Reporting to the Feds

[Shikima]

http://www.politico.com/story/2016/01/obama-gun-control-rule-mental-illness-217340

Anyone want to weigh in?

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[milesed]

If true, it creates a difficult bind for us. I have plenty of patients who should never be allowed to own or possess firearms, but live in an area that is VERY gun friendly. They can easily get weapons from family, friends, neighbors. On one hand, it may impede someone from seeking services who really needs treatment. On the other, are we liable for NOT reporting if a patient shoots someone?

 

[PikminOC]

this is completely untrue

??

 

[Bartelby]

On the other, are we liable for NOT reporting if a patient shoots someone?

Excellent question. If this reporting system is real it seems to be a major violation of patient confidentiality. From the sound of it you would basically report on someone for being mentally ill and, since you are not volunteering up more information, I would think the reviewers are supposed to presume the worst. I can see psychiatrists vastly over reporting with such a system, because who wants to take the chance of having not reported the next James Holmes (or for that matter on the guy who just shoots himself in the head)?

 

[splik]

this is what is actually says if you read it:
·Include information from the Social Security Administration in the background check system about beneficiaries who are prohibited from possessing a firearm. Current law prohibits individuals from buying a gun if, because of a mental health issue, they are either a danger to themselves or others or are unable to manage their own affairs. The Social Security Administration (SSA) has indicated that it will begin the rulemaking process to ensure that appropriate information in its records is reported to NICS. The reporting that SSA, in consultation with the Department of Justice, is expected to require will cover appropriate records of the approximately 75,000 people each year who have a documented mental health issue, receive disability benefits, and are unable to manage those benefits because of their mental impairment, or who have been found by a state or federal court to be legally incompetent. The rulemaking will also provide a mechanism for people to seek relief from the federal prohibition on possessing a firearm for reasons related to mental health.


·Remove unnecessary legal barriers preventing States from reporting relevant information to the background check system. Although States generally report criminal history information to NICS, many continue to report little information about individuals who are prohibited by Federal law from possessing or receiving a gun for specific mental health reasons. Some State officials raised concerns about whether such reporting would be precluded by the Privacy Rule issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Today, the Department of Health and Human Services issued a final rule expressly permitting certain HIPAA covered entities to provide to the NICS limited demographic and other necessary information about these individuals.






the emphasis is on states reporting to NCIS. clinicians are specifically discouraged from directly reporting.

 

[MacDonaldTriad]

The only effective argument that would prohibit all persons with mental illness from owning firearms would be a belief that no one should own firearms. Short of this I wouldn’t want to get involved in deciding who can and who can’t. Society always wants us to be soothsayers, but we are not. Show me a psychiatric soothsayer and I’ll show you a legal defendant.

 

[WisNeuro]

Just a misdirected "fix" to a larger problem. Putting the onus on mental health professionals to guess who is dangerous and what not is just a PR move. Extremely low base rate issue, for which clinical decision making is, sometimes, but not often, marginally better than chance.

 

[sunlioness]

I'm failing to see how this is anything new. Aren't involuntary commitments and such already reported? At least at the state level.

Like Splik said, this looks like an automatic administrative thing based on certain events that we really would have little to do with.


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[WingedOx]

Just a misdirected "fix" to a larger problem. Putting the onus on mental health professionals to guess who is dangerous and what not is just a PR move. Extremely low base rate issue, for which clinical decision making is, sometimes, but not often, marginally better than chance.

Just another example of the lay public having no idea what we actually do.

IL (or was it the city/county?) had a ballot resolution last election along the lines of "should people convicted of domestic violence be mandated by law to see a mental health provider for an evaluation?"

What a wonderful way to create a liability problem and increase the number of people in my office who don't want to be there!

 

[Shikima]

Just a misdirected "fix" to a larger problem. Putting the onus on mental health professionals to guess who is dangerous and what not is just a PR move. Extremely low base rate issue, for which clinical decision making is, sometimes, but not often, marginally better than chance.

I have a magic 8 ball in my office. Would that work?

 

[WisNeuro]

I have a magic 8 ball in my office. Would that work?

Just about as well as any of our currently used measures do. If that thing could also write up my CYA note when I have to assess these things, it'd be gold.

 

[sunlioness]

I really need to get a magic 8 ball.


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[Shikima]

I really need to get a magic 8 ball.


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I bought it with my ill gotten gains from an unwary survey that was completed in 4.5 minutes.

 

[thoffen]

So, this is a law that gives high risk patients explicit reason not to trust mental health providers. Sounds like a good thing for everyone, right?
Seems like the real function of this legislation is for society to blame mental illness for the risks in promoting gun ownership and to distance anyone who might have doubts about their ability to responsibly use a firearm from those doubts. Sounds like a good thing for everyone, right?

 

[wolfvgang22]

What a deliberately inflammatory and irresponsible article by Politico! The headline and the first paragraph make it look like doctors and healthcare providers are all the sudden going to have to do new reporting, when later on in the article they quote the rules as unchanged from before.

 

[sunlioness]

Politico is being deliberately inflammatory and irresponsible?!

No way!!!


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[Information Underload]

What a deliberately inflammatory and irresponsible article by Politico! The headline and the first paragraph make it look like doctors and healthcare providers are all the sudden going to have to do new reporting, when later on in the article they quote the rules as unchanged from before.

Well, the laws are unchanged because this isn't law. It's an executive action. What standing does one have to violate HIPPA--federal law--to report someone to this registry? The Brady Bill only allows this information to be submitted to the registry with the informed consent of the patient. This attempts to change that (i.e., no informed consent required), but if I'm a patient, I'm suing a physician who turns me into this registry for violating HIPPA. Good luck showing how an executive action can override federal law. Of course, this executive order will be found unconstitutional in a matter of weeks because it is.

 

[DD214_DOC]

The author does not understand the rules and how the process works. The actual rule (which you can link to and read from first paragraph) clearly DOES NOT ALLOW your physician, psychiatrist, psychologist, or other HIPAA covered provider/entity to freely report patients to this database. This rule removes the possible HIPAA-related restrictions of specific entities that are DIRECTLY INVOLVED in the adjudication or involuntary commitment process or those entities which maintain a repository/database of said individuals that may have prevented them from notifying the FBI for inclusion in the NICS database. I am all for personal liberties, but this is clearly a very inflammatory article that is completely inaccurate and should be removed.

 

[FlowRate]

The only effective argument that would prohibit all persons with mental illness from owning firearms would be a belief that no one should own firearms. Short of this I wouldn’t want to get involved in deciding who can and who can’t. Society always wants us to be soothsayers, but we are not. Show me a psychiatric soothsayer and I’ll show you a legal defendant.

Indirectly, I think you bring up the question of what "diagnosis" really means. Using diagnoses to treat people a certain way under the law implies that they are perfectly accurate entities which predict future behavior. I think of diagnoses as imperfect sets of words associated with and sometimes used to summarize what should be found in much greater detail in a physician's official charting. Or sometimes it's just a billing-related button you hastily clicked so that Epic would let you submit your note.

 

[splik]

here's more accurate reporting, i.e. theres no story and as i said it was complete nonsense above:

http://www.nytimes.com/2016/01/07/u...i-will-receive-health-data.html?smid=tw-share