Great care for your patient starts with a strong team.

Adam J. Altman, MD

Angela Au Barbera, MD

Helga S. Barrett, OD

Jennifer H. Cho, OD, FAAO

Christine Gieringer, OD

David S. Goldberg, MD, FAAP

Marion J. Haligowski III, OD

Dawn Hornberger, OD, MS

Y. Katherine Hu, MD, MS

Lucinda A. Kauffman, OD, FAAO

Christina M. Lippe, MD

Barry C. Malloy, MD

Michael A. Malstrom, MD

Mehul H. Nagarsheth, MD

Abhishek K. Nemani, MD

Tapan P. Patel, MD, PhD

Jonathan D. Primack, MD

Kevin J. Shah, MD

Michael Smith, MD

Anastasia Traband, MD

Monica Wang, OD

Denis Wenders, OD

Linda A. Whitaker, OD, MS

With 20+ eye care specialists, Eye Consultants of Pennsylvania is the leading eye care practice in the region. Our doctors are always available for consults and referrals on eye issues, and our entire practice is committed to cooperative management of your patient. That means that we communicate and consult 360°. We share information, and we provide direct cell numbers to our partner physicians. And ultimately, it means better care and outcomes for your patients.

For consultations and referrals, call 610-378-1344.

Vision Correction (Including Bladeless LASIK) | Low Vision | Macular Degeneration | Neuro Ophthalmology Oculoplastics | Orthoptic Therapy | Pediatric Ophthalmology & Optometry | Vitreo – Retinal Surgery funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control” (Am J Public Health, 2018 July; 108(7): 865-867).

In the 26 years since the Dickey Amendment was passed, opportunities were lost while gun violence increased no more tragically than in multiple school shootings, e.g., Columbine High School, Colorado (1999), Sandy Hook Elementary, Connecticut (2012), Stoneman Douglas High School in Parkland, Florida (2018), and Robb Elementary in Uvalde, Texas (2022) to name only a few. in addition, these years have been marked by other mass shootings in churches, synagogues, and many other public venues across our nation. continued on next page >

Gun Violence and Public Health

continued from page 11

Such horrific events elicit grief, outrage and demands to “finally” do something about gun violence in America. However, the responses to such an outcry range from those who say the problem is one of a mental health crisis, not a gun problem (after all “it’s people who kill people not guns”), to those who demand the most restrictive gun legislation possible.

The United States is unique among many nations struggling with gun violence due to a very specific, and some say problematic, provision within the U.S. Constitution.

Second Amendment:

The specifics of exactly what the framers of our Constitution intended will be debated exhaustively. (Does a “well-regulated militia” mean that anyone can have any gun anywhere at any time?) However, no one will argue that the existence of this amendment complicates the debate involved in our national and local efforts to agree on steps to reduce injuries and deaths due to firearms. This tension frequently arises between courts and legislators who attempt to regulate who can have access to which firearms under what conditions.

In July 2022, Congress passed the “Safer Community Act,” the first federal legislation regulating guns since the passage of the Brady Handgun Violence Act (the “Brady Bill”) in November 1993, a span of nearly 30 years. This legislation:

• Creates a pool of $750 million dollars to encourage states to create “Red Flag” laws which would keep deadly weapons out of the hands of individuals determined by a court to be a significant danger to themselves or others.

• Expands protection for victims of domestic violence by including convicted “dating partners” as well as spouses in data bank notifications of abuse perpetrators.

• Cracks down on illegal gun dealers.

• Expands background checks including juvenile and mental helth records for gun purchasers under 21 years of age.

• Creates federal offenses for “straw purchasing” and “gun trafficking.”

• Provides $250 million for community-based violence prevention initiatives.

However, this legislation did not include restrictions on “assault weapons,” semi-automatic weapons, or high-capacity magazines which have been key factors in many mass shootings. A Pew Research Center study in July 2022 reported that six out of ten Americans want Congress to pass even stronger gun laws (pewresearch.org).

The Berks County Perspective

The County is suffering

Like so many other communities, Berks County suffers from the impact of gun violence. District Attorney John Adams sees this frequently. He states that guns are involved in approximately 90% of violent crimes that occur in our community. Furthermore, he notes that there has been an increase in homicides and gun violence in Berks and throughout much of Pennsylvania over the past two to three years. In particular, he has seen “a huge increase in the number of people charged with the offense of Persons Not to Possess” (18 PA section 6105), a statute that charges someone with illegal possession of a firearm because of an underlying criminal conviction. Our local police are especially concerned with this increase as more of their calls involve a firearm, a high-risk situation for everyone involved.

DA Adams believes we need to do a better job cutting the supply of firearms to those who are ineligible to possess but who obtain them through a “straw purchase” when another individual purchases that firearm for them. He also advocates for “legislation to completely stop the sale and possession of any type of ‘Ghost Gun’ (kits and privately made firearms that lack serial numbers and other identifying markings by design) as this type of gun has become a criminal’s best friend in their attempt to bypass our gun laws.” He states that the vast majority of our firearms crimes are committed by those who for many reasons including age, lack of a license and/ or prior criminal involvement to commit crimes with a firearm, do not have a legal right to possess one. “We see few incidents where a lawful gun owner uses a gun to commit a crime”.

Domestic and Intimate Partner Violence

One area where gun violence is all too common and tragic is the area of Domestic Violence or Intimate Partner Violence. According to Beth Garrigan, the CEO of Safe Berks, an advocacy organization for victims of intimate partner violence, abusive acts occur frequently and include psychological or physical behaviors that intimidate, manipulate, control or harm a partner, sometimes resulting in death. She states that “when guns are present in domestic violence situations, victims are five times more likely to be killed by their intimate partner.” In addition, “even if the abuser does not kill their victim, they may repeatedly use a gun to threaten, intimidate, and/or terrorize them to exert power or control.” Furthermore, the abuser may additionally threaten children or other family members.

The time of greatest risk for violence is when the victim is leaving the abusive relationship and that is when Safe Berks works particularly closely with victims to develop a safety plan. She states that one important means of preventing gun violence in Domestic Abuse situations is to limit an abuser’s access to firearms through such measures as Protection from Abuse (PFA) Orders. In Pennsylvania, all final PFA orders require relinquishment of firearms. Also in PA, anyone convicted of a crime of Domestic Violence must relinquish their weapons within 24 hours. While such laws at both the state and federal level have made improvements, there are still “loopholes,” and these laws are only as effective as their enforcement provides.

Preventing Violence in Schools

Another area where gun violence has been tragically encountered is in schools. Names like Columbine, Sandy Hook, Parkland, and Uvalde have become seared into the American psyche. Although statistically schools are some of the safest places for children, when violence and particularly gun violence occurs in schools, it is devastating. The Reading School District (RSD) is particularly aware of the threats facing children and youth today that put them in harm’s way. While there will always be conflict and stressful situations for students, the rise of social media has made such problems both more pervasive and subtle. Bullying and cyberbulling as well as feelings of isolation, loneliness, anxiety, and depression can cause intense feelings leading to suicide or acts of violence. According to Anne Fisher, Director of Student Support Services in the RSD, although school social workers, counselors and nurses have primary responsibility for student mental health, school personnel at all levels receive training to recognize children in distress. The RSD employs many external community resources as well as internal resources, e.g., the Aevidum “I’ve got your back” clubs for Middle School students. Safety training occurs for students and staff and parents are encouraged to be a part of efforts to decrease conflict and support the mental and physical health of their children.

Our Medical Community

Perhaps no group in our community, other than police, are more directly affected by gun violence than our Emergency Department/ Trauma physicians, nurses, and staff. According to Ankit Shah, MD, a staff physician in the Emergency Department at Reading Hospital, his staff treats approximately 100 gunshot victims each year. There are specific security protocols, “lockdowns,” initiated and the ED staff is placed on high alert. Gun shot wounds can be superficial but all too many are devastating, requiring intensive staff time and resources and these patients with their severe life-threatening wounds can have their own traumatic emotional impact on staff. His experiences have led him to the conclusion that guns and especially high impact guns with large volume clips or the aptly named “assault weapons” should be drastically restricted due to their potential for devastating and large-scale harm. In addition, his work convinces him of the need for effective gun safety measures. These include gun locks, separation of guns from ammunition, and secure storage requirements that will better prevent gun theft and guns from being used for criminal purposes, self-harm, or accidentally by children or others who do not have the knowledge or capability to protect themselves or others from harm.

The Effects of Mental Illness

When discussing gun violence, whether mass shootings or suicide, one issue that frequently arises is the role of mental illness. Does mental illness contribute to gun violence, and in particular, should a mental illness disqualify one from gun ownership?

Eduardo Espiridion, MD, Chair of the Department of Psychiatry at Reading Hospital/Tower Health, addressed these points. He argues that mental illness “should not be a blanket disqualification” for responsible gun ownership. However, there are psychiatric conditions, especially untreated ones, that raise alarms for safety concerns. Such individuals should be treated and addressed individually. One specific concern is “a person who is deemed high risk for completed suicide.” Such individuals should have their guns surrendered to family members or the police. It is always important to avoid stigmatizing those among us with a diagnosis of “mental illness” while seeing that they have access to the care they require.

A Public Health Approach to Gun Violence

There should be little doubt that gun violence is a major threat to the health and safety of our community. Physicians and their health care colleagues should therefore take an active role in reducing the incidence of violent firearm events as they would in preventing other threats to health and safety. Indeed, with their knowledge and experience of public health principles, physicians can be leaders in reversing this increasing tide of gun violence.

One successful example is the organization “Cure Violence Global” which is a “violence interruption program… that aims to stop the spread of violence in communities by using the methods and strategies associated with public health and disease control: detecting and interrupting conflicts, identifying and treating the highest risk individuals and changing social norms” (cvg.org). This organization was founded by Gary Slutkin, MD, a World Health Organization epidemiologist, who after ten years battling infectious diseases in Africa, returned home to the U.S. and asked why we could not employ the same public health principles to reduce our violence epidemic as he did to control HIV and tuberculosis in Africa. Over the past 20 years, “Cure Violence Global” has demonstrated proven results, through the application of public health principles in its many programs created to reduce the incidence of violence in communities around the world.