Key Significance of Occupational Medicine in Prevention of Tragic Events due to Misuse of Firearms

Abstract

Occupational medicine is an extremely important branch of medicine that deals with examination of persons who do jobs in special working conditions. Thus, it enables that an adequate person comes to adequate workplace and so preventing accidents at work, early retirement and invalidity. Besides that, occupational medicine examines citizens applying for permits to possess and carry firearms, drive cars and other means of transport, sailors, divers, pilots and all kinds of athletes. This paper demonstrates the consequences of inadequate capability assessment for possession and carrying firearms of a retired army officer, which resulted in death of an innocent person in Rijeka, in Croatia. The aim is to accentuate the extreme importance and seriousness in assessment of a candidate’s capability to possess and carry firearms, which is not only a problem in Croatia, but internationally. Because of relatively easy access to firearms, this problem is particularly evident in the USA, where there are initiated many campaigns for limiting and stricter control of firearms acquisition by the citizens. Not intending to reduce the rights or the quality of private occupational medicine practices, I hold it necessary to limit possibilities to carry out examinations for possession and carrying firearms to government practices for occupational medicine and the private ones only with a long time experience and acquisition of special licences to conduct such an extremely responsible duty.

Keywords: Licence for holding and carrying firearms, Occupational medicine, Prevention of tragic consequences

Case Report

In July 2016, Rijeka’s daily newspaper Novi List, published an article about a perfidious killing of a quiet citizen who lived in one of Rijeka’s sky scrapers, committed by a retired army officer. The retired army officer, aged 70, lived in his flat. According to other residents he was prone to conflicts and as such was in arguments with the majority of other sky scraper residents. As a former army officer, he possessed hand firearms, i.e. he had a registered pistol. According to the Law for Possession and carrying Firearms in Republic of Croatia, it is compulsory for each person in possession of firearms to take a medical examination every 5 years. The assessment about capability to possess and carry firearms is performed by Occupational medicine, on the basis of confirmation issued by a family doctor. Although the family doctor wrote that the above mentioned person suffered psychological problems, the occupational medicine specialist assessed him positively for possession and carrying firearms. One morning the retired army officer waited for his neighbour in front of their lift and killed him with several shots from his pistol.

The motive for murder was a recent argument about rising and holding pigeons on the balcony of the building where the neighbours lived. The murderer was arrested and after several days released and allowed to defend himself outside of prison. However, due to public pressure, he was arrested again and is now waiting for court proceedings. During the search of his apartment, a target was found with initials of also other neighbours pinned on it. They were on a hit list. The retired army officer most likely will not be free again, i.e. he will probably end up in an institution for the mentally ill. However, a question arises whether the tragedy could have been prevented and why did one family with children lost their father. This case is not an only case, every now and then in Croatia as well as all over the world one can read about tragic consequences of use of firearms in hands of mentally ill persons.

Discussion

Occupational medicine and Family medicine on the level of primary health care are directly connected [1]. This is of extreme importance because the occupational medicine specialist most often does not know the person who comes to them for their first licence or extending the current permit for possession and carrying firearms or driving licence. Therefore, a family doctor who has a detailed insight into a person’s medical records has to issue a verification that has to be brought to the occupational medicine specialist. Occupational medicine is extremely important preventive branch of medicine that deals, apart from the above mentioned, also with examinations of all persons who do jobs in special work conditions [2]. In such complex examinations the team make a psychologist, a psychiatrist, ophthalmologist and indirectly engineer of medical- laboratory diagnostics.

The activity of Occupational Medicine in Republic of Croatia is regulated via 2 basic laws. Primary law is the Law of Health Protection as published in People’s Gazette No 150/2008 where is under Article 26 Occupational Medicine listed as a preventive branch of medicine on the primary level. The second law is the Law on Safety at Work published in People’s Gazette No 71/2014 that deals with Occupational Medicine activities integrated in the program of health safety measures and safety at work.

The Occupational Medicine team boss is the occupational medicine specialist who issues and signs a medical certificate that the applicant has to present to the Police in order to obtain permit to posses and carry firearms [3]. The consequences could be grave, i.e. irreversible because the misuse of firearms most often ends up in death or severe wounding.

According to the Weapons Act, People’s Gazette No 63/2007, Article 10, candidates to posses and carry firearms have to submit the mentioned medical certificate as proof that they are capable to posses and carry firearms to the relevant Police Station according to their place of residence. According to the same Weapons Act, Article 11, the medical certificate can be issued only by an occupational medicine specialist competent for such kind of examinations.

Particularly important is the Rule published in People’s Gazette No 22/2013. This is the Rule on health examinations for determining health capability to posses and carry firearms. Disputable is Article 10 Point 2, which regulates certifying health capabilities where there are psychological and behavioural disturbances involved. This point states that it is contraindicated issuing of certificates to persons with psychological and behavioural disturbances caused by consumption of psychoactive substances - except with persons in stable remission, without clinically significant disturbances or damages in social and random functioning.

For this reason, the occupational medicine specialist is often in a very difficult situation because the patients put on them strong pressure and if persons with intention to obtain permission to carry firearms in their medical records have a history of mental illness, they create various ways to obtain certificates that they are healthy and cured. Regardless of such certificates, if patients were diagnosed with a serious mental illness or had an addiction, occupational medicine specialist must not issue a certificate for possession and carrying firearms.

This paper describes a case of a 70 years old retired psychologically disturbed army officer whom killed his neighbour. Evidently, an occupational medicine specialist had not done his job properly, because the family doctor did indicate patient’s mental problems. Probably, the psychologist and the psychiatrist had assessed that the patient at that time was not in a psychotic state, which evidently was a bad assessment.

If necessary, the occupational medicine specialist as the team’s boss has to give a negative opinion, regardless of his colleague’s disagreement, because he is the responsible one who signs the medical report - certificate for police. The only defence for occupational medicine specialist that was in charge of this case is that the current Law on Firearms in the country is partially incomplete. The final judgement is left for the occupational medicine specialist because the current law states that although a person has mental disturbances and is on medication, they can be able to posses and carry firearms if their state is such to safely handle it. In such a case the occupational medicine specialist has to assess, which is very delicate job, whether it is safe for such a person to posses and carry weapons.

The Occupational Medicine which in Republic of Croatia became Occupational and Sports Medicine has a very wide range of tools for assessment of work and specific capacity. The occupational medicine can in detail assess physical capacity (not only at a standstill but also at strain and during physical and sports activities [4]. It is also important to perform a good assessment of mental capabilities.

The persons who have an official permit for possession and carrying firearms are not and cannot be mentally ill persons. That does not mean that amongst them there could not be found persons prone to impulsive reactions who are not registered as psychiatric patients [5]. Therefore, it is very important the assessment of a risk of a possibility of violent behaviour with potential candidates [6]. Firearms are held for protection and not for violent or criminal use. It can also be used in sports and in hunting. For safe handling of firearms, apart from mental stability, regular neurological state is also important. Neurological disturbances can lead to unwanted movement and uncontrolled pressure on trigger of a hand firearm [7]. Firearms triggers are very sensitive and a very fine feeling is needed to accomplish a balanced shot.

Special problem represent adolescents who carry firearms to high schools [8]. Very often emotional immaturity combined with fear, humiliation and other negative feelings can lead to unwanted consequences.

In France, according to the law, it is compulsory for doctors to inform the relevant authorities if exists psycho- physical contraindication for possession and carrying firearms [9]. Hunters often apply for permits to possess and carry firearms.

Due to all the above mentioned it can be concluded that medical centres with occupational medicine teams have to be very objective and well trained to assess the ability to posses and carry firearms [10]. With all due respect to private polyclinics and occupational medicine practices, advantage should be given to the government practices which are financially independent of candidates’ examination fee. Namely, it cannot be said that a human life is worth about US 70 $ (price in Republic of Croatia for examination for possession and carrying firearms), because this is what one pays to obtain a certificate. If a word goes around that a particular occupational medicine specialist does not hand out medical approvals easily, they are in danger of losing their patients and their livelihood. Nowadays, occupational medicine is first of all a commercial medicine, one that charges for its services. Without any doubt there exist some very hard working and serious teams in the private practices of occupational medicine. Such teams should be awarded by the government special permissions for work with firearms permit applicants and go through appropriate licensing. In this entire system, it is necessary to control arms dealers in order to avoid selling firearms to criminal organizations [11].

Who is once given a permit to posses and carry firearms, does not mean that they have to have it all the time. This is the reason why medical examinations are carried out every several years. Ill persons, especially very ill persons, sometimes commit suicide, so to those in possession of firearms this is made easier [12]. Elderly persons, demented, become unsafe to possess and carry firearms and it has to be taken away from them [13]. If it is a matter of a memento, such firearms can be neutralized by a specialist gunsmith and given back to the owner. Persons in possession of firearms in case of grave illness will more often commit suicide than those who do not have it [14].

The control of issuing firearms to individuals as well as the control of firearms dealers proved to be necessary [15]. Nevertheless, the number of criminal acts carried out with illegally held weapons is incomparably higher than the registered.

Finally, primarily for their protection, also women of the modern world, especially those that experienced violence, heavy humiliation and suffering, are more and more prone to applying for permit to possess and carry firearms [16].

One has to bear in mind that firearms are always a potential danger and that they can fall in hands of family members, children (although weapons should be kept locked up in special cabinets). Because of that the present and future owners have to be told to think carefully whether to purchase firearms or not.

In conclusion, on the basis of this example of mentally ill retired army officer who unfortunately is not the first and not the last such case, there should be initiated the action of not only carrying out checkups on persons in possession of firearms, but primarily on occupational medicine practices (the private ones first of all) that give out permits so easily, considering only their profit and not considering the possible consequences for family and society.

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