vermont and Maryland) passed similar laws in the last week, so the timing to make change is appropriate.

By empowering the physicians we entrust with our health to be vigilant and take action without hesitation when firearms pose imminent risks, we can save lives here in our state, too. In the Massachusetts Legislature, two bills are in the Joint Committee on the Judiciary concerning Extreme Risk Protection Orders (H. 3081 and 3610), with H.3610 suspected of moving out of committee in the next week. We cannot continue to tolerate the horrific impact of gun violence on our communities.

As medical students, we hope to practice medicine to make our patients and community members safer without the fear of violating patient confidentiality. Let’s arm our physicians with the real prescriptions they need to tackle this public health crisis.

Meet the Author
Meet the Author
Alexander Pomerantz and Suhas Gondi are medical students at Harvard Medical School. They previously worked in the Massachusetts State House and in the US Senate.