Physicians’ perspectives on Extreme Risk Protection Orders (ERPOs) in the clinical setting: Challenges and opportunities for gun violence prevention

Abstract

Background Firearm-related injuries remain a heavy public health and clinical burden in the United States. Extreme Risk Protection Order (ERPO) laws, which create a path through a civil court process to temporarily remove firearms from individuals deemed to be at risk of harming themselves or others and are one strategy designed to reduce firearm violence. Maryland was the first state to authorize clinicians as ERPO petitioners. Objective We aim to document a sample of Maryland physicians’ perspectives about the utility of, any barriers to, and other thoughts on clinicians as ERPO petitioners. Design A series of semi-structured interviews with Maryland physicians identified through a combination of purposive and snowball sampling. We coded the transcribed interviews and analyzed the coded transcripts for themes using deductive content analysis. Setting/Participants 13 Maryland-based physicians interviewed over Zoom in and around Baltimore City, Maryland. Results The interviewees had overall positive feedback about ERPO as a gun violence prevention tool in the clinical setting. They identified several barriers to effective implementation such as time spent on paperwork and in court, a lack of awareness among clinicians about ERPO, threats to therapeutic alliance, and a sense of futility in a culture where firearms are easy to obtain. Solutions such as providing clinician education about ERPO laws, allowing for virtual court testimony, and creating a consult service with ERPO specialists to manage ERPO petitions were discussed. Limitations This study includes a small sample of Maryland-based physicians. Conclusions The physicians we interviewed expressed interest in knowing more about ERPO laws and emphasized education as an important tool for improving implementation. Addressing physicians’ concerns about ERPO implementation will improve their ability to be effective and efficient petitioners.

Older adults and planning for firearm safety: A qualitative study of healthcare providers

“…Our study is limited due to the small sample size, however, we captured a diverse range of providers caring for older adult firearm owners. Our secondary analysis of healthcare providers' perceptions of firearm safety planning is a novel and initial exploration of relevant themes, similar to other studies in the firearm literature 27–30 . Future studies should include larger sample sizes, with adequate representation to allow for thematic saturation by provider type and specialty.…”

“…Our secondary analysis of healthcare providers' perceptions of firearm safety planning is a novel and initial exploration of relevant themes, similar to other studies in the firearm literature. [27][28][29][30] Future studies should include larger sample sizes, with adequate representation to allow for thematic saturation by provider type and specialty. Most of our participants were white and two-thirds identified as having a liberal political orientation.…”

Women Veterans’ perspectives, experiences, and preferences for firearm lethal means counseling discussions

“…Given that participants voiced concerns that disclosing firearm access during clinical encounters may impact their ability to legally possess a firearm or that such disclosure may result in firearms being seized (a sentiment demonstrated in other qualitative studies) [11,65], it is essential to ensure that clinicians are well-versed in the rare instances in which seeking mental health care may have the potential to impact patients' firearm rights. Indeed, while participants in this study (and others) maintained apprehensions about disclosing firearm ownership status out of fear that doing so would result in involuntary firearm seizures or restrictions [11,65], such instances are rare; to date, only two states enable healthcare providers to act directly as petitioners for extreme risk protection orders (Maryland as of 2018; Colorado as of 2023) [66,67], and many healthcare systems (including the Veterans Health Administration) do not report directly to the National Instant Criminal Background Check System (NICS) [68]. Importantly, the disclosure of firearm access or ownership in itself is not a factor that impacts reporting on federal background check forms.…”

Integration of extreme risk protection orders into the clinical workflow: Qualitative comparison of clinician perspectives

“…We expand on prior research describing barriers and facilitators to clinicians' involvement in ERPOs [11,12] in several ways. First, we conducted this research in a state where clinicians cannot independently file an ERPO, which is the case for most states with an ERPO law.…”

“…Most clinicians have expressed willingness to independently file ERPOs; however, some clinicians remain hesitant due to lack of knowledge, concerns about time, and fears of liability [9][10][11][12]. Although the current model law published by the US Department of Justice calls for clinicians to be independent petitioners, only four states (Connecticut, Hawaii, Maryland, and New York) and Washington D.C. currently allow clinicians to file an ERPO.…”