we're the only nation in the world where this happens. and i think that that's a useful kind of place to think about it, why we feel to helpless. .. but if you just think about suicide for a moment, which is where i come from, if we could decrease the suicide rate -- suicide is the 10th leading cause of death in the united states.

more than 20,000 people a year die from firearm suicide. if we could decrease that by 10 percent or 5 percent, how many people is that? the 2nd leading cause of death for teenagers, think about where they get the guns. they can legally buy them. they get them from their parents. in the home typically or a family member. we can intervene in all kinds of ways without legislation, although we also have to have legislation, too. but from a place of caring and concern where something is going south, and rarely happens overnight. there usually signs, warning signs that someone is heading in the crisis. as neighbors, family, friends, we can take it upon

ourselves to voluntarily the way we would voluntarily take our keys even from a stranger if you are out in a restaurant or bar, the bartenders will often do it. these are strangers to them, but they know it is a dangerous thing. we have to start thinking about the dangers of gun violence not through the lens of the tip of the mass shooting iceberg, as rhetoric and devastating as they are, but through a lens that looks at gun violence is a problem with many potential interventions, and the people who just keep putting mental illness out there as the problem are intentionally or unintentionally blocking us from developing broader perspectives that will lead us forward. and my feeling is that we need to move forward with more light, less heat, less pro- and anti- gun rhetoric. it is not helpful. what i would leave you with

this, we need to come from a place where, as i say when i talk about this, i don't want my kid to shoot yours. i don't want your kid to shoot mine. i don't want my kids to shoot themselves. i'm pretty sure we can get everyone to agree they feel that way, and we can start from there. what is the risk? , start looking at the evidence -based interventions that can prevent some of these tragedies, and they happen every day. again, from my perspective the 20,000 firearm suicide deaths, it is a staggering number. when you look at homicide deaths it's about 11,000. it is almost twice the number, and that is rarely what anyone is talking about the talk about mental illness and suicide. to the audience member who

brought up i want to thank you. i believe that is one of the most significant myths that mental illness is strongly associated with violence, people with mental illness. people with mental illness are rarely violent toward others. they are even more rarely violent using firearms. when they arewhen they are violent using a firearm they kill themselves much more often than anybody else and then factor of more often the victims of violence and the perpetrators of it, and anybody who tells you otherwise does not have a good handle on what the evidence demonstrates. thank you. [applause]

>> my name is bill nettles, united states atty. for district south carolina. carolina. i was appointed by the president in 2011. my job is to make south carolina safer. take a little bit different view. i don't think my job is to put people in prison. have you putting people in prison is one of the least effective in most expensive tools i have to make the state safer. having said that, i'm from sumter, literally preaching of the congregation. i'm going to try to talk a little bit about what we're trying to do because i want to leave more time for conversation. i think what my job is as chief federal law enforcement officer is to make a better decision about who we are putting in prison and who we are not.

but we need to do is take the lessons that we learned from the war on drugs which is lasted 20 years and cost a billion dollars and landed us with a generation of people in jail that had it been treated as a public health issue we would have productive people in the streets rather than having this long-term note. what we started trying to do comanche fallbrook is driven all the way up here because condos you have to pry people out of columbia to go to charleston. but as i say about the world -- the war on drugs, it's about how much money it would take to make columbia look like charleston. but we were very fortunate the chief could come in from huntington, west virginia where he had done very

progressive things in terms of improving the quality of life. we are lucky to have it. he and i have started a project of it done in greenville, and they can comeau one that we have done in the pd and what we are trying to get. we are working here in columbia, charleston. what we are trying to do this, the basic landscape of south carolina, i speak for the department of justice. one of these days i'm not going to be in this job, a little more interesting, but the.is the state of south carolina, we don't have gun laws. and whether that is right or wrong i can't speak to. give you an example, and dental -- in pennsylvania as a manager, when i was

speaking to him that i gun prosecutions, he was pointing out that they basically don't do gun prosecutions in federal court in pennsylvania because if you have taught can't run or whether it is two or three duis you don't get down the gun. whether it's good or bad, the department of justice, not commenting. they don't have to do federal gun cases as much. in south carolina we are the only game. but i would like to do, and they came here intending to speak more. i'm going to speak less because i want to hear more from what they have gotten say. my job is to make a decision i have prosecutorial discretion. it is often abused. i'm trying not to. i was a public defender forever,, so i come at this with a little bit different view. what we are doing is instituting programs and

calling it a focus deterrence model for bringing people in. right now we're going to every juvenile of every time juveniles your released from jail they are going to them and saying, let's be serious about this. let's not make it a federal case, we are the federal government. so here is what happens or can happen to you if you get , the gun. here is what can happen. we are doing that. every everythat. every time a juvenile gets released they are putting them on notice about the ramifications of being a felon in possession of a handgun. we need to be smart about that. i'mthat. i'm not interested in picking up 18 euros and giving them ten years in federal prison. the next step is for my office and the chief policymaker to figure out

who we can start focusing on is really,really, really really the people that are adversely affecting the communities. the way we're starting to do that and chief homework and i have done one in columbia. getting ready to do one in charleston, all of the state , bringing people in, and i will at lunch basically threatened to have the marshall's not let these people leave the airport until they agree to help me because i can do that. is to help us have a better understanding. i heard the questions from over here. we can do with gun violence what we did on the war on drugs, to use it as another means to incarcerate a race of people. we have got to do is make --

learn what we failed to learn and take that forward and have better understanding of who we need to be focusing on, who we need to be locking up into we need to be giving help to. that is how we need to do it , and that's what i hope to do on this. to that end, we have started identifying people, bringing the men in bringing the community in. but we do is what have this thing we brought them all in comeau one side of the table as law enforcement. fbi, secret service, all the local law enforcement, atf. we had the law enforcement people. on the other side of the podium we had a number of

different programs people like jobs, mental health, and in the audience we identified about 50 people that have the requisite felonies, had violence in the history command we wanted to say to them command we have the community behind the. they said we know who you are. this is the community. the community is tired of people getting shot. you have got to stop it.it. there will come a time where you have the opportunity to have a gun command i'm asking you not to do it for a whole host of reasons. it makes your community less safe. we are doing focus deterrence, and i don't mind , one of the great things about talking like

this is when you go up north they all think your stupid. i can tell you whenever we have gone talk about the type of things were doing we have been routinely told there on the front edge of it. the problem is there's know road map. so i am extraordinarily happy that we have these folks here today and you have my commitment to try to design the way so that the people that we can do a better job of deciding who we need to be incarcerating. thank you. [applause] >> hello again.

i am going to be talking to you all about something that i don't think gets enough attention when we talk about gun violence in the us. that's what i'm going to call removal. so people in this country get per have a from purchasing and possessing firearms for a number of reasons. on the federal level felons, persons convicted of domestic violence, persons adjudicated mentally defective but what happens after that? these persons are prohibited from purchasing and possessing weapons. they can go buy a new one. she was going and check.

>> or have law enforcement go and possess the person. the reason i think that removal is so important is because we have already identified these people as being too dangerous to have firearms. i will tell you a story about kristen palmer component. the sufferers of years of physical and mental abuse at the hands of her husband kevin palmer. in an affidavit she wrote, he has kicked me, strangled me, trying to drown me, slapped me, trust me by the hair and bit metering arguments. he has kicked, with, pulled

his hair and have my child when disciplining them. on february 19, 2014, kristen anger consigned criminal complaints that resulted in the arrest of kevin palmer. kristen was granted an emergency protective order against her husband. her parents with whom she and griffin were staying in virginia were also granted a protective order against kevin palmer. hours after these protective orders were issued kevin palmer shot and killed kristen palmer, griffin palmer, and nancy griffin. he also shot terry griffin it was the only survivor who crawled all the way from his house to our neighbors. in virginia protective orders prohibited from purchasing and transporting

park -- firearms. nobody went to kevin's house and told him he was no longer able to possess firearms and no one took them from him. and that is part of the reason this was allowed to happen. i want to talk to a little bit about what states are currently doing.doing. thirteen states that have no statutory explicit authority. particularly i'm going to talk to you about domestic violence restraining orders. there are 12 states12 states that authorize judges to order the removal of firearms from subjects with protective orders, final protective orders, and there ar5 states that require judges to order suspects term of firearms. much smaller number of states that authorize and require judges to order this during ex parte proceedings which are usually an emergency repetition ago the

request in order to make a case to say they are in such immediate danger that the respondent cannot be there to be heard at that time. and this is a multifaceted process. in order is issued.issued. the person is told they are no longer able to possess firearms and are told how to remove them. questions arise about who these people surrender to my legs onto the guns during the duration of the order. typically that is law enforcement, but we have states that allow licensed dealers to hold on to firearms for the duration of an order. in states that allow 3rd parties to hang on to those. and to appear in court for the judge and the judges on to say yes or no you are a

good person any others. before nor has expired which is great. the judges have what i call implicit authority. that would include ordering the surrender of firearms. touchstone typically use that authority well, either they are not aware that they can or unwilling. there was a study done on protective orders and reliant -- in rhode island, even in cases where petitioner stated that they were afraid of the respondent because of guns, because they had used comes on them before and held them to the head hit them with it

, judges refused to order and surrender the firearm. it's a big problem in the united states. i would like to talk to you more about this concept of the gun violence restraining order. it is something that we have discussed a lot and was pioneered by the consortium for firearm policy, and there are two statutes right now then do a similar process, one in connecticut and when indiana for law enforcement only where law enforcement officer or prosecutor can go seek a warrant for the removal of firearms. as you have heard other panelists mentioned, california has enacted a one-of-a-kind law called the gun violence restraining order. what is so interesting is that allows family members to act as petitioners as well. family members can go to court and petition, and we have talked a lot about some

of the reasons why they can go do that, immediate danger to self or others, but based upon a number of factors that researchers like daniel and others have identified as being good risk factors for future violence including reason threats of violence or acts of violence , the violation of the protective order, a conviction for a violent offense and patterns of violent acts. judges can also consider the reckless use, display, or brandishing a firearm, the history of use or attempt of use of physical force, any violation of an order, drug and alcohol abuse, recent acquisition of firearms. what is so great is that like the crises that are faced by these individuals, the provisions are temporary. unlike a mental health education which will result in a lifetime prohibition

unless that person petition for restoration the temporary order last 21 days the final order lasts one year, and respondents respondents are for the opportunity to terminate your where they go to court and say i'm no longer in crisis, let me show you. ofof course petitioners can also apply for the renewal of an order to come back and say, sorry,say, sorry, but this person is still in crisis, still in danger and the judge will reevaluate and decide whether or not that's true. so these are really, really interesting developments. i would love to talk to you more about it at lunch. hopefully mike all your questions here, you will have more later. so without any more time, i would like to get writing the questions. the 1st one i would like you to answer the person asks, mass shooters may not

be insane. i understand their actions, but they seem to have behavioral or personality deficiencies, a lot of anger, hate, racism, can anything be done in a public education system to help? >> i think that there are a lot of things that can be done to help, and i think that the questioner has put a finger on one of the changes in perspective that need to happen, which is that if you cast a wide net you are likely to catch a lot of fish. if you cast a small net trying to find mass shooters your likely miss everybody. so i think that the more we teach people about anger, coping skills, recognizing signs of depression, destigmatize mental illness so that people are not

afraid or don't want to be identified and go for help or treatment, family members or less afraid of identifying people due to the stigma of mental illness , and put these in place and the kind of places where people are, schools, religious organization, community organizations, boy scouts, girl scouts, the more people become conversant and understanding the better off we are going to be in terms of preventing all kinds of gun violence, suicide, general homicide, the vast majority of which is interpersonal and that very small sliver that also is mass shooting. there is never one intervention that will fix everything, but to my understanding i do not think public health success is measured by 100 percent anyone intervention being 100 percent effective which is why i don't understand any time someone makes a

suggestion they say that would not have stopped this or that mass shooter. 100 percent effectiveness is not the metric by which we measure. the changing social attitude , public education, those are very powerful tools. look at what they have done in regard to smoking, in regard to wearing seatbelts and cars, childproofing homes, created a billion dollar industry and those little plastic things. no one would have a baby putting this little plastic things in the sockets. so that is what we have to be looking forward which is part of why the public health approach to the problem would do. you know, mental health and behavioral health is about professionals from all about change. the helplessness that we

can't change anything needs to be challenged. we can change so many of these things, and it does not require billions of federal dollars to do. it requires a better understanding of the nature of the problem and the better understanding for all of us on the individual and committee level. yes, all of those things i think would be very helpful. >> our next question is california is the 1st day to enact gun violence restraining order. what is there data on this success and shortcomings? the bill was passed and signed by the governor in september of 2014. it will not go into effect until january 1 of next year , so there is currently no data. but i can tell you that folks in my office are working hard to make sure

that implementation go smoothly and that we have some researchers who are already gearing up to look at the data that comes out of this as soon as it is implemented and will hopefully tell us. our next question is, is it possible to talk to make it possible for family members to achieve a guna gun violence restraining order was some level of anonymity and that is a really good question. in california, which is the only place family members are allowed to petition from a law enforcement officers are allowed to petition as well. anchorage family members to reach out to their local law enforcement agency. if you're worried about a family member reach out, tell them what they know and asked them if they would

petition for you which will hopefully provide some anonymity. another is some worry about creating conflict where you reach over legal intervention. >> that is also an issue for people who have a family member with serious mental illness. one of the problems with the mental health system currently is that it is -- even if someone meets criteria for involuntary hospital commitment it is incredibly difficult to get them involuntarily committed the hospitals. we don't think the funding and resources have decreased to the same level they were 1850 before they started building. so the resources are not there and sometimes people have to be let go from an emergency room even if they meet commitment criteria because it violates their civil rights to keep them in an emergency room. if there passed a certain amount of time of the bed

cannot be found for them in a psychiatric hospital. families become concerned because it has gone down this route, trying to get someone involuntarily committed when they have refused voluntarily to get help and the person walks out the door and now there anger is focused on family command i will say that families, when people with serious mental illness become violent families are the primary victims of that. it is a very real concern for people with mansell, serious mental illness as well. >> our next question is what legal issues may cross simple lines? i assume we are still talking about the gun violence restraining order when we ask this question. those of you who don't know, the release of private health information, and that was a concern of ours as well which is part of the reason that up to this point

we have been advocating, have not been advocating the inclusion of doctors or mental health professionals as petitioners and i would like to open it up to the rest of the panel to discuss this as well. >> so, concerns, regardless there is an emergency exception the confidentiality whether it is mandated are not which is that circumstances where someone is in danger to harming themselves are other people confidentiality is company interested public safety. legally mental health professionals have a duty to report the intended victim. so where it gets a little if here is what if there is no intended victim, that is the

stuff that lawyers argue about all the time and for mental health perspective i learned many years ago when one of these issues came up my practice, i would rather be sued for breach of confidentiality that for wrongful death. i we will always err on the side of breaching someone's confidentiality. when you are involuntary psychiatric hospitalization. >> unfortunately this will be a last question here. i encourage you to seek out the panelists.

we often say these people are crazy or messed up which is nearly synonymous. >> i think that is important that we put it in context. the focus on gun violence is almost exclusively on mass shootings, almost. if we put it in the context we can see that mass shootings really are the very small tip of the iceberg. i don't take anything away from the tragedy. there's so much, violence, 40,000 people year. 33,000, 40,000 suicides.

30,000 people a year die from gun violence, less than 1 percent of those involved mass shootings. we need to be looking at the big numbers, suicides, interpersonal all sides. in most mass shootings, not all the person does not intend to survive them. we are likely to also catch people who may be thinking about for whatever reason that it is almost impossible to fathom. for mental health professionals want to take a lot of other people with them. so we have to keep the context and perspective and not let it keep getting narrowed down. it is true. if you look for the

.5 percent of people in essence of nonviolence when is an individual with mental illness your probably not going to find them. but we want to talk about is looking for people who are dangerous. evidence ofevidence of risk of dangerous behavior with or without mental illness, just take a mental illness piece out of it and say felons, much higher than mental illness. by orders of magnitude command to some mental illness? of sure that you. that's not what there looking for. the stop focusing on the natomas, risk-based commit

dangerousness based on evidence. for the -- with or without the mental illness take that piece out of it altogether and return the focus. it's very hard thing to do. >> that will end our morning panel. [applause] >> now a panel on the role of physicians in preventing gun violence plus firearms legislation. the manual a any church in charleston, south carolina hosted the symposium earlier this month. >> good morning.

i would like to inform people's understanding of gun dangers and outcomes. professor and chair of the department of public health sciences. i would like to remind folks about something that happened in 1985. 1985, the nobel peace prize was won by theone by the international physicians for the prevention of nuclear war. the us affiliate of physicians for social responsibility. physicians historically have had a major role in addressing social issues and being the community theater. you think about the dr. when you'redoctor when you're a little kid in terms of his role in the community. physicians can play important roles and wellness , prevention, and education.

this topic in this panel is what is the role of the physician and community leadership as well as interventions in the office that can help inform the issues of gun violence. so how can physicians be part of the prescription? today's panel, we have to groups, organizations represented also in the audience from the medical university of south carolina and also local physician organizations. the process will be five to seven minutes for each panelist then than 30 to 40 minutes to have open dialogue about the questions in this area. so, doctor robert ball is a 7th generation charleston physician, college of

charleston graduate. and he has been a public health officer, also was an internist, infectious disease specialist in the public health officer at dh ec and is currently professor in the department of public health sciences as well as the college of charleston. the 2nd panelist is doctor wanda fiber -- wanda filer. pres.president of the american academy of family physicians. she is a public health advocate. we found her at the strategic health institute. she combines the arenas of public policy, public health education, advocacy in the media to be awareness of health issues and the need for change. finally, we also have a local physician, charleston physician was spearheaded a group of local citizens this the organization.

and finally, doctor wayne riley is a present for the american college of physicians, the nation's largest medical specialty organization professor of medicine at vanderbilt professor of healthcare management at vanderbilt university, member of the institute of medicine. i would like to have doctor riley had us off with some comments. >> good morning. i am honored to be here on hallowed ground to talk about physicians role in reducing firearm violence. you know, there was a time in this country where we did not think we could cure polio. prevent its crippling effects on both young and old. there was also a time in this country where we did

not think we could prevent needless deaths and injuries and disability. there was aa time in our country not too long ago where we did not think we would ever be able to prevent the spread of hiv and aids. now, friends, these three examples really -underscore how we as positions think about firearm problems and it is pretty significant that you have three organizations who are participating in this very special event that represent almost half, more than half of the physicians in the united states of america. and that is because we feel strongly that similar approaches that we have made progress in other issues that affect the american public are relevant to the discussion about preventing

firearm violence today. now, those of us who have been called to the profession of medicine, brenda, we get our calling, too. to serve the human body. and we respect and pay homage to those of you who have been called to minister to the spirit. those of us who have been called to minister, if you will, to the human body have a duty to not only cure disease but to prevent disease. and so as we think about this to the present not only look at them on the exam room on that date but

communities coast to coast, this is vitally important that physicians and patients have dialogue over firearm violence. and i want to salute the american bar association. we approach the bar association because we were getting frustrated with the lack of correct dialogue around firearms. we were frustrated with the intellectual -- that opponents were engaged in. and we hear it all the time on some of the shows and channels that i am sure you are familiar with. but this is a public health problem. make no mistake about it. listen to some of the sophistry that comes out of some organizations.

the event of war on poverty, war cancer, we need to have a warrant firearms. fifty-two other medical organizations decrease firearm violence. i can never stop death. i maydeath. i may be able to treat a disease and curate for the moment, but i know ultimately i cannot stop death. that's the same way we have to look at firearm violence. the commonsense things that we are advancing, we know we are not going to stop every mass shooting for that we're going to stop every intimate partner violence situation.

hundred percent is not the goal. now our commonsense approaches are very simple. i'm from louisiana originally. hunting and gun ownership is embraced. but do you really need an assault style weapon to shoot? if you need an assault style weapon to hunt you really do need to find another hobby.

there are no civilian rationales for anyone to have an assault style weapon. secondly, we fear there is no reason to have expended ammunition clips available for guns. god knows that is what happened downstairs in this building. there's know reason to have expanded magazines. we call for more vigorous, robust background checks. commonsense does not

infringe upon the second amendment involved. and i think we have heard evidence that there is a robust background check. money was given to him by someone his family. we want more research. the place the needs to do the research on gun violence is the centers for disease control and prevention. and there is a congressional block against funding and research on gun violence that must end. they call for that ten. again, some of this may come as a surprise to you. why the doctors of the nation are concerned about firearms. i submit to you it is our responsibility.

we can only about the patient in front of us at that moment but about this community and communities san bernardino to sandy hook to wisconsin to chattanooga to lafayette, louisiana. even in the places where we have had issues. more important, the inner-city violence that affects my hometown new orleans, inner-city chicago, here in south carolina, the black on black crime that is taking away future generations who contribute to our nation. again, that is the prison by which we look at this as the nations physicians. this has to be approached in the same way we went after aids, seatbelts, cancer, polio epidemics of this we

can do. we feel very strongly that we have to play a role in advancing very commonsense approaches and again, not to eliminate but a markedly decrease gun violence in this great country. thank you. [applause] >> i would like to remind you that there are cars to pass around. >> good morning. ladies and gentlemen my family physician. brought trained in family medicine i trained and family and community medicine. a lot of times we think the medicine for talk about the care of the patient. in family medicine primary care take care of newborns, senior citizens in every body shape and size and color in between. and we are passionate about

the care we give to the community in this country. i represent 120,900 family physicians. we do one out of five us office visits. a lot of the time our patients are children. a lot of time they are children in rural america were no one else is available. a lot of the times they are in inner-city, often children of lower socioeconomic means. i work at a federally qualified health center. we have five sites. i got involved in the issue of violence 25 years ago when an entire family of patients were murdered. i had just seen the baby in the newborn nursery. i talked to mom about breast-feeding, car seats, spoke to her about immunizations. all those things that i have been trained to talk about, but physicians were not trained or and violence. i am here to tell you that

that is changing and changing fast. but when valerie decided that she was going out one night after husband paul killed her two children, killed her mother, killed his two -year-old nephew and then waited for her to come home and killed her, that for me was a transition peemack. it was a a point for me to say what could i have done differently. what -- how can i make a difference in the lives of these patients, make a difference in the lives of my committee command as surely as i stand here i will tell you that because of screening people for domestic violence, sexual assault, guns in their homes , talking to them about safety, talking to the children and teenagers all over the country and something called anticipatory guidance i know

for a fact i have saved lives. i know it. those of the people that don't end up in my newspaper on the tv, but they do end up coming back and giving me a hug. they never coming back and saying, i'm okay today but i just needed to talk. and that is what we as positions are here to do. this is a public health crisis. now,now, on my personal and professional journey to learn and teach about violence and i now usei now use my role as president of the american academy of family physicians, little bit is a bully pulpit to my own members to help to educate them about something that i would like you all no about because i believe the charleston and by extension south carolina and this country are at an inflection. we have an opportunity to say it is a new day and take the tragedies that happened downstairs, the tragedies that happen, the family that i care about and change the

trajectory of the country, change the trajectory of the city and the future i'm going to ask each of you and this may be painful, going to ask each of you take a very private quiz. a nasty ten questions. i want you to score yourselves. but as you are doing this, i want you to think about your coworkers, the people you love, the people in your families. you need to share your number, but i want you to tally up in your head. this is called the adverse childhood experience study. and this is my lecture about when i go around the country and talk to my fellow family physician colleagues. i nasty give yourself one point -- and the latin questions. while you were growing up during your 1st 18 years of life did aa parent or other adult in the household often or very often swear at

you, insult you, put you down or humiliate you or act in a way that made you feel afraid that you might be physically hurt? if so, one point. question number two, to the parent or other adult in the household often or very often push, grab, slap, or throw something at you? have you ever been hit so hard that you have marks over injured? answer to either of those another point. question number three, did an adult a person at least five years older than you ever touch her fondle you or have their body touch you in a sexual way? attempt are actually have oral, anal, or vaginal intercourse with you, another peemack. number

four, do you often or very often feel no one in your family loved you thought you were important or special cuemack's family did not look out for each other, feel close to each other more support each other, another point. question five, didfive, did you often or very often feel you did not have enough to eat command were dirty clothes, and no one to protect you, parents were too drunk or high to take care of your take you to the dr. if you needed it? another point. were your parents ever separated or divorced? another point. was your mother or step mother often or very often pushed, grabbed, slapped, or have something thrown at her, sometimes often or very often kick, bitten, hit with the pfister hit with something hard? ever repeatedly hit a few minutes are threatened with a gun or knife? another peemack. did you live with anyone who was a problem drinker or alcoholic or who used street drugs? another point. was a household member depressed are mentally ill or did a household member attempt suicide? another point. the last question, did, did

a household member go to prison? yes or no? another point. i'm going to ask you tally up your own points. what we know from the adverse childhood experience study is that if your score is six or higher your life expectancy just dropped 20 years. your likelihood of getting chronic heart disease went up eightfold. your likelihood of using substance abuse is up about 1600 percent. you are more likely to be a pregnant teen or the father of a pregnant teen. youyou are more likely to be a perpetrator and victim. we need to think about what we are doing in our communities, and our families of origin, how do we support one another and lower the scores? this has implications not only to the violence our communities but chronic disease, teen pregnancy,

substance abuse, all the different issues we see an american healthcare. possibly this is the determinant, he experiences that our children are experiencing, future trajectory. we as a community can come together and change that path. how do we make sure our families have the resources they need, they get public policies are in place not only to reduce the agent the you heard earlier of injury, the gun. i asked children all the time, do you have a gun in your home. if i live in florida as a physician will not allowed to ask that. i can ask you if you can buckle your car seat. i'm not asking the mom to be an unsafe driver. if you have a gun in your home it's important that i have a chance to talk to you about safety, about how we keep the children safe.

i talked to the child when they go to their friends house. i have patients that i have taken care of you have died at a friend's home because again was pulled out. this needs to stop. i think you heard doctor riley and i say and others, america's physicians are here to help you. is the pres.president of the south carolina academy of family physicians right here in charleston. we are here to help you and the partners in this work. bless you and god speed. [applause] >> thank you. you want to go next? >> thank you. it is an honor and privilege to be here with you. it is a great day in charleston, south carolina lawyers and doctors work together on public health issues. carlson has become a shining example of the positives

that can result from gun violence. my greatest sympathies to the folks here at mother emanuel in my admiration for their standing up and doing the right thing. i can identify with doctor webster's comparing gun violence tunics -- and infectious disease epidemic which it is with the defined incubation period or interval between episodes which is getting shorter and shorter to the point that many americans are using the term terrorism in reference to gun violence. iviolence. i don't think that is an appropriate. ..

>> >> regarding their patients, we must also stretch the mental health aspects even though there are some disconnects and mental-health and a gun violence. one recommendation that is under consideration, that there are now four states that bezel physicians talking about gun violence to their patients and

florida is the ball striking example that is now under u.s. court of appeals. but there are four other states south carolina rejected such an amendment three years ago. to muzzle physicians but we must expand criteria particularly psychiatrist but those are report mentally unstable patients to proper authorities to discuss openly get to gun safety. with their patients. x point. we must work with our legal community and law enforcement to expand background checks to become universal. we know we cannot stop private or though law will for the deranged cycle path that will pop up but the background checks qb legally

expanded as we have heard and still protect second amendment rights. including though waiting period and led the eight assault rifle sales you don't sell for or what does a 420 at a time. with the date the about in the british and quickly should consider to regret san francisco did they disclose the last gunshop to read to this city passing ordinances that require gun sales to be videotaped and kept for a least one year with stricter record-keeping so the last good shop just closed as a result. hallelujah. the legal action prompted by the little community there. -- medical communities to back the sec wrote in the op-ed piece published on

sunday november 8:00 p.m. there were 200 copies a at the vestibule if you wish a hard copy. universal background check, education and through publications and yesterday there was the hotbed and the president of the aba that underscored many of the points that these two doctors have written an article to refer reference to. do we have copies of that? we can get them. and we have heard reference to congress law preventing the cdc from doing research a nerve root cause analysis of the violence as it has done the reporting of the

numbers of people who are killed by firearms homicide and suicide. but they can only report the numbers. the cdc has been forbidden to do research john root cause analysis. to do individual or mass shootings ended just so happens a retired republican from arkansas sent a letter to congress that we just retired from recommendation that law be repealed it arrived in congress on bedstand guess what happened wednesday afternoon? santry day go.

-- san bernardino. then we can push the cdc for root cause analysis. then i pose this question. in south carolina there are laws that wed a bartender cells -- sells excess alcohol and that person that is under the influence commits public carb -- charm with injuries or deaths and not only is that individual responsible but the bartender is held criminally and civilly responsible. we heard about the minnesota case where the badger group in a civil case had to pay

$6 million to the police officers. if we can do this for bartenders bedlight not similar laws to hold guns sellers accountable? i think we should. and a quotation from dr. keat we must learn to live together as brothers and sisters or perish as fools. faq. [applause] >> i really appreciate this opportunity to be here. i have a plastic surgeon by treaty and rose panels discuss how people look so this is a little different. things got different here in charleston six month ago. that is what breeds we here today to introduce you to

the people end the back and want everybody to be educated about this. it was started by an attractive young lady about 100 pounds soaking wet and asked what can we do after this tragic event? and that is how this started. we gathered and spent time to you do this out of awareness and we cave with a bishop and to address the public health issue by educating citizens come off building awareness to support non partisan in the -- legislation. and obviously be were galvanized in that manual. as they work to reduce gun

violence to reduce by one-half, while we still support the second to bed to bed draped. i owed to shotguns and rifles myself but the common refrain that i hear from would fellow doctor isfahan is this is complicated. yes it is. but talky about the california majority experience, make the all dead transactions, all commercial sales and background checks, that would be fed to a load that 85 percent of the barracoons all agreed even the nra membership you can reduce the violent death by half.

that is phenomenal and do a full. is it a democracy? why are people city to us? weedy your help to stand up so we can change that. we go the of, did the problems we have spent talking again about that all boarded. -- awarded. we have a two-pronged approach with community awareness and education and kerry is to read that. this is an effort you will hear more about to get churches to stand up its end jiri to make people aware of the problem.

we also have other community outreach and specific flee south to address and educate legislators. this is an opportunity local in charleston and started right here locally funded. but not well funded yet. we beat you to you join us and stand up and bit what the problem is to take responsibility it is all of our problem. we need to join in a proactive, 90 emotional way to see what we can do to make this better. [applause] >> i thought this was a wonderful group of the

presenters. [applause] absolutely riveted. so physicians can be part of the prescription. positions should include a history of gun violence and a reporting program of the epidemiology? >> yes. i agree with that and concept. we teach medical students to ask a number of things and i am sure you have run the gauntlet. that is purposeful so that we as physicians get to know you as a patient. we don't want to go you as a diabetic but the 54 year-old

teacher with three kids and six grandchildren who likes to play be go. we want to know about you as a percent. that is where this converges with that. we want to know if you have firearms is your home. if you do, are they safely locked up from those six grandchildren? yes. there is a proper role and the context of the physician and patient relationship to have a safe conversation about firearms. this is why of medical organizations are fighting back seriously against the statues and florida and three other states to prohibit the as a position from ascii that simple question. in our view that is of violation of first

abridgment rights from those that try to contort themselves for their conception of the second to -- amendment. [applause] >> there are health centers in the country so how campus network of the front line of many public health issues be properly utilized? it is an untapped. >> amen. [laughter] in the office there are 20 languages we have a very diverse country and i have to learn how to help people navigate in a culturally appropriate way. that expertise country out of that world is huge as

there are cultural differences how we treat dizzies or prevention or attitudes issued conversations and that will be true around changing the culture of the violence. the expertise and experience will come down to make sure whether you have your work and charleston that the representatives are at the table. they are required to have committed the panels and patient panels to say how are we do we? that is another way to enter into the community. the people who'd close-up problem source you across multiple cultures. the local organizations and the association's there is a

huge opportunity to bring them and to that conversation did that is what is needed to sustain a culture change. >> have thus gore's been related to further violence and gun violence? >> i do not know the specifics of the violence but would not be surprised. it is about 25 years old and studied -- started with mostly middle-class predominantly college education patients and the kaiser permitted to a system and california. they gave a questionnaire that has been expanded to 10 questions. they sold reported. they found if they looked at

the medical records at that time of 70,000 sold reporting people -- 78,000 then they would follow them over 20 years that chronic dizzies rate lupus, a chronic heart disease or sexual assaults or domestic violence perpetration a at the same time is an issue how we're treating our children has huge implications for the well-being of this station and i think i have this conversation with law-enforcement and i have met with all chief of police said my cutie -- my county. i did this study at the army war college and they are seeing recruitments and the

trauma that they would press children. there is a conversation and to be had how to do a better job to protect the children of this community. >> dr. webster? baby she is not here. we will ask him later. he had to leave. but we can find out more about back to with whole issue of how does violence in the exposure through your childhood relate to later issues back with the cdc funded research. >> that leads to the question and how can we help remove that congressional ban?

>> clearly dr. ziad lawyers have to work together we have excellent legislators here who'd have already opposed bills before the state we need to do this at a federal level and have a right to every congressman and and and the bill the but the addresses are available of the web site just change the name. to get them to repeal the cdc banon research. if enough spoken out you tried to educate our congressmen and then they would respond. that is the positive. the negative is the senate rejected an expanded

background check amendment to a larger bill on another matter to piggyback the bed to bed. -- the bed to bed but will be brought to the seventh floor. >> with a lot of these incidents with family violence there are folks who are murdered but at the same time a group who are the victims and survived. also post traumatic stress a huge all of us every day exposed to this type of federation and have a little bit of stress that impacts our will be candid with the key of c is the debate today from june. even when i get upset about what is happening how can we

do something about this? so what is the role of the opposition -- of the physician m. the process of recovery? band including the community ? >> i am aware through conversations that the families are having a tough time as one would expect in various phases of grief, experience see ptsd all over again just as a result of what happened and he ted. if there is another event like t. ted they have to

relive the through msnbc wall-to-wall coverage. is very painful. so if they show signs of ptsd if with the spiritual advisers and their pastor or whenever to talk about it and is somewhat therapeutic but is something that we underestimate how the beach and adds ptsd as the country we are traumatized and could sometimes back to lead to be frozen in place.

but you have to go back to work. i looked at both the to push the of boulder up the hill. sometimes it feels we don't move at all but over time we will. think of the things that have occurred i never would have expected bill sodality walked out of prison in my lifetime. em barack obama to become president. we have to keep it up. also political pressure. is a defendant - - positions are drop dash fault either just like the nra has up packed and moved so do we. we put money behind goobers of congress to get their attention because we know how the process works.

>> also keep in mind what i see with patients. >> with those extended families this is the law holiday season of the first thanksgiving in the first christmas and hanukkah it is so raw it is incumbent to reach out. don't forget next year. or the like year after that. it doesn't ago way. these people need you and you are that the work queued extended family. just show week that you care by show we up is a message

that you give a dealer but they need to hear from you and i don't underestimate the need to hug your pastor because they do a lot of hard work as well. [laughter] >>:final question can physicians request removal? >> here is anecdote. i had an order to serve as president of the medical school we had a suicidal political student brought to my attention. she visited one of our counselors and said she was struggling academically you'd wanted to hurt herself and slapped with a pistol under her pillow every great so we got her to where she is called in a relaxed and

said can we get it? so we said security to get and it was brought back in and locked up. she was admitted to a psychiatric facility for intervention and was '01 months. one day she showed up at the office had wanted the dog back. -- the gun back. my staff went scrambling and i called the general counsel and advice said we have a medical student in the lobby and once the gun back. legally you have to give it to herbert rice said i love you but i will overrule i will long give it back. so she left a about three weeks later i get a service that she was a week before withholding her bond per

course i will gladly go said judge said you have refused? i said yes. i gave the scenario. he took about ted bennett said chambers sent kate back out and said i will render a verdict i will rule for the wounded -- will lead but i will order it destroyed and you have to pay her $600. i said i will write to the check right now. [applause] >> no more questions. do you have indeed been to say? >>

[applause] >> search to leave the narrative of songwriters feeling that they don't

understand where it is coming from is not do but we live today where everything is tractable the nsa can know where i am and what you talk about there is no reason the artist and creators should not know where their songs are streamed in and how they are paid >> host: we will introduce you to use hippa tea chairman and ceo of recording industry association of america. >> guest: we represent labels like columbia and at the tech capital, but out parsee a and the artist and they support.

we do a wide variety of the league's to support those artist. we give gold and platinum records for artistic achievement we do data had lobbied in litigation and to reassure the law supports protecting rights. piracy work. to promote the transition into the digital marketplace >> host: some of the issues we will talk about how do people get their music? >> guest: you would buy a seedier listen to radio guy you can stream like the internet radio station like pandora or old debated on spotify or apple musec you

can do it on ruble -- mobil or individual albums the variety of ways is astounding. >> host: but that transition from ted years ago to what we go to day, what has that done to the music industry? >> guest: it has caused a lot of difficulty. the fact of the matter is the transition has operated relatively smoothly if you consider we are 75% digital. with an extraordinary transition. but there are bumps in the road as to figure out what is necessary to license the download service or the streaming service or how do the contracts applied. how