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Medicine and Public Issues
20 August 2019

Extreme Risk Protection Orders Intended to Prevent Mass Shootings: A Case SeriesFREE

Publication: Annals of Internal Medicine
Volume 171, Number 9

Abstract

Urgent, individualized interventions to reduce firearm access, such as extreme risk protection orders (ERPOs, colloquially known as “red flag” orders), provide a rapid, focused response when risk for imminent firearm violence is high. Studies to date suggest such interventions are most commonly used to prevent suicide and are effective. Authorizing legislation has often been enacted after public mass shootings but, to our knowledge, there have been only 2 reported cases of ERPO use in efforts to prevent mass shootings. California enacted the nation's first ERPO statute, which took effect in January 2016. The authors are evaluating that statute's implementation and effectiveness and are seeking to obtain court records for all 414 cases occurring in 2016 to 2018. Based on 159 records received thus far, this article presents an aggregate summary and individual histories for a preliminary series of 21 cases in which ERPOs were used in efforts to prevent mass shootings. Most subjects were male and non-Hispanic white; the mean age was 35 years. Most subjects made explicit threats and owned firearms. Four cases arose primarily in relation to medical or mental health conditions, and such conditions were noted in 4 others. Fifty-two firearms were recovered. As of early August 2019, none of the threatened shootings had occurred, and no other homicides or suicides by persons subject to the orders were identified. It is impossible to know whether violence would have occurred had ERPOs not been issued, and the authors make no claim of a causal relationship. Nonetheless, the cases suggest that this urgent, individualized intervention can play a role in efforts to prevent mass shootings, in health care settings and elsewhere. Further evaluation would be helpful.
Urgent, individualized interventions to reduce firearm access provide a rapid, sharply focused response when risk for imminent firearm violence is high and alternative measures, such as arrest or psychiatric hospitalization, are inappropriate or have been ineffective (1–3). Special-purpose, court-issued restraining orders are most common; these are properly referred to as extreme risk protection orders (ERPOs) and are known colloquially as “red flag” orders. Policies and procedures for ERPOs are based on those for domestic violence restraining orders. Petitions can be submitted to the court by family members; by law enforcement officers; and, in Maryland, by physicians and other health professionals. As of August 2019, fifteen states and the District of Columbia have enacted ERPO statutes. Two other states use a related firearm recovery procedure known as a risk warrant, which can be issued by a judge following a request from law enforcement.
Both ERPOs and risk warrants rely on actions by judges or other judicial officers and include due process protections. They provide for immediate firearm recovery and a time-limited prohibition on possession and purchase of firearms and ammunition. Studies to date suggest such interventions are most commonly used to prevent suicide and are effective for that purpose (3–5).
History links these interventions to public mass shootings as well. Legislatures in Connecticut, Indiana, California, and Florida enacted ERPO or risk warrant laws after public mass shootings occurred in those states. Postevent investigations of mass shootings suggest that ERPOs and risk warrants can play a role in preventing them. Nearly 80% of perpetrators of mass violence in public places make explicit threats or behave in a manner “indicative of their intent to carry out an attack” (6, 7). For example, public mass shootings in Parkland, Florida (8); Aurora, Colorado (9); and Tucson, Arizona (10), among others, were committed by assailants known to family members, acquaintances, law enforcement agencies, and in some cases health professionals to be at high risk for violence. Public mass shootings in California, Texas, and Ohio in late July and early August 2019 have led to widespread discussion of the potential for ERPOs to prevent such events (11, 12) and reports that Congress may consider legislation to create a federal ERPO policy (13).
To our knowledge, there have been only 2 reported cases of ERPO use in efforts to prevent mass shootings. In Vermont, an 18-year-old man described the Parkland shooting as “fantastic” the day after it occurred, made concrete threats (even to the police), wrote plans to commit a mass shooting at his school (“I'm aiming to kill as many as I can”), and owned firearms (14). Vermont's first ERPO was issued against this man in April 2018, the day after the governor signed the authorizing legislation (15). In December 2018, an ERPO was obtained for a Washington man accused of threatening a mass shooting at a synagogue (“I'm shooting for 30 Jews”) and a school. Twelve firearms were recovered (16). Neither of these credibly threatened mass shootings occurred.
California enacted the nation's first ERPO statute (17), which took effect in January 2016. We are evaluating the implementation and effectiveness of that statute and describe here a preliminary series of 21 cases in which ERPOs were used in efforts to prevent mass shootings. Descriptions include outcome data through August 2019.

California's ERPO Policy

In California, ERPOs are known as gun violence restraining orders (GVROs). Law enforcement officers may petition for temporary emergency GVROs 24 hours a day. During business hours, law enforcement officers and family members may petition for what the statute refers to as ex parte GVROs (orders issued in response to a request by one party to a case, without a hearing). Ex parte petitions are usually acted on by a judicial officer the day they are filed. Emergency and ex parte orders last up to 3 weeks. Petitioners may also request a GVRO issued after notice and hearing (“order after hearing”), which can last up to 1 year. At the hearing, which is required, the burden is on the petitioner to establish that the order is justified.
The level and immediacy of threat required for a GVRO varies with the type of order being requested. The subject must pose “an immediate and present danger” (18) for a temporary emergency order, “a significant danger, in the near future” (19) for an ex parte order, and “a significant danger” (20) for an order after hearing. The standard of evidence that must be met also varies—”reasonable cause to believe” for a temporary emergency order (21), “substantial likelihood” for an ex parte order (22), and “clear and convincing evidence” for an order after hearing (23). Judicial officers must follow specific rules of evidence in considering petitions for ex parte GVROs and those issued after a hearing (24). Under California law, all firearms and ammunition to which a prohibited person has access are subject to recovery, regardless of whether the prohibited person owns them. (Prohibited persons include, among others, persons subject to GVROs, felons, and persons convicted of violent misdemeanor crimes.) Search warrants can be issued as needed.

Methods

We have requested county court records for the 414 GVRO cases initiated in 2016 to 2018 and registered with the California Department of Justice. The registry contains extremely limited information, including subject identifiers, demographic characteristics, and location; petitioner name; order type and dates; court with jurisdiction and its case number; and information on service (delivery) of the order. More detailed information is usually available in court records. Although these are public, courts may require physical presence at the courthouse to obtain a copy.
Courts have thus far provided 159 records, from which we present here all 21 cases in which 1) a judicial officer issued a GVRO after the subject of the order had made a clear declaration of intent to commit a mass shooting or had exhibited behavior suggesting such an intent, and 2) the subject had or would soon have access to firearms. We conducted print, broadcast, and Internet media searches using Google, based on subjects' names and locations, from subjects' GVRO dates through August 2019 to identify post-GVRO violent events (mass shootings, homicides, or suicides) committed by study subjects.

Results

Cases were identified in 10 counties. Most subjects were male and non-Hispanic white; the mean age was 35 years (range, 14 to 65 years) (Table 1). The source population of 414 persons subject to GVROs was older (mean age, 42 years [range, 15 to 92 years]) but was also predominantly male (91%) and non-Hispanic white (61%).
Table 1. Characteristics and Outcomes of 21 Cases in Which GVROs Were Used in Efforts to Prevent Public Mass Shootings
Table 1. Characteristics and Outcomes of 21 Cases in Which GVROs Were Used in Efforts to Prevent Public Mass Shootings
Four cases representing the range of circumstances in which GVROs were issued are summarized in Table 2, and the remaining summaries appear in the Appendix. Most subjects made explicit threats and owned firearms (Table 1). Four cases arose primarily in relation to medical or mental health conditions, and such conditions were noted in 4 others. In 14 cases, petitions were filed by law enforcement officers acting on information provided by members of the public. Fifty-two firearms were recovered, 26 of them in 1 case. In 3 cases, subjects had very recently purchased firearms but, as a result of California's 10-day waiting period, had not yet acquired them. These acquisitions were blocked by GVROs; according to California Department of Justice records, these subjects did not own other firearms.
Table 2. Summaries of 4 Representative Cases*
Table 2. Summaries of 4 Representative Cases*
Orders after hearings were issued in 14 of 15 cases in which they were requested. No mass shootings, other homicides, or suicides by persons subject to GVROs were identified.

Discussion

In these cases, GVROs allowed for immediate intervention to reduce firearm access, in most instances because of timely reports from threatened parties and members of the public. It is impossible to know whether violence would have occurred had GVROs not been issued, and we make no claim of a causal relationship. This is a preliminary report that is subject to other limitations. The cases are not taken from the full population of 414 and may not be representative of all GVROs involving threatened mass shootings. The seemingly high proportion of threatened mass shootings among GVRO cases (13% in this study) may also not be representative. The higher mean age for all 414 cases is expected if, in California as elsewhere, most ERPOs are issued in response to concerns about suicide; risk for suicide among non-Hispanic white men increases with age (25).
The limitations notwithstanding, these cases suggest that this urgent, individualized intervention can play a role in efforts to prevent mass shootings, in health care settings and elsewhere. In their demographic characteristics, frequent declarations of intent, declarations of animosity toward targeted populations, and access to firearms, these individuals resemble persons who have committed mass violence (6, 7, 26–31). California has responded to concerns that the policy might be abused by making it a misdemeanor to file a GVRO petition “knowing the information in the petition to be false or with the intent to harass” (32). Further evaluation of the implementation and effectiveness of ERPO policies in California and other jurisdictions where they have been enacted would be helpful.

Appendix: Case Summaries

Cases are grouped by primary event characteristic. Individual cases may have features associated with several characteristics. Cases 1, 8, 13, and 17 are also reported in Table 2 in the main text.

Workplace Targeted

Case 1

A car dealership manager contacted police after a 30-year-old male employee threatened to shoot his supervisor and other employees if he was fired. He told the person to whom he declared his intentions that he would warn him first so that he could escape. Shortly after the mass shooting in Las Vegas, Nevada, he had reportedly commented, “If I were him, I would shoot up a mosque and then shoot it out with the cops.” The dealership was planning to suspend the subject the morning after they contacted the police. California Department of Justice records indicated that the man's wife owned 2 handguns, a shotgun, and a rifle. A GVRO was obtained the following day, 5 firearms were recovered, and a 1-year order after hearing was subsequently issued.

Case 2

A member of the public reported to the California Department of Justice that a 21-year-old man whose employment was recently terminated had threatened to shoot coworkers. Investigation revealed the recent purchase of a shotgun, with the 10-day waiting period expiring in 2 days. Agents served a GVRO the following day and notified the retailer to confirm that the firearm would not be released. Four hundred rounds of shotgun ammunition were recovered during a search of the subject's home. The subject contested the order and denied making threats, but a 1-year order after hearing was subsequently issued.

Case 3

A car dealership hired armed security and reported to police that a 65-year-old male employee had returned to the dealership a day after being fired stating that he could “take somebody out.” During the week before he lost his job, the man told a coworker he would come to work armed to frighten the manager and came wearing an empty handgun holster; the handgun was in his vehicle, which was parked in the dealership's lot. The subject, a veteran, told investigating officers that he had extensive experience with firearms, owned many but had none at home, and was familiar with explosives. When officers asked if there was reason to be concerned about him hurting his former coworkers, he responded, “If we were back on the border of Syria and Israel then hell [yeah].” California Department of Justice records identified him as the owner of 1 handgun. Officers obtained a GVRO the following day, and the court subsequently issued a 1-year order after hearing.

Case 4

A 33-year-old man quit his job with an armed security service after a dispute with a supervisor. Over the next 11 days, he threatened to shoot a specific former coworker and texted others to say that he was watching them and could kill them if he wanted to. The threatened coworker and the company reported the man's behavior to the local police 4 times. California Department of Justice records indicated that the subject owned 4 handguns, a GVRO was obtained, and a 1-year order after hearing was subsequently issued.

Case 5

During telephone calls with his mother and a family friend, a 24-year-old man with a history of excessive alcohol and marijuana use threatened to kill employees of the family business, his family, and himself the following day by shooting or bombing. He had threatened employees twice previously, and a prior conviction for a separate weapons offense had led to residential mental health treatment. The subject's uncle closed the business because of safety concerns, reopened the next workday with private security on site, and reported the incident to the police 3 days later. The subject's mother petitioned for a GVRO 3 days after the uncle contacted the police, and the order was issued. The subject filed an agreement with the order and surrendered 26 firearms (1 shotgun, 4 rifles, 2 assault-type rifles, 18 semiautomatic pistols, and 1 of unspecified type). A 1-year order after hearing was subsequently issued.

Case 6

A 48-year-old male police officer attempted suicide by shooting himself in the head at police headquarters. He survived but later resigned, blaming workplace mistreatment for his suicide attempt. The man's firearms were recovered during a search of his residence, but he retained access to 2 shotguns belonging to a household member. About 8 months after his suicide attempt, he accused members of the police department of continued harassment and stalking. The police headquarters lobby was kept locked with armed officers on duty. A week later, the subject returned to headquarters with the shotguns, claiming that they had been tampered with. Because the household member was unwilling to deny the subject access to the shotguns, the police department obtained an emergency GVRO, recovering the shotguns (along with replica handguns). One-year orders after hearing were issued for the ensuing 2 years.

Case 7

A 37-year-old man celebrated his birthday by target shooting with a coworker, after which they and a friend used alcohol, marijuana, and cocaine. During the celebration, the subject told his companions that he would bring his firearms to the local gas station where he worked and kill infidels and nonbelievers. The coworker contacted police, who obtained an emergency GVRO, contacted the subject 2 days later, and recovered 3 firearms (a pistol and AR-type rifle from the subject's home and a shotgun from his cousin's home). The AR-type rifle did not have a serial number and had prohibited design elements, so the subject was arrested for possession of an assault weapon. A temporary order was petitioned for and granted after the emergency order expired. A 1-year order after hearing was subsequently issued.

School or Children Targeted

Case 8

A 21-year-old male posted a series of threatening statements on Instagram that were directed at his former high school, including, “Rip [name deleted] high school,” “Nobody w[ill] be graduating from [ZIP code deleted],” “I hate all of u,” “Hope I die tonight somehow,” and “Dead or in jail.” An acquaintance who saw the posts flagged down a police officer, and a different acquaintance reported a post that appeared to show the man holding an AR-type rifle. Both reporting parties were aware of prior school shootings and were concerned about a recurrence. The school district learned of the threats the following day and closed the school, and the subject was arrested that afternoon on a charge of making a threat with intent to terrorize. A temporary GVRO was obtained, and a 1-year order after hearing was subsequently issued.

Case 9

A high school assistant principal contacted a juvenile services police officer after a 15-year-old male student spoke favorably of the Parkland shooting, stating that “school shooters are gods,” and threatened a mass shooting and bombing at a school assembly scheduled to take place in 2 days. The subject had also threatened the student who reported this information and was suspended from school for 5 days. The subject had a prior history of violent threats, racist behavior, and telling other students that he could get access to firearms. Police arrested the subject at his home on a charge of criminal threat and obtained a GVRO. The case was subsequently dismissed at the request of the petitioning agency.

Case 10

A school administrator reported to the police that a 14-year-old male student with a history of racist comments at school had posted videos on Instagram of himself using firearms, favorable comments about school violence and shootings, racist comments, and suggestions of animal cruelty. A related investigation had determined that the student used school computers to research firearms and search on terms such as “white power.” His father owned a 9-mm semiautomatic pistol and a .30-caliber rifle. The student was taken into custody for an emergency psychiatric evaluation and claimed that he had been joking. A GVRO was obtained, and the father's firearms were turned in to a licensed retailer the day the order was served. A 1-year order after hearing was subsequently issued.

Case 11

Five children aged 11 to 15 years contacted police after a 62-year-old woman told them she was going to “blow their heads off” while pointing what appeared to be a firearm at them. The investigating officer interviewed the subject at her home shortly after interviewing the children. The subject confirmed her behavior but reported that the object was a paper towel roll wrapped in black duct tape. She added that a real revolver was under a table in her living room and gave the officer permission to search for it. The officer obtained an emergency GVRO while at the subject's home, took custody of the firearm, and arrested the subject on a charge of criminal threat. The subject continued to state that she would like to “teach those kids a lesson” and “go to their homes to finish off each one of them.” A 1-year order after hearing was subsequently issued.

Case 12

When the principal and a security officer at an elementary school approached a 26-year-old man after he drove over a planter into the school's parking lot, the man threatened to punch someone. After being asked to leave, he stated he was going to explore the school grounds, drew a knife, and threatened to stab the principal and officer. More officers arrived and took the subject into custody after a struggle. Investigation revealed that the subject was scheduled for jury duty 2 days after the incident, had posted images of ammunition and vague threats to his family on Facebook, and owned a Glock semiautomatic pistol. The police obtained a temporary GVRO while the subject was still in custody, citing concern that he might return to the school to seek revenge for his arrest, and recovered 1 firearm from him. A 1-year order after hearing was subsequently obtained.

Medical or Mental Health Condition

Case 13

Employees at a Veterans Service Center that supplies social and behavioral health services contacted the police early on a Friday evening, immediately after a 48-year-old client threatened them while on speakerphone, “I'm going to come and hunt you down and take you out! Don't think I'm a little worm, I can take you all out, I know where you all are!” The client was a Gulf War veteran diagnosed with posttraumatic stress disorder. On the basis of their prior contacts with the subject, the employees believed the threats were credible. After interviewing the employees, the investigating officer went to the subject's home, arrested him on a charge of criminal threat, and presented a petition to a judge by telephone on Saturday. A GVRO was issued. At the hearing for a 1-year order after hearing, the subject denied possessing firearms. The order was issued.

Case 14

Just after 1:00 a.m., a 47-year-old man deliberately drove his SUV onto a sidewalk and accelerated toward pedestrians, shouting “I'm going to kill you!” The man fled the scene without hitting anyone but was taken into custody and arrested a few minutes later on a charge of assault with a deadly weapon. A month earlier, the man's father had contacted the police concerned that his son was acting delusional and paranoid and was claiming he might die that day. The father reported that his son owned 4 handguns, 3 AR-type rifles, and a shotgun. California Department of Justice records, which do not include rifles and shotguns acquired before 2014, indicated that the man owned 10 handguns. The subject had prior contact with law enforcement related to controlled substance use, delusions, and violent threats and reported having several firearms in a safe in his apartment. A GVRO was obtained the day after his arrest, 8 firearms were recovered, and a 1-year order after hearing was subsequently issued.

Case 15

An orthopedic clinic contacted the county sheriff immediately after a 44-year-old male patient, upset about his treatment, left the clinic threatening to retrieve his shotgun from his home and shoot everybody in the clinic. Deputies went to the patient's home, where his vehicle was present but his mother declined to provide information. Four days later, the patient contacted his health insurer threatening to shoot insurance company employees and clinic staff and stating, according to the deputies' report, that “the next time he was going to be seen was on CNN” and that “if they were going to mess with his health, he would mess with theirs.” The following morning, deputies returned to the patient's home, where his mother again declined to assist. They contacted the patient, who was inside the house, by telephone; he reported possessing a rifle and a shotgun. California Department of Justice records confirmed he owned 2 semiautomatic pistols. Deputies obtained an emergency GVRO, persuaded the patient to come out of the house, and informed him of the order. After obtaining a warrant, they searched the house and vehicles belonging to the patient and his mother, recovering shotgun and rifle ammunition but no firearms. The patient was arrested on a charge of criminal threat, and a criminal protective order was issued 2 days later. Bail was set at $100 000, and the patient remained in custody during the adjudication of his case. About 4 months later, he pleaded no contest to a felony charge of criminal intent to terrorize and was ordered to show proof of relinquishment of his firearms. The patient reported that his 2 handguns had been stolen and that he had given his rifle and shotgun to friends.

Case 16

Law enforcement officers responded to a call from a trailer park about a 58-year-old intoxicated man who was threatening to kill people because he had cancer and could not be “fixed.” The man threatened to kill any law enforcement officers who approached his trailer and to kill others if officers left the scene. After several hours of negotiation, during which the subject told the agency dispatcher that he had loaded his firearms, he was persuaded to leave his trailer. Officers had obtained a temporary GVRO; they arrested the man, took him to jail after emergency department evaluation, and recovered a shotgun and 2 handguns from his trailer. The subject was released on bail 2 days later with a prohibition from firearm or ammunition possession during adjudication of his case.

Political, Social, or Domestic Motivation

Case 17

An acquaintance of a 31-year-old man who was known in his Muslim community as a supporter of the Islamic State contacted police to report that the man made repeated threats of mass violence. The acquaintance was concerned about a mass shooting at a nearby mosque or shopping mall. Investigation revealed that the man was on the Terrorist Screening Center Watchlist. He was not known to own firearms but had recently purchased an FN 5.7 semiautomatic pistol, a powerful handgun originally available only to military personnel and law enforcement officers. Because of California's 10-day waiting period, the subject had not yet acquired his handgun. The police contacted the California Department of Justice, which obtained a GVRO the following day, preventing acquisition of the firearm. No information on an order after a hearing was available.

Case 18

The Federal Bureau of Investigation (FBI) contacted a local police department about a 22-year-old man who was the close associate of a man recently charged with providing material support to the al-Nusra Front, a foreign terrorist organization. Both men had traveled to Turkey on one-way tickets, possibly to cross into Syria, but had returned to the United States. According to the FBI, the al-Nusra Front encouraged its members to engage in lone-wolf attacks on large public gatherings rather than joining the conflict in Syria. One week before the FBI contact, the 22-year-old man, who was not previously known to own firearms, purchased an AK-47–type rifle, meaning that the 10-day waiting period would expire in 3 days. The man had begun working at an indoor firing range 1 month earlier but was fired the day before the FBI contacted the police. According to the FBI's interview with the range manager, the man disliked dealing with customers but was very interested in handling firearms. He lived within walking distance of public events, scheduled 2 and 3 weeks later, that were expected to draw 50 000 to 100 000 people. The police department obtained and served a GVRO the following day, blocking acquisition of the rifle. A 1-year order after hearing was subsequently issued.

Case 19

A woman contacted the police to report that the previous evening her intimate partner, a 32-year-old man who lived with her and her 22-month-old son, had stated that he slapped the child while she was at work, leaving red marks on the child's face. The woman left with the child and presented to the police station the following morning for an interview. She reported more than 10 prior similar events. That morning, she received text messages from the subject, including, “I promise you. If something, or anything happens to me or my things, I will be karma. And I will come back 10 fold on anybody and everybody,” and “I don't want to shoot or kill anybody. But I'm promising you if something does happen. And if I pull the trigger on one person. I'm not stopping there until I'm caught.” The woman was aware that the subject owned an AR-type rifle, an AK-type rifle, a .22-caliber rifle, and 2 semiautomatic pistols. Police obtained an emergency GVRO that day, arrested the man, and recovered 1 handgun. A temporary order was issued 5 days later. According to the petition, the subject still had access to firearms. A judge dismissed the matter 3 weeks later at a hearing that the petitioning law enforcement agency did not attend.

Case 20

A 21-year-old man pointed a gun at another person stating that he could kill him any day of the week, that it was very easy to kill people, and that he would not mind killing others. He told the threatened person that he had killed 4 people who were terrorists. Law enforcement obtained an emergency GVRO. No further information is available.

Case 21

A 47-year-old woman was the mother of a young man shot and killed by police officers. At a public hearing of that department's police commission 10 weeks later, she stated repeatedly that because police officers had killed her son, she intended to kill police officers. Twelve days after the hearing, a search of California Department of Justice records identified the subject as the owner of 4 handguns. Two weeks after that, a temporary GVRO was issued. The subject denied possessing any firearms. A petition for an order after hearing was denied.

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Garen J. Wintemute, Veronica A. Pear, Julia P. Schleimer, Rocco Pallin, Nicole Kravitz-Wirtz, Elizabeth A. Tomsich30 October 2019
Counting the Unpredictable--Authors' Response
As the commenter notes, we drew no inference of a causal relationship between the use of gun violence restraining orders and the non-occurrence of mass violence in the 21 cases we reported; the commenter is counting “saves,” not us. He appears to raise the larger question of the effectiveness of extreme risk protection orders (ERPOs). As we reported, three studies have found an association between use of ERPOs and reduced risk of suicide, with a number needed to treat of 10-20 for prevention of a fatality (1-3). These are very promising findings, and we look forward to further information on the outcomes of extreme risk protection orders in California and elsewhere.

References
1. Swanson J, Norko MA, Lin MH-J, et al. Implementation and effectiveness of Connecticut’s risk-based gun removal law: does it prevent suicides? Law Contemp Probl. 2017;80:179-208.
2. Swanson JW, Easter MM, Alanis-Hirsch K, Belden CM, Norko MA, Robertson AG, et al.
Criminal justice and suicide outcomes with Indiana’s risk-based gun seizure law. J Am Acad
Psychiatry Law. 2019. Online publication ahead of print April 15. DOI:10.29158/JAAPL.003835-19.
3. Kivisto AJ, Phalen PL. Effects of risk-based firearm seizure laws in Connecticut and
Indiana on suicide rates, 1981–2015. Psych Serv Adv. 2018;69(8):855-862.
Charles Jessee28 October 2019
Counting the Unpredictable
With the link between mental illness and gun violence being hotly debated, mental health care professionals maintain they have little or no ability to predict who will become lethally violent. “...45 percent of the mass public shooters from January 1998 through June 2019 were seeing mental health care professionals within six months of their attacks.” (What type of gun control will actually make us safer? John R. Lott, Jr. President, Crime Prevention Research Center, Before the Pennsylvania State Senate Judiciary Committee September 24, 2019) While patients under direct treatment of mental health care experts cannot be accurately identified as potential killers, the authors do so by retrospective document review, counting “saves” attributable to Red Flag orders. With 38% of ERPO cases reviewed, 13% of those were counted as “saves” in prevention of mass murder. While the authors heavily caveat their ongoing work, the media and gun control advocates promote this work as proof that Red Flag laws work. While authors cannot held responsible for misinterpretation of preliminary results by partisan advocates, academic press offices rarely emphasize caveats in press packages provided under embargo until date of publication. Scrutiny of publications usually happens well after the news and social media have made such scrutiny a moot point.

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 171Number 95 November 2019
Pages: 655 - 658

History

Published online: 20 August 2019
Published in issue: 5 November 2019

Keywords

Authors

Affiliations

Garen J. Wintemute, MD, MPH
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Veronica A. Pear, MPH
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Julia P. Schleimer, MPH
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Rocco Pallin, MPH
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Sydney Sohl, BS
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Nicole Kravitz-Wirtz, PhD
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Elizabeth A. Tomsich, PhD
UC Davis School of Medicine, Sacramento, California (G.J.W., V.A.P., J.P.S., R.P., S.S., N.K., E.A.T.)
Financial Support: By grants from the Fund for a Safer Future (NVF FFSF UC Davis GA004701), The California Wellness Foundation (2014-255), and the Heising-Simons Foundation (2017-0447) and by the UC Davis Violence Prevention Research Program and the University of California Firearm Violence Research Center.
Corresponding Author: Garen J. Wintemute, MD, MPH, Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, 2315 Stockton Boulevard, Sacramento, CA 95817; e-mail, [email protected].
Current Author Addresses: Drs. Wintemute, Kravitz-Wirtz, and Tomsich; Ms. Pear; Ms. Schleimer; Ms. Pallin; and Ms. Sohl: Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, 2315 Stockton Boulevard, Sacramento, CA 95817.
Author Contributions: Conception and design: G.J. Wintemute.
Analysis and interpretation of the data: G.J. Wintemute, V.A. Pear, J.P. Schleimer, R. Pallin, S. Sohl, N. Kravitz-Wirtz, E.A. Tomsich.
Drafting of the article: G.J. Wintemute, E.A. Tomsich.
Critical revision of the article for important intellectual content: G.J. Wintemute, V.A. Pear, J.P. Schleimer, R. Pallin, S. Sohl, N. Kravitz-Wirtz.
Final approval of the article: G.J. Wintemute, V.A. Pear, J.P. Schleimer, R. Pallin, S. Sohl, N. Kravitz-Wirtz, E.A. Tomsich.
Obtaining of funding: G.J. Wintemute.
Administrative, technical, or logistic support: J.P. Schleimer, S. Sohl.
Collection and assembly of data: G.J. Wintemute, V.A. Pear, J.P. Schleimer, R. Pallin, S. Sohl, E.A. Tomsich.
This article was published at Annals.org on 20 August 2019.

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Garen J. Wintemute, Veronica A. Pear, Julia P. Schleimer, et al. Extreme Risk Protection Orders Intended to Prevent Mass Shootings: A Case Series. Ann Intern Med.2019;171:655-658. [Epub 20 August 2019]. doi:10.7326/M19-2162

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