APPs, HIPAA, and “red flags” with ERPOs

Firearm-related injuries are currently cited as the leading cause of death among youth in the United States [1].  More than 48,000 Americans died from homicides, suicides, or accidents involving a gun in 2021 [2].  

APPs cannot ignore two major facts:

FACT#1:  Americans have a constitutional Second Amendment right to keep and bear arms; Americans have the right to make responsible decisions to protect their families.

FACT#2:  Americans should not suffer death, physical injury, or psychological trauma from a public health issue that is 100% preventable.

As clinicians trained in science and facts, APPs must lead their communities in efforts to keep our children and neighbors safe and healthy.  Our physician colleagues from the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Emergency Physicians, the American Congress of Obstetricians and Gynecologists, the American College of Physicians, the American College of Surgeons, and the American Psychiatric Association – groups whose members represent most U.S. physicians – have long issued a call to action in addressing gun violence as a public health threat [3].  These groups have collaborated to create recommendations and solutions that do not infringe on our Second Amendment rights [3,4].  

PAs, NPs, and our professional organizations must also know how to address this critical public health issue.

One solution endorsed by our physician colleagues is Extreme Risk Protection Order laws. Commonly known as ERPOs or “red flag laws,” such laws allow for quick-intervention court orders to temporarily prevent a person “in crisis” from possessing or purchasing firearms [5].  

To date, 21 states and the District of Columbia have adopted ERPO laws: California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, and Washington [6].

Studies demonstrate ERPOs are a promising component of this public health crisis [7].  However, a concern I have as a clinician is whether medical professionals can petition for an ERPO for a patient without breaking HIPAA laws.

Petitioners who can legally request ERPOs vary from state to state and may include law enforcement, family members, and medical providers [5,6].  I practice in Michigan, and we just passed an ERPO law that will go into effect next year.  Michigan will allow APPs to petition for ERPOs, but other states limit healthcare workers’ ability to disclose such information.  

Does your state have an ERPO law?

Can APPs disclose a patient’s protected health information in your state to prevent or lessen potential firearm injuries?  

If you believe a patient presents a threat to themselves or others, do you know how to petition for an ERPO?

Nikki Rataj Casady, DMSc, PA-C

email@appcolleague.org