GPs push back against firearm health check

Some West Australian GPs are declining to take part in new firearm health assessments, saying the controversial reform creates ethical dilemmas, legal risks, and a strain on doctor-patient relationships.
 
Effective as of 31 March, new state laws require gun owners, or those seeking gun ownership, to have a medical professional, including GPs, complete a Firearm Authority Health Assessment every five years to attest to whether they are physically and mentally fit to own a gun.
 
However, a number of GPs are choosing not to partake in the process.
 
This doesn’t come as a complete surprise. A newsGP poll in July 2024 found 80% of respondents said they would not be willing to do a health assessment for gun licencing purposes.
 
RACGP WA Deputy Chair Dr Mariam Bahemia told newsGP there is no denying that some GPs have concerns about their involvement in the process, but adds that it is ‘still early days’.
 
‘It is true that not all GPs feel comfortable completing the assessment for all patients and therefore some are declining to complete it,’ she said.
 
‘But it is important to note that WA GPs are not deliberately obstructive, we just take our responsibilities seriously.
 
‘Not all applicants for the health assessment will have complicated physical or mental health histories, and each GP needs to consider each patient individually. There are many people around the state who, for different and valid reasons, require a firearm authority, and many GPs will feel comfortable assessing their patients, and forming a determination based on that patient’s history.
 
‘GPs perform health assessments and make decisions of significance for their patients every day they go to work. However, the Firearm Health Assessment has left many feeling deeply unsettled.’
 
She, along with Dr Richard Taylor, who is an experienced rural GP, worked on the Health Assessment Working Group representing the RACGP’s WA Faculty for two years.
 
During that time, the WA Deputy Chair says they expressed concerns on behalf of the state’s GPs about certain aspects of the assessment and ‘raised foreseeable issues relating to its implementation within general practice’.
 
One of the most pressing concerns raised by GPs was the potential to be held responsible, or be required to appear in the court, in the instance that a health assessment leads to a determination of fitness to hold a firearm, and the patient goes on to commit an act of violence or self-harm.
 
This concern has been further amplified by an inquest currently underway into a stabbing attack that took place in Bondi Junction in April 2024, which resulted in seven deaths. The killer’s former psychiatrist has appeared in court, while his GP is also testifying this week.
 
WA Police has advised that GPs who put their name to a health assessment will be protected from civil or criminal liability should a firearm-related incident occur.
 
However, Dr Bahemia says for GPs, it is more complicated than that.
 
‘Despite reassurances from WA Police, many feel they may be held responsible for decisions and determinations they made in good faith, when a firearm owner is involved in an incident or act of violence,’ she said. 
 
‘We have been reassured by WA Police our assessment is “just a point in time” but we know our patients are not just that.
 
‘The assessment of “fitness” may sound simple, but mental and physical health issues can and do fluctuate. There must be an understanding by the WA Police, GPs and the community, that providing an accurate prediction of risk is not always possible.
 
‘GPs care about the wellbeing and safety of their patients and of the community at large. Protections against civil and criminal action are reassuring, but this does not protect a doctor from the weight of responsibility for the decisions they make.’
 
Dr Bahemia said there are a host of other professional and ethical concerns, which GPs fear could impact the doctor-patient relationship.
 
While the WA Government had provided assurance that the final decision to grant or deny a firearm licence sits with the Commission of Police, she says GPs are concerned patients may delay, or avoid, presenting with physical or mental health issues due to fear that their history could hinder their ability to own a firearm.
 
‘GPs are concerned about balancing the confidential history of our patients, which must be protected and balanced against the safety of the community,’ she said.
 
‘There are also concerns about the nature of confidential information provided to us, and an erosion of the doctor-patient relationship.’
 
Further to that, Dr Bahemia says GPs fear hostility from patients in the instance that they either decline to do an assessment or make a determination that contributes to their application being declined.
 
This presents particular challenges for rural and remote GPs, who are often a part of small, tight-knit communities. 
 
Dr Bahemia says from the moment the reform was first flagged, the college had had particular concerns for rural and remote GPs for whom she says the process will be ‘more burdensome’, with many already ‘stretched to their limits’.
 
‘It would be beneficial if GPs could be assured of support in terms of better access to non-GP specialists and psychiatrists, occupational therapists and psychologists to assist them with patients in whom there may be some concerns about physical or mental health aspects in their history,’ she said.
 
‘However, this support is already limited in these areas, and it is also expensive. There needs to be better, more timely access.’
 
The RACGP’s WA Faculty, together with WA Police, hosted a webinar in March titled ‘FAHA: What’s GPs need to know’ to provide a comprehensive overview of the process, along with resources for GPs. A recording is available on the RACGP website.
 
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FAHA firearms gun law reform medico-legal mental health