Introduction
Domestic violence is as old as the history of human civilization. In almost all societies, the ‘master’ of the house was considered entitled to reprimand and ‘if necessary’ physically punish his spouse. In most cases this punishment went unnoticed as people and even in cases when police responded it could do nothing because it was a considered a “family matter. In cases involving violent men, even the life of the women and children was threatened and by 1885[1] shelters for battered women and children began to be established in United States.
The Centers for Disease Control and Prevention (CDC) defines intimate partner violence as “actual or threatened physical or sexual violence, or psychological and emotional abuse, directed toward a spouse, ex-spouse, current or former boyfriend or girlfriend, or current or former dating partner”. Other terms used to describe domestic violence include Intimate Partner Violence (IPV), domestic abuse, spouse abuse, courtship violence, battering, marital rape, and date rape[2]. Although violence is normally directed towards female spouse, violence by women against men is also becoming a problem.
Types of Domestic Violence
Intimate Partner Violence (IPV)
According to Department of Justice analysis IPV affected more than 32 million Americans in 2001[3] [Tjaden and Thoennes, 2000]. The statistics shows that almost 85% of the IPV victims were women. IPV is a major preventable public health problem and includes physical, sexual or psychological injury by a present or ex-intimate partner.
Elder Violence
Intimate partner violence can extend to elder abuse. Elderly people could be affected by violence from their spouse as well as from the younger family members over matters such as financial. Elderly suffering from age related illnesses can sometime become victim of rage from their spouse or family members.
Child Violence
Violence against children is probably even more common than against adult. The child protective custody agencies statistics are generally considered underestimations but even according to this statistics 906,000 children were confirmed as being maltreated in 2002[4]. This data includes 61% children falling victim to neglect, 19% to physical abuse, 10% to sexual abuse and 5% children subjected to psychological and emotional abuse [DHSS, 2005].
Statistics of violence against children appears to be severe underestimation as the National Committee to Prevent Child Abuse reports that over three million children experienced some form of abuse (physical, sexual, neglect, or emotional abuse).
Domestic violence has been surrounded by many myths preventing identification of violence in many social groups. Those responsible for preventing domestic violence have to recognize that domestic violence occurs in all socioeconomic, ethnic and racial classes. Women are 6 times more likely to be victim of violence by IPV than from a stranger [Hotaling and Sugarman 1990]. Intimate partner violence is responsible for 30% of female homicides in the United States [Burgess, 2001]
This information shows that domestic violence has to be a serious concern for health professionals who are among the first to see the victims of domestic violence. The national statistics mentioned above is also reflected in data on domestic violence in California.
Domestic Violence in California
California is among the few States taking active steps to curb domestic violence. The available data on domestic violence in California is presented below [Brown-Miller, 2006]. This data was used by [Brown-Miller, 2006] to develop a cost benefit analysis for domestic violence prevention.
For 1998, DHS’s EPIC branch reported that 2,116 women over 12 years old were hospitalized due to violent injuries; 157 of these women reported that injuries were caused by their spouse or partner.
For 2000, DHS reported 1,915 women over 12 years old were hospitalized due to violent injuries; 156 of these women reported that their spouse or partner caused the injuries.
California is among the leaders in attempting to counter the domestic violence in United States. It is among the few States which has enacted laws addressing domestic violence training, screening patients for the purposes of detecting spousal or partner abuse, has enacted protocols for identification of partner abuse as part of medical screening; documentation in medical records of injuries related to IPV and provides referral to services to the IPV victims. California has also enacted domestic violence reporting laws and protects against discrimination by insurance companies for victims of domestic violence.
California’s statutes relating to domestic violence
Statute Type
Details
Training
CA Bus & Prof. Code §2191(h) directs the Division of Medical Licensing to “consider” including a continuing education course providing training to physicians on routine screening for domestic violence. CA Penal Code §13823.93 establishes two hospital-based training centers to train medical personnel to perform medical evidentiary examinations on domestic and sexual violence victims.
Screening
CA Health §1233.5a requires medical clinics to screen patients for domestic violence. CA Health §1259.5a requires acute care, acute psychiatric, and chemical dependency recovery hospitals to routinely screen patients for domestic violence.
Protocols
CA Health §1233.5 requires licensed clinic boards and medical directors to establish and adopt written policies and procedures to screen patients for domestic violence, document injuries and refer patients to available services. CA Health §1259.5 requires acute care, acute psychiatric, and chemical dependency recovery hospitals to establish written policies and procedures to screen patients for domestic violence, document injuries and refer patients to available services.
Mandatory Reporting
AB1652 §992 (1993) and amending statue AB74X §19 (1994) requires any health practitioner (as defined in Penal Code §11165.8) employed in a health facility, clinic, physician’s office, local or state public health department, or other facility operated by a local or state public health department, to report providing medical services to a patient whom the practitioner reasonably suspects is suffering from any wound or other physical injury caused by firearms and/or assaultive or abusive conduct.
Insurance Discrimination
CA Insurance Code §10144.2, CA Health and Safety Code §§1374.7and 10144.3 states that no life insurance carrier, disability insurer covering hospital, medical or surgical expenses, nor any health care service plan, respectively, can refuse to issue or renew coverage, cancel an existing policy, deny coverage or increase the premium on an insurance policy to anyone who has been the victim of domestic violence.
California’s mandatory domestic violence reporting law was enacted in January 1994. The law calls for any licensed health practitioner to report a case of domestic violence meeting the specified condition to the authorities within 48 hours. For the purposes of the law the health practitioner is defined to include practitioners such as a health care provider, surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, optometrist, MFCC, MFCC trainee or registered intern, emergency medical technician I or II, paramedic, public health employee who treats minors, coroner, person who performs autopsies, and a religious practitioner who diagnoses, examines or treats children [Penal Code 11165.8].
The health practitioner employed in a health facility; clinic; health care provider’s office; local or state public health department; or public health department operated clinic or facility is required to make a report if s/he provides medical services for a physical condition to a patient whom s/he knows or reasonably suspects is:
- Suffering from any wound or other physical injury inflicted by his or her own act or inflicted by another where the injury by means of a firearm and/or
- Suffering from any wound or other physical injury, that is the result of assaultive or abusive conduct.
Assaultive or abusive conduct is defined to include 24 criminal offenses, among which are murder, manslaughter, torture, battery, sexual battery, incest, assault with a deadly weapon, rape, spousal rape, and abuse of spouse or cohabitant.
The health practitioner is required to make a report by telephone immediately or as soon as practically possible and send a written report to a local law enforcement agency within two working days. In order to workout if the health practitioner (nurse) is required to report the domestic violence case to the authorities (police) the flow sheet given below can be used for analysis (Figure-1).
The Health Care professional must submit a telephone report immediately followed by written report to the local law enforcement agency (police) within two working days.
A report is only to be submitted if the health care professional has provided medical services for a physical condition. If the health professional has provided only counseling or social work services to a person with DV injuries, reporting is not required.
The telephone and written report must include the name of the injured person, if known; the injured person’s whereabouts; the character and extent of the person’s injuries; and the identity of the person who allegedly inflicted the injury in the report. Form OES920[5] is used for the written report. The DV report to the legal authorities is not a substitute for medical record. The health professional must complete the medical record as normal and also record
Any comments by the injured person regarding past domestic violence or regarding the name of any person suspected of inflicting the injury;
A map of the injured person’s body showing and identifying injuries and bruises;
A copy of the reporting form
Health worker is required by law to report the DV case. Even if the patient does not want to report the incident the health professional is obliged to report the incident. As a part of mandatory obligation, the health worker is not obliged to inform the patient but as an ethical duty it is appropriate to inform the patient that the case has to be reported to the authorities.
If the victim of domestic violence is a child, the Child Abuse and Neglect Reporting Act will apply to the incident and Child Protection Service report may also be required. The Mandatory Reporting of domestic violence is a must requirement and failure to report is a misdemeanor crime and may also be subject to civil law case [DV, 2007]. The DV reporting law with a six-month jail term and $1,000 fine, and inclusion of all health practitioners, including the nurses ensures that DV cases will get reported. The reporting procedure to be followed is summarized in Figure-2. The booklet ‘Respond to Domestic violence’- Medical Staff Training Guide for California Physicians[6] provides excellent information on issues related to IPV and DV and provides information on documents and Forms, screening for IPV, responding to IPV and reporting IPV to law enforcement authorities.
