Fall 2001; Volume 2, Number 2|
Feature: Violence and Healthcare
Interview with Esta Soler and Lisa JamesContinued
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LJ: This isnt exactly an exhaustive list: reporting states should not mandate that women and doctors report violence to the police, insurance victims should not be discriminated against (they have been in the past), training - healthcare providers need to learn how to recognize and help a victim, screening meaning asking women during checkups whether they are victims of abuse, and protocols health systems must have clear steps for doctors to follow.
The Trouble with Mandatory ReportingHHPR: Does mandatory reporting help victims of domestic violence?
LJ: No. Further endangering the victim is the problem with mandating the reporting of domestic violence to the law enforcement without the victims consent. Theres a very real fear of retaliation. If we were confident that the batterer would be put away and safely out of arms reach, that might be a different story. But in many cases, the best scenario for the patient is not to have her perpetrator either arrested or re-released.
However, when states have had mandatory reporting laws, we found that the awareness of domestic violence as a household issue increased because the healthcare providers are particularly concerned with liability and their ethical and legal obligation. So its been good in that way in many states.
HHPR: Who should be making the decision to report domestic violence the victim, the doctor, or the law?
LJ: Its critical that we leave the decision-making power in the hands of the victim. She knows whats best for her. We have also found, anecdotally, on a large scale, that many victims of violence are hesitant to come to the healthcare setting because they know about the reporting requirement, so theyre hesitant to disclose. And more frightening is that theyre hesitant even to seek health care.
HHPR: To ensure that the victim is in control of her medical records and safety, who should be responsible for protecting the confidentiality of what goes on during the checkup the healthcare system or the criminal justice system?
ES: What you dont want is to turn all of the intervention and screening thats going on in the healthcare system - albeit not as much as we want - into a law enforcement program. We want it to be a healthcare program. Were not saying that we should create separate and unequal laws with respect to domestic violence. We do agree that you must report a serious felonious assault, but not every incidence of domestic violence is like that.
Mandatory reporting undermines the responsibility of the physician, and theres no evidence that the criminal justice system is the best place for all situations, so why do that? It just creates an additional burden and the efficacy of that is still very much in doubt.
The National Academy of Sciences report from a couple years ago told states that you should not do mandatory reporting until you do the research to see whether its the right way to go. So theres been a real slowing down of that public policy.
We believe very strongly that the whole approach to the issue of domestic violence is not just about health intervention and screening. It is about setting a public health framework on this issue. The strategies that you use are different than if you just set a criminal justice framework. For us, the public health and the healthcare system are two of the places where we really would like to see a significant shift away from having this almost sole reliance on the institution of the justice system to deliver this service. We havent seen that shift, but thats what were working on.
Insurance DiscriminationHHPR: How have insurance companies treated victims of domestic violence in the past?
LJ: A while back, we found that a number of insurance companies were discriminating against the victims of violence and denying them insurance, basically putting them and their experience as a victim of domestic violence on par with people like hang-gliders or people who do highly dangerous activities.
HHPR: And how have states responded?
LJ: Before the Pennsylvania Coalition Against Domestic Violence (PCADV) took this issue on, a lot of the major insurance companies were denying coverage to victims of violence. It was only through the hard work of the Pennsylvania Coalition in helping states pass laws that prohibited insurance discrimination that weve come quite far in this area.
Twenty-two states have enacted legislation that protects victims of domestic violence. The leadership there is thanks to Nancy Durborow from the PCADV. Overall, we still need to continue to work to strengthen those discrimination laws, because as we encourage providers to screen, intervene, and document, we definitely dont want it to then come back to the victim and harm her in some other way.
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