Assessment of Physician Self-reported Knowledge and Use of Maryland’s Extreme Risk Protection Order Law

Importance: On October 1, 2018, Maryland's extreme risk protection order (ERPO) law took effect. This was the first ERPO law in the United States to authorize clinicians to initiate a civil court process to temporarily prohibit people behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. This is the first publication reporting results from a survey of physicians about ERPOs. Objectives: To assess Maryland physicians' knowledge, past use, and likely future use of ERPOs, and to identify barriers to physicians' use of ERPOs and strategies to address those barriers. Design, Setting, and Participants: This survey study conducted at The Johns Hopkins Hospital in Baltimore, Maryland, surveyed physicians, including emergency medicine physicians, pediatricians, and psychiatrists, using a 15-question online instrument between June 15, 2019, and July 1, 2019. Data analysis was performed in July 2019. Exposure: Maryland's ERPO law. Main Outcomes and Measures: Knowledge, use, and likely use of ERPOs, barriers to use, and strategies to address those barriers. Results: Ninety-two of 353 physicians invited (26.1%) completed the survey; 1 respondent reported having filed an ERPO petition. Sixty-six respondents (71.7%) described themselves as not at all familiar with ERPOs. After reading a brief description of the ERPO law, 85 respondents (92.4%) indicated that they encounter patients whom they would consider for an ERPO at least a few times per year. Fifty-five respondents (59.8%) reported that they would be very or somewhat likely to file an ERPO petition when they identify a qualifying patient. Respondents identified time as the main barrier to using ERPOs (not enough time to complete paperwork, 57 respondents 62.6%; not enough time to attend hearing at courthouse, 64 respondents 70.3%), followed by concern that filing an ERPO would negatively affect their relationship with the patient (36 respondents 39.6%). Having a coordinator to manage the process (80 respondents 87.0%), training (79 respondents 85.9%), participating in court hearings remotely (68 respondents 73.9%), and having access to legal counsel (59 respondents 64.1%) were all selected by large majorities of respondents as strategies to address barriers to ERPO use. Conclusions and Relevance: Awareness of ERPOs among physicians in the sample was low. Physicians are treating patients who would qualify for an ERPO, and respondents in the sample indicated a willingness to use ERPOs. Training, providing access to legal counsel, designating a clinician to process petitions, and allowing clinicians to participate remotely in court hearings were strategies respondents identified to address barriers to ERPO use. These survey findings identify concrete solutions for addressing barriers to physician use of ERPOs.