Delegates Ask AAFP for Help in Protecting First Amendment Right to Counsel Patients

Measure on Opioid-prescribing Resource Referred to AAFP Board

September 16, 2011 04:45 pm David Mitchell Orlando, Fla. –

When Andrew Carroll, M.D., a full-time family physician in Chandler, Ariz., volunteered to practice tactical emergency medicine with a local SWAT team, he was required to carry a weapon.

His wife wasn't thrilled when he brought his new gun home.

"The first thing I did was sit down with my wife and kids and show them how to make the gun safe," Carroll said, referring to the use of a safety, removal of the magazine, etc. "That’s extremely important for every person in a house that has a gun to know."

Carroll, an alternate delegate to the AAFP Congress of Delegates, was one of several AAFP members who expressed concern during testimony before the Reference Committee on Health of the Public and Science and the Congress of Delegates that their rights to have similar conversations with their patients might be threatened by legislation, such as a law that recently took effect in Florida. That law restricts what physicians in Florida can say to their patients about firearms, with severe penalties for noncompliance.

In response, the Washington AFP submitted a resolution to the COD that called for the Academy to reaffirm its policy regarding the health benefits of counseling families about the safe storage of guns. It also called on the AAFP to write to Florida's governor and lawmakers condemning the new law, to write a letter to the National Rifle Association, or NRA, condemning its advocacy of the law, to monitor proposed legislation in all states that could infringe on physicians' First Amendment rights, and to adopt a policy opposing any such legislation.

Story highlights

  • During the 2011 Congress of Delegates, delegates urged the AAFP to support physicians' First Amendment rights to counsel families about gun safety.
  • The request came in response to a Florida law that restricts physicians from discussing gun ownership or gun safety with their patients.
  • Delegates also debated recent federal efforts to enforce CME requirements on physicians and others who prescribe opioids to their patients.

Anne Montgomery, M.D., an alternate delegate from Spokane, Wash., acknowledged during reference committee testimony that the Academy already had taken some of the steps requested in her state's resolution, but she reiterated the request for a letter to the NRA. The reference committee agreed and offered a substitute resolution calling for such a letter.

However, during the Sept. 14 Congress of Delegates session, Carroll and others opposed that tactic, saying that a letter to the NRA was unlikely to be effective and that a bolder strategy was needed. The issue ultimately was referred to the AAFP Board of Directors.

Delegates also referred a resolution on opioid prescribing to the Board of Directors. The issue has been a hot topic since the White House announced a multifaceted strategy to curb prescription drug abuse in April. That plan includes mandatory CME for health care professionals who prescribe controlled substances. In addition, Sen. Jay Rockefeller, D-W.Va., introduced a bill in Congress that calls for prescribers to complete 16 hours of mandatory CME related to opioids and pain management every three years. The AAFP has voiced opposition to both the White House plan and the bill.

District Court Judge Blocks Florida Law Designed to Mute Docs on Gun Safety

As the AAFP Congress of Delegates was concluding in Orlando, U.S. District Judge Marcia Cooke was granting a preliminary injunction( in Miami against a Florida law that bars health care professionals from asking patients if they own guns and if they are storing them properly. In granting the injunction, Cooke said the law infringed on physicians' First Amendment rights.

"The impact of this law has already caused serious rifts in physician-patient relationships," said Dennis Mayeaux, M.D., chair of the Florida AFP, which was one of three organizations and six individuals who filed a lawsuit challenging the law. "The preliminary injunction will now allow us to talk to our patients again about firearm safety."

Gov. Rick Scott, who signed the law three months ago, told The Miami Herald he plans to appeal the ruling in the case.

In response to these federal proposals, however, delegates from the Washington chapter submitted a resolution asking the Academy to endorse the use of Cautious Evidence-Based Opioid Prescribing(, a monograph put out by Physicians for Responsible Opioid Prescribing. But the resolution met with opposition for a variety of reasons, including concerns about endorsing a single resource when many others are available.

AAFP Director Richard Madden Jr., M.D., of Belen, N.M., asked that the issue be referred to the Board of Directors, which already has asked the Commission on Health of the Public and Science to develop a response to the issue of pain management and opioid abuse. The Academy's actions on the issue to date are covered in Board Report O.

Delegates from Iowa and Washington testified during the reference committee that their states already are implementing requirements for CME related to opioid prescribing, and they are seeing some fallout from those actions.

"Medical groups in Washington already are stopping seeing chronic pain patients, including some of our large community health centers," said Montgomery during reference committee testimony. "It's going to be a big crisis."

The only items from the Reference Committee on the Health of the Public and Science adopted by delegates were a substitute resolution encouraging physicians to routinely ask patients of reproductive age if they intend to become parents in the next year and to provide services as indicated, and an amended substitute resolution encouraging early literacy programs.