by Kevin Fickenscher

First posted on The Fickenscher Fileson 12/26/2012

Thoughts that we should consider so that Newtown never happens again …

Kevin Fickenscher, MD, CEO AMIA

At the outset, let me apologize for the length of this note.  I was moved by the moment.  Despite the joy of the holidays and time with family, the last couple of weeks have been traumatic for all of us. I don’t even need to say the words.  You all know what I’m talking about – Newtown, Connecticut.  In hushed tones at every Christmas event, we invoke the memory of twenty young, innocent children and six adults while leaving the memory of the murdered mother and the suicide of her disturbed son out of the picture.   We’ve had shooting before but this one hit us all in the gut.  This time it wasn’t just folks we didn’t know, it was senseless trauma against innocent children that could have been one of our children, or grandchildren, or simply the children we know in our lives.

I was stunned by the situation as was most of America, if not the world.  How could twenty some children be gunned down so senselessly?  At first, I – like many people – pointed at guns.  But, was it just the guns?  Or, was it also the way we treat mental illness in the country?  After some reflection, I came to the conclusion that it was the guns as well as the way we treat mental illness.  While managing guns is a big issue that we must debate and consider if we want to foster a civil American society, we also need to debate the failings of our mental health system – or, lack thereof – and the seeming glorification of violence and mayhem as a contributor to violence in America.

Immediately following the tragedy, I attended my usual Sunday services at church where my pastor, Dr. Charlie Parker, serves as the lead minister.  He gave a homily.  The original Advent homily was to be focused on “Joy!”  So, what’s a minister to do with a pre-published homily like “Joy” when a tragedy like Newtown occurs?  Well, he spoke the truth.  First, he noted that too often when a crisis occurs we stop doing something because we are seemingly paralyzed because we don’t know what to do and, as a result, we don’t do anything to make a difference.  The end result of doing nothing is that no solutions are forthcoming.  He then admonished us that we could “make a difference” even if the path to resolution of the problem is not immediately clear!  He quoted Rabbi Edwin Friedman who said that we must “cherish uncertainty”.  In other words, there are no easy answers.  He went on to suggest that out of our communal dialogue will come the answers.  It is clear that we – as a society – must set a new course if we want to chart a different destiny.  And, it’s clear that without a national discourse, we will end up doing nothing yet again.

At little further on in his homily, Charlie quoted Isak Dennison, who stated, “God made the world round so we would never be able to see too far down the road.”  How prophetic and yet somewhat disconcerting because it means that we are not in control!  We do not always have the answers immediately available to us.  Without the communal dialogue, it is likely that the final solution that we can all live with will not become apparent.  So, my conclusion at the end of his homily was that now is the time to do something!

At the central core of policy considerations in America today, it seems to me that the solution is not at the extremes.  I’ve been talking about this for some time because it seems to me that the answers to the great questions of our era are in the middle.  However, we are a society that has unfortunately become captive to the fringe perspectives on far too many fronts.  And, while I make this argument, I realize that answers in the middle are not so very clear at the present time either.  As it relates to guns, violence and mental illness; I’ve heard multiple options bantered about in recent weeks from friends across the political spectrum.  So, where are we in this ongoing debate on gun violence in America?  The range of perspectives offered by friends and colleagues ranged from:

  • Ban all assault weapons in the USA and retrospectively place substantial daily fines on those who do not comply with the requirements;
  • Don’t allow entry into schools – regardless of whether or not someone is known – unless they go through a security process?
  • Ban specific types of assault weapons;
  • Require gun education of everyone who buys a gun, to…
  • Teach Principal’s and other lead teachers on how to use weapons so that they can “return fire if fired upon.”

I do offer that from my perspective the most absurd suggestion was that which was offered by the National Rifle Association – an armed guard in every school.  My immediate response was: What do we do for those who go to a movie in Aurora, Colorado?  What about a student who is simply walking across campus at Viriginia Tech?  What do we do for those who gather at the mall in Anyplace, America?  What about the violence of guns that could occur while traveling on mass transit systems like the Washington, DC Metro or the New York City subway system or BART in San Francisco?  What do we do for those who are not at the places we determine are the most vulnerable?

First and foremost, we should not allow our anger and our emotions to be dissipated.  We should not allow the time and distance of the event to placate our perspective.  We must join together as a PEOPLE WHO BELIEVE IN A CIVIL SOCIETY.  Furthermore, we should not allow the environment to create a situation where our children are afraid to go to school!  We should not be afraid to go to the movies!  We should not be afraid of violence at the mall!  We should feel free to amble across campus at will without risk of violence.  In the final analysis, we must demand a more civil society!  So, the question we should be asking ourselves is, what laws and what processes need to be implemented to make the “civil society” reappear?

In thinking about the laws of the land, I considered the following:

  • Article 1, Section 2 of the US Constitution states: “The House of Representatives shall be composed of members chosen every second Year by the People of the several States…” – it does not specify the process.  It does not delineate apportionment.  It provides none of the details yet, we do select our Members of the House of Representatives every two years.  Does this mean that we should use the Constitution as a template for how we implement the laws that govern us?  I think so…
  • Article 3, Section 1 of the US Constitution states: “The judicial Power of the United States shall be vested in one supreme Court, and in such inferior Courts as the Congress may from time to time ordain and establish…” – Nowhere in the Constitution does it stipulate how cases should move from the lessor courts to higher courts.  There is no outline of what is permissible or not from consideration by the Courts.  There are no details on the qualifications for the judges that sit with considerable power over the laws of the land.  Again, it seems to me that the Constitution is a template because the details are missing…
  • Amendment I to the Constitution states: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech…” So, do we need permits for large gatherings in some cities across the USA?  Can we yell “fire” in a packed theater without impunity?  Can we say anything about anybody without impunity without potential recourse for liability?  I think not…
  • Amendment II to the Constitution states: “A well regulated Militia, being necessary to security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” – it does not stipulate what is meant by “infringed.”  It does not define the process whereby we allow people to “keep and bear Arms.”  It does state the “a well regulated Militia” is necessary but does not define was “well regulated” means nor does it clarify what is meant by necessary.   In other words, the details are missing and again, the Founding Fathers were clearly creating a template for future generations to use a guide for the laws of the land…
  • Amendment IX to the Constitution states: “The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people.”  What does this mean?  Well, it means that we the people are in charge and can interpret our Constitution as we see fit.  Have we done that for Amendment II to the Constitution or have we become captive to one perspective offered by one powerful lobby – the National Rifle Association?  It’s clear that the lobbyists have won the day so far.  Furthermore, are the positions of the lobby group really the positions of the members or are they position of the manufacturers who contribute the vast majority of funds for the operation of the NRA?
  • And, finally, Amendment X – perhaps the most important amendment to the Constitution – states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”  That statement seems fairly clear.  We the People are responsible and in charge …

If you read the entire Constitution which I did this past weekend, it is filled with all sorts of dos and don’ts but is entirely lacking in specificity.  It was left to we the people who will from “time to time” make changes and pass laws to govern the process of the Constitution.  That’s what makes our treasured Constitution a living, breathing, viable document after more than two hundred years.  I’m not a lawyer.  I’m not a Constitutionalist.  So, I’m not steeped in the nuance of Constitutional law.  At the same time, I am a common sense person and it seems to me and, at the end of the day, our founding fathers clearly left us the responsibility for working out the details of our public policy through debate and discourse.  We’ve done it on any number of issues of the last couple of centuries.  It seems to me that we’ve been held captive by a few to a concept that “the right to bear arms” somehow means anyhow, anywhere and anyway!  Nothing could be further from the truth.

Don’t we require everyone who wants to drive legally in this country to obtain a drivers license from the state?  We also go even further by requiring that you carry personal car insurance in case you’re in an accident.  If you drive without a license, you are fined and even put in prison from some offenses.  In a like manner, we require everyone who wants to practice medicine to obtain a license.  Doctors must pass tests and demonstrate their ability before being granted a license then, to practice at a hospital or similar institution, you need to get “privledges” which are granted by the medical staff.  It’s long.  It’s arduous.  But, it protects the American public. One more example: stopping at stop signs means “stop at stop signs”.  Am I too simplistic?  I don’t think so.  We have lots of laws and requirements in society even though we have certain inalienable rights…

So, it seems to me that we should seriously consider what Amendment IX says and recognize that we the people can act because we ultimately are responsible.  The question then remains, what should we do relative to guns in America?  Again, I do not know all of the answers or even the details of the following ideas but it seems to me that these ideas deserve serious consideration:

  1. We should look at how one can obtain a gun.  We don’t want to necessarily preclude people from getting guns but going through a process to hold a gun seems reasonable.  I grew up in North Dakota where hunting is a yearly ritual.  So, I understand the “sport” which requires the use of guns.  However, just like being a physician requires a license to practice, requiring licensure for gun ownership that stipulates appropriate guidance and controls on who can own and use a gun – seems prudent.
  2. Mental illness is horribly undertreated in this nation and it must change.  Healthcare is responsible in my book for allowing this travesty to have devolved over the last couple of decades.  We need to escalate the treatment for mental issues of all types to the level where appropriate medical treatment is easily available.  It needs to be community based.  The healthcare community is clearly failing on this front and there is a lack of advocacy from the public.  Perhaps that will change in the aftermath of the Newtown incident. It’s clear that random mass killings are on the increase.  In the last decade, we’ve seen three times the number of such killings as occurred in the 1980s, when gun laws were weaker. In fact, a 2011 University of California at Berkeley study found that states with strong civil commitment laws have about a one-third lower homicide rate. It’s clear that we need to change our mental health policies and allow for treatment of those who may not seek or cannot obtain appropriate mental health care.
  3. Personal background checks should be done on everyone prior to the purchase of a gun – regardless of where or when the sale occurs – period!  We’ve done similar types of policy changes in the aftermath of 911.  Getting through security at an airport is a hassle but, it’s worth it.  I don’t worry about shooters on airplanes anymore!!
  4. The sale of semi-automatic assault weapons should be banned just like we did in 1994.  Those who argue against such a measure note that the ban did not work, which is the conclusion of a University of Pennsylvania study commissioned by the Justice Department.  Why? It’s because the major problem with a ban is how do we account for all of the existing assault weapons that are owned by the American public.  George F. Will in a recent column pointed out that in 1994 there were 1.5 million assault weapons in circulation and 25 million large-capacity (i.e., more than 10 bullets) magazines in circulation. He stated that with “a reservoir that immense [it] can take 100 years to draw down.”  He’s probably right but, even if it takes one hundred years, we should try so that the grandchildren of our grandchildren do not have to feel unsafe in going to school.  I also think we should create a penalty of significance that will get the vast majority of the American public to turn in their assault weapons.  Fines and prison sentences should work.  We need to be much clearer on the types of weapons which can be purchased.  Does anyone really need a bazooka in America?  What are the parameters?  Somehow, the “right to bear arms” has been extrapolated to include virtually every type of weapon from antiques to assault weapons which are made for military operations.  Do we allow the American public to own nuclear ballistic missiles?  What about tactical missiles?  Then, there are tanks?  So, where is the line?  We’ve obviously drawn one.  Nuclear and tactical missiles are not allowed.  On the question of tanks – I’m not so sure?  The question clearly does seem to be about drawing a line and where the line should be drawn.  If we really think that simply allowing the ownership and holding of guns somehow protects America, I believe we are absolutely mis-informed and have been bambozzled (yes, I use that word with intent) by a group that does not represent the interests of the vast majority of the American public.
  5. Let’s apply a rating system to software games just like we do to movies so that parents will have some guidance on the gaming programs that are available to their children.  Those who call for such guidance have a point in my estimation.  We need to do a better job of monitoring violence so that it does not seem so simple, so that violence is recognized are irreversible rather than as rebootable.

Finally, if we – the people – are powerful in “perspective”, we will overcome “control” by any force at any time.  After all, “we the people” are in charge.  Not some of us.  Not a small group of us.  But, all of us!  Now is the time to express our opinions but more importantly to support action so that there are no more Newton-like incidents anyplace in America …

Dr. Kevin Fickenscher
Dr. Kevin M. Fickenscher is the Founder of CREO Strategic Solutions, LLC – an organization focused on senior executive strategic support, leadership development and assistance with evolving care delivery models. Previously, he served in a variety of leadership roles within the healthcare industry on both a domestic and international basis. He is a recognized physician executive with extensive experience in strategic and operational development in complex healthcare organizations. He is a thought leader related to technology and information management and holds extensive experience in organizational transformation and development, physician management, health policy analysis, leadership development, clinical quality and resource/care management, among other areas. Dr. Fickenscher is considered to be a dynamic, visionary leader in healthcare throughout the world has consistently been ranked among the Most Powerful Physician Executives in Healthcare by Modern Healthcare.


  1. On this new year day, I woke up and I could not stop reading this thoughtful piece end to end. This is America and we believe in “We can do better”. And I agree totally that “arming more” is not a solution. I watched Lincoln over the holidays and I was moved by the leadership demonstrated at that pivotal time in America history. We need not only moral but also tactical leadership to drive us through a meaningful solution that goes into annals of history. Time to time the country has been blessed with leaders such as Lincoln, FDR, JFK, and Reagan. I sincerely pray that we have such a leader who has the “will” to deliver.

  2. Good post; I agree with everything you say. The only problem is that the (gun) fanatics are more persistent and, well, fanatical than the rest of us, who tend to lose interest in such issues as the immediate event fades. Thus, they often win. The trick will be to sustain our resolve and determination to implement all these suggestions against the incessant lobbying and throwing of money at our craven legislature. Good luck to us.

  3. Great post. There is an interesting correlation between antidepressant usage and this in school gun violence. I guess it keeps coming back to the age old question…nature or nurture?


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