BETTER TREATMENT SOUGHT FOR DOMESTIC VIOLENCE EPIDEMIC

HEALTH & ENVIRONMENT

By Suzanne Batchelor - WeNews correspondent

(WOMENSENEWS) --A recent survey of Colorado physicians about a state law requiring them to report domestic violence injuries shows a low level of compliance by doctors.

The surprising results are raising profound questions about the effectiveness of mandatory domestic violence reporting laws.

The participating physicians' responses, said Kim Feldhaus, a Denver emergency physician and professor who conducted the survey published in January, suggest that while requiring physicians to report incidents of domestic violence to legal authorities may help some victims, it doesn't safeguard women adequately.

Routine screenings by doctors' offices for domestic violence, other experts argue, could be a better alternative that empowers patients to take charge of their own lives by offering them information and support.

Of the 684 Colorado physicians surveyed by Feldhaus, only 4 in 10 reported domestic violence injuries to the police. Emergency physicians were found more likely than family physicians to report the injuries to police.

The doctors surveyed indicated that many patients didn't want their injuries reported to police for fear of retaliation by their attackers. Some doctors said they feared for the patient's safety even when police were called. Police may interview the perpetrator against the patient's wishes, doctors told Feldhaus, or arrest and release the batterer, increasing the danger of retaliatory violence.

"Denver tries to do these cases within 72 hours," said Feldhaus, "but surely these perpetrators are not all going to jail. Some are being charged, but released, or on parole. So there's always retaliation involved and we know that it always gets worse when the victim is trying to separate."

Feldhaus said emergency physicians are more likely to report domestic violence to police because the injuries they see are more severe and they are less likely to know the victim and her intimate partner. Family physicians usually see less critical injuries and may know and treat the perpetrator and children as well as the victim, increasing their concern about retaliation.

Pitfalls of Mandatory Reporting

The survey, Feldhaus said, reveals how difficult it is for physicians to comply with so-called mandatory reporting laws--also on the books in California, Kentucky and Texas--while taking care of their patients' safety. "It's a huge dilemma," she said.

Doctors face the problem of honoring patient confidentiality and choice when the injured woman doesn't want the abuse reported to police. "Physicians in states with mandatory reporting laws come across circumstances where they are clearly in conflict with their patients' rights," said Feldhaus.

Doctors say that even when they report domestic violence cases, police don't always charge the perpetrator, or else they may jail him only briefly, depending on the features of the criminal legal process. Sometimes making a police report, doctors say, results in batterers retaliating with more violence against the patient. On the other hand, doctors know that not reporting doesn't safeguard patients either.

Doctors told Feldhaus they sometimes feel helpless to stop the violence. "Even when patients talk to police and to social services, they make their own decisions and sometimes those decisions are to return to the assailant. It may seem like a bad choice to a physician but it's the patient's right to make that choice," said Feldhaus. Physicians can warn a spouse of their concerns, tell her that the abuse is a crime, but cannot force her to go somewhere different than she wants to go, Feldhaus added.

"Our legal system cannot keep these victims safe. We see it every day," said Feldhaus, the leader of several domestic violence studies. "It's the ex-boyfriend that shoots you, the ex-husband that tracks you down." Domestic violence specialists say abusers fear loss of control over the victim and react angrily to anything that threatens such control. Abusers are often concerned about having the woman out of his immediate control and can try to restrict her activities, including shopping or visiting family and friends. A woman's statement to an abuser that she is separating from him or her act of reporting the abuse to police may precipitate additional violence.

Karen, a California woman, tells such a story on the Web site of the Family Violence Prevention Fund, a national organization based in San Francisco, Calif.:

"During the last two years of our marriage I tried to leave many, many times. Each time I attempted to leave he would accelerate his violence. Once I got as far as getting into my car, but he opened the car door before I could lock it. He bashed my head against the inside of the passenger door and dragged me screaming all the way down the block to our apartment."

Domestic Violence Has Epidemic Proportions

Nearly a third of U.S. women report being physically or sexually abused by a husband or boyfriend at least once over a lifetime, according to a survey by The Commonwealth Fund in New York, quoted on the Web site of the Family Violence Prevention Fund.

The federal Centers for Disease Control and Prevention in Atlanta offered a lower, but still very high statistic. In a press release in February, federal agency said, "Twenty-five percent of women report physical or sexual assault by a current or former partner during their lifetime." The health impact of these assaults extends beyond the violence injuries, the agency said, including higher rates of unintended pregnancy, increased risk for sexually transmitted diseases, multiple mental health problems including depression and panic attacks, various gynecological problems, stomach ulcers, migraine headaches, spastic colon and other digestive diseases.

Feldhaus has become an advocate for police, prosecutors, social services professionals and doctors to work out a safer system for domestic violence victims.

Routine Screening Advocated for Domestic Violence

Advocates say healthcare providers have an alternative that's safer and more helpful than mandatory reporting: routine screening for domestic violence, with offers of support and community resources. While performing a routine screening, a physician would ask about symptoms during an examination and would question the patient about violence and fear of violence from an intimate partner and offer options for action.

"There's a whole clinical strategy that we believe in beyond mandatory reporting, that we believe is much more important, and that is healthcare-provider screening for women, even intervening," said Debbie Lee, managing director of health at the Family Violence Prevention Fund, which is supported by private foundations and the U.S. Department of Health and Human Services.

"Because violence is so common in many people's lives, I've begun to ask all my patients about abuse. Has your partner ever hit you or physically hurt you, threatened you or forced you to have sex when you didn't want to?" said Lee, who heads the fund's National Health Resource Center on Domestic Violence. "What the healthcare provider's role should be," she said, "is to identify the abuse, to provide information about domestic violence and the impact on her health and to provide her with resources in the community for help."

"A doctor may say, 'I don't care how angry he is, he shouldn't hit you. You need to think about what safety precautions you can take--can you leave the house? Have a suitcase packed? Have friends to stay with?'"

"I remember visiting a shelter and one woman said, 'I remember you, I went to San Francisco General and you asked me (about domestic violence) and I never said anything, but it was the start of my understanding my situation,'" recalled Lee. "It's like planting a seed for someone, that I could do something and try to get out of it."

Move against Mandatory Reporting

Lisa James, program manager for the Family Violence Prevention Fund, added that "by asking about abuse, they end her isolation and provide her with information about the impact on her health, but also the support that's available to her." The resources offered can be the police, but referrals to law enforcement are a small part of the picture.

"Victims of abuse tell us regularly that the asking of the question was the most important intervention for them. Not so much the contacting police, or knowing the resources available, but just having the physician ask that question," said James.

"Imagine you're going to the doctor and no one ever says a word. In a way, by not asking, the provider and all of us are colluding," said James. "By asking, it acknowledges that she is going through this and opens up a number of doors; it says that she doesn't deserve it and there's help available."

"We don't support mandatory-reporting laws. We support reporting to police with the patient's consent," added James.

Rita Smith, executive director of the National Coalition against Domestic Violence, also opposes mandatory reporting laws.

The law requires doctors to report information that could endanger women's lives. The patient needs to have control over who gets that information, said Smith. "Their lives are at stake."

Suzanne Batchelor has written also for the national science series "Earth and Sky" and on health and medicine for Medscape, CBS Healthwatch, WebMD and the Texas Medical Association's "Healthline Texas."

For more information:

Family Violence Prevention Fund--Programs Health Care: - http://www.endabuse.org/health

Information on domestic violence screening for healthcare providers: - Toll-free at 1-888-RXABUSE