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Published in CenterView on February 11, 2013

Debate waged over health care’s place in stemming gun-related violence

By Gary Pettus

Dr. Ralph Didlake was on call the day police let him inside the smoke-filled office of his colleague, shortly after her estranged husband had broken in and shot her to death.

Ralph Didlake“I was a trauma resident then, in the 1980s, so I had already seen gunshot wounds – but always in the ER, always in a controlled environment,” said Didlake, professor of surgery.

“I had always felt personally safe; it’s much different when there’s still gun smoke in the air.”

Some 30 years later, the smoke still clings to Didlake, suffusing his attitudes on a touchy subject President Obama and major medical organizations have urged physicians to tackle: gun violence.

“The chaos I saw in that office has certainly shaped my opinion as an academic and a physician,” said Didlake, director of the Center for Bioethics and Medical Humanities. “But, as an academic, it’s particularly difficult to avoid appearing to speak for the university and from speaking inappropriately as a faculty member.

“On the other hand, if there is a public health issue, as physicians, we are obligated to speak.”

For anyone, even doctors, the discussion is loaded with political and societal consequences, especially here in the South, where the Second Amendment looms like an Eleventh
 Commandment.

John Porter“It’s not like the Founding Fathers wrote it,” said Dr. John Porter, chief of the Division of Trauma Surgery. “It’s like God wrote it.”

There are those who believe doctors should butt out.

“Unless there is a physician who is a certified firearms specialist, he should stick to his own endeavor, which is healing the sick or treating a catastrophic disease,” said Dave Workman, a firearms instructor and communications director of the Bellevue, Wash.-based Second Amendment Foundation.

“Gun people don’t practice medicine.”

Dr. Timothy Wheeler, director of Doctors for Responsible Gun Ownership (DRGO), said it’s “perfectly OK” for doctors, as citizens, to express their views, but he refuses to equate gun violence with seatbelt use or underage drinking.

“It’s not a public health issue,” said Wheeler, whose California-based organization is a project of the Second Amendment Foundation. “The attempt of organized medicine to present it as one is simply a ruse to get physicians involved in advocating for gun control.

“The leadership of most national medical organizations is heavily skewed toward liberal, progressive views about guns. They do not represent the views of physicians at large across America.”

Closer to home, Dr. David Elkin, a child psychologist in the Department of Psychiatry, said clinicians should try to identify and intervene with children at-risk for committing violence. The newly launched Children, Adolescent and Youth (CAY) Center can do that, said Elkin, its executive director.

Still, even if gun violence is considered a public-health issue, “there are other, more pressing issues, especially in Mississippi,” he said.

“Let’s fix diabetes or obesity first, and get a bigger bang for the buck. Those issues affect more people.”

Yet, the mention of gun violence resonates with Didlake, Porter and others at UMMC. This institution sees more gunshot victims, including patient transfers, than any other medical facility in Mississippi, a state that recorded 1,098 gunshot cases in fiscal 2012 – down slightly from the Trauma Registry’s previous year’s total of 1,139, but up from the three years before 2011.

Deaths by firearms in 2011, the latest year available on the Department of Health’s website, included 266 suicides and 216 cases of homicide/legal intervention.

UMMC’s trauma team does handle a greater number of motor vehicle-accident victims and victims of falls, a reflection of statewide caseloads recorded by the Mississippi State Department of Health (a frequency of 35 percent and 23 percent, respectively).

“But 9 to 10 percent of our patients are gunshot patients,” Porter said. “We see a total of 5,000 patients each year, so as many as 500 have gunshot wounds. That’s more than one a day.”

Many are suicide attempts, made with handguns.

Amber Kyle, director of Adult and Pediatric Trauma Services, has noticed that at least one part of the population seems to be getting hit more often: children.

“It’s ‘You’ve got shoes I want,’ ” she said. “Or it happens when parents don’t keep their guns locked away.

“Or children who are bystanders get hit in a drive-by shooting.”

For instance, Sanaa Hill, then 8, survived a head wound from a stray bullet that struck her in December 2009 at a Boys and Girls Club in Jackson, where she was doing her homework.

When it comes to children who are shot, Dr. Nan Frascogna probably sees more accidental hunting-related wounds in the pediatric emergency room, she said.

Patients treated there are under age 16, said Frascogna, assistant professor of pediatric emergency medicine. “So we miss a lot of the teenage gang-related gunshot violence. But in recent memory we have seen at least a couple involving a drive-by.”

Drive-by or gang-related shootings aren’t gripping the nation now, though; instead, it’s a recent wave of mass, or high-profile public, shootings, including those at an elementary school in Newtown, Conn., and at an Aurora, Colo., movie theater.

As part of his plan to address gun violence, President Obama last month called on physicians to discuss gun safety with patients and alert law enforcement about threats of violence.

That’s also a political sore spot.

Even so, several professional medical organizations and publications urged their members to massage it, including the American Medical Association, the Annals of Internal Medicine, the American College of Surgeons, the American Psychological Association and the American Academy of Pediatrics.

“For physicians, the problem with talking about gun control in Mississippi is that everybody owns a gun,” said Porter, who served 16 years in the Army. “It’s only been in the past few weeks that I have spoken my beliefs on gun control, because it’s a minority opinion.

“No one listens. Everybody remembers the story where someone broke into Susie’s house and Susie had a gun.”

Advising Susie on gun safety is not her physician’s place, even if she has children at home, Wheeler said. “It’s wrong.”

Florida has passed a gag law, now under review, that forbids a doctor from broaching the subject, and some other states are considering copycat laws.

“Such measures degrade the doctor/patient relationship,” Didlake said. “Physicians must reject this as strongly as possible.”

Didlake also believes in more government-funded research, especially for prevention and to unearth the root causes of gun violence, just as other studies have led to checks on cancer and traffic accidents.

”that could lead to more effective solutions,” he said. “We’re not talking about just gun control.”

Apparently, though, speaking out about gun violence is politically risky, as the Annals of Internal Medicine charged in a Jan. 1 editorial, “A New Year’s Resolution for Physicians: Time to Focus on the Public Health Threat of Gun Violence.”

“In the past, Annals has encountered difficulty in convincing experts who are passionate about public safety to write commentaries after mass shootings,” the editors wrote. “These thoughtful people revealed that they declined to write about guns for fear that public funding supporting their research programs (which were not directly related to gun violence) might dry up if they advocated for stricter gun control.”

Research priorities are often “modulated” by political influence, Didlake said. Institutions must seek funding for these studies anyway, he said. “Public policy and legislation should be based on solid information rather than on ideology or loud assertions.

“It’s a particularly interesting discussion here; we’re in a politically conservative state and a small state. In our current political climate, the way political discourse is carried on, consensus and compromise are now painted as moral failure.

“But that used to be called statesmanship.”


 

MISSISSIPPI TRAUMA RATES

Motor vehicle collisions: 35 percent
Falls: 23 percent
Assaults(includes homicide, suicide, gunshot wound, stabbing,
blunt force trauma, sexual assault, child abuse, intentional poisoning,
and intentional strangulation/suffocation): 20 percent 
Motorcycle/ATV: 8 percent
Other Transport: 6 percent
Fire/Inhalation: 3 percent
All Other: 5 percent

Source: Mississippi State Department of Health

 

GUNSHOT WOUNDS (fiscal years)

2008: 800
2009: 975
2010: 1,033
2011: 1,139
2012: 1,098

Source: Mississippi State Department of Health

 

GUNSHOT WOUNDS (UMMC)

2008
Total: 351
Adults: 312
Children (under age 16): 39
Transfers from other state hospitals:  adult, 161; children, 29
Deaths: adult, 35; children, 5

2009
Total: 345
Adults: 324
Children: 21
Transfers: adult, 169; children, 16
Deaths: adult 25; children, 0

2010
Total: 359
Adults: 335
Children: 24
Transfers: adult, 172; children 13
Deaths: adult 24; children, 2

2011
Total: 380
Adults: 349
Children: 31
Transfers: adult, 163; children, 23
Deaths: adult, 26; children, 1

2012
Total: 400
Adults: 360
Children: 40
Transfers: adult, 143; children, 25
Deaths: adult, 25; children, 3

Five-year total: 1,835
Adults: 92 percent
Children: 8 percent
Transfers: percentage of adults, 48; percentage of children, 68
Total deaths: adult 135; children, 11

Source: UMMC Trauma Department