SAN ANTONIO – Nineteen children and two teachers were gunned down inside a classroom in Uvalde. Their faces have become part of an expanding American tapestry.
We hope we don’t have to commit to memory any more photos of lives taken far too soon, but in the back of our collective minds, many of us fear we will.
When and where are the bigger questions.
“I’m angry. I’m still angry,” said Dr. Ronald Stewart, chair of the Department of Surgery at UT Health San Antonio and a trauma surgeon at University Hospital.
Stewart has worked at the hospital for four decades.
In the last five years, he’s treated victims from two of the worst mass shootings in U.S. history.
Stewart knows well the wounds caused by the firepower used in the shooting at the First Baptist Church in Sutherland Springs and most recently at Robb Elementary School in Uvalde.
“The AR-15 is designed to be easy to stay on target. There’s multiple wounds per patient,” Stewart said. “We don’t usually see them because the medical examiner usually sees those patients.”
Still, some mass shooting victims have made it into Stewart’s care.
“A lot of tissue damage, a lot of destruction,” he said. “There’s a path of the bullet that gets injured. But with high-velocity wounds, what happens is there’s a zone much larger than the bullet itself that the tissue gets injured or destroyed or is missing.”
For the last eight years, in the wake of the Sandy Hook Elementary School killings, Dr. Stewart has been working alongside fellow physicians as part of the American College of Surgeons to find solutions to gun violence.
“It doesn’t require someone to put aside Second Amendment rights,” said Stewart. “It doesn’t require someone to put aside the view that we have a public health epidemic of firearm-related injury and violence.”
But a solution requires understanding the problems, and that takes education.
Stricter gun laws are often the first target.
To learn more about guns, KSAT Explains consulted someone who knows them well — Brock Wilkerson, owner of A Place to Shoot on the South Side.
“Basically, an AR-15 is a semiautomatic rifle,” Wilkerson said.
He adds that “AR” does not mean “assault rifle,” as many believe. It stands for ArmaLite, a company that first introduced the AR-15.
Wilkerson said perhaps the biggest misunderstanding about the weapon is that other guns have similar, or the same, characteristics.
The ammunition in the AR-15 can be used in guns of a different style, for example.
Wilkerson demonstrated what he sees as perhaps the biggest misconception about the AR-15 by comparing it to a semiautomatic rifle first manufactured in the 1960s.
“This doesn’t look near as aggressive as this gun,” he said, referring to the AR-15. “This is a semiautomatic firearm. It has a magazine on it, just like the rest of the ARs. It’s been made for a long time. The longer the magazine, the more round capacity. So this gun could, in all reality of it, shoot just as many times as that caliber right there (the AR-15).”
“They are identical functioning guns, but one looks more aggressive than another one,” he added.
In Texas, a person must be 18 or older to buy a rifle or a shotgun and 21 or older to purchase a handgun.
If a buyer purchases a firearm from a licensed dealer, they must undergo a background check.
A customer fills out a form, and the information is run through the National Instant Criminal Background Check System.
“Those checks can take just a couple of minutes,” said Wilkerson. “On a bad day, they can take 30 to 45 minutes to an hour.”
But gun ownership does not always require such a check.
“Right now, the background check law does not apply to private sales or transfers,” said Bill Piatt, who specializes in constitutional law at St. Mary’s School of Law. “So if someone wanted to purchase a gun and give it to a relative as a gift, they would not have to do a background check on the person who’s going to receive the gun.”
Texas also has what’s referred to as Constitutional Carry. It’s a law that allows a person 21 years or older to openly carry a handgun in public, in a holster, without a license.
Texas law does not specifically put restrictions on who can carry a shotgun or a rifle or how they can be carried.
Some people cannot own any guns in Texas.
“And those include felons, certain domestic relations violators, some misdemeanants, and a number of other categories in the state statute,” said Piatt.
Constitutional Carry law
It’s undeniable that AR-style rifles are used again and again in mass shootings. It’s a gun that shoots ammunition at three times the speed of sound.
The parents of the victims in Uvalde had to provide DNA so the bodies of their children could be identified. The town’s only pediatrician, Dr. Roy Guerrero, conveyed the magnitude of their injuries in a U.S. Congressional hearing on June 8.
“Two children whose bodies had been pulverized by bullets fired at them — decapitated, whose flesh had been ripped apart,” Guerrero testified.
In the wake of the shooting in Uvalde and several others that have followed, there have been calls for a ban on AR-15s and similar weapons.
From 1994 to 2004, the U.S. had an assault weapons ban in place under President Bill Clinton.
The ban also included magazines that could hold more than 10 rounds. Read more about the ban here.
“Most of us, I believe, in the gun industry feel like we’re going the wrong direction,” said Wilkerson. “The shootings themselves have increased. The access to firearms has not.”
Wilkerson believes the U.S. needs to look more closely at mental health and entertainment as reasons many have become desensitized to violence.
“I would argue and say that a lot of the video games of the day might have a greater impact on the psychological aspect for kids than a firearm,” Wilkerson said.
Doing more to improve mental health often enters the conversation after a mass shooting, usually a point made by those who don’t see stricter gun laws as the answer. That’s concerning for those who work in the mental health profession.
“I really want to get away from linking mental health and mental health care to tragedies like we’ve had recently,” said Christopher L. Wallace, emergency room psychiatrist for University Health.
“The biggest difficulty is that we’re not necessarily all talking about the same things,” said Jess Sandoval, a UT Health physician and child & adolescent psychiatrist for the Center for Health Care Services.
“I think that there is much good that can be done. But the vast majority of school shooters actually do not have a diagnosable mental illness,” she added. “And the vast majority, they’re more likely to be people who have a mental illness, are more likely to be victims rather than perpetrators of violence.”
“I think the bottom line is that mental health support services are woefully lacking in the state of Texas,” said Wallace. “That usually means funding, where we’re running about 50th out of 50 states for funding services.”
Red Flag Laws
Concerns over a person’s mental state and access to guns are combined in red flag laws. Nineteen states have them, but Texas does not.
Florida passed a red flag law after 17 people were shot and killed at a high school in Parkland in 2018. It allows a judge to take guns away from someone determined to be a threat to themselves or others. It has been used more than 5,000 times in Florida in four years.
“There is the requirement under all state statutes and under the constitutional provisions of due process that within — depending on the statute — two to 14 days after the order seizing the weapons, the person from whom the weapons were seized has the right to appear and contest and have a full due process hearing over the allegations,” said Piatt.
In 2018, after the shooting at a high school in Santa Fe, Texas, where 10 people were killed and 10 others were wounded, Gov. Greg Abbott issued a report asking state lawmakers to adopt red flag laws.
Months later, Lt. Gov. Dan Patrick publicly said he opposed them, and ultimately no such law was created.
In the wake of the 21 people killed at Robb Elementary, a bipartisan bill has been signed into law by President Joe Biden that incentivizes states to create red flag laws.
It’s unlikely Texas will do so as Abbott has not indicated he supports the idea.
Some of the biggest additional provisions of the bipartisan law expand background checks for gun buyers ages 18 to 21 and boost mental health and school security funding.
The American College of Surgeons supports the legislation, but the group has its own recommendations on how to curb gun violence.
It’s an epidemic Dr. Stewart says is a matter of public health.
Two Common Narratives on Guns
“We tell ourselves two stories that are often are conflicting stories that I think are overly simplistic,” Stewart said.
Since the Sandy Hook Elementary School shooting, Stewart’s research and nationwide travels as part of the American College of Surgeons helped lead the group to identify two common narratives when it comes to guns.
One is called the “Firearm & Freedom” story, while the other is the “Firearm & Violence” story.
People who belong to the Firearm & Freedom group see guns as personal protection and a symbol of constitutional liberty. They typically see gun control as freedom control.
Those in the Firearm & Violence group see guns as harmful and a symbol of violence. That harm limits their freedom to feel safe, especially in places like churches and schools.
The American College of Surgeons examined those narratives to find a common one while leaning on their members who know guns. That includes members of law enforcement, veterans and NRA members, according to Stewart.
That common narrative looks like this: prioritize protecting liberties of the constitution while acknowledging gun violence is a major, preventable cause of death.
“It intentionally borrows from those competing stories we tell ourselves,” Stewart said.
The ACS created a list of 14 recommendations to stop gun violence. Some of the most significant include the following:
background checks for all gun sales
create a gun registration
reclassify certain weapons, like the AR-15 (This could lead to more stringent licensing requirements to own them.)
require gun safety for all owners
require safe gun storage
create red flag laws
Working with researchers and community groups to understand the root causes of violence is also critical to the ACS recommendations to prevent another mass shooting.
“You’re talking about truly, completely innocent children and, to me, the most kindest, sincere, honest professionals that we have, which are elementary school teachers. I’m married to one,” Stewart said. “Telling those stories about the impact on those families — it should move everyone in America, everyone, to do something different.”