Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)

In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.

Dr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.

“These are the injuries that the [patients] will come in, and they’ll look at me, and they’ll talk to me, and then they’ll die,” says Colwell, who’s been at Denver Health, the city’s biggest public hospital, for 20 years.

Often, Colwell will treat a shooting victim, and then treat the shooter after he or she has been caught by police. Colwell describes a case from a few months ago in which he treated a woman who later died — and then her husband, who fired the gun.

“They had had a fight. He had caught her in what he felt was cheating, and he had lost his temper,” he says. “He went and grabbed the pistol that he had for home defense at his bedside, and he made a snap decision.” Now, he adds, “his life will never be the same, and hers was gone.”

Colwell says it’s remarkable how often people who pull the trigger are surprised at the consequences of their actions. And he’s deeply disturbed by how easy guns are to get.

“I see patients every day that are right on the edge of being unstable. … They describe problems with access to medications; problems with access to psychiatric care or substance abuse care; problems with access to homes or to shelter,” says Colwell. “But they don’t describe problems with access to guns.”

Dr. Katie Bakes, who has worked with Colwell in the emergency department for 10 years, also says it’s the gunshot victims that she can’t shake.

A few weeks ago she treated a three-year-old who’d been shot in the head. Her mother had shot each of her three children and then committed suicide. “Our patient was the only one who was a survivor,” Bakes says.

Such experiences have made Bakes unequivocal in her opposition to guns.

“I hate guns. If I could snap my finger and get rid of all the guns I would. I think they’re evil,” Bakes says, “I don’t really care what the other side of the argument is. I just don’t want to see another 3-year-old come in and be shot in the head.”

Bakes and Colwell say gun injuries feel much more deliberate than any other kind of trauma they see.

“It’s so senseless,” Bakes says. “You know, it’s not an accident, somebody intentionally pulled the trigger for whatever reason.”

But not all physicians share this perspective.

Dr. Jack Cletcher, a retired orthopedic surgeon, has treated his share of gunshot victims, too, from the streets of Chicago, and, decades ago, he took care of wounded soldiers just off the plane from Vietnam. He can sympathize with Bakes and Colwell, but he doesn’t agree that laws need to change.

“This is the kind of emotional reaction that occurs with these horrible catastrophes that happen,” Cletcher says. “The gun is only the instrument. It’s not something that happens because the gun does it. There has to be somebody holding the gun to do it.”

Cletcher is opposed to most of the new gun restrictions lawmakers are talking about in Denver and Washington.

“I don’t think we need new laws, we just need to make the ones we have work better,” says Cletcher, who would rather see lawmakers focus on better treatment for the mentally ill, and keeping guns out of their hands.

Recently, leaders of the Colorado Medical Society went to Washington to lobby for measures to help prevent gun violence. Strengthening mental health care was on their agenda, and they support President Barack Obama’s executive action for increased research into gun violence.

Dr. John Bender, the organization’s president-elect, showed Rep. Ed Perlmutter, D- Colo., the results of a recent survey of the medical society’s members in which about two-thirds want to see gun regulations strengthened and about a third don’t.

No similar survey exists for doctors nationwide, but a majority of AMA delegates have endorsed tighter restrictions on guns. Not all doctors agree, but among those calling for stricter gun control laws are the AMA and several groups of specialists, including the American College of Emergency Physicians, the American Academy of Family Physicians and the American Academy of Pediatrics.

This story is part of a partnership that includes Kaiser Health News, Colorado Public Radio, and NPR.

(Photo: Scott Olson)

In a new review, researchers from Harvard and Boston Children’s Hospital crunched the numbers looking at firearm-related fatalities and firearm legislation across the U.S. Their conclusion: more laws in a state are associated with fewer deaths, across the board — as well as for homicides and suicides individually.

The researchers worked with the Brady Center to Prevent Gun Violence to calculate “legislative strength scores.” The center weights laws according to such factors as background checks on gun sales, permit-to-purchase requirements, and limiting handgun purchases to one a month.

The writers stress their study could not determine cause and effect, and more research is needed.

How many gun laws are there, overall? That’s hard to determine, too, say the authors. From the study:

It is challenging to calculate the exact number of firearm laws: a single law may have multiple parts; laws are potentially passed at the national, state, county, and city level; and there is no repository available for tallying these laws.⁵ The factoid that there are “20 000 laws governing firearms”⁵ has been erroneously quoted since 1965, but the most recent and reliable estimate, performed in 1999, counted about 300 state firearm laws.⁶

Here’s a chart from the study showing the association between household firearm ownership and firearm deaths. For you non-statisticians out there, focus on the black line:

(Source: JAMA Internal Medicine)

The researchers also include statistics on firearm deaths for 2010:

• 16,259 total homicides, 68 percent by firearms — or 11,056 firearm-related homicides
• 38,364 total suicides, 51 percent by firearms — 19,566 firearm-related suicides

Learn More:

U.S. Gun Murders: Visualizing the Numbers (KQED’s Lowdown)

Editor’s note: State lawmakers are expected to hold a joint legislative hearing on guns and gun laws Tuesday. 

Sandra Macias of Fairfield looks at posters she’s made for marches and rallies demanding more gun control. In 1995, Macias’s 14-year-old son Alex Stasenka was accidentally shot and killed. (Photo/Mina Kim)

Remember those ads from the early 1990s that encouraged people to intervene if a friend who had been drinking was about to get behind the wheel? ‘When friends don’t stop friends from drinking and driving, friends die. Friends don’t let friends drive drunk.’

Researchers believe this type of public health campaign that was successful at reducing motor vehicle fatalities could also be used to reduce the number of gun deaths and injuries, including suicides. David Hemenway is a professor of health policy at Harvard and director of the Harvard Injury Control Research Center.

In California there were more than 1,300 gun related homicides in 2010 according to data from the Centers for Disease Control. Yet more people — nearly 1,500 — died from gun suicides. Hemenway said an effective awareness-raising campaign could reduce the number of suicides or fuel demands for better gun safety standards, including safer gun storage practices.

“We are in a society where we have lots of guns, and for a variety of reasons we will always have lots of guns,” Hemenway said. “What we want to be able to do is figure out a way to live with our guns. Right now we are dying with our guns.”

Sandra Macias’s 14-year-old son Alex Stasenka was shot dead —  accidentally — by the brother of one of his friends. The Fairfield mother of three –- including Alex — said the brother was playing with a shotgun he had found in the garage when he pointed it at Alex and pulled the trigger.

“Time passes and you continue to live your life, but it’s never the same,” Macias said.

Macias wasn’t there when her son was shot 18 years ago. But she said she knows the moment it happened.

“I was at a conference, and I just felt this surge of energy and I just jumped up out of my chair and walked to the back of the room,” Macias said. “I just felt like something was wrong, but I just didn’t know what it was.”

While most of the gun debate has centered on banning weapons or high capacity magazines, or controlling other aspects of gun ownership, Harvard’s David Hemenway said more research is needed on whether easy access to guns contributes to injuries and deaths.

“The [CDC] is afraid to even say the word guns, let alone do any research in guns, even though this is an enormous public health problem,” Hemenway said. “There’s very little money out of foundations. So we really lack a lot of good research.”

But Hemenway is hopeful. President Obama recently directed the CDC to support research into the causes of gun violence and ways to prevent it. The president also clarified that doctors could discuss gun ownership with patients. Hemenway said he’s working with pro-gun groups to see what public health strategies might appeal to gun owners.

“Certainly this is our big opportunity here, so it really behooves us to take advantage of this,” Hemenway said. “We can really do so much better as a country protecting our children, protecting our young people, than we are currently doing.”

Fairfield’s Sandra Macias was less optimistic as she looked through posters she made after her son’s death, for rallies and marches that demanded more state and federal regulations on guns.

“It’s been seventeen years, and we’re still talking about the same things.”

Among other things, Macias wants to see stiffer penalties for gun owners who don’t use or store their weapons responsibly.

“I’m a very angry person. I don’t think I was before,” Macias said. “The fact that people can own guns and not be responsible when something like this happens I mean, and my son is dead, my son is gone.”

Macias said her son Alex would have turned 33 years old this year.

Gina Scialabba contributed to this report.

Mina Kim reported this story as part of KQED’s ongoing coverage of gun violence. Learn more:

Oakland Residents Plead: Pay Attention to Killings

Among Oakland’s Dead, What’s a ‘Typical’ Case?

Oakland’s Gun Problem: 11 Firearm Crimes a Day

Listen to Mina Kim’s story:

Caheri Gutierrez, before the shooting.

Last weekend was an especially violent one, even for Oakland. On Friday, four people were killed, and over the rest of the weekend, 11 people were shot, though not fatally. There were 126 homicides [PDF] in Oakland last year, cementing the city’s distinction as one of California’s more violent urban centers. Oakland certainly doesn’t have a lock on gun violence. Other cities like Stockton are struggling, too. But the situation in Oakland has been going on for some time now, and locals are giving a lot of thought to what it means to live under the constant threat of violence.

As part of KQED’s occasional series, “What’s Your Story,” Oakland native Caheri Gutierrez (pronounced “Carrie”) shares her story about working with at-risk high schools students after she herself was shot in the face as a teenager. Guiterrez is a Violence Prevention Educator for Youth Alive, an Oakland non-profit with a mission to prevent youth violence. Below are excerpts of my conversation with her:

“I was just in the car and all of a sudden I started to feel like I was getting electrified. It was really intense shocks from the top of my head to the bottom of my feet. The guy that was driving, my friend, starts screaming that he’s been shot.

I reached over to him to try to help his hand and that’s when he looked at me, and he was like, ‘Oh my God, Caheri. It’s you. They shot you. They shot you.’ I touched my face and my hand just went inside of my face.

Five days later, I wake up at Highland Hospital and my hands are tied to the hospital bed. I have tubes coming in and out of my nose and out of my mouth. It was hard.

An x-ray of Caheri Guiterrez's jaw soon after she was admitted to Oakland's Highland Hospital.

Some of my family members are, you know, gang-related, and so is my brother. And I remember my uncle asking my brother, ‘Who did it? Where are they from? What are we going to do? Are we going to get them?’And things like that. I couldn’t talk but I was just like, ‘NO. This cannot happen to anybody else.’

While I was at the hospital I was connected with an intervention specialist. Her name was Tammy Cloud. I got out of the hospital a month later. And Tammy comes to my house and she was like, ‘I think you should come to this program and talk to the high school students about getting shot and how you think about life now.’

Besides my personal story, I teach them a curriculum about violence. It makes me feel like I make a difference. It makes me feel very hopeful because I am a victim to the violence that happens in Oakland. And I’m one of the many victims. And when you talk to someone and you can give them an example of what can happen, I think they really soak that in and they think twice about hanging out with people who are gang-related, or even picking up a gun.  Ever since then, honestly, I feel like getting shot happened for a reason.”

MORE:

Listen to Caheri Gutierrez’s story:

You can also read Caheri Guiterrez’s blog.

(Image: Kaiser Health News)

We think of the Centers for Disease Control as collecting data on just about everything. But scientists say a lack of funding and political pressure had long prevented them from researching gun violence. And not just the possible causes of violence — but data collection around specific acts of violence.

On Wednesday, the president addressed the need to look for those causes in his proposals to curb gun violence. In a section [PDF] titled “End the Freeze on Gun Violence Research,” the president directs the CDC to research gun violence and also wants Congress to pony up $20 million to expand the national database on violent deaths.

“We don’t benefit from ignorance,” Obama said. “We don’t benefit from not knowing the science from this epidemic of violence.”

From the president’s plan:

… for years, the Centers for Disease Control (CDC) and other scientific agencies have been barred by Congress from using funds to “advocate or promote gun control,” and some members of Congress have claimed this prohibition also bans the CDC from conducting any research on the causes of gun violence. However, research on gun violence is not advocacy; it is critical public health research that gives all Americans information they need.

Larry Cohen, executive director of Oakland’s Prevention Institute, called the backing of research “perhaps the most important part” of the President’s proposals.

“People have been working for years to prevent violence, but it’s like we’re working with blinders on, because there are certain very obvious places we’re unable to look,” Cohen said. ”Clearly there’s no way to look at the epidemic and not realize that guns are a clear element of homicide, and yet we’re told, ‘don’t look at guns.’”

NBC News quoted scientists who were equally enthusiastic about the president’s plans. From NBC:

(Scientists say) pro-gun advocates — including the National Rifle Association — had choked off funding for CDC firearms research starting in the mid-1990s and imposed a chilling effect on those who dared to pursue it.

“He’s saying this is very important and I’m going to back you on this,” said Dr. Mark Rosenberg, president of the Task Force for Global Health and director of the CDC’s Center for Injury Prevention and Control from 1994 to 1999. “Basically, they’ve been terrorized by the NRA.”

If you’re wondering how we got here, Slate published a great explainer:

In the 1990s, politicians backed by the NRA attacked researchers for publishing data on firearm research. For good measure, they also went after the Centers for Disease Control and Prevention for funding the research. According to the NRA, such science is not “legitimate.” To make sure federal agencies got the message, Rep. Jay Dickey (R-Ark.) sponsored an amendment that stripped $2.6 million from the CDC’s budget, the exact amount it had spent on firearms research the previous year.

To be fair, Dickey later recanted and published an opinion piece in the Washington Post, titled “We won’t know the cause of gun violence until we look for it.”

Now researchers will get a better opportunity to look.

(Image: Kaiser Health News)

Did you know the Affordable Care Act stands up for gun rights?  The “Protection of Second Amendment Gun Rights” section (page 19 in this PDF) says the health law’s wellness programs can’t require participants to give information about guns in the house. It also keeps the Department of Health and Human Services from collecting data on gun use and stops insurance companies from denying coverage or raising premiums on members because of gun use.

The Newtown massacre renews the controversy about whether gun violence is a public health issue. Should health authorities view guns in the same category as pneumonia and car crashes? The debate has been going on for years, with epidemiologists arguing firearms can kill just as many as a bad flu season and gun-rights advocates viewing any attention from public health officials as a step toward gun confiscation — the beginning of the end of the Second Amendment.

The ACA language was included at the request of Nevada Democrat Sen. Harry Reid, the Senate majority leader and a gun rights supporter. Reid’s office did not respond to a request for comment, nor did the National Rifle Association.

Public health scholars criticize the measure because they say it keeps doctors and nurses from doing their jobs.  While the law doesn’t ban doctors from asking about guns, it places limits on what information they can record. The fear is physicians will avoid the topic altogether, inhibiting a full conversation about firearms hazards.

“A lot of people buy guns every year, and it’s a health concern,” said Susan Sorenson, professor of social policy at the University of Pennsylvania. “For physicians and other health care professionals not to be able to ask about these issues and record them is counterproductive.” Doctors ask patients about illegal drug use, disease history and sexual habits, Sorenson said. Why not guns? “To regulate what the provider can or can’t do really intrudes into the role of the health care provider,” she added, “which is to ensure the health of the individual and the people who are living in that home.”

But some think firearms in your closet are none of a doctor’s business. Marion Hammer, a former NRA president and lobbyist for the group in Florida, told Kaiser Health News last month that people don’t take their children to the doctor ”for political dialogue or for pediatricians to ask us not to exercise a constitutional right.”

She was referring to a Florida law that limits conversations doctors can have with patients about guns. Last summer U.S. District Court Judge Marcia Cooke permanently enjoined the state from enforcing the statute, saying it restricted free speech.

The Connecticut massacre has also renewed criticism of Congress’s decision years ago to defund research on guns and public health by the Centers for Disease Control.

“We are in an environment when children are dying and we are playing political games,” Dr. David Satcher, who was director of the CDC in the 1990s, told the Atlanta Journal-Constitution.