Your patient, Michael, walks into your clinic for a routine evaluation. You have treated Michael in the past and he has always been pleasant and compliant with his medical care. As you continue with your examination, Michael discloses he has a gun. Feeling uncomfortable and unaware of what to do, you nervously proceed with the examination. After you complete your assessment and Michael exits, you sit down in your office with the realization that you just examined an armed patient. Your mind spins about what to do next and how you can protect your patients, staff, visitors, and yourself.
The described scenario may be shocking and unimaginable, but such scenarios have occurred within medical facilities and among CAP member practices. Since the landmark Supreme Court case, New York State Rifle & Pistol Association, Inc. v. Bruen (Bruen), there has been a growing interest in the ability to carry concealed firearms.¹ In Bruen, the Supreme Court held that the Second and Fourteenth Amendments protect an individual’s right to carry a handgun for self-defense outside the home.² The Supreme Court also held that New York State’s requirement that an applicant demonstrate a “special need” (i.e, evidence of a particular threat, attack, or extraordinary danger to personal safety) before being issued a permit to carry a handgun, is a violation of one’s constitutional rights.³
As a result of Bruen, some California counties have experienced increases in the number of applications to carry concealed firearms. For example, in 2023 and in response to Bruen, San Diego County’s applications to carry concealed firearms doubled.4 Though only certain counties have experienced application increases, all California counties have issued concealed firearm permits.5 Therefore, it may be likely that you will encounter someone with a concealed firearm.
In response to the Bruen case, the California legislature spearheaded and passed Senate Bill 2 (SB 2) last year, which was prompted by the belief that state-mandated restrictions were necessary to limit the public settings in which a person could carry a concealed firearm.
SB 2 and the Expansion of Sensitive Place Designations
Generally, in California, it is illegal to carry a firearm in public.6 However, California permits an individual to carry a concealed weapon if they possess a carry concealed weapon (CCW) permit.7 To obtain a CCW permit, a person must complete the following: a background and criminal history check, a minimum 16-hour training course, and a live-fire shooting exercise demonstrating safe handling and shooting of a firearm.8 There may also be a requirement for a police interview and psychological examination, which is county dependent.9 Once granted a CCW, a person may carry a concealed firearm except in certain designated sensitive places.10
California currently recognizes school zones, state buildings, local public buildings, sterile areas of an airport (i.e, areas of the airport that are controlled by screening of person protocols), passenger terminals, and public transit facilities as sensitive places.11
On January 1, 2024, SB 2 became effective and sought to further expand the sensitive place definition to encompass healthcare facilities, including medical offices and public or private hospitals.12 However, on December 30, 2023, a federal judge in the U.S. District Court for the Central District of California issued a partial preliminary injunction, which prohibited the enforcement of certain SB 2 provisions that expanded the sensitive places scope, including healthcare facilities.13,14
Managing Safety and Setting Expectations
Until the legal dust settles, the constitutionality of designating medical facilities as sensitive places remains uncertain. Despite this uncertainty, it is best to address the issue of concealed firearms by proactively providing guidance to staff on the proper management of CCW cases before they happen. At a minimum, if you prefer that patients not carry concealed firearms within your facility, your procedure should consist of the following:
- Set expectations from the beginning. Communicate early with your patients that to support a peaceful, comfortable, and safe environment for other patients and staff, it is preferred that they do not bring firearms into the facility/office regardless of whether they hold a CCW permit. Posting signs indicating this information is an option.
- If a firearm is discovered or the patient discloses that they are legally carrying a concealed weapon, the patient should be informed that the examination cannot safely proceed because of the interference the firearm causes with the assessment process. It should also be explained that the facility is unable to safely secure the firearm during the examination and that the firearm must be secured off the premises before the examination can safely continue.
- Instruct your staff not to offer holding or handling a patient’s firearm at any time. Instead, direct the patient to secure the firearm offsite.
- Consider including the above procedures as part of your facility’s workplace violence plan. For assistance in developing your plan, you can access CAP’s medical practices workplace violence toolkit at https://www.capphysicians.com/articles/workplace-violence-toolkit-medic…. Free assistance regarding workplace violence prevention programs in healthcare is also available by contacting Cal/OSHA Consultation Services at (800) 963–9424 or InfoCons@dir.ca.gov.
By taking the proactive steps described above, you will be better equipped to manage patients who may be carrying a concealed firearm, and help protect yourself, your staff, and your patients.
Bryan Dildy, MPA, CPHRM, CPPS, is a Senior Risk Management and Patient Safety Specialist. Questions or comments related to this article should be directed to BDildy@CAPphysicians.com.
References
¹Ben Christopher, A Boom for Concealed Carry Classes, But Long Waits for Permits, Capitol (May 3, 2024, 9:39 AM),
https://calmatters.org/politics/2023/03/california-concealed-carry-perm…
²New York State Rifle & Pistol Association, Inc., v. Bruen, 597 U.S. 1, 23 (2022)
³Id. at 2-3, 30
4Danielle Dawson, Concealed Carry Permits on Rise in San Diego County after Supreme Court Decision Last Year, FOX 5 (May 10, 2024, 12:42 PM)
5Ben Christopher, A Boom for Concealed Carry Classes, But Long Waits for Permits, Capitol (May 3, 2024, 9:39 AM), https://calmatters.org/politics/2023/03/california-concealed-carry-perm…
6Cal. Penal Code Sections 25400, 25850
7Cal. Penal Code Sections 26150, 26155
8Cal. Penal Code Sections 26150, 26185, 26165
9Cal. Penal Code Section 26190
10District of Columbia v. Heller, 554 U.S. 570, 626-27 (2008) & Bruen, 597 U.S. at 30 recognized the concept of “sensitive places” and the ability to prohibit firearms within such places without violation of the Second Amendment.
11Cal. Penal Code Section 26230
12Id.
13Order at 43, May v. Bonta, Case Nos: SACV 23-01696-CJC (C.D. Cal. Dec. 20, 2023).
14State of California Department of Justice, https://oag.ca.gov/ogvp/new-firearm-law (last visited May 3, 2024).