Gun Law Forces Mental Hospitals to Name Patients

As an unexpected consequence of a gun control law that took effect Jan. 1, the names of people admitted for mental health treatment at California hospitals are being recorded in state law enforcement computers.

Although meant to keep firearms away from those who are considered dangerous to themselves or to society, the practice also applies to psychiatric patients who voluntarily check themselves in for treatment and have no history of violent behavior.

Their names, addresses and the fact that they were admitted to a hospital are being entered into the files of the state Department of Justice even when these people have expressed no interest in obtaining a firearm.

Justice officials insist that the files are used only to determine eligibility in case any of these patients apply for firearm ownership. And they stress that the information is not being shared with other agencies. In the case of those who undertake treatment voluntarily, the officials also have pledged to destroy the medical records once the patients complete their therapy and are released.

Nonetheless, psychiatrists and other health professionals have expressed alarm about the practice, particularly how it is being applied to those who enter treatment on their own. They remain concerned about possible breaches of patient confidentiality. And although there is no evidence that patients have been frightened away from seeking treatment, these experts question whether some in need may reject help rather than have their conditions disclosed to law enforcement agencies.

“The worst outcome is that someone would refuse a hospitalization or the doctor would not recommend it . . . and the person ends up in a suicide. That would be horrendous,” said Dr. Thomas Ciesla, a psychiatrist at St. John’s Hospital in Santa Monica.

“People feel very strongly about the confidentiality of their medical records,” said another public health expert who asked not to be identified. “They are not comfortable when their records are collected in a central database by law enforcement.”

The decision to record the names of psychiatric patients stems from unprecedented new controls on firearms put into effect this year in two bills signed by former Gov. George Deukmejian.

The most far-reaching bill extended the 15-day waiting period, already required for the purchase of handguns, to rifles and shotguns. That measure, by Assemblyman Lloyd G. Connelly (D-Sacramento), included a provision that denies gun ownership or possession to those involuntarily held for psychological evaluations.

A second bill, by Sen. Barry Keene (D-Benicia), amended an obscure 1969 law that was meant to keep guns away from psychiatric patients during the period of their hospitalization. The effect of the amendment, however, was to require mental health facilities to provide information on psychiatric patients--regardless of whether they were admitted voluntarily or involuntarily.

The bill had escaped the attention of mental health advocates and the Justice Department until last fall, after it was signed into law. Keene indicated that he did not realize patients who were not considered dangerous would be included on the list.

Since Jan. 1, when the legislation took effect, the names of about 4,000 people who had been held involuntarily for psychiatric evaluation and found to be dangerous have been sent by hospitals to the department, said Fred Wynbrandt, assistant director of the law enforcement division. Ownership of firearms by these people is prohibited for at least five years.

The department said its screening process blocked the sale last month of guns to three of those on the computerized list. Shelley Rife, a department supervisor, said officials expect that the names of about 100,000 people who are considered to be a danger will be entered into the computers each year under the new law.

In January, hospitals also sent to Justice Department computers the names of about 3,000 hospital patients who are not considered dangerous, including those who are voluntarily admitted, people under conservatorships and patients unable to care for themselves.

Wynbrandt said alcohol and drug abuse residential care facilities, most of which use counseling as the basis for treatment, are not required to report the names of their patients.

Mental health professionals said in interviews that many of those who voluntarily seek hospitalization do so for treatment of common illnesses not necessarily connected with violence, including anxiety and panic disorders, depression, stress, dementia and some alcohol-related problems.

“There is absolutely nothing to indicate that this population of voluntary patients is any more dangerous than anyone else,” said Sandra Goodwin, a consultant to the Assembly Health Committee, which was not asked to review the bill before it became law.

Mental health authorities told The Times that it is still too early to assess the adverse impact, if any, of the reporting requirements on patient care. But they indicated that hundreds of thousands of names of mental patients--both voluntarily and involuntarily hospitalized--may be reported to the Department of Justice in compliance with gun control laws.

“Because of the stigma attached to mental illness, it takes a lot to get to the front door of a psychiatric facility,” Goodwin said. “This (new law) gives a person just one more reason not to accept voluntary treatment until it is too late.”

Sue North, director of governmental affairs for the California Psychiatric Assn., said she is also concerned that the requirement threatens the privacy rights of these patients.

“How paranoid do you have to be to see that as a possible infringement on your civil rights?” asked Dr. Peter Gruenberg of Los Angeles, president of the Southern California Psychiatric Society.

Top officials of the Justice Department have promised to give their highest priority to safeguarding the confidentiality of information gathered on psychiatric patients who are voluntarily admitted. Once these patients are discharged, computer records will be destroyed, they have assured hospitals.

Health professionals say that such assurances are not enough and note that it could take weeks or longer for state records to be purged once a patient has been discharged.

However, Wynbrandt of the Justice Department insisted that the information provided by psychiatric facilities is limited, contains no reference to a patient’s diagnosis or treatment and is intended to show whether the person is considered dangerous and ineligible for a firearm.

“I don’t see there is a conflict between medical confidentiality and what we are doing,” he said. “This is a public safety issue.”

Psychiatrist Ciesla, echoing the opinions of many colleagues, countered: “Anybody who says, ‘I’m from government. Trust me. I’ll help,’ that’s a standard joke in our community. Nobody believes that.”

Caught off guard by the new law, public and private hospitals and psychiatrists are exploring emergency legislation to change the law. They maintain that patients who voluntarily admit themselves to psychiatric facilities were inadvertently included in the new gun controls.

Keene, who introduced the bill that created the controversy, said he will examine the issue and may carry remedial legislation, if necessary.

“If we’ve overlooked sensitivity to the privacy issue, we may have to take another look at how to conduct background checks (that are necessary to) keep firearms out of the hands of people who are mentally unbalanced,” Keene said.

Meanwhile, there is continued distrust of Justice Department intentions by many mental health professionals.

Late last year, the department erroneously informed hospital officials that the confidential information would be included in criminal “rap sheets” and made available to police on a “need-to-know” basis. The error threw some psychiatrists, hospital officials and care providers into what one source described as “near panic.” Justice Department officials subsequently issued a correction. Yet suspicions persist.

Even with assurances that access to patient information is tightly restricted, mental health care providers find themselves caught between the dictates of the new reporting law, patient confidentiality statutes and their own ethical standards that restrict the dissemination of patient information.

“They see (the law) as a violation of their ethics,” said one legislative source.

Psychiatrists contacted by The Times, however, said that while doctors are reluctant to comply, they knew of none who refused to do so. Hospital spokesmen likewise said the names are being forwarded, some under protest.

Failure to report, they noted, could expose them to enormous liability lawsuits if a patient with no previous history of violence wounded or killed someone with a firearm.