Hospitals Lax in Spotting Domestic Violence : Health: Study finds training in emergency rooms is insufficient. Officials say identifying abuse cases is first step toward developing plans.

Relatively few California hospitals are looking for victims of domestic violence in their emergency rooms, in large part because physicians are not being adequately trained to diagnose abuse, a new survey on family violence said Tuesday.

As a result, victims receive treatment for their injuries but few receive intervention that could stop a pattern of abuse that often leads to more severe batterings, said the study by the Family Violence Prevention Fund, a 13-year-old San Francisco nonprofit group.

Local health care officials say that the diagnosis and reporting of domestic violence cases has lagged well behind policies developed to identify child abuse, rape and the abuse of the elderly. All those cases are required to be reported to authorities under California law, but spousal abuse is not.

The study estimated that one-fifth to one-third of all women who visit an emergency room are there because of abuse by a spouse or male companion. But David Langness, a spokesman for the Hospital Council of Southern California, called the estimates too high. “The numbers are overly general and nondefinitive,” he said.

Nevertheless, he said hospitals are concerned about the lack of programs for abused women.

“The problem, as the study shows, is that there is no model policy, so no one really knows how to identify battered women patients who show up in emergency rooms” and who do not or cannot disclose that their injuries stem from abuse, he said.

Dr. Brian Johnston, an emergency room physician at White Memorial Hospital in Los Angeles and president of the Los Angeles Society of Emergency Room Physicians, said: “We are currently underreporting and failing to recognize spousal abuse and domestic violence.”

The survey said studies show that 94% or more of victims of domestic violence are women battered by their male partners.

Among the reasons it cited for the failure to detect victims of family violence in the emergency room were time constraints and lack of training on the part of physicians and hospitals; and, on the part of victims, a reluctance to identify their partner as the cause of the injury.

The unprecedented survey was sent to all California hospitals and drew what its authors said was an unusually high 87% response rate.

However, 58% of the hospital managers and directors who responded to the survey did not, or could not, provide an estimate of how many of their emergency room patients had been found to have an injury caused by domestic violence.

Those who did respond made comments such as, “We really have no way of knowing,” or “This is just a guess,” the study said.

Esta Soler, executive director of the Family Violence Prevention Fund, said in an interview from her San Francisco office that only one in five California hospitals are in compliance with 20-month-old guidelines on identifying and handling battered adults established by the Joint Commission for the Accreditation of Healthcare Organizations.

Soler said “there is no system set up for physicians and nurses to report” domestic violence cases.

“They are treating the injury. The next step is that we need to get to is: How did it happen? Then it becomes: What do we do next? And then it comes to developing safety plans. But we can’t get to that point until we start identifying cases,” said Soler, who appeared at the news conference with Dr. Robert E. McAfee, president-elect of the American Medical Assn., and Dr. Molly Joel Coye, director of the California Department of Health Services, both of whom spoke in support of the survey.

Release of the study comes at a time when the Los Angeles County Medical Assn. is making an organized effort, in concert with the offices of the district attorney, sheriff and city attorney, to educate physicians on what to look for and how to handle battered victims.

Dr. Michael Durfee, coordinator of the child abuse prevention program for the Los Angeles County Department of Health Services, said that although the public health system had developed procedures for identifying the needs of abused children, rape victims and elderly abuse victims, it had fallen short with battered women.

“Among physicians, the awareness of domestic violence is lower than (with) child abuse. They are less apt to see it if it is sitting in front of them,” he said. “It’s true. We are incredibly ignorant. What is also true is we are less dumb than last year, and that it is inaccurate to say that we aren’t learning.”