Doctors and Guns Redux

[Frank Ettin]

Originally Posted by JimPage

I don't have proof to provide but I have been told by the VA doctor that all narcotic prescriptions at least are on a single database so that they will be able to trace those who try to get multiple prescriptions from several doctors. That sounds reasonable to me....

There probably is a central database for that VA facility, or even one that covers multiple VA facilities. A multi-location group medical practice will customarily now have a medical record database covering all physicians who practice in that group because patients might be seen by multiple doctors in that group. Indeed in today's world of medical care there are integrated provider groups systems (generally one or more hospital with associated ancillary medical facilities together with groups of physicians who practice at those facilities) which maintain medical record databases shared by the hospitals and physicians which practice as part of that group system. However, those various databases are unique to each system that maintains them, and other groups of providers do not have access.

All that does not mean that there is a single database of all prescriptions written for everyone in a particular State. Nor does it mean that a state police agency has access to such non-existent single database, or the multiple databases that do exist, for the purposes of some sort of data mining.

Originally Posted by JimPage

....The news cited some (at least three as I recall) instances of NYSP confiscating pistols of those with prescriptions to drugs used for mental patients.....

That might be, but it begs the question of how the NYSP acquired the information.

In any case, in post 31 you wrote:

Originally Posted by JimPage

Here in New York state the State Police review a central data base of prescriptions searching for drugs prescribed for mental illness. New York "Safe Act" is their cover.....

It appears now that statement is not accurate, or at least you can not find good evidence to support it.

If it is not in fact true that NYSP search a [non-existent] database for prescription drug information, how does claiming that to be true further a serious discussion?

[jmhyer]

In my state, such a database exists...for narcotics drugs, at least. Pharmacies report narcotic prescription to the database. But, how the database works (or is intended to work) is not exactly what is described by Jim. If I suspect a patient in my care to be abusing the system in an attempt to get excessive narcotics, I can search the database using the patient's name and birth date to see prescriptions, amounts, prescribing provider, places they were filled, etc.

Now, whether it can be searched by government entities is a question to which I don't have the answer. And I also don't know that it can be searched "in reverse" (i.e.- input a certain drug name and see a list of people who have or have had prescriptions filled for it). My suspicion is that it COULD be searched that way by a determined hacker and/or an overreaching governmental authority.

[Frank Ettin]

Originally Posted by jmhyer

In my state, such a database exists...for narcotics drugs, at least. Pharmacies report narcotic prescription to the database. But, how the database works (or is intended to work) is not exactly what is described by Jim. If I suspect a patient in my care to be abusing the system in an attempt to get excessive narcotics, I can search the database using the patient's name and birth date to see prescriptions, amounts, prescribing provider, places they were filled, etc....

I gather then that you're a physician or some other provider of medical care. So perhaps such databases exist in some States. As a provider you would be in a position to have personal knowledge.

And if they work as you've described, they could be operating in conformity with HIPAA. But HIPAA does regulate the permissible uses and disclosures of protected health information without the consent of, or opportunity to object by, the patient (45 CFR 164.512). While 45 CFR 164.512 does authorize very limited disclosure of protected health information to law enforcement, such disclosure is subject to strict requirements as the information which may be disclosed and the circumstances and purposes for which it may be disclosed. HIPAA would not permit a law enforcement agency to access such a database for a fishing expedition.

[Chris_B]

It may not be the point but I think it is relevant. Personally I don't think the government should be strip mining your medical records for information. If it gets to the point where the government is prosecuting you for information they shouldn't have had access to in the first place (IMHO), then there are bigger issues at stake than what you said to your doctor...

Surely it is relevant. I don't feel that the gov should be doing that either. But we do agree that that was not my point.

[JimPage]

Well, I am happy to find that I wasn't 100% wrong. I appreciate the clarification such as it is. It would be nice to actually find out where those news reports came from. But I have observed the press to be wrong often, particularly when politics is involved.

[44 AMP]

While it is incumbent on the person making the claim to provide proof, I would like to point out that in cases involving govt agencies "doing things they shouldn't" that there is often NO PROOF until there has been an actual CONVICTION in court.

The best that may be able to be provided is other people, making the same, or similar accusation.

Which, while possibly quite true, is NOT proof, either.

Nor does it mean that the alleged abuse is NOT going on. Only that there is no documentable proof, at this time.

[Frank Ettin]

Originally Posted by 44 AMP

....Nor does it mean that the alleged abuse is NOT going on. Only that there is no documentable proof, at this time.....

There must always be some decent evidence or documentation. "It's the government and we don't like them" is never enough.

And sources matter. A bunch of guys in the bar, or Alex Jones, or similar sources aren't reliable. The Wall Street Journal is another matter.

People (both gun people and anti-gun people) believe a lot of things that aren't true in part because they don't understand the difference between evidence and guesses and in part because of confirmation bias.

[Aguila Blanca]

Frank, the whole question of evidence when dealing with a government agency as huge as the Social Insecurity Administration or the Veterans Administration is very dicey. I know with absolute certainty, as a result of frequenting the local VA hospital for most of my primary health care, that part of the intake before each appointment (along with taking my temperature and blood pressure) is to ask if I'm feeling depressed today, "even a little bit." And yet other members here, who go to other VA facilities, report that they have not been asked that question.

I can't prove or document that what I'm reporting is true, but it has happened enough times that I am acutely aware of it, and I assure you that I'm not making it up. On the other hand, the question is posed in such a routine way that people who perhaps weren't already aware of this issue may, in actuality, have been asked the question, answered it, and not had it register strongly enough to remember it.

Or it's possible that different VA regions follow different guidelines, or even that some facilities DON'T follow guidelines. (Where's my shocked face? Oh, yes ... )

[Shenna9220]

Aguilar you have it spot on and it goes beyond the VA. If your primary health insurer is Medicare or Medicaid, they are required to asked about your mental health. I know this because during my last checkup the nurse started asking the questions on and I inquired why and was told the gov. Requires they ask. My understanding for the Fl law that was struck down was that the gov. Wanted to/did add the gun safety. Fl. Was just trying to get in front of it. All of this is just more stuff the new administration will have to fix, it's just going to take more than a month to get it done

[Frank Ettin]

Originally Posted by Aguila Blanca

Frank, the whole question of evidence when dealing with a government agency as huge as the Social Insecurity Administration or the Veterans Administration is very dicey.....

Often it's difficult to determine with evidence exactly what is going on and why. But the fact that it's difficult to find evidence to prove a supposition doesn't turn a suspicion into a fact or a guess into reality.

Originally Posted by Aguila Blanca

...I know with absolute certainty, as a result of frequenting the local VA hospital for most of my primary health care, that part of the intake before each appointment (along with taking my temperature and blood pressure) is to ask if I'm feeling depressed today, "even a little bit."....

Which means what? Is asking that kind of screening question a bad idea? Is it inconsistent with the standard of care expect of competent physicians? Is there a good "art of care" rationale for that sort of routine question?

It would be worthwhile to have some input from a physician on that issue.

[heyjoe]

Shenna9220 Aguilar you have it spot on and it goes beyond the VA. If your primary health insurer is Medicare or Medicaid, they are required to asked about your mental health. I know this because during my last checkup the nurse started asking the questions on and I inquired why and was told the gov.

again I would like to see documentation of this. Over the last 5 years, I have had 3 primary care physicians, multiple specialists, have medicare as my primary health insurer and have never been asked about my mental health. I find that businesses sometimes cite non existent laws or government requirements for what is in reality is just that business policy.

[Aguila Blanca]

Since the VA almost killed me three years ago by not letting me see a cardiologist for a VERY evident heart problem, I have kept an outside doctor on standby through Medicare. Yesterday I went to that office for my annual wellness check. Before we even started with medical stuff, there was a four-page survey that included mostly questions pertaining to mental health -- how do you feel about life, are you sad, do you enjoy living, yada yada.

To my very great surprise, it didn't ask if there are guns in the house.

[44 AMP]

To my very great surprise, it didn't ask if there are guns in the house.

They don't HAVE to! They can, and have come out with anti gun "recommendations" without asking a single question about guns. I was actually involved in one of those "surveys".

It was a "safety & risk assessment" study, done at a government facility I worked at. Standard type questions, about safety attitudes, wearing PPE, availability of PPE, and things like that, including driving habits (do you wear a seat belt, do you drive within 5mph of the speed limit, etc.)

There were NO questions about guns, hunting, or anything at all like that. The only question that even remotely touched on anything violent was "during the past year, was any member of your family involved in a physical fight?"

Now, when the "results" came back, and bear in mind that these results were intended to give us ways to improve safety, they had a list of things we could to do reduce our risks.

One of the listed things was
"avoid handguns"

I'm not kidding, that's a direct quote. I didn't flip out, but I did get ticked off! And I went to my manager about it. I didn't mention anything about gun rights, or anything like that, I pointed out how, since they didn't ask even a SINGLE question about firearms, putting in "avoid handguns" spoke directly to their credibility, and therefore, EVERYTHING they recommended was now suspect. My boss agreed. His boss agreed, and it went up the food chain.

The contractor who did the "study" lost their contract. I think only because I got things going, and because I didn't call their attitude about guns into question, what I questioned was their procedure, and how including guns in their results came from nowhere.

I mention this to make everyone aware that these agenda driven zealots can produce anti-gun "findings" without even bothering to ask any questions.

I have a strong suspicion that kind of attitude isn't just limited to anti gun bias, but that's where its easiest for me to recognize.

[Don P]

Well I'll ask this, what about the drugs that prescribed for more than one ailment? I had some trouble sleeping so the doc writes a script for me. I get home and check and it also is used for treating mental disorders anxiety I believe. I called the doc back told him I would not fill the script and to remove it from my records. He did as I asked and now if he talks about a new script I ask what else if any is it used to treat.

[heyjoe]

many medications are used for multiple conditions. They are even used for conditions off label. you can use rxlist to see what uses a particular medication has.

[ThesNazud]

Originally Posted by heyjoe

many medications are used for multiple conditions. They are even used for conditions off label. you can use rxlist to see what uses a particular medication has.

Exactly, I'm on a medication that is used mostly to treat parkinson's, but I was prescribed it for restless leg syndrome....

[Itsa Bughunt]

Two things:
Narcotic drug registries. In my wife's case, it was the insurance company who caught my wife doctor shopping and put a stop to it.

I found the question, "do you keep guns in your residence?" on a pre admission questionnaire for a new clinic I was using. I left the answer blank, and wasn't questioned about it.

[Chris_B]

Report:
After spending much of the last two weeks in hospital in MA, the subject came up exactly zero times. This means:

When EMTs collected me
When three major hospitals in three different cities including Boston treated me, one as a patient for five days
When three different rounds of prescriptions were written including one for oxycodone
During several followups over the phone
During surgery pre-screening
During out-patient physical therapy evaluation

I expect that the "question" would come right before 'do you feel safe in your home'. I believe that MA will at some time begin asking this "question", but right now, no.

[Aguila Blanca]

Originally Posted by Itsa Bughunt

I found the question, "do you keep guns in your residence?" on a pre admission questionnaire for a new clinic I was using. I left the answer blank, and wasn't questioned about it.

The problem with leaving it blank is that the information is probably transcribed by someone in the office into an electronic version of the form. You don't know if the person copying your data to the form will leave that entry blank, or perhaps interpret a blank as a "Yes."

It's even possible that the electronic form might be programmed to not allow a question to not be answered. (No, I don't know this to be the case with medical records, but I have encountered it numerous times with other types of forms.) In that case, the person entering your information has to put something. He or she probably wouldn't be at all comfortable putting "No," because what if a gun incident were to occur and the form came to light? So the "safe" answer would be "Yes."

Do I keep guns in my residence? No, my guns are all adults and they can go out any time they wish. I occasionally take them out with me when I go places.

[Itsa Bughunt]

@heyjoe
"many medications are used for multiple conditions. They are even used for conditions off label. you can use rxlist to see what uses a particular medication has."

I got a medication to treat insomnia. On the Walgreens fact sheet it stated this drug is used to treat major depression, and the off label use to treat sleeplessness.

ot: Remember back in the day they'd give you Codein and flexeril to treat a sprain or fracture? Now it's Vicodin or Percoset and Xanax. Lots of people dying from the misuse of those drugs.

[P5 Guy]

If this is a cause of worry "Just Say No"

[oldbadger]

This is so simple to understand. The AG in MA is anticipating being able to access medical records sometime in the future without going to too much trouble. She is trying to enlist doctors to influence people about gun ownership negatively and record the response, maybe in a simple way as having the doctor “check a box” in the record along with other demographic data such as date of birth. This fits nicely with the push for doctors to utilize a method of "electronic medical record keeping." I have mixed feelings about the questions about depression or being "blue".
Oh, and by the way, I liked the comment from Aguila about keeping guns in his house.

[Loosedhorse]

Keying off the OP, if I may:

this is a professional "boundary violation" on the part of doctors

No. While there are many sources discussing the term "boundary violation," I find this one, with its definitions, particularly helpful: http://www1.ucirvinehealth.org/magne...%20Conduct.pdf

So, if there is a boundary violation here, I would think it is by the AG: specifically, her trying to direct which discussions should occur between a patient and a doctor for the purposes of personal political gain. (Still, I doubt that this particular AG recognizes any "boundaries" at all for herself.)
----

presuming to lecture patients about something that's a constitutional right

It's also the doctor's constitutional right to discuss this topic (and others) with patients. At least for now, according to the 11th Circuit: http://media.ca11.uscourts.gov/opini...14009.enbc.pdf

The argument that the patients' 2nd Amendment rights must blot out the doctors' First Amendment rights seems for now unpersuasive.
-----

There is at this time NO scientific or logical basis for a conclusion that legal gun ownership by lawful private citizens represents ANY health risk whatever; that goes for the owners, their families, and the public at large. Therefore, any "medical advice" against owning guns is likely unjustified and incompetent.

One can certainly make logical arguments for advice that guns not be left accessible to suicidal persons or to unsupervised children. I note that the NRA recommends that we "Store guns so they are not accessible to unauthorized persons."

Many factors must be considered when deciding where and how to store guns. A person's particular situation will be a major part of the consideration. Dozens of gun storage devices, as well as locking devices that attach directly to the gun, are available. However, mechanical locking devices, like the mechanical safeties built into guns, can fail and should not be used as a substitute for safe gun handling and the observance of all gun-safety rules.

Source: https://gunsafetyrules.nra.org/

Still, no one should confuse either safe storage of guns or gun control with suicide prevention.

There are also good arguments against violent criminals possessing guns, and against them using guns to commit crimes--in fact, there may already be some laws about all that, if I recall correctly. Perhaps the AG should stick to her true area of competence: advise criminals to follow the law.

[squidmp]

Haven't been on in a while but see this post come back around from time to time and finally decided to add my worthless two cents.

Prior to Retirement

Dr.: Do you have any firearms in your home?
Me: So how much illegal and/or illicit photos do you have on your personal computer at home?

Dr: ?????, Well uh! I am asking about you.
Me: And I am concerned about you also and want to ensure you are not doing anything illegal that would prevent you from being the great care giver you are to me.

Dr. O.k. Moving along as questions about firearms dropped.

Concerning Risk mitigation:

Dr.: To ensure you avoid certain risks at home and/or on the job you need to avoid the following items, of which involves firearms, (mind you this prior to retirement).

Me; Dr, if you would look at my job description you would realize that I am a Federal L.E. and if I avoided firearms which are a part of my job description, I would not be able to perform my job. And a risk mitigation for you would be to avoid using needles when giving vaccines and so forth as you might stick yourself or poke someone in the eye.


After retirement, response is same as before except now I assist new shooters and inform during risk mitigation discussions that in order to assist others in knowing the possible dangers of firearms I inform and assist in proper handling techniques and go into the certain what ifs. Kinda the same as you (the Dr.) do when giving shots or discussing ways to live a healthier life.

Concerning the questionnaire, I always write IF I have any issues to discuss I will ask the care provider directly.

So what happens is they will ask me about my response and I will rephrase the question to them: Have there been any patients you just wanted to hit over the head today?

Then it goes to as mentioned previously about them being concerned for me and I let them know that in order for me to continue to receive good care from them I have to ensure they are in a good state of mind for their safety and mine.

Most know me now and avoid the nonsense. Every now and then I will get a new one filling in or whatever and I secretly know they want to take me out after I mess with their head.

[DaleA]

I secretly know they want to take me out after I mess with their head.

Yeah, about this...

I want to tick off my health providers about the same way I want to tick off my food servers.

Reminds me of an old Reader's Digest Humor in Uniform joke. A semi-deserted small town train station during WWII. A young spit and polish officer wants to buy something from a vending machine but doesn't have any change. He sees a young private and goes over to him.
"Excuse me, private. Do you have change for a dollar?"
"Yeah," says the private reaching into his pocket, "I got a bunch of change right here."
"Didn't they teach you anything in basic training private? When you answer an officer you come to attention and say 'sir'. Now let's try it again. Do you have change for a dollar?"
The private snaps to attention and loudly yells. "SIR, NO SIR!"