AAPA HOD Out of Line

[FBIDoc]

I have personal and professional reasons for opposing the AAPA setting policy outside the purview of what we do as PAs.  Discuss...

 

2014-C-01 recommends an amendment to 2013-B-01 resolution by substitution. It states:

"The AAPA supports policies and educational programs that will effectively reduce homicide, suicide and other violence that occurs through the use of firearms. The AAPA also supports measures that effectively reduce the criminal ownership and use of firearms. As the AAPA represents the diverse membership of physician assistants, the AAPA supports the requirement of:

 

1. Reporting by physician assistants to law enforcement agencies persons in their care exhibiting behavior dangerous to themselves or others making them unfit to purchase or own firearms.

2. Supporting state legislation that allows PAs to counsel patients regarding firearm ownership and safety.

3. Participation in educational programs on the safe storage and use of firearms.

4. Training programs for the safe use and employment of firearms.

5. The enforcement of current laws for the purposes of public safety regarding firearms."

 

Negative implications acknowledge that it is a hot topic right now. Recently American Academy of Pediatrics released a policy statement on gun violence. The NRA immediately released a rebuttal. It is likely a statement from AAPA will also result in a similar response.

 

2014-C-02

"AAPA believes that all existing gun laws be strictly enforced."

 

It is proposed that as PAs we carry the responsibility not only for treating disease and injury but also for prevention of such. Firearms are believed to be part of this statement. This resolution was proposed because previous policy (HX4400.2.2) refers only to handguns. Some feel it is redundant and will fall under the same response from NRA and other pro-arms groups.

 

2014-C-03

"AAPA believes that with the exception of transfers between first degree relatives, background checks be mandatory for all ownership transfers of firearms."

 

This resolution encourages laws requiring background checks before ownership. There is currently not a requirement for background checks before the sale of some firearm sales. 

Negative Implications include the fact that some members feel this is not an appropriate topic for the profession to be discussing.

 

2014-C-04

"AAPA believes that criminal and civil penalties should be imposed on all individuals who are found to knowingly transfer possession of a firearm to an individual who was prohibited from possessing it."

Again the negative implication is that this is an area that is not appropriate for AAPA policy.

 

2014-C-055

"AAPA believes that gun owners should be subject to criminal and civil penalties if their improperly secured firearms are the cause of an injury or used in a crime."

Negative implications include previous and also that penalties may be too harsh.

 

2014-C-06

"AAPA believes that civilians should be banned from owning automatic and semiautomatic firearm/magazine combinations capable of firing, without reloading, more than ten times per minute."

 

Negative implications include above and that the law may be a violation of a citizen's constitutional rights.

[pglaser01]

Agree...Although it is a PAs duty to actively treat, counsel, etc.  It is in no way related to the description of a PA to speak out or take action involving anything to do with civil or criminal rights that is not directly related to a patient.

[physasst]

I'm really not sure what your issue with this is.

 

The NRA may respond negatively? So what? Are they a medical organization? Why would we care what the NRA had to say? I'm asking honestly.

 

This has a lot to do with mental health patients and public health policy. None of this is law, but rather, a clarification of the Academies positions.

 

In no part during this recommendation do they state that law abiding citizens who are eligible to own firearms should be prohibited from doing so.

 

Mike

[pglaser01]

I suppose you are correct...however, I'm just tired of every single thing being political.  Why the pressure to have to choose sides for every single thing?  Why can't we just be able to say, "look, that's not what I do.  I just want to do my job."  Call it burying your head in the sand if you will, but the AAPA seems to have a lot more pressing issues to worry about...

[Guest Paula]

AAPA would stand a little higher in my book if they did not offer these type of resolutions which sound political and not health related.  If they framed the discussion around how to treat and get services for individuals who might be prone to commit suicide or homicide, then I might support them.  But it is all framed as a political discussion on firearm safety, not focusing on the individual who struggles with mental health issues. 

 

Yes, they are getting into gun ownership rights.  Read the last 2014-C-06

 

These type of issues are one of the reasons I won't join AAPA. 

[ToppDog]

2014-C-06

"AAPA believes that civilians should be banned from owning automatic and semiautomatic firearm/magazine combinations capable of firing, without reloading, more than ten times per minute."

 

Screw them.  This is where they crossed the line, & are supporting the restriction of guns from legal & responsible gun owners.  I, too, am tired of them spending their time & our money on hot button political issues when they should be concentrating on advancing the profession.  I will not be renewing my AAPA membership any time soon.

[Guest Paula]

Like maybe AAPA needs to pay attention to the Missouri Senate bill that passed to allow medical grads who are unmatched residents to become assistant physicians and take on PA nomenclature for CMS purposes.  

 

Now THAT is an issue that matters.

[Acebecker]

Overstepping the bounds of the AAPA HOD.  It's not our place to get involved politically.  Yes, we are required to report when someone is a danger to him/herself or another.  That is good medicine, that is good preventative care.  But the criminal realm is not ours and we ought to stay out of it.  There is no place for us to have a stance on what types of firearms ought to be allowed.  There is just no place for us on most of those resolutions.  The AAPA ought not go there.

[FBIDoc]

I'm really not sure what your issue with this is.

 

The NRA may respond negatively? So what? Are they a medical organization? Why would we care what the NRA had to say? I'm asking honestly.

 

This has a lot to do with mental health patients and public health policy. None of this is law, but rather, a clarification of the Academies positions.

 

In no part during this recommendation do they state that law abiding citizens who are eligible to own firearms should be prohibited from doing so.

 

Mike

Mike,

 

See the other folks' comments as well, but my issue is where the AAPA crosses the line from a PA advocacy/lobby group to taking a political position that some would argue violates the Constitution.  It is in no way conceivable for the AAPA to weigh in on "duh" issues such as 2014-C-04 "AAPA believes that criminal and civil penalties should be imposed on all individuals who are found to knowingly transfer possession of a firearm to an individual who was prohibited from possessing it." or 2014-C-02 "AAPA believes that all existing gun laws be strictly enforced."  And the HOD most certainly has no business making policy statements about what type or style of firearm/firearm accessory an individual can possess (2014-C-06 "AAPA believes that civilians should be banned from owning automatic and semiautomatic firearm/magazine combinations capable of firing, without reloading, more than ten times per minute."), especially when there is compelling data to demonstrate this type of ban will have no effect on firearm fatalities (true, but for another thread)

 

I echo Paula and Andrew's statements that the AAPA should concentrate its efforts, and our money on issues that directly affect PAs in this country, and stay out of politics that are not germane to PA practice.

[ventana]

Like maybe AAPA needs to pay attention to the Missouri Senate bill that passed to allow medical grads who are unmatched residents to become assistant physicians and take on PA nomenclature for CMS purposes.  

 

Now THAT is an issue that matters.

 

 

BINGOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

 

Why are they writing this crap when there is HUGE issues at a state level that need attention!!!!!!!!!!!!!!!!!!!!!

[Acebecker]

Like maybe AAPA needs to pay attention to the Missouri Senate bill that passed to allow medical grads who are unmatched residents to become assistant physicians and take on PA nomenclature for CMS purposes.  

 

Now THAT is an issue that matters.

 

Comment was in poor taste so I deleted it.  It sounded funny to me at the time. 

[physasst]

Like maybe AAPA needs to pay attention to the Missouri Senate bill that passed to allow medical grads who are unmatched residents to become assistant physicians and take on PA nomenclature for CMS purposes.  

 

Now THAT is an issue that matters.

 

Paula,

 

I'm sure the AAPA is paying attention to this. But the HOD does not have the capacity to react to spur of the moment legislative developments. This is what the legislative affairs staff does. The HOD develops policies or attempts to clarify Academy policies. They provide guidance to the BOD, and to the Academy staff. There is a very clear definition of what the HOD does, and how it functions. It is not set up to respond to things that occur over a 2 week time frame. It is moreover, not the HODs job to address this. This is why we have an entire legislative affairs staff. Lastly, the AAPA does not typically get involved in state level legislative issues unless the state chapter asks them to. I have no idea what MOAPA was up to, but this entire situation evolved over a 2 week time period.

 

http://www.aapa.org/twocolumn.aspx?id=1985

 

If you want to talk with the Federal Affairs workgroup, feel free to email them.

 

FAWG@aapa.org

[coloradopa]

This would make too much sense, ergo the HOD cannot do it. 

Maybe because we have policy on this, the  Missouri Academy is all over this and it looks like its dead as a doornail. 

 

Fundamentally the AAPA HOD is a constituent organization. The requirement for a resolution are that two COs sponsor it. If you want to blame someone blame the COs that are bringing this up (in the case of most of the gun stuff the Maine Academy). My guess is most of this will be dealt with rather quickly or shunted off to a committee. There will be stuff in A that will take up a lot of time so fatigue should set in by the time these come up. 

[jmj11]

I totally agree that with so many pressing issues that influence our daily practice, the AAPA, including the HOD, should not be involved with political issues that don't relate.  I stand poised to rejoin the AAPA after a 15 year absence, but then things like this happen that turn me away again.

 

DELETED: Because I've told my story before, so I sound like I'm whining.

 

 Let these things be fought out elsewhere but not in our organization.  We have many, many, many other more pressing needs.  We are way, way down on Maslow's Hierarchy of Needs.

[Guest Paula]

I thought AAPA no longer has a governmental and legislative affairs committee.  They have been calling for volunteers to do the work.  You have to be a member of AAPA to volunteer.  

 

I did email the FAWG.  

[taotaox1]

So glad to see the AAPA is working toward even greater irrelavance than the AMA. They are unlikely to ever get a cent from me, for this, and other reasons....

 

Sent from my PC36100 using Tapatalk 2

 

 

[physasst]

This discussion is interesting, in only that the response is predictable. Ahhh, Refcom C...always a fascinating place as David C knows all to well. There is a clear public health issue involving guns. I must admit, despite being in the military, I have never understood the fascination that Americans have with guns. I will never own another one (I only have 2 now that were my fathers, and are so old, they would likely be dangerous to fire, kept only for sentimental reasons), and never plan to fire one again, for any reason....

 

Reminds of a few patient encounters. I can say that my institution has large signs saying that guns are banned on our premises. I have had 3 patients over the past several years show up for appointments who had weapons on them, I make them all change into a gown, so I always see the weapon. All 3 times I explained to the patient that I would not be able to see them until they took that to their vehicle and off the premises, or I could have security come and lock it up for them. One had his wife take it to the car.

 

The other 2 got dressed and left. Oh well. It's not an option. I will not see you as a patient if you are armed.

 

As far as discussing it with patients, I think of it as no different than discussing smoking, drug use, or any other potentially dangerous activity. I've talked with parents about whether or not their child has a helmet when they ride a bike, why would I not ask if there was a firearm in the house and counsel them about safety? There isn't any difference to me. I'm not sure why people get their feathers ruffled on this.

[cinntsp]

So glad to see the AAPA is working toward even greater irrelavance than the AMA. They are unlikely to ever get a cent from me, for this, and other reasons....

 

Sent from my PC36100 using Tapatalk 2

 

 

Why don't you join and do something about it?

[taotaox1]

I am a student member currently, as it was included in our tuition. PAFT will get my finanical support when I graduate.

 

Sent from my PC36100 using Tapatalk 2

 

 

[PACdan]

This discussion is interesting, in only that the response is predictable. Ahhh, Refcom C...always a fascinating place as David C knows all to well. There is a clear public health issue involving guns. I must admit, despite being in the military, I have never understood the fascination that Americans have with guns. I will never own another one (I only have 2 now that were my fathers, and are so old, they would likely be dangerous to fire, kept only for sentimental reasons), and never plan to fire one again, for any reason....

 

Reminds of a few patient encounters. I can say that my institution has large signs saying that guns are banned on our premises. I have had 3 patients over the past several years show up for appointments who had weapons on them, I make them all change into a gown, so I always see the weapon. All 3 times I explained to the patient that I would not be able to see them until they took that to their vehicle and off the premises, or I could have security come and lock it up for them. One had his wife take it to the car.

 

The other 2 got dressed and left. Oh well. It's not an option. I will not see you as a patient if you are armed.

 

As far as discussing it with patients, I think of it as no different than discussing smoking, drug use, or any other potentially dangerous activity. I've talked with parents about whether or not their child has a helmet when they ride a bike, why would I not ask if there was a firearm in the house and counsel them about safety? There isn't any difference to me. I'm not sure why people get their feathers ruffled on this.

You don't have to understand the cultural significance of firearm ownership in the United States or its historical and modern day constitutional relevance in your position. Why should PAs, whom ought to be occupied with the practice of medicine venture into this realm?

 

What are you offering your patients while talking about firearms? Are you a certified range safety officer or firearms instructor? I guess you're giving common sense advice about not leaving guns accessible to children and the like. That's fine. The AAPA doesn't need to pass a resolution on magazine capacities for you to do that. It's totally irrelevant.

 

 

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[UGoLong]

Some points go through my mind when I read about the firearm proposal to the HOD:

 

1. The HOD is a place where almost anyone can bring up almost anything (like a state legislature). That doesn’t mean that every idea should be passed into law, but a little discussion (as long as it doesn’t interfere with other, more pressing business) is the price you pay for the freedom of open discussion.

 

2. It’s well and good to talk about the culture of America, except that none of us was there when it started. Perhaps it would be good to remember what those settlers faced and the nature of the weapons they had at hand. I probably wouldn’t have left my cabin without a gun either. 

 

3. While guns have a role in American culture, their ubiquity also appears to have a not-insignificant role in killing Americans. It’s hard for me to forget one of my patients, a middle-aged woman who had just had her second son shot to death on a street corner with a handgun. And also to know that this push to remember the old America is brought to you -- in part -- by a segment of corporate America that makes money from selling guns.

 

I personally wouldn’t have brought up the issue in the HOD, nor would I have much patience for discussing it for hours and hours. However, regardless of where you come down on the issue of guns, a few minutes of talk about it won’t kill anyone, nor should it dampen one’s spirit for having a national professional association of PAs. I belong to PAFT as well and recognize that the AAPA is imperfect and in need of change. Without it though, as a profession, we would be toast.

 

Let's have a little patience for people who want to talk about things that we don't agree with. That's the American culture I choose to remember today.

[pglaser01]

Some points go through my mind when I read about the firearm proposal to the HOD:

 

1. The HOD is a place where almost anyone can bring up almost anything (like a state legislature). That doesn’t mean that every idea should be passed into law, but a little discussion (as long as it doesn’t interfere with other, more pressing business) is the price you pay for the freedom of open discussion.

 

2. It’s well and good to talk about the culture of America, except that none of us was there when it started. Perhaps it would be good to remember what those settlers faced and the nature of the weapons they had at hand. I probably wouldn’t have left my cabin without a gun either. 

 

3. While guns have a role in American culture, their ubiquity also appears to have a not-insignificant role in killing Americans. It’s hard for me to forget one of my patients, a middle-aged woman who had just had her second son shot to death on a street corner with a handgun. And also to know that this push to remember the old America is brought to you -- in part -- by a segment of corporate America that makes money from selling guns.

 

I personally wouldn’t have brought up the issue in the HOD, nor would I have much patience for discussing it for hours and hours. However, regardless of where you come down on the issue of guns, a few minutes of talk about it won’t kill anyone, nor should it dampen one’s spirit for having a national professional association of PAs. I belong to PAFT as well and recognize that the AAPA is imperfect and in need of change. Without it though, as a profession, we would be toast.

 

Let's have a little patience for people who want to talk about things that we don't agree with. That's the American culture I choose to remember today.

 

While I can understand and agree with you there, as I've highlighted; the AAPA is not merely people. 

 

An association that supposedly represents nearly 100k professionals would do well to actually wait to get feedback from those they represent before making a political statement that proves to be a very divisive topic. Especially at a time when a group like the AAPA desperately needs to come across as unified.

[HLReed]

While I can understand and agree with you there, as I've highlighted; the AAPA is not merely people. 

 

An association that supposedly represents nearly 100k professionals would do well to actually wait to get feedback from those they represent before making a political statement that proves to be a very divisive topic. Especially at a time when a group like the AAPA desperately needs to come across as unified.

 

Like any representative democracy, the AAPA can only represent those who are actively involved in the process (the silent, by definition, are not heard). The point of the HOD is that anyone who wants to be involved in the process has a forum to present ideas and oppose said ideas. This IS the time for feedback. If you aren't an HOD delegate, you can contact the delegate that represents you and voice your concerns.

[SocialMedicine]

firearms is a medical and public health issue in the United States. Suicide and homicide are two large sources of mortality and morbidity among our patients. And the indirect health health consequences of survivors etc such as depression, post traumatic stress might be just as large. And the resulting anomie to society is enormous. So I do not think it inappropriate for the AMA or AAPA to be thinking about firearm issues. Not sure how I feel about the policy though. 

 

"1. Reporting by physician assistants to law enforcement agencies persons in their care exhibiting behavior dangerous to themselves or others making them unfit to purchase or own firearms. "

 

Unfit to purchase or own a firearm seems a bit subjective. Individuals with history of panic attack or major depression ? And is there even a mechanism to report this to the police other than dial 911 and make a report ? 

 

Interesting. I would love to see someone explore this further in JAAPA if it is passed. 

[FBIDoc]

I really love when people state that firearms are a public health issue, or that death by firearms is a large source of mortality in the US without either knowing the true data or by choice omitting it.  The most recent facts (2011 data) from the DOJ, FBI, and CDC are as follows, which clearly point to the fact that despite higher per capita firearm ownership than ever before, the exact opposite is trending:  mortality and morbidity are declining and violent crimes using firearms are at an all-time low

 

• violent firearms crimes are 49% lower than 1993
• accidental deaths by firearms account for 11,078 homicides and suicides 19,392  - fewer than falls, motor vehicle causes, and poisonings
• combined, all firearms mortality account for 16% of accidental death and 1.2% of all-cause mortality - to put this in perspective, there are more deaths in the US from Parkinson's disease and pneumonitis from solids than by firearms

My point here is that this is an emotional and political topic - not one that need be brought into the HOD or even an exam room IMHO.  It is not the place for a clinician to report to authorities whether or not a person should be legally allowed to posses a firearm.  It IS in our purview to report whether a person is a danger to themselves or others based on clinical information, and then it's up to the legal system to decide who should and shouldn't have firearms.  We need to stay away from the political side of this discussion.

 

I will say this: as a clinician and responsible gun owner, I advocate for gun safes, a thoughtful and effective background check system to prevent felons and the mentally ill from possessing weapons (not to be used as a registry of firearm ownership), continued work toward prevention of suicide, enforcing current applicable laws, and the teaching of the proper/safe use of firearms.