Facing the Issue Head-On : Health-care workers have in the past bandaged battered women and sent them home. Now they are working on being part of the solution.
Last February, several days after UCLA emergency room workers treated a woman with head, leg and pelvic fractures, they learned that she had been injured in a fall from a second-story balcony--and that her husband had pushed her.
But like most hospitals, the physicians had treated her broken bones without asking the questions that until recently were considered too personal or too political: How did this happen? Are your children safe? Do you know domestic violence is a crime? Do you need an emergency protective order?
“I don’t know if any follow-up was done, either,” said nurse Kelly Hubbell.
Now, partly as a result of a state law passed last year spelling out health workers’ responsibility to report all cases of domestic violence to police, UCLA and many other hospitals are starting to treat spousal abuse as diligently as child and elder abuse. Another law required all health-care professionals to be trained by the first of this year to recognize signs of domestic violence.
“Historically, physicians didn’t feel this was a part of our job,” said Dr. Mitzi Krockover, UCLA assistant professor of medicine. “What we’re realizing more than ever is that it is our job. It is a health problem.”
One 23-year-old woman recently treated at the UCLA emergency center for internal bruises after an angry boyfriend pinned her to the floor, said, “They were very nice. They asked me a lot of questions. Where was I hit? How was I thrown? Would I like to speak to a social worker?”
They gave her a pseudonym to use for the evening in case her boyfriend came by asking for her. A social worker gave her a referral for counseling and shelters.
“They told me no one should have to take physical or mental abuse from anyone,” she said.
UCLA policies also call for interviewing the victim apart from whoever brings them in, often the abusive partner who, experts said, may try to answer for the victim. If victims are reluctant to admit they have been abused, physicians are encouraged to press with wording like, “We see victims with similar injuries to yours who have been hit by their partners. Could this have happened to you?”
In addition, a UCLA program coordinated by Hubbell now routinely offers around-the-clock counseling by psychiatrists and social workers for victims of domestic violence; temporary protective orders issued by judges on call; referrals to shelters, and quick investigation by campus police. Next year, legal services also will be available from a nonprofit law firm.
Women’s advocates have been working for years to improve physicians’ response to domestic violence, partly to give victims more care and support in preventing violence, but also to create a “paper trail” that will substantiate battering in the event of subsequent legal action.
They cite surveys showing that battered women turn more often to physicians for help but that the medical profession has received lower effectiveness ratings than lawyers, clergy and police. One survey showed that at least one-quarter of all emergency room visits by women related to battering but only 5% were recognized as such.
The good news, advocates say, is that health-care professionals are catching up with legal and law enforcement professionals to create a coordinated approach to preventing domestic violence.
Last October’s crime bill, for instance, included the hefty $1.6 billion Violence Against Women Act that targeted funds for shelters and judicial education, among other things. It also allows female victims of violence to define rape and battery as a hate crime and to sue for damages in federal court.
If there is bad news, it is the possibility that mandates to report domestic violence will in some cases increase the danger to victims. “It could further anger the batterer to the extent he takes out his anger on her with additional beatings,” said Janet Nudelman, senior program specialist with the San Francisco-based Family Violence Prevention Fund.
The fund is now testing domestic violence programs in six California hospitals: Los Angeles County/USC Medical Center, San Francisco General Hospital, Scripps Memorial in La Jolla, Sonora Community Hospital, Valley Medical Center in Fresno and Kaiser Permanente in Sacramento.
“In fact, women are in more danger right after the reporting,” Krockover said. When a woman begs her physician not to report, the decision becomes extremely difficult, she said. “If someone comes in with an injury and you strongly suspect or they tell you it is caused by domestic violence it is your legal responsibility to report,” she said. Otherwise, health-care professionals can be charged with a misdemeanor and fined.
“But if you don’t, she’ll go back in the situation, he’ll beat her up again and maybe he’ll kill her,” she said.
Last year, 56 women were killed in Los Angeles County as a result of domestic violence and at least seven of them had restraining orders, said Gail Pincus, director of the Domestic Abuse Center in Northridge.
“What the batterer does is threaten, ‘If you do anything, I’m going to kill you.’ In fact, we find doing something tends to stop him. He never thinks anything is going to happen to him.
“Where we need to work is the kind of response a woman is going to get when she goes into the emergency room,” she said. “It’s the quickness of what happens. If she reports and it’s days before the cops come, she is going to be in fear every second until something happens. If they respond immediately, there’s much more likelihood of their safety being enhanced.”
To resolve the problem, health-care workers should inform their patients that they are required to report and involve them in the reporting and in creating a safety plan, Nudelman said. “If it’s dangerous for a cop to come by her house, she lets them know that.” The victim can also be contacted by police at the hospital or at the home of a relative or a friend, she said.
Carol Arnett, coordinator of the Los Angeles County Domestic Violence Council, said it is unfortunate that the law requiring reporting came before the one requiring training. “I get far more calls from health-care professionals wanting to know about mandated reporting rather than wanting to learn about domestic violence and provide adequate safety and treatment for battered women,” she complained.
At least one former victim of domestic violence said she is thrilled that health professionals are getting involved.
One 41-year-old said she had been treated over the course of her 14-year marriage at various hospitals in Los Angeles for broken ribs, a broken nose and other injuries caused by her husband. Doctors and nurses accepted her stories that she had fallen. Besides, she said, “He would always be there right with me, so I could not say anything right there even if I had wanted to.”
She said he even beat her up while she was in a hospital, staying with her children who were being treated for other, unrelated conditions. “We were there so long he didn’t like it. We would get into arguments. On two occasions he dragged me into the women’s bathroom and beat me. I had black eyes. Not once did any nurses or doctors or social workers ask how this occurred.”
Kramer said counselors told her not to leave him because he was mentally ill. At one point, she attempted suicide.
Now working as a victims’ advocate, she said she returned to that same hospital two years ago to train health-care professionals in domestic violence. “I perspired. I got goose bumps. I cried. It was very emotional,” she recalled. “The social workers and nurses and interpreters were in tears. They said they want me to go back and train on the floors.
“It’s wonderful,” she said about the changes. “It’s so exciting.”