Doctors Speak Out

In the wake of the mass shooting in Las Vegas, several Richmond medical care providers share their views on gun violence, plus more of the week's health news

by

The numbers are numbing: 59 dead, 530 injured Sunday evening in Las Vegas, the worst incident of its kind in recent American history. Through Wednesday, there have been 341 shootings in which at least four Americans have been killed or wounded since the beginning of the year, according to the website massshootingtracker.org; those shootings claimed 472 lives and left 1,761 wounded.

Two occurred in Richmond: a drive-by shooting on July 19, with five wounded, including two teen girls, and one on June 15 that left one dead and three hurt. The worst mass shooting in modern Virginia history was at Virginia Tech in 2007, resulting in 32 deaths.

Such stats don't even take into account shootings involving fewer victims, nor suicides and accidental shootings. In Virginia, firearms-related deaths are second only to drug overdoses in the number of state residents killed in 2016. They are expected to claim 985 lives in the state by year's end (a decline from 1,057 the previous year), according to a report on fatal drug overdoses from the Virginia Medical Examiner's Office. 

The opioid epidemic has resulted in a series of initiatives with bipartisan support to get it under control, but there's no such consensus when it comes to guns, a human tragedy that's sparked an unending debate when it comes to crafting a national legislative policy. But gun violence, like opioids, is also a public health issue. What's the proper response?

We consulted some of Richmond's health care providers for their insights. We asked each of them the following questions: 

  1. Should gun violence be considered a public health issue?
  2. What is the role (if any) of individual healthcare providers in addressing gun violence?
  3. What do you see as the role (if any) for state and federal healthcare agencies in addressing gun violence?

We also asked for any additional comments they cared to add. We received responses from three VCU Health professionals (Bon Secours and HCA declined to participate) and the director of the VCU Center on Society and Health. Responses, edited for clarity and brevity, follow.

Bela Sood

Senior professor for child and mental health policy and child and adolescent psychiatrist, Children's Hospital of Richmond at VCU

Any event that has an impact upon the physical or mental health of individuals becomes a health-related issue. In addition to the fact that gun-related events lead to significant mortality and morbidity (death and physical damage), [they carry] a high economic burden on health care systems.

Health care systems respond immediately to the crisis at hand by triaging and taking care of injured people in an emergency room. They provide direct care but also have to counsel the families of the injured and assess the needs of the individual and the community in the short and long term, both for long-term physical loss as well as mental health issues such as post-traumatic stress disorders, depression, anxiety and hypervigilance. These elements also have an impact on people's occupation secondary to missed work or absenteeism and loss of productivity.

In addition, the state office of the medical examiner has to handle the deceased victims of the event, which leads to a burden on the system. Debriefing, setting up autopsy arrangements and management of the dissemination of accurate information leads to enormous stresses on a system.

Psychological ramifications of trauma are felt not only by those who have lost an immediate family member but also by the extended family, the community they live in. The need for counseling services as well as the poor response to treatment of many of these conditions causes long-term health consequences and a prolonged health care burden.

In addition, such events cause a contagion of community fear and produce anxiety. Vulnerable individuals with baseline anxiety see an exaggeration of problems.

Gun violence is a preventable public health issue.

Whenever we consider a health care event, such as injuries from motor vehicular accidents or smoking-related lung cancer, the public health field studies the event carefully and determines what the risk factors are for poor health outcomes. That way, we are able to reduce the events by putting laws in place to mandate actions. There was a clear reduction of public hazard by mandating the use of seat belts to reduce deaths in motor vehicle accidents and also through prohibiting the use of tobacco in public places to reduce baseline rates of smoking and exposure to secondhand smoke.

Alas, funding has been missing in the public sector to study risk factors and effective interventions to put a stop to gun-related violence and reduce the incidence of the public hazard caused by unsafe gun practices. The Centers for Disease Control and Prevention have data on gun-related homicides and suicides but does not have the mandate to study this phenomena. It does so in other arenas with alacrity: [The] Zika virus and its threat, for example, produced a swift study and suggestions for intervention.

On a state and federal level, gun violence needs attention in a bipartisan way to solve this public health issue. The solutions require wisdom, foresight and a strategy in which it is a win-win for everyone, particularly for potential victims.

As a child psychiatrist, I see the irreparable damage done to the mental health of our children from the trauma related to gun violence. Today, I saw a 10-year-old child petrified because he had seen his 5-year-old cousin die last week by a self-inflicted, accidental gunshot.

Gun violence is also connected and strongly linked to suicide. The availability of instruments [that] can produce damage to such an extent in a short period of time clearly multiplies risk for completed suicide.

Unless we begin to recognize violence in all its forms, including that related to guns, diligently study risk as well as effective intervention strategies, our country will continue to see tragic events that have become all too common. It's time for a nonpolitical discussion of why gun violence is a preventable, expensive, public health issue. We should be investing the dollars spent in emergency rooms on prevention of these events. Let's learn about the causes of gun violence, effective ways to prevent it, and then create effective policies.

Robin Foster

Director, child protection team, Children's Hospital of Richmond at VCU, pediatric emergency medicine specialist

Gun violence has direct effects on the victims who receive morbid or mortal injuries ... but gun violence has a much broader effect in the neighborhoods in which it occurs, whether it happens once in a blue moon, as in Las Vegas, Sandy Hook or Blacksburg, or whether it occurs nightly, like in many large cities across the country. All those who are exposed to trauma are at risk of long-term medical and mental health issues including substance abuse, eating disorders, depression and anxiety. It is not only a public health issue ... it is a public health crisis.

As a pediatric provider, it is important to support parents with education and tools to ensure a safe environment for their children. Discussion of safe gun storage, gun locks and safe gun use should be addressed to minimize the risk of injury. Parents should understand that the person most at risk of being shot by a gun stored in the home is a member of the household, not a stranger. Health care providers, especially pediatricians, should also be advocates for families and children to embrace higher education and job opportunities that disrupt this cycle of violence that occurs in our urban neighborhoods. We need to advocate for alternatives to violence.

There is no other country in the world that has a similar degree of gun violence and mass-casualty shootings. I think it is time for state and federal health care agencies to engage in the prevention of gun violence. I think that prevention campaigns and education programs regarding gun safety and responsible storage and use must exist for all ages of people in the community. Improvements in mental health screenings done at routine health maintenance visits may serve to increase the identification of those who are in crisis and may pose a threat to public safety if [the person is] a current gun owner or having access to guns.

Michel Aboutanos

Medical director of the VCU Trauma Center

[Gun violence is] more of a public health crisis.

Health care providers play a significant role on many levels, especially regarding the impact of the violence on our patients, their families, and the recidivism that we see, especially at a trauma center.

I submit that it is indeed the health care provider who sees and experiences, on a daily basis, the effect of violence, the terrible injuries both physical and psychological, and who has the most social responsibility to speak out.

There's a need for advocacy to truly study the issues, look at the impact on the entire community, in terms of productive life loss, economic influence, and the type of programs that can be cost-effective in mitigating the risks. Without policies most efforts are limited.

We must look at a multidisciplinary, community-based approach with sufficient funding to truly evaluate the problems and the solutions.

Steven Woolf

Director, VCU Center on Society and Health, professor, Department of Family and Population Health

Gun violence is absolutely a public health issue, as are all causes of fatal and nonfatal injuries.

It is an especially urgent public health issue because of the large number of Americans who die each year from accidental and intentional shootings.

Clinicians play a role in the prevention of injuries, from advising their patients to use seat belts to the prevention of falls. Prevention in gun injuries is among those responsibilities. For many years, pediatricians have counseled parents to keep their weapons stored securely and separately from ammunition to avoid accidental firearm injuries to children. This continues to be recommended by the American Academy of Pediatrics.

The protection of the second amendment is a sensitive issue in the United States, but the death toll from firearms requires responsible efforts to stem the alarming use of lethal weapons and the possession of guns by individuals with mental illness. The death rate from guns in the United States far exceeds anything measured in other industrialized countries.

HEALTHY DEVELOPMENTS

A roundup of the week’s health and medicine news

  • Fine foods from five chefs are featured at Starry Night, a fundraiser for the Virginia chapter of the Cystic Fibrosis Foundation, to be held at 6:30 p.m. on Oct. 12 at the Altria Theater. The 24th annual event will feature creations from celebrated local chefs Brittanny Anderson, Walter Bundy, Lee Gregory, Dale Reitzer and Joe Sparatta. Drinks, music and an auction are also part of the event. $250 for an individual ticket and up, with 200 to 250 expected to attend.
  • Behavioral health care services will be expanded to refugees, Latin immigrants and underserved youth in Richmond through a $1.1 million grant to a Virginia Commonwealth University psychology professor, Heather Jones. The four-year federal grant will be used to increase the number of doctoral students in psychology who will provide care to the underserved through the Primary Care Psychology Training Collaborative at VCU, according to a release.
  • The nonprofit Reach Out for Life, which helps women in need receive free mammogram screening, will hold its annual golf tournament benefit, Swing for Pink, on Oct. 16 at Sycamore Creek Golf Club in Manakin-Sabot. It’s a four-person scramble format, $125 per golfer.
  • Free health care information with Virginia Commonwealth University experts is available through seminars offered at Lewis Ginter Botanical Garden. Upcoming sessions include: “Advance Directives Made Easy" at 5:30 p.m. on Oct. 17; “Early Detection of Lung Cancer” at 5:30 p.m. on Oct. 26; and “The What and Why of Diabetes” at 5:30 p.m. on Nov. 7.
  • Zebrafish research being conducted by a University of Richmond biology professor may lead to changes in how bone diseases are treated or lead to finding a way to reverse the effects of the diseases, according to a release. The researcher is Isaac Skromne, who has received a $340,000 federal grant to fund his work with a University of Miami, Florida, collaborator, to test therapeutic potentials of carbon nanodots in bone diseases. The dots, which can be used to deliver medicine to bones, will be made in the Miami research laboratories and shipped to Richmond to be injected into the fish for study, according to the release. 
  • Henrico Doctors’ Hospital has a new chief operating officer, Zachary Reed. According to a release, Reed comes to Richmond after serving as the director of operations for Northeast Georgia Medical Center in Braselton. Reed earned his master’s in health administration from VCU, and a bachelor’s in business administration from Marshall University.