Texas Physicians Propose Mass Violence Prevention Strategies
By Sean Price


How should Texas address the incidents of mass violence that have rocked the state in recent years? Physicians laid out medicine’s priorities before a special committee of the Texas House of Representatives late last week.

The hearing of the House Select Committee on Mass Violence Prevention and Community Safety, which was held in El Paso, featured testimony from Alan Tyroch, MD, who spoke on behalf of the Texas Medical Association, and Joseph Penn, MD, who spoke for the Texas Society of Psychiatric Physicians.

Dr. Tyroch is chair of surgery at the Texas Tech University Health Sciences Center El Paso and the trauma medical director at University Medical Center in El Paso. He coordinated the trauma care for 14 patients after the mass shooting at an El Paso Walmart that killed 22 and wounded 26 last year.

Echoing TMA’s official policy on firearms, Dr. Tyroch said physicians recognize that gun ownership is associated with personal freedom and protection.

But, as with tobacco use and other health threats, TMA members “remain focused on proven prevention and harm-reduction methods in all areas of public and population health,” he said. “Physicians accept their role in addressing mass violence and firearm safety, and we are compelled to do all that we can to help protect our patients and their families.”

Dr. Tyroch outlined TMA’s eight recommendations for addressing mass violence:

  • Prioritize the prevention of firearm injuries and death with improved education about firearm safety.
  • Promote the Texas Hunter Education and Certification Program developed by the Texas Department of Parks and Wildlife.
  • Ensure patient-physician communication is protected so physicians can provide guidance on the dangers of firearm ownership in the clinical setting. This includes ensuring firearms are not accessible to children, adolescents, or people with mental, behavioral, or substance use disorders.
  • Strictly enforce federal and state gun control laws.
  • Promote the use of trigger locks and locked gun cabinets.
  • Equip and empower the Texas Department of State Health Services to perform unfettered study of issues involving firearms and public health. Texas should participate in national surveillance studies on violence in the U.S., ensuring the state has timely, accurate data on firearm-related issues.
  • Develop an effective process for implementing protective orders to respond to people reported to be at high risk of violence to themselves or others.
  • Align Texas law with federal HIPAA allowances on disclosing patient information for safety. Currently, HIPAA allows greater disclosure than state law of confidential patient information if the physician or provider determines there may be imminent physical injury by the patient to others.

The House committee – which previously met in Austin, Farmers Branch, and Odessa – also heard from Dr. Penn, a TMA member who is clinical professor of psychiatry at The University of Texas Medical Branch at Galveston and mental health director for UTMB Correctional Managed Care.

Mental health is not a predictor of – and not the major factor in – mass violence, he told the committee. Mental health services and patients have been stigmatized by widespread beliefs that mental health plays a large role in mass violence.

“Since it is difficult to imagine that a mentally healthy person would deliberately kill multiple individuals, it is commonly assumed that all perpetrators of mass violence must be mentally ill,” he said. But the “stereotype of an individual with a severe and persistent mental disorder such as schizophrenia, where schizophrenia is the sole factor contributing to mass violence, is unfounded.”

According to published research, including a 2018 study by the FBI, only 4% to 7% of people with mental illness alone were violent in any given year, and their risk of being violent accounts for only 4% to 5% of the total violence in the population, Dr. Penn says.

Also, there is no one-size-fits-all assessment tool that can help identify the next individual(s) who will commit mass violence, he says.

“Overall, the best predictor of future violence is past violence,” Dr. Penn said.

Last Updated On

February 03, 2020

Originally Published On

January 13, 2020