Pediatricians and NRA: Physician gag rules and the CDC, ACA, and states.

Pediatricians vs. the NRA: The Fight Isn’t Over Yet

Pediatricians vs. the NRA: The Fight Isn’t Over Yet

Health and medicine explained.
Feb. 1 2013 2:53 PM

The Pediatricians vs. the NRA

How the gun lobby is trying to gag doctors from talking about kids and guns.

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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?”

Helena Rho, a former assistant professor of pediatrics, lives and writes in New York. You can read her work at