In recent weeks, the Press Herald and other media outlets have reported on factors that have stymied the routine use of Maine’s “yellow flag” law. The law, passed by the Maine Legislature in 2019, allows for a temporary block of an individual’s ability to possess and purchase guns, based on law enforcement recommendations, a medical exam and a judge’s signature.
Maine’s “yellow flag” law “asks emergency physicians to step away from what they do best – performing lifesaving interventions for their critically ill patients – in order to perform a complex psychiatric evaluation,” Brandon Giberson writes. John Locher/Associated Press, File
Maine is the only state to have a law like this. Similar laws in other states, so-called “red flag” laws, do not require an exam by a medical practitioner in order for the restrictions to take place. In Maine, this law was passed, tasking this complicated psychiatric exam largely to Maine’s emergency medicine physicians. During the legislative process, the Maine Chapter of the American College of Emergency Physicians, the Maine Medical Association, the Maine Hospital Association and the Maine Association of Psychiatric Physicians all expressed concerns about this legislation. The resulting law required that a mechanism be put into place for mental health experts to perform this exam remotely.
Emergency physicians are trained to master the triage and management of multiple sick and injured patients, stabilizing and treating victims of traumatic injuries and serious medical issues, performing invasive procedures, counseling patients and their families and diagnosing and treating undifferentiated medical problems. Although emergency physicians are well versed in treating patients during times of mental health crises, administering detailed forensic psychiatric exams is not part of typical emergency medicine training. They routinely make decisions about which patients require hospitalization, but this is different from the public safety risk assessment to determine which members of the community are safe to possess or carry weapons.
Emergency department physicians are the leaders of arguably the most time-sensitive department in the hospital. They are often the only physician in the hospital trained to triage, evaluate, treat and ensure safe disposition for dozens of patients that enter through their doors – 24 hours a day, seven days a week. This is a very complicated set of tasks. Because of a global pandemic and a lack of inpatient beds, psychiatric care beds and specialty services, emergency physicians are increasingly asked to “wear more hats,” caring for patients for many hours, sometimes even days.
Not surprisingly, this has greatly decreased the time an emergency physician has to take care of each individual patient. This statute asks emergency physicians to step away from what they do best – performing lifesaving interventions for their critically ill patients – in order to perform a complex psychiatric evaluation. This clearly jeopardizes the fair treatment of both the subject of the evaluation and all the other patients in the emergency department. Not only are emergency physicians not specially trained in this type of forensic exam, but there is also not nearly enough time in a shift to complete this exam while keeping the rest of the department safe.
To be clear, the intent of this law is well-meaning and emergency physicians in Maine are eager to help eliminate gun violence and prevent the mass shootings that this law seeks to address. As caregivers for victims of violence here in Maine, no one witnesses this more and understands this better than the emergency physician. Though called for in the law, remote evaluation by a medical professional has not been implemented. It is time for the Governor’s Office and Maine’s Department of Health and Human Services to ensure a system and standards are put into place immediately so that the “yellow flag” law can be effectively used without sacrificing care.
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