Domestic violence reporting laws: Are they effective?
Five states have passed laws that obligate medical providers to report domestic violence, but there is scant evidence to indicate that these laws actually help victims.
Every ED nurse has been outraged at witnessing the burns, bruises, and broken limbs caused by domestic violence. Many have been tempted to call the police, even if the patient doesn't want the incident reported. Five states (California, Colorado, Kentucky, New Hampshire, and New Mexico) have now passed laws that require reporting of domestic violence to law enforcement. Opinions differ about whether this should be part of the ED nurses' role.
Opponents of reporting laws argue that victims of domestic violence will avoid seeking medical care, knowing the police will be called. "There are anecdotal examples of women who didn't seek care for their injuries because they knew about the reporting law and felt it would increase their danger," reports Patricia Salber, MD, FACEP, an emergency physician at Kaiser Permanente in Oakland, CA, and an American College of Emergency Physicians (ACEP) board member.
After the reporting laws were passed, a local community hospital put up a sign in the waiting room announcing that domestic violence was a reportable crime. Shortly afterward, the numbers of identified victims declined. "They were the only hospital in the area which had the number of victims identified go down instead of up," notes Salber. "That may have been because they let people know it would be reported."
Instead of reporting, ED clinicians should focus on safety assessment and planning, says Salber. "There is a perception that if you just pick up the phone and report this, they will lock up the batterer and throw away the key, and the woman will be safe. But that usually isn't what happens when you make that phone call."
There is no evidence that making a police report actually leads to an effective criminal justice intervention, Salber says. "Or even if there is an intervention, that may not be the best thing for the victim," she adds.
Other ED clinicians argue that domestic violence should be treated as a crime to be punished, regardless of the victim's reluctance to press charges. "I think we have to get down to basics here. This is a crime and there is a law against it," argues Gregory Henry, MD, FACEP, chief of the department of emergency medicine at Beyer Memorial Hospital in Ypsilanti, MI, and a former president of ACEP. "If the guy hit a woman he didn't know, we would report that without question. So why in the world wouldn't we report this? I don't know how punching your wife in the face is different than punching a stranger."
Victims need to accept that the police will be involved, Henry says. "I don't know why we've picked one group of people, and said we're going to report all crimes of violence in every other situation, but not this one," he adds.
Failure to report may leave victim in danger
If abuse goes unreported, there will be no documentation to prosecute a batterer in the future, he emphasizes. "There needs to be a record that this individual has done this 10 times before," he says. "Otherwise, if they move on to the next woman, there will be no record."
Women who fear revenge from abusers if the police are called are probably in more danger going home, says Henry. "If they're being beaten up that badly, doesn't going home put them in further danger?" he asks.
Reporting abuse would more likely frighten an abuser than incite retribution, Henry says. "If a guy knows the police are looking, that is a big incentive for him to clean up his act," he stresses. "Police visibility on the street is normally a deterrent to crime. Why would this particular situation be any different?"
Those against reporting laws contend that there is no research to show the laws are effective. A 1998 report concluded that it was unclear whether the reporting laws were effective.1 "In particular, the committee recommended that states refrain from enacting reporting laws until more research is done," says Elizabeth McLoughlin, ScD, director of programs for the Trauma Foundation in San Francisco, CA.
A recent assessment of California's 1994 mandatory reporting law showed that reports to police have not increased in the two years since its implementation.2 The study's authors theorize that the failure of the law may be due to fewer victims seeking care, fearing their partners will be arrested by police.
"Many victim advocates fear the law is doing more harm than good," says Carolyn Sachs, MD, MPH, the study's principle investigator and an emergency physician at the UCLA Emergency Medicine Center in Los Angeles, CA. "Victims may not be seeking medical attention because they know their partners will be reported, and medical professionals may feel torn between their alliance to their patients and compliance with a state law."
Reporting laws are in conflict with the proper relationship between the nurse and the patient, says McLoughlin. "Health care providers should not be jeopardizing access to care by being the conduit by which law enforcement is notified," she says.
More research needs to be undertaken before other states pass reporting laws, says McLoughlin. "We need to determine whether these laws are doing more harm than good," she adds. "We have to find out what happens after health care providers report, and whether the lives of the women who reported are better or worse."
Statistics on prosecution also need to be considered. "There is a requirement to report, but no guidelines as to what the police do with the reports," McLoughlin notes. In California, violence prevention activists have been working with the state legislature to modify the law so patients would be able to request that police not be called, she reports.
References
1. Violence in Families: Assessing Prevention and Treatment Programs. National Research Council Institute of Medicine report, Washington D.C., 1998.
2. Sachs CJ, Peek C, Baraff LJ, Hasselblad V. Failure of the mandatory domestic violence reporting law to increase medical facility referral to police. Ann Emerg Med 1998;31:488-494.
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