Saturday, March 02, 2013

My Day With Our State Legislature

It was a long day in Annapolis yesterday.  I was one of an estimated 1,300 people who showed up to give testimony on gun legislation.  For details, see The Baltimore Sun article.

On the public testimony, I was #162  and I went at nearly 9 pm, they were estimating 16 hours of testimony and it didn't start until 4:30 pm. My quick demographic estimates: 99% white, over 90% Male, & over 95% or those who came to testify opposed the governor's bill. The supporters, including busloads of school children, were outside rallying in the morning.

There were 4 hours of expert testimony, then I heard  4 hours of  public testimony with the same handful of messages : civil rights, why I need an assault weapons, statistics on how gun control doesn't decrease violence, I'm gonna move to another state if this passes, you're going to make me a criminal, go after the criminals and the mentally ill,  all of these measure prevent straw purchases but no one is ever prosecuted for straw purchases, this won't fix anything, and my personal favorite: the little girl who testified that if the law passed she'd have to move away from her friends, her school, and going to McDonald's.  Where were the victims of gun violence? Where were the mental health advocates?  They were part of the expert testimony -- I'll talk more about this below--but I was the only one (of those I heard) who was not giving public testimony on the Firearms Act.  I left after I testified, but it went on until early the next day --I've heard 3 AM and 6 AM. 

I got to testify around 9 pm, maybe a little earlier, thanks to our kind psychiatric society lobbyists who signed me up, even though I wasn't the designated speaker for the expert testimony. It fast-forwarded me out of a long line to get into the building and I got me a much better number than I'd have gotten myself, being that I'm not a "morning person."  I was psychologically prepared to stay until 10 or 11, so being heard by 9 was good.  I'd brought a peanut butter and jelly sandwich, a pear, and some carrots.  I resorted to water from a faucet in the rest room, and at one point, I was sitting on the floor of the hearing room with my phone charging while I tweeted, and a kind staffer offered me a chair.  I didn't want a chair, but I did ask if he could get me a cold beer. 

I had prepared three minutes of testimony, but given the numbers, they cut the time to one minute. Everyone ran over, and the Chairman, Delegate Pete Hammen, sometimes let people ramble on, and other times, cut them off.  I thought he was incredibly rude and dismissive to me.  I seem to remember going to meet with him years ago, and that he was dismissive then --not to me specifically but to our psychiatrist group.  Is this my imagination or does he not like psychiatrists?  I think I felt like our readers feel when they talk about being dissed because they are psychiatric patients; I felt dissed because I was a psychiatrist.  I pointed out to him that I was the only person there not testifying on the Firearms Bill, I was talking about HB810 --mandatory reporting of dangerous patients.  He'd been more patient listening to  gun-owner after gun owner make one of the same 4-5 points about why they oppose the legislation.  Me, as the only one giving testimony on a different bill, he cut off repeatedly and was quick to dismiss.  In all fairness, it was nearly 9 pm and everyone was fading, some of the legislators had left, and  I can't imagine what they were like at 3 AM.  I did go over my allotted time and I did give my testimony as a story, not as bullet points, something I knew might be risky. The bill's sponsor had been in and out of the hearing room, but during my testimony, he was gone. 

There was on ob-gyn who testified in favor of the bill --one of only 3 pro-gun control advocates I heard --  and they were much nicer to her.  I guess on the positive side, someone in the room applauded me -- no one else was applauded while I was in the hearing room -- and one of the legislators said, while I was speaking, "That's why we shouldn't pass this."  So I guess it was worthwhile.  No one had any questions for me, but Hammen phrased it as "Any questions? Next." And they were all understandably a bit zoned out by that hour.  One person gave testimony that she'd been mistakenly diagnosed with a mental disorder and could never get a gun because no one would say the doctors at the hospital were wrong, and this was part of the Firearms Act.

By the way, when someone (? I think it wasn't one of the bill's sponsors, but I missed the introduction) described HB810, he described the three Tarasoff options and said this bill would require mental health professionals to tell the police if there was a specific threat against someone else. He proposed it as a tightening of the Tarasoff requirements, while the HB810 actually undermines Tarasoff.   In fact, the bill requires mental health professionals to report to the "Director of Mental Hygiene" : a nonexistent agency.  Perhaps they meant MHA or DHMH.  The Direct of Mental Hygiene then decides whether to tell the State Police for the purpose of preventing gun sales (so reporting to the FBI NICS database, I assume?), who then decides if they should contact the local police. 

As far as the expert testimony went -- the first 4 hours of the proceedings --Dr. Brian Zimnitsky from the Maryland Psychiatric Society did a great job, and an internist testified who also did a wonderful job-- he described that 1/4 of his patients have psychiatric issues and how hard it is to get people in to see psychiatrists, how many don't take insurance and how clinics aren't open late for people who work, and the long waits.  And he was very articulate about how the process to get your gun back doesn't/won't work because psychiatrists  won't certify people to use guns, either because they are liberal urbanites against gun ownership, or because they won't accept the liability.  Dr. Zimnitsky did a good job of re-iterating that with a little more detail about what it is we can do.  It was very confusing because the Firearms Act was the focus of attention, yet there were other mental health issues which got no space for discussion.  And most of the testimony was about the details of guns and assault rifles and statistics about how gun control effects morbidity and mortality.

Overall, Dr. Zimnitsky was the only psychiatrist, and there were 2 psychologists and 1 lawyer from the Maryland Disability Law Center -- in 4 hours of expert testimony, and the 4+ hours I watched of public testimony.  Is there anyway to get a stronger psychiatrist presence at the table?  These lawmakers clearly don't understand the issues, and I think it's hard because they seem to have their minds made up about psychiatric patients and either they are not open to learning, or we're not doing a good enough job explaining.  Even with the Emergency Petition issue that came up, it sounded like EP's happen when a doctor files one, and there was no mention of the fact that a family member or neighbor can easily obtain one, and then if the professional in the ER doesn't have enough information, they may want to hold a patient for a day or two to observe and clarify whether they are safe. In this case, a person will be deprived of a civil right without any due process. This was an 11th hour amendment that was brought into the Firearms Act on the night it passed the state senate.

There was nothing mentioned about doctor-patient confidentiality and how this is necessary for psychiatric treatment to ensue.  The point was made they times that using a 30 day cutoff for reporting would affect eating disorder patients who aren't dangerous, but I think the point should be that reporting voluntary patients forces physicians to violate the doctor-patient confidentiality that is necessary for psychiatric treatment it and  deprives people with mental illness of a civil right and that this singles out psychiatric patients as the only group of people who can be deprived of civil rights without any legal due process.  It's all terribly stigmatizing and may well serve the opposite of the intended effect: to leave people fearful of psychiatrists and less willing to get help.  And it's striking that HB810 only applies to mental health professionals and no other health care provider is being asked to report dangerousness.  I wasn't really sure by then end of all of it if the 30 day voluntary inpatient reporting was still part of the bill passed by the senate; it was twice mentioned that this had been removed.  We need to move the terminology from "the mentally ill" to "those who are dangerous" for any reason.

It's amazing that there is nothing about substance abuse, that you can go for eight rehabs, and still have your arsenal. 

In terms of actual safety issues, I think it might be helpful, though I imagine it's too late, to have a  process by which all physicians are "allowed" (as opposed to required) to violate confidentiality and the police are "required" to investigate and confiscate weapons then have a quick legal process that would ensue to return such weapons if they were confiscated in error.  This could be used for psychiatric patients, substance abusers, or simply angry, mean people who are making threats or behaving erratically.  And because it wouldn't be about just reporting to a database, it might serve as a mechanism to get guns out of the hands of those who have them illegally, something none of this legislation addresses.

If you read through all this, thank you.  Eleven hours yesterday and I needed to vent.  It was really fascinating and I'm so glad I went.