Fall 2001; Volume 2, Number 2|
Feature: Violence and Healthcare
Interview with Esta Soler and Lisa JamesContinued
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LJ: Its a little different. The 22 states legislation looks strictly at insurance companies specifically discriminating against victims of violence and denying them coverage. That is one component of our concern about medical records privacy. On one hand, it is important for a healthcare provider to ask about violence, identify victims, and then document it, so we can study and understand domestic violence as a healthcare issue. But if that information gets sent out to a variety of different places, including the insurance company, and the insurance company denies the victim coverage, thats obviously not going to help her.
HHPR: Aside from the threat of insurance discrimination, why do IPV victims need extra protections?
LJ: Sharing information from medical records can have other unfortunate negative ramifications. Again, the issue of retaliation comes up. In many cases, medical records are not that private, and inappropriate disclosure of health information can really harm the victim. We have seen some cases where medical records and results of visits have been sent home. After the perpetrators discovered that the victim has gotten care for her injuries, they retaliated with further violence.
Employers, law enforcement agencies, and even members of the victims community can discover domestic violence in the records. They may either discriminate against the victim or alert the perpetrator. The community members are of particular concern in smaller, more rural areas. Theres a huge web of information that gets disseminated once anything is in the medical record. For domestic violence victims, its not just a matter of privacy, its a matter of safety, and in some cases its life-threatening information.
We were working on including specific pieces that would protect victims of domestic violence when the Secretary of Health and Human Services, Tommy Thompson, put out the federal standards for privacy of medical and health information. There are a number of key areas where you need to pull out victims of domestic violence and add extra protections for them.
We were quite pleased that a number of protections that we requested for victims of domestic violence were actually included in the new medical privacy rules.
HHPR: And what were some of these protections, specifically?
LJ: Some key protections have to do with keeping the victim in control of her medical records. A victim of violence must be informed in advance so she has an opportunity to agree or to object or to restrict certain uses of her or his healthcare information. Providers have to obtain patient consent prior to disclosing or using the health information for treatment or payment for their healthcare operations.
There are also many regulations about how to restrict disclosure and how to accommodate reasonable requests by the patients of how they want to communicate with the healthcare system. Perhaps they would send bills to a different place than their home if they want. They can set up a P.O. box if they want, and health plans must accommodate those reasonable requests in order to communicate with the patient. Those are some examples.
Another important measure to protect victims of violence concerns who has access to both their records and access to visitation when a victim of domestic violence is in care. In many cases, its direct family members or spouses, but obviously in the
case of domestic violence, the spouse might be the person who actually put them in the hospital. So if the patient chooses, they should be able to have the right to limit both the health information and the access to the patient within the healthcare setting for obvious reasons. These are a few of the about fifteen or twenty major protections included in the legislation.
HHPR: How long would it take to evaluate the effectiveness of the new federal standards for privacy?
LJ: The key to these regulations and making them effective will be the actual implementation of them. Its yet to be seen how comprehensive that will be. It will take some work at the state level to ensure that health plans are implementing the new regulations, not only specific to domestic violence, but across the board.
Close to HomeHHPR: From personal experience, I know that the volunteer training program for the Cambridge-based Transition House, the oldest domestic violence shelter on the East Coast, puts very little emphasis on the healthcare side of domestic violence. I suspect, given what youve said about the uniqueness of the FVPFs views, that most volunteers across the country are not aware of the possibility of intervening on the healthcare front.
However, there are many undergraduate volunteers who might be interested in the healthcare aspect. How might they get involved? Do you think there is a role for college-age volunteers in your national Health Cares About Domestic Violence Day (October 10, 2001) initiative?
LJ: Absolutely. One of the reasons for having Health Cares About Domestic Violence Day is to raise awareness of domestic violence as a health issue. Even people who are involved in the field, despite the incredible work going on around the country, arent aware about it.
People dont see domestic violence as a healthcare issue. But its a huge healthcare issue. It is currently at epidemic proportions, and its impact is much more than just injuries. Its frightening, actually, how detrimental the violence can be to a victims health and how incredibly helpful the health system is as a point of identifying victims that were not reaching through shelters. So, yes, that is one of the goals of this day.
We not only need to target clinicians and encourage them to screen. We also need volunteers and domestic violence advocates to encourage providers to screen for domestic violence. We must raise awareness about domestic violence as a health issue among the general public.
With regard to the Health Cares About Domestic Violence Day initiative, we have a number of student organizations, including the American Medical Student Association and the American Womens Medical Student Association, that are participating, particularly student health care organizations and domestic violence coalitions.
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Esta Soler is the founder and Executive Director of the San Francisco-based Family Violence Prevention Fund (FVPF). She has been appointed to serve on the Presidential Commission on Crime Control and Prevention and the National Advisory Council on Violence Against Women.
Lisa James is the programming director of the FVPFs National Health Care Standards Campaign.
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