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Survey: Doctors’ political views may affect patient care

Politics in the exam room? A new study suggests patient care may vary depending on whether the doctor is a Democrat or a Republican — at least when it comes to some hot-button health issues like firearm safety.

Health care has long drawn partisan political fights, like state laws surrounding abortion, or Florida’s law restricting doctors from discussing guns with patients. But there’s been little research on the doctor-patient side of those controversies. Can physicians leave their own political ideology at the door during something as simple as a checkup?

So Yale University researchers took an initial step, looking up voter registration records and linking more than 20,000 primary care physicians to their party affiliations. Then they surveyed more than 200 of those doctors about how they’d react to different scenarios — health issues that might come up when a new patient outlines his or her medical history during a routine physical.

Suffering depression? In denial about alcohol abuse? Ride a motorcycle without a helmet? Political affiliation didn’t matter; the survey found doctors of both political stripes would react about the same to patients with those and some similar health issues.

But Republican and Democratic doctors differed significantly when it came to some more politicized issues — abortion, marijuana and guns, the researchers reported.

Faced with a woman who wasn’t currently pregnant but had undergone two abortions earlier in life, Republican doctors were twice as likely as their Democratic counterparts to say they’d discourage any future abortions and 35 percent more likely to discuss so-called mental health aspects of abortion, said study co-author Eitan Hersh, a Yale political science professor.

Faced with a man who uses recreational marijuana three times a week, Republican doctors were 64 percent more likely to say they’d discuss marijuana’s legal risks and 47 percent more likely to urge them to cut back than Democratic doctors.

And Democratic doctors were 66 percent more likely to say they’d urge parents of small children not to store guns in the home — while Republican doctors instead preferred to ask about safe storage of the firearms, concluded the survey, published in Proceedings of the National Academy of Sciences.

“This was really an eye-opener,” said bioethicist Nancy Berlinger of The Hastings Center, a nonpartisan research institute.

She wasn’t involved with the study but said it sheds light on the problem of “implicit bias” that affects people throughout society — the judgments we’re not consciously aware of making.

“We’re all biased in some way. We can be biased for something as well as against something,” Berlinger explained. When it comes to deeply partisan divides, doctors “can’t screen that out just like the rest of us can’t screen it out.”

Consider firearm safety, an important public health issue particularly for children, who too often are killed or injured when they find and play with a gun. The American Academy of Pediatrics advises that doctors ask about the presence of guns and counsel parents who keep firearms to store them unloaded in a locked case, with the ammunition locked up separately.

Berlinger said doctors could examine if public health successes — such as how, over decades, child car seats became mandatory and embraced — bring lessons in communicating the need to also keep children safe from accidental shootings without the parent tuning out.

When patients choose a doctor, “they don’t necessarily know what they’re getting ahead of time,” Hersh said, noting that many other issues, from transgender health to end-of-life care, may be affected by the physician’s political views.

He called the survey a first step to studying the actual impact on patients. (The survey couldn’t reflect whether doctors had recently changed their party affiliation, and didn’t include those who live in states that don’t have registration by party.)

“We don’t leave things at the door,” said Dr. Matthew Goldenberg, a Yale psychiatrist who co-authored the research. “Both patients and practitioners should be aware that there are these biases.”

By Lauran Neergaard, AP Medical writer

Does this gun make me look fat? Firearms spur fashion niche  

Does this gun make me look fat?

For decades, women have had few discrete clothing choices for pistol-packing mamas. They could wear baggy T-shirts or coats, or put it their guns in a purse and hope it didn’t get swiped or that they didn’t have trouble getting it out in an emergency.

Enter holsters, corsets, camisoles and other clothing designed to be flattering, feminine — and functional — for women packing heat.

“I don’t want to dress in tactical gear and camo all the time. I love tactical clothing for the range. It’s comfortable. I don’t want to ruin my everyday clothing,” said Marilyn Smolenski, who in 2012 created Nickel and Lace, a company that caters to women who want to carry a firearm concealed but don’t want to trade in their femininity. “But I don’t want to wear it to the grocery store.”

Smolenski started her company right around the time when Chicago city laws changed and she could again legally carry a firearm. When that happened, she struggled to find something that didn’t make her look frumpy and didn’t broadcast that she was armed. Most of the clothing was geared to men — coats with hidden pockets, or holsters that tuck neatly inside a waistband. But until the last few years, those weren’t always great options for women who don’t wear belts as frequently and are more likely than men to wear form-fitting clothing, making it difficult to hide the fact they’re carrying a firearm.

“When you put a man’s holster on a woman’s body it sticks out. It doesn’t hug the body,” said Carrie Lightfoot, founder and owner of The Well Armed Woman — “where the feminine and firearms meet,” according to its tagline — in Scottsdale, Arizona. The store does everything from providing firearms instruction to women to selling a variety of concealed carry clothing. One of the company’s first missions was to design and produce a holster that recognized the differences in body types and clothing styles between men and women.

Women’s waists tend to be shorter, providing less room to withdraw a gun from a holster. Hips and chests can get in the way too, she said.

Lightfoot and Smolenski said that some manufacturers tended to “shrink it and pink it” — thinking that taking gear produced for men and making it smaller and brightly colored would satisfy female customers. They and their counterparts emphasize they are driven first by function and safety before aesthetics come into the equation.

“Women need to know they can carry effectively,” Lightfoot said. “I think the key is finding a way to carry it so you can be comfortable and move through your day without being poked and having a big hunk of metal in your pants and not be able to sit at work.”

Both also are advocates for providing women with information and guidance on ways to feel secure and be safe. For Smolenski, that goal has led to the creation of the annual Firearms and Fashion Show which includes seminars on personal safety. Her company actually got its start with a line of jewelry — from necklaces that can be pulled away easily and then used as a weapon to “chopsticks” that can both be used to hold up hair and then be wielded against an attacker.

For Anna Taylor, the founder and CEO of Dene Adams LLC — named after her grandfather, who first taught her to respect firearms and handle them safely — the road to creating a line of concealed-carry clothing began at around the time she became a single mom and the safety of the family rested on her shoulders. When she got her first concealed carry permit in 2013, she went through seven different holsters.

“Some were hard and uncomfortable. Some of them I’d have to take off and set down when I went to the bathroom and I was afraid I would go off and leave it just like I’ve left my phone behind before. Others, belly- band types with a print so bad you could see the grip or outline of the gun through my clothes,” Adams said. “So when I went out in public, I felt like I had these awkward arms always trying to hide this thing.”

Her first design involved a mousepad and a post-partem corset to create a soft holster. She was able to carry the kids around, nurse, give the kids baths — even jump on the trampoline — “and I could forget that it was there.” With her last $200, she found a manufacturer willing to do a small run. Flash forward three years and she now has products on shelves at nearly 100 dealers around the country. She has expanded into safety and training and is now an NRA pistol and rifle instructor. She even has a few men who buy her products — including, she said, air marshals, who gravitate to the snug, comfortable designs.

“We have options that don’t have lace. We have solid black,” she said.

Autopsies suggest killer targeted victims at Pulse nightclub

More than a third of the 49 patrons killed during the Pulse nightclub massacre were shot in the head, and most of the victims had multiple bullet wounds, according to autopsy reports released this week.

Only two victims at the LGBT club had traces of soot, gunpowder or stippling, meaning most of the victims were likely more than 3 feet away when they were shot in the deadliest mass shooting in modern U.S. history.

The autopsies show that about half of the victims had five wounds or more, and one victim had 13 wounds.

Gunman Omar Mateen was killed during a shootout with law enforcement officers following a three-hour standoff June 12.

“It shows he shot a lot and had a lot of ammo,” said Dr. Stephen Cina, a Colorado-based forensic pathologist, who has no connection to the case.

The large number of head injuries and multiple wounds on victims suggests Mateen was targeting his victims rather than shooting randomly, said Josh Wright, a former Florida Department of Law Enforcement firearms analyst who now has a forensics consulting firm in Tallahassee.

“I wouldn’t expect to have those many hits on those many people if you weren’t actually trying to take aim and make sure you hit your target rather than running around, spraying bullets,” said Wright, who also has no connection to the case.

The Florida Department of Law Enforcement is investigating whether anyone died from friendly fire during the shootout at the gay nightclub.

Officers knocked down a wall and stormed the club, killing Mateen in hail of gunfire. Mateen, who had pledged allegiance to the Islamic State, was shot eight times by police.

Cina said without evidence of stippling — particles of gunpowder in the skin — it’s difficult to know if the victims were shot in the head point-blank.

Michael Knox, a Jacksonville-based firearms expert, said the large number of victims with multiple wounds could also suggest Mateen was firing rapidly at groups of people in the crowded nightclub.

The unusual paths of some gunshots support eyewitnesses who said people were crouching under tables and hiding in toilet stalls.

“Some tried to run or hide under tables so you’re going to have these weird bullet paths,” he said.

Republicans demand right to carry firearms at convention

About 32,000 people so far have signed a Change.org petition to allow guns at the Republican National Convention in the name of safety.  Ohio is an open carry state, but the Quicken Loans Arena, where the convention is being held in July,  is a gun-free zone.

Petition signers contend the ban on firearms will make them “sitting ducks, utterly helpless against evil-doers and criminals.”

“Cleveland, Ohio, is consistently ranked as one of the top ten most dangerous cities in America,” the petition says. “By forcing attendees to leave their firearms at home, the RNC and Quicken Loans Arena are putting tens of thousands of people at risk both inside and outside of the convention site.”

That argument has become ubiquitous among members of the National Rifle Association, anti-government militants and gun owners who feel unsafe without weapons. The same argument was made prior to the 2012 RNC in Tampa, but the Secret Service stepped in and banned firearms.

Critics say that Trump and his angry followers present the greatest danger to the RNC. His appearances are often marked with violence toward protesters, blacks, Muslims and others whom Trump rails against from the podium. He encourages his followers to create mayhem.

Protesters effectively shut down a recently scheduled Trump appearance in Chicago by surrounding the area where he was scheduled to speak.

The petition notes that: “All three remaining Republican candidates have spoken out on the issue and are unified in their opposition to Barack HUSSEIN (sic) Obama’s ‘gun-free zones.’”

Petitioners include quotes supporting the universal right to carry firearms from each of the three remaining political candidates (below):

Donald Trump said “I will get rid of gun-free zones on schools — you have — and on military bases on my first day. It gets signed my first day … you know what a gun-free zone is to a sicko? That’s bait.” (Jan. 8. 2016)

Ted Cruz has accurately pointed out “shooting after shooting after shooting happens in so called gun-free zones.” He continued, “look, if you’re a lunatic ain’t nothing better then having a bunch of targets you know that are going to be unarmed.” (Dec. 4, 2015)

And Ohio Governor John Kasich has been a leader in this movement to eliminate deadly “gun-free zones” starting with his brave decision to fight the Democrats and end “gun-free zones” at National Guard facilities in Ohio. (Dec. 18, 2015)

The signers also claim that carrying firearms is a “God-given” right:

“We are all too familiar with the mass carnage that can occur when citizens are denied their basic God-given rights to carry handguns or assault weapons in public. EVERY AMERICAN HAS THE RIGHT TO PROTECT AND DEFEND THEIR FAMILY (sic). With this irresponsible and hypocritical act of selecting a ‘gun-free zone’ for the convention, the RNC has placed its members, delegates, candidates and all US citizens in grave danger.

“We must take a stand. We cannot allow the national nominating convention of the party of Lincoln and Reagan to be hijacked by weakness and political correctness. The policies of the Quicken Loans Arena do not supersede the rights given to us by our Creator in the U.S. Constitution (sic).”

Scott Walker signs bill allowing concealed carry of switchblades and knives

Gov. Scott Walker has signed a measure allowing people to carry concealed switchblades and knives.

The governor, often criticized as a shill for the National Rifle Association, gave his signature to the measure on Saturday afternoon during the National Rifle Association and Wisconsin FORCE’s annual convention in Weston.

Wisconsin FORCE, or Firearm Owners, Ranges, Clubs and Educators, is an NRA-chartered association that advocates for the right to bear arms.

Manufacturing, selling, transporting, purchasing or possessing a switchblade has been illegal in Wisconsin for decades. The Republican-authored bill eliminates the prohibition as well as permits anyone who can legally possess a gun to carry concealed knives of any length without a concealed carry license. The bill also bars local governments from enacting knife regulations stricter than state law.

Throughout his tenure, Walker and Wisconsin Republicans have continually eased restrictions on firearms. Just one week after a racially motivated massacre at a Charleston, South Carolina, church, Walker signed into law a measure eliminating the state’s traditional 48-hour waiting period before purchasing a firearm.

In signing the law, Walker claimed that guns were being singled out for regulation, even though other lethal weapons were not. He pointed to a recent incident in which someone had been killed with a bow and arrow near a Neenah school.

PolitiFact researched the story and found it was untrue, giving Walker a “pants on fire” rating for the statement.

Obama: NRA pushed ‘conspiracy’ theory that ‘somebody’s going to come grab your guns’

President Barack Obama mocked conspiracy theorists and tore into the National Rifle Association for pushing “imaginary fiction,” as he described his plans to tighten gun control rules as modest first steps toward tackling gun violence in America.

In a prime-time, televised town hall meeting last week, Obama fielded tough questions from high-profile gun control opponents and supporters alike, often answering with sympathy and without confrontation as he tried to reassure Americans there is a middle ground on a fiercely divisive issue.

The town hall featured several well-known figures in the gun debate. Former Rep. Gabrielle Giffords, who was shot in 2011, stood as her husband, Mark Kelly, asked Obama about confiscation theories. Taya Kyle, whose late husband was depicted in the film American Sniper, asked the president about why he doesn’t highlight falling murder rates. Cleo Pendleton, whose daughter was shot and killed near Obama’s Chicago home, asked about his proposals to stop gun trafficking across state lines.

Kimberly Corban, an NRA supporter, told Obama she’d been raped by an intruder and now feels that owning a gun “seems like my basic responsibility as a parent … I refuse to let that happen again.”

Obama didn’t hold back when asked by CNN moderator Anderson Cooper about the notion that the federal government — and Obama in particular — wants to seize all firearms as a precursor to imposing martial law. He blamed that notion on the NRA and like-minded groups that convince its members that “somebody’s going to come grab your guns.”

“Yes, that is a conspiracy,” Obama said. “I’m only going to be here for another year. When would I have started on this enterprise?” Obama defended his support for the constitutional right to gun ownership while arguing it was consistent with his efforts to curb mass shootings. He said the NRA refused to acknowledge the government’s responsibility to make legal products safer, citing seatbelts and child-proof medicine bottles as examples.

Taking the stage at George Mason University, Obama accused the NRA of refusing to participate in the town hall despite having its headquarters nearby.

“Since this is a main reason they exist, you’d think that they’d be prepared to have a debate with the president,” Obama said.

NRA spokesman Andrew Arulanandam said beforehand that the group saw “no reason to participate in a public relations spectacle orchestrated by the White House.” Several NRA members were in the audience for the event, which was organized and hosted by CNN. And the NRA pushed back on Twitter in real time, noting at one point “none of the president’s orders would have stopped any of the recent mass shootings.”

The White House has sought to portray the NRA, the nation’s largest gun group, as possessing a disproportionate influence over lawmakers that has prevented new gun laws despite polls that show broad U.S. support for measures like universal background checks. Last year, following a series of mass shootings, Obama pledged to “politicize” the issue in an attempt to level the playing field for gun control supporters.

The American Firearms Retailers Association, another lobby group that represents gun dealers, did participate in the forum. Asked how business had been since Obama took office, Kris Jacob, vice president of the group, replied: “It’s been busy.”

“There’s a very serious concern in this country about personal security,” he added.

Obama’s actions on guns have drawn major attention in the presidential campaign, with the Democratic candidates backing Obama and the Republicans unanimously voicing opposition. Donald Trump, addressing a rally in Vermont just as Obama was holding the town hall, said he would eliminate gun-free zones in schools on his first day if elected to the White House.

“You know what a gun-free zone is for a sicko? That’s bait,” Trump told the crowd.

Obama’s broadside against the NRA came two days after his unveiling of a package of executive actions aimed at keeping guns from people who shouldn’t have them. The centerpiece is new federal guidance that seeks to clarify who is “in the business” of selling firearms, triggering a requirement to get a license and conduct background checks on all prospective buyers.

The plan has drawn intense criticism from gun rights groups that have accused the president of trampling on the Second Amendment and railroading Congress by taking action on his own without new laws. Just after his 2012 re-election, Obama pushed hard for a bipartisan gun control bill that collapsed in the Senate, ending any realistic prospects for a legislative solution in the near term.

Ahead of the town hall, Obama put political candidates on notice that he would refuse to support or campaign for anyone who “does not support common-sense gun reform” — including Democrats.

All the candidates running for the Democratic presidential nomination support stricter gun laws, so Obama’s declaration in a New York Times op-ed isn’t likely to have an impact on the race to replace him. Instead, it appeared aimed at Democratic congressional candidates from competitive districts who might want Obama’s support on the campaign trail this year.

After guns wound and kill, bills pile up for victims and society

It was 1:30 a.m. on the first day of summer in 2014 and Claudiare Motley had just dropped off a friend after coming into town for his Milwaukee Tech High School 25-year class reunion. He was parked around North 63rd Street and West Capitol Drive, writing an email on his phone, as two cars pulled up.

Motley, then 43, knew “something was going on” as one of the vehicles turned in front of him and stopped. He put his phone into his pocket, shifted his car into gear. A teenager jumped from the car and tapped Motley’s window with a gun.

He accelerated as 15-year-old Nathan King fired, shattering glass. Motley rammed the car in front of him out of the way. He sped off and looked in the rearview mirror to see if they were chasing him.

“I just saw blood gushing out of my jaw,” Motley said.

After more than a year and six surgeries to repair his injuries, Motley estimates his out-of-pocket costs to be at least $80,000, and he expects more medical expenses as he continues to recover.

His efforts to get state victim’s compensation for his medical bills not covered by insurance have been unsuccessful so far. Motley’s credit has taken a hit, and he estimates lost earnings because of time he could not work in his family’s international law firm to be between $40,000 and $60,000.

Wisconsin taxpayers and health care providers also pay a high price for gun violence. In April, Mother Jones magazine pegged the cost of gun violence to Wisconsinites in 2012 at $2.9 billion in direct and indirect costs, or $508 for every person in the state.

Those figures include the financial and psychological tolls taken when a bullet forever alters the lives of victims and shooters alike. There are lost wages, stunted futures, shattered plans, life-changing trauma.

Firearms are a big factor in crime statewide. In 2014, guns were involved in 75 percent of murders, 56 percent of armed robberies, 27 percent of aggravated assaults and 3 percent of forcible rapes, according to the state Department of Justice.

Taxpayers pay all of the costs for police, prosecutors and incarceration — and sometimes to defend the accused — in gun crimes. And 79 percent of health care costs in Wisconsin associated with firearm-related injuries are paid by the public, according to a 2014 report using 2010 data by the Urban Institute, a Washington, D.C.-based think tank.

When he is released from prison, King — who is now paralyzed from the waist down because of a separate shooting days after he shot Motley — will probably face limited employment opportunities. Motley said he does not expect to see much of the $29,339 in court-ordered restitution.

State taxpayers paid about $1,500 for the 50 hours spent by Milwaukee County Assistant District Attorney Joy Hammond to prosecute King during the case that ended in September. They paid $1,537 for King’s attorney, Ann T. Bowe.

Residents of Wisconsin will spend about $405,000 to keep King in prison during his 12-and-a-half-year sentence for the Motley shooting and a later armed robbery in which King himself was shot. After he is released, King will be on extended supervision for seven and a half years at a cost to taxpayers of at least $21,000 in today’s dollars.

The tally for the Motley shooting — at least half a million dollars — is the cost of just one shooting in a city that this year has seen 691 people shot, including 131 killed, by firearms as of Nov. 15. That was a 77 percent increase in gun homicides from November 2014 and an 11 percent increase in nonfatal shootings.

Entire communities pay price

In addition to victims, entire communities face costs, including reduced property values in high-crime areas and increased costs to keep the public safe.

“It’s not just a problem for the individuals who are unlucky enough to get shot,” said Philip Cook, professor of public policy, economics and sociology at Duke University. “It’s a problem for whole communities. It’s a drag on economic development, it’s a drag on quality of life in a variety of ways.”

Violence was one of the things that prompted Motley to move out of his hometown of Milwaukee about eight years ago. He and his wife, Kimberley, and three children moved to Charlotte, North Carolina, in part to escape what he calls a “cultural acceptance of violence” and a “proliferation of guns and illegal drugs.”

“You always hear the bad things that could happen, but you never really think … that you actually encounter something like that,” he said.

A report from the Center for American Progress, a progressive public policy organization, suggests that a reduction in violent crime — including homicides, rapes and assaults — could have large impacts on urban areas. The report, which analyzed 2010 crime levels in Milwaukee and seven other cities, suggested a 10 percent reduction in homicides could boost residential real estate by $800 million in Milwaukee.

The report noted such a reduction could generate “large revenue gains” from property taxes, but it did not provide an estimate. Cutting homicides by 25 percent, it projected, could add $2 billion in increased housing values.

Experts say because the cost for each shooting is so high — often in the tens if not hundreds of thousands of dollars — anything that could reduce gun violence would likely be worth the investment.

“Almost any reasonable policy that reduces crime will pay for itself,” said David Weimer, a University of Wisconsin-Madison professor of political economy and expert in cost-benefit analysis.

But not everyone agrees on the best way to curb gun violence. Some have called for expanding background checks and for banning certain types of assault weapons.

Jeff Nass, executive director of Wisconsin Firearm Owners, Ranges, Clubs and Educators Inc., disagrees. He said any cost-benefit analysis should include the positive value that guns have when used for self-defense.

Nass, whose organization is affiliated with the National Rifle Association, argued that violence and gun issues are separate. He called for more prosecution of illegal gun possession and gun crimes.

“Bad violence is bad violence. Whether it’s done with a knife, a gun, whatever, it’s the person,” Nass said. “The people that we know are violent — that we know are in the criminal element — need to be held accountable.”

Gun violence drives up medical costs

The medical costs of shootings are often borne by taxpayers. Those costs usually begin with a trip to the hospital from the scene of the shooting.

Last year, paramedics from the Milwaukee Fire Department provided services to 297 shooting victims. The average cost was $1,300 per patient, or roughly $386,100.

Statewide, there were 349 hospitalizations and 742 emergency department visits because of firearm-related injuries in 2014, according to Department of Health Services data.

About half of emergency visits and 60 percent of hospitalizations are covered by Medicaid or Medicare, which are public insurance programs. The total amount public insurance programs paid for gun-related injuries in 2014 was about $6 million after negotiations between health care providers and the state and physician fees are factored in.

The Wisconsin Hospital Association, which provided information to the Wisconsin Center for Investigative Journalism used to reach this estimate, cautioned that it is “very rough.”

Dr. Stephen Hargarten, chair of the Department of Emergency Medicine at the Medical College of Wisconsin, said firearm injuries are “very, very expensive” to the public. Unlike knives and other methods of assault, firearms are more deadly and can leave significant long-term disabilities, he said.

“It’s costly to all of us because a significant portion of the people who are injured with bullets are those who are on Medicaid, Medicare or self pay,” said Hargarten, director of the college’s Injury Research Center.

Ted Miller, senior research scientist at the nonprofit Pacific Institute for Research and Evaluation, said there may be additional costs for mental health care for those impacted by violence. Miller is is an expert in the costs of gun violence and other injuries at the institute, which uses research to recommend ways to improve public safety and health. For every type of homicide, he said, somewhere between 1.5 and 2.4 family members and loved ones of the victims seek mental health care.

Often, those costs, which vary from person to person, also are covered through public insurance programs, said Dr. Marlene Melzer-Lange, a professor of pediatrics at the Medical College of Wisconsin and program director of Project Ujima at the Children’s Hospital of Wisconsin in Milwaukee. Project Ujima provides mental health services to both adults and child victims of violent crime.

A small percentage of shootings leave victims paralyzed or gravely injured. That can lead to being placed on the state’s long-term care programs, which cost taxpayers roughly $3,100 a month for nursing home care or $530 a month for in-home care.

Legal, law enforcement costs high

Another cost is police response. That can vary significantly, from sending two officers to a report of shots fired to shutting down several blocks as officers canvass an area looking for evidence in a homicide. The time it takes to conduct an investigation depends on the cooperation of victims and witnesses and other factors.

“It’s different for every shooting,” said Milwaukee Police Department Sgt. Tim Gauerke. “Every one of them is based on the circumstances on hand.”

In 2014, the department dispatched units to 6,622 reported calls of shots fired — an average of 18 calls a day. Those calls may have overlapped with the 3,632 incidents of gunshots detected by the department’s ShotSpotter detection system, which allows police to pinpoint locations where a firearm has been discharged in an area of 11 square miles in the city.

That system expanded last year with a one-time funding of $350,000 split by the state and Milwaukee, and now costs the city more than $320,000 a year.

Wisconsin’s largest city has the most homicides and nonfatal shootings in the state. According to the Milwaukee Homicide Review Commission, there were 75 firearm homicides and 583 nonfatal shooting victims in the city in 2014. The Milwaukee County District Attorney’s Office prosecuted more than 1,100 cases involving a firearm last year.

To support efforts this year, the state, the city of Milwaukee and Milwaukee County formed the Milwaukee Gun Violence Reduction Initiative. The Legislature’s budget-writing committee unanimously backed $366,800 for the state to hire two assistant attorneys general to work as special prosecutors for gun cases in Milwaukee. Democratic and Republican lawmakers called the program a “Band-Aid” solution.

On the other side of firearm-related cases, the State Public Defender’s Office provides legal representation to defendants who cannot afford an attorney.

Since 2012, the office has appointed private attorneys to represent defendants in 832 armed robbery cases, paying each an average of $1,415. (Armed robbery can include any type of weapon, including a gun.) That amounts to $1.2 million and does not include the cost of paying public defender staff who represented other armed robbery suspects.

After they are convicted, inmates cost Wisconsin taxpayers an average of $32,800 a year. The average cost to supervise an offender after release is about $2,800 annually.

Police caught King, the teenager who shot Motley, shortly after the June 21, 2014, after he committed another crime. In that incident, King attempted to steal a woman’s car. She pulled out a gun and shot him, leaving King paralyzed from the waist down.

Motley fought to ensure King was tried as an adult because he felt a sentence in the juvenile system would have been too light.

“I just felt that was not enough to teach a lesson to a person who was really violent,” he said.

Gun violence costs wide-ranging

It is not just victims and perpetrators who pay a high price. There are other costs — some of them hard to quantify.

“We don’t know some of the other less easily defined costs of the fact that people in rural areas won’t come to Milwaukee because they’re scared,” said Hargarten of the Medical College of Wisconsin. “There’s an impact on tourism. There’s an impact maybe on businesses trying to locate somewhere else because the perception is that Milwaukee is not very safe.”

Miller said another understudied cost is the impact of adverse childhood experiences — serious traumas, such as witnessing or being a victim of gun violence. Studies show those experiences can harm brain development and may increase future health problems, including heart disease, depression and drug abuse.

“I think a lot of us for a long time have said violence is a public health problem, and a lot of people didn’t really believe it,” said Melzer-Lange of Project Ujima. “Your health either as a witness or as a direct victim is going to be affected downstream.”

Schools also pay for gun violence. According to a 2013 article in the trade magazine Campus Safety, 88 percent of school districts nationwide made or planned to make security enhancements after the Sandy Hook Elementary School mass shooting in 2012.

There is also the “value of a statistical life.” Economists calculate that number by summing up what people are willing to pay for a small reduction in the probability of death. For example, if each person living in a community of 100,000 would pay $100 to reduce the number of deaths by one each year, the value of life would be $10 million.

The U.S. Department of Transportation puts the value at $9.4 million. This value is used nationwide by the department to analyze whether the cost of a certain potentially life-saving regulation or transportation improvement is worthwhile.

Miller puts the statistical value for one person injured by gun violence at $6.2 million. He said that “accounts for the pain, suffering and the lost quality of life for victims and their families.”

Victims can get some of their costs covered. Wisconsin’s Crime Victim Compensation Program caps the amount victims and their families can receive at $40,000 and only for out-of-pocket expenses. Qualifying families can also receive up to $1,000 to clean up a crime scene and $2,000 for a funeral. In all, $4.1 million was awarded in 2013-14 for 2,498 claims. The average claim paid was $3,205.

What can be done to curb violence?

Reducing gun violence requires a multi-faceted approach, experts say, with policy initiatives at the federal, state and local levels.

“If we can make those cities safer for gun violence, then they can develop and become places that thrive economically where businesses are investing in them, where employment becomes generally available,” said Cook of Duke.

Wisconsin lawmakers have offered some solutions. Gov. Scott Walker recently signed into law a bill that establishes mandatory minimum sentences for felons who commit certain violent crimes while illegally possessing a firearm.

State Democrats want to expand background checks for firearm purchases and ban semiautomatic weapons. A bill with bipartisan support would prevent those who commit multiple or violent misdemeanors from purchasing a firearm for 10 years, but those bills have not moved far in the Legislature.

During a Nov. 4 discussion before voting to pay for additional prosecutors for Milwaukee gun crimes, Democrats called for more action.

“Until we get to the bottom of addressing trauma and giving people hope by giving people opportunity through jobs, nothing’s going to change,” said Sen. Lena Taylor, D-Milwaukee.

Twenty-four Democratic U.S. senators and 114 House members are urging President Barack Obama to use his executive powers to require universal background checks nationally.

State Republican lawmakers during the committee discussion saw different answers to the gun violence problem.

State Rep. Dale Kooyenga, R-Brookfield, said the problem needs to be addressed on multiple fronts. The state already has “a lot of gun laws,” and he said some of the issues may not be solvable through public policy.

“What Milwaukee needs and what kids need in Milwaukee is not more district attorneys,” Kooyenga said. “We need more fathers, and the other part of it is we need more schools.”

Sen. Alberta Darling, R-River Hills, called for more police officers and getting “habitual criminals” off the streets.

Motley agreed in part. He said repeat offenders, such as the 17-year-old who gave King the gun used to shoot him are part of “an epidemic that’s going on in the system.” Motley wants to find a way to prevent shootings and get guns off the streets, a focus that helps relieve some of the anger he feels at what happened to him.

“I’m not going to lay down. That’s not who I am,” Motley said. “And I’m just going to keep fighting.”

Ashley Luthern of the Milwaukee Journal Sentinel, Emily Forman of 371 Productions and Kate Golden of the Wisconsin Center for Investigative Journalism contributed to this report.

Editor’s note: This report was produced in collaboration with Precious Lives, a two-year project investigating the problem of gun violence among young people, its causes and potential solutions in the Milwaukee area and statewide. Other partners in the project are 371 Productions, the Milwaukee Journal Sentinel, Milwaukee Public Radio 89.7 WUWM and The Voice 860 AM WNOV.

The Wisconsin Center for Investigative Journalism’s coverage is supported by The Joyce Foundation. The nonprofit Center (WisconsinWatch.org) collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the UW-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

NRA-backed Republicans fight Dem bill to stop terrorists from buying assault weapons

People on the U.S. government’s terrorist watch list often can’t board commercial airliners, but they can walk into a gun store and legally buy pistols and powerful military-style rifles.

Following the Paris attacks, Democrats renewed calls for Congress to pass legislation aimed at preventing terrorists from buying guns. Similar bills — including a post-Sept. 11 measure backed by the Justice Department under President George W. Bush — have been stymied for years by the National Rifle Association and its representatives in Congress.

According to a March analysis by the Government Accountability Office, people on the FBI’s consolidated terrorist watchlist successfully passed the background check required to purchase firearms more than 90 percent of the time, with more than 2,043 approvals between 2004 and 2014. The office is an investigative branch of Congress.

The FBI is notified when a background check for the purchase of firearms or explosives generates a match with the watchlist and agents often use that information to step up surveillance on terror suspects. Under current federal law, however, association with a terrorist organization doesn’t prohibit a person from possessing firearms or explosives.

About 420,000 people are on the list administered by the FBI’s Terrorist Screening Center, though only about 2 percent of those are U.S. citizens or legal permanent residents legally able to buy guns.

The new Democratic push, which is considered unlikely to succeed in the GOP-controlled Congress, is focused on legislation by U.S. Sen. Dianne Feinstein, D-Calif., that would let the attorney general compile a list of known and suspected terrorists.

Federally licensed gun dealers would be barred from selling firearms to them, just as they are already prohibited from sales to people with felony convictions or serious mental illnesses. The proposed legislation would not prevent transactions that don’t involve licensed dealers, such as those between private individuals at gun shows or many sales online, which don’t currently involve background checks.

Feinstein introduced her bill in February, well before the mass killings in Paris injected new life into terrorism and public safety as top-tier political issues. 

Feinstein’s bill echoes legislation the late U.S. Sen. Frank Lautenberg, D-N.J., proposed repeatedly over the past decade. U.S. Rep. Peter King, R-N.Y., also has long pushed the same legislation.

Meanwhile, Republicans took advantage of voters’ newly aroused security concerns in late November, when they easily pushed legislation through the House preventing Syrian and Iraqi refugees from entering the United States until the administration tightens restrictions on their entry.

That issue put Democrats on the defensive. Forty-seven of them voted for the bill, ignoring a veto threat by President Barack Obama, who said the current screening system is strong and accused Republicans of fanning fear among worried voters.

Democrats are hoping to turn the political tables on Republicans by focusing the debate instead on terrorists’ access to guns.

“I think this is a no-brainer,” said Feinstein, a longtime gun control supporter. “If you’re too dangerous to board a plane, you’re too dangerous to buy a gun.”

Congress has yet to vote on Feinstein’s proposal.

Senate Majority Leader Mitch McConnell, R-Ky., has not said whether he would be open to allowing a vote.

The GOP-run House has not held any votes on major gun control measures since the killings of 26 children and adults at Sandy Hook Elementary School in Newtown, Connecticut, in 2012.

House Speaker Paul Ryan, R-Wis., did not respond directly when asked if he favored barring people on the watch list from buying guns. He said, “We are just beginning this process of reassessing all of our security stances.”

The NRA opposes Feinstein’s bill.

NRA spokeswoman Jennifer Baker pointed to past instances where innocent people were added to the watchlist either in error or as the result of tenuous ties to others involved in suspicious activities. She said her group wants to ensure Americans wrongly on the list are afforded their constitutional right.

Under current law, people can try persuading the Justice Department to remove their names from a terror watch list or can file lawsuits challenging their inclusion.

Dems: Bring back 48-hour wait period for gun purchases

In the wake of yet another rash of high-profile mass shootings, Democratic lawmakers in Wisconsin held a news conference on Oct. 14 calling for the reinstatement of a law mandating a 48-hour waiting period before purchasing handguns.

In June, GOP lawmakers repealed the waiting-period law, which had been on the books for 40 years. 

“This (reinstatement) bill is one small step in a larger effort to try to curb gun violence in our communities,” said state Sen. Nikiya Harris Dodd, D-Milwaukee, in a press statement. “The 48-hour waiting period is a proven method to reduce impulsive actions by those who are looking to harm themselves or others.”

The Democratic effort, however, has virtually no chance of succeeding in Wisconsin’s Republican-controlled Legislature.

Only nine states and the District of Columbia require waiting periods for handgun purchases, ranging from three days to two weeks, according to the Law Center to Prevent Gun Violence, a gun-control advocacy group.

Gov. Pat Lucey signed the waiting-period bill into law in 1976 to provide a cushion of time for people to cool off before acting out violently during times of intense personal crises, such as jealous rages. The cooling-off period also was designed to discourage suicides, particularly impulsive suicides.

More than half of all deaths by suicide in the United States are carried out using firearms, according to the U.S. Centers for Disease Control and Prevention. In fact, more people die of self-inflicted gunshots than shots fired by others. Although more people attempt suicide by overdose, they are successful only 3 percent of the time. Suicide attempts using firearms succeed 85 percent of the time.

“For those considering an impulsive violent act, handguns have the deadly appeal of being both highly lethal and accessible,” said state Rep. Gordon Hintz, D-Oshkosh. “Contrary to popular belief, suicides most often take place in a relatively brief time frame of intensified vulnerability. For someone considering hurting themselves or others, the 48-hour waiting period provides a time to cool off and reconsider.”

Republicans counter that the waiting period inconveniences law-abiding citizens. They argue that the waiting period was enacted because background checks in 1976 required digging through file cards by hand. Today the state Department of Justice can perform online background checks almost instantaneously.

NRA Agenda

Wisconsin Republicans took up the repeal bill shortly after the National Rifle Association’s call in April for an end to such laws. The NRA’s legal action institute said the law had become an unnecessary inconvenience for handgun dealers and buyers.

Gov. Scott Walker signed the repeal of the waiting-period law just one week after a racist gunman killed nine African-American people attending a Bible study meeting in a church in Charleston, South Carolina. Walker defended his timing, which progressives criticized.

“If we pulled back on this, it would have given people the erroneous opinion that signing the law today had anything to do with what happened in Charleston,” Walker said. “This allows Wisconsin’s law to catch up with the 21st century.”

Between 2008 and 2014, the NRA spent $3.5 million to support Walker, according to the Wisconsin Democracy Campaign. 

Wisconsin’s Republican leadership has made the expansion of gun ownership and gun owners’ rights a priority since taking over all aspects of state government in 2010.

In June, in addition to overturning the waiting-period law, Wisconsin’s Republican majority also passed two bills expanding the state’s concealed carry law. One measure allows active-duty soldiers stationed for at least a year in Wisconsin to obtain a state concealed carry license. The other enables former police officers who worked out-of-state but now reside here to apply for a federal concealed carry license if they obtain annual training through the Wisconsin Department of Justice, sparing them a trip back to their former state to obtain the training.

Also in June, Republicans pushed through a law allowing off-duty, retired officers to carry guns at schools. The law’s chief Senate sponsor, Sen. Van Wanggaard, R-Racine, said it would create another line of defense for students and teachers if a shooter attacks them.

Opponents said allowing non-uniformed officers to carry guns at schools could scare students and allow non-officers to carry concealed weapons without school administrators being able to interfere. They also said officers who are mentally unstable could create deadly situations in schools.

Obama ends long-running transfer of military gear to police

President Barack Obama ended long-running federal transfers of some combat-style gear to local law enforcement on May 18 in an attempt to ease tensions between police and minority communities, saying equipment made for the battlefield should not be a tool of American criminal justice.

Grenade launchers, bayonets, tracked armored vehicles, weaponized aircraft and vehicles, firearms and ammunition of .50-caliber or higher will no longer be provided to state and local police agencies by the federal government under Obama’s order.

“It can alienate and intimidate local residents and send the wrong message,” he said.

Obama made his announcement in Camden, New Jersey, where he praised efforts by the police department to improve their relationship with a poor community struggling with violence.

With police under increased scrutiny over highly publicized deaths of black suspects nationwide, Obama also unveiled the final report of a task force he created to help build confidence between police and minority communities. And he issued a broader appeal for Americans to address racial disparities and the needs of poor communities before they erupt into disorder.

He also reiterated his call for overhauling sentencing practices for nonviolent drug crimes.

“We can’t ask the police to be the ones to solve the problem when there are no able-bodied men in the community or kids are growing up without intact households,” he said.

In Camden, Obama visited the police Real-Time Tactical Operational Intelligence Center and watched live video displays of city neighborhoods being monitored by officers. He also stopped by a community center where he met with young people and local police officers.

Ahead of his Camden remarks, Obama stopped briefly in nearby Philadelphia to praise its police and fire officials for their quick response to last week’s deadly Amtrak wreck.

In addition to the prohibitions in his order, Obama also is placing a longer list of military equipment under tighter control, including wheeled armored vehicles like Humvees, manned aircraft, drones, specialized firearms, explosives, battering rams and riot batons, helmets and shields. Starting in October, police will have to get approval from their city council, mayor or some other local governing body to obtain such equipment, provide a persuasive explanation of why it is needed and have more training and data collection on its use.

Programs that transfer surplus military-style equipment from the Pentagon and other federal agencies have been around for decades, but Congress increased spending to help departments acquire the gear in the wake of the 9/11 terror attacks.

The issue of police militarization rose to prominence last year after a white police officer in Ferguson fatally shot unarmed black 18-year-old Michael Brown, sparking protests. Critics questioned why police in full body armor with armored trucks responded to dispel demonstrators, and Obama seemed to sympathize when ordering a review of the programs that provide the equipment.

“There is a big difference between our military and our local law enforcement and we don’t want those lines blurred,” Obama said in August.

The review, published in December, showed five federal agencies spent $18 billion on programs that provided equipment, including 92,442 small arms, 44,275 night-vision devices, 5,235 Humvees, 617 mine-resistant vehicles and 616 aircraft. At the time, the White House defended the programs as proving to be useful in many cases, such as the response to the Boston Marathon bombing. Instead of repealing the programs, Obama issued an executive order that required federal agencies that run the programs to consult with law enforcement and civil rights and civil liberties organizations to recommend changes that make sure they are accountable and transparent.

The report from the 21st Century Policing task force has a long list of recommendations to improve trust in police, including encouraging more transparency about interactions with the public. The White House said 21 police agencies nationwide, including Camden and Philadelphia, have agreed to start putting out never-before released data on citizen interactions, like use of force, stops, citations and officer-involved shootings. The administration also is launching an online toolkit to encourage the use of body cameras to record police interactions. And the Justice Department is giving $163 million in grants to incentivize police departments to adopt the report’s recommendations.

Sacramento, California, Mayor Kevin Johnson, the president of the U.S. Conference of Mayors, praised Obama’s actions, saying they “show how serious he is about doing this now and doing this right.”