Domestic Violence: Why the Florida Legislature Must Do More to Protect the Silent Victims
Consider the following not uncommon scenario: A triage nurse1 in a busy emergency room of a hospital in a large metropolitan area assesses a female patient and documents in her nurse’s note the following findings: “Hit by a fist to Rt eye. Seeing white flashes in both eyes X 2 mos.” The emergency room physician later evaluates the same patient and documents the following note: “Pt 24 y/o BF c/o hx2 head trauma but presents with complaint of flashing lights in peripheral vision. Pt. first noticed it after blunt trauma to R eye. It has since spread to the L eye. Pt. symptoms assoc with tingling over the head. Not assoc with position. No risk factor for vascular disease except HTN.3 & #x201d; On exam, the physician documents “mild swelling right eye, eye—EOMI,4 PERRLA.5 Fundus—neg,6 visual field intact, vision 11/100 bilaterally. No bruits.7 No murmur, lungs clear.” The physician diagnoses the patient with “blunt trauma of the face, HTN,” and reschedules her to return to the ophthalmology clinic in one week for a blood pressure check.8
In this example, the physician fails to elaborate upon the history obtained by the triage nurse. In fact, the physician has removed the victim from the picture, and only her right eye remains. The physician has also removed the perpetrator from the note. The fist is no longer connected to the person who inflicted the abuse. The physician’s note does not acknowledge the physical act but instead refers to “blunt trauma.” The physician’s evaluation leaves little room for the victim to discuss what may have been her most pressing reason for seeking care—that she has been the victim of domestic abuse.
To combat this ever-increasing problem, the Florida Legislature has taken bold steps to require that every health care professional licensed in the state receive ongoing education concerning how to identify and screen for domestic violence victims, and what measures should be taken to ensure that the victim and her family receive referral to the proper resources.9 This article will review how domestic violence is defined in Florida, and how pervasive domestic violence is. It will address in what settings physicians are likely to encounter these victims and will further elaborate on what cues physicians must be attuned to in order to identify these “silent” victims. The article will discuss how physicians struggle with the ethical and legal obligations they must adhere to in order to satisfy not only their statutory obligations but also to maintain the standards of the profession. It will review how other states have dealt with mandatory reporting requirements for physicians who encounter victims in their practice, and will recommend that Florida enact similar legislation. Finally, the article will discuss briefly the resources that are currently available for victims and their families.
Defining Domestic Violence
Domestic violence, which sometimes is referred to as spouse abuse or battering, refers to the victimization of an individual with whom the abuser has or has had an intimate or romantic relationship.10 Unfortunately, researchers in the field of domestic violence have not agreed on a uniform definition of what constitutes violence or an abusive relationship. The prevailing suspicion about domestic violence is that assaults are “physical, frequent, and life-threatening.”11 Advocates for battered women contend that financial abuse and property abuse are also forms of domestic violence perpetrated against women.12 Whatever the definition, it is important for physicians and the attorneys who counsel them to understand that domestic violence, in the form of emotional and psychological abuse and physical violence, is prevalent in our society, and the abuse can be stemmed only through a multi-displinary approach.
Unfortunately, domestic violence and abuse has become a fact of life for many American women and children.13 Statistics demonstrate that between four and six million women are abused annually in the United States,14 and that a woman is more likely to suffer assault, rape, or murder by a husband or partner than by a stranger.15 As a result of these troubling statistics, Governor Lawton Chiles appointed a Task Force on Domestic Violence on September 28, 1993, to investigate the problems associated with domestic violence in Florida and to compile recommendations as to how the problems should be approached and, ultimately, resolved. On January 31, 1994, the task force issued its first report on domestic violence. This report recommended standards to measure accurately the extent of domestic violence and strategies for increasing public awareness and education; it identified programs and resources that are presently available to victims in Florida; it made legislative and budgetary suggestions for needed changes and provided a methodology for implementing these changes; and it identified areas of domestic violence that require further study.16
As a result of this report, the Florida Legislature enacted legislation during the 1995 legislative session implementing various suggestions of the task force. An important effort achieved by the legislature was to define the term. Although domestic violence has many names—wife abuse, marital assault, woman battery, spouse abuse, wife beating, conjugal violence, intimate violence, battering, partner abuse, and family violence—in Florida, domestic violence is defined as any “assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member17 by another who is or was residing in the same single dwelling unit.”18 Because this definition is more a behavioral definition, rather than a legal one, it has been criticized for not being specific enough.19 This is a valid criticism and as physicians, attorneys, and law enforcement officers struggle to understand the definition as it applies to their professional obligations, the Florida Legislature will certainly have to revise the definition accordingly.
Most importantly, as a result of the Governor’s Task Force on Domestic Violence, the Florida Legislature amended F.S. §455.222 to require that all physicians, osteopaths, nurses, dentists, midwifes, psychologists, and psychotherapists obtain, as part of their biennial continuing education requirements, a one-hour continuing education course on domestic violence.20 To date, this mandate has exposed vast numbers of health care professionals practicing in Florida to the issue of domestic violence.21
Demographics, Dynamics, and Victim Identification
As part of the statutorily mandated continuing education course, physicians and other health care professionals must understand that any patient who walks into their offices may be a potential victim. For example, researchers have demonstrated that abuse of women cannot be predicted by any demographic feature related to age, ethnicity, race, religious denomination, education, socioeconomic status, or class.22 in fact, in at least one study, the majority of battered women surveyed were intelligent and well-educated—or at least more educated than their batterers.23 Many of these women held jobs in which they were delegated some measure of responsibility.24 Many battered women come from middle-class families and are successful career women.25 The battered woman may have low self-esteem, hold traditional views about the woman’s role in the home, believe she is responsible for the batterer’s conduct, and she may deny the anger she feels toward the batterer.26 She may put forward a capable, confident face in her public life, while at home she slips into a passive role over which her batterer has complete control.27 These, of course, are generalities with no one woman fitting all of the characteristics described. This general description serves, however, to effectively dispel the false stereotype of the battered woman and to help demonstrate that battered women are people with whom everyone might identify in some way.28
Because women who are abused often suffer severe physical injuries, they will likely seek care from a physician.29 Accordingly, physicians are in a critical position to identify domestic violence victims in a variety of clinical practice settings in which women receive care. Statistics demonstrate that large numbers of trauma victims presenting to hospital emergency rooms are domestic violence victims. Evidence exists that at least one in five women seen in emergency departments has been the victim of abuse.30 Other studies demonstrate that 42 percent of female trauma victims between the ages of 18 to 20 were victims of abuse, and that 18 percent of injured women over the age of 61 presenting to an emergency room also reported being battered.31 Because a gynecologist or obstetrician frequently is a woman’s primary care physician, these physicians must be particularly sensitive to domestic violence issues.32 Studies demonstrate that battering starts or intensifies during pregnancy.33 Remarkably, the 1985 National Family Violence Survey found that 154 out of every 1,000 pregnant women were assaulted by their mates during the first four months of pregnancy, and 170 per 1,000 women were assaulted during the fifth through the ninth months.34 At least one study has documented that approximately 37 percent of obstetric patients are physically abused while pregnant.35
Once physicians recognize that each of their patients can be a potential victim, it is imperative that these physicians utilize proper assessment tools in order to avoid the scenario previously described in this article. Obviously, the key to an initial screening is to obtain a complete and adequate history. Establishing that a patient’s injuries are secondary to battering is the first task. Clearly, there will be times when a victim is injured so severely that treatment of these injuries becomes the first priority.36 After such treatment is provided, however, it is important that the physician not ignore the reasons that brought the victim to the emergency room. The physician must collect information to facilitate a comprehensive assessment of the victim’s needs, resources, and priorities in order to develop immediate and long-range plans designed to minimize and eliminate future abusive episodes.
The obvious cues are the physical ones. Injuries range from bruises, cuts, black eyes, concussions, broken bones, and miscarriages to permanent injuries such as damage to joints, partial loss of hearing or vision, and scars from burns, bites, or knife wounds.37 Typical injury patterns include contusions or minor lacerations to the head, face, neck, breast, or abdomen.38 These are often distinguishable from accidental injuries, which are more likely to involve the periphery of the body.39 in one hospital-based study, domestic violence victims were 13 times more likely to have sustained injuries to their breasts, chests, or abdomen than other accident victims.40 Abused women also are more likely to have multiple injuries than accident victims.41 Physicians should suspect physical abuse when this pattern of injuries is seen in a woman, particularly in combination with evidence of old injury.42
In addition to the trauma-related problems domestic violence victims suffer, a number of studies have identified domestic violence as a problem afflicting a number of women who seek care for medical problems. While acute injuries may be the most obvious manifestation of domestic violence, it is often the long-term medical and psychological consequences of battering that are most debilitating over time.43 For example, in addition to the physical signs and symptoms previously discussed, battered women also may exhibit psychological cues that resemble an agitated depression.44 As a result of prolonged stress, these women often manifest various psychosomatic symptoms that generally lack an organic basis.45 They may complain of backaches, headaches, and digestive problems.46 Often, they will complain of fatigue, restlessness, insomnia, or loss of appetite.47 Great amounts of anxiety, guilt, and depression or dysphoria also are typical.48
Unfortunately, physicians often respond to these women by diagnosing the patient to be neurotic or irrational.49 These women are labeled as being “crocks” or “hysteric,” and sometimes are assigned the pejorative psychiatric diagnostic label of “somatization disorder,” “self-defeating personality disorder,” or “borderline personality disorder.”50 Physicians must cast aside these misperceptions of abused victims and sensitize themselves accordingly.
Florida Physicians’ Ethical and Legal Responsibilities
Although physicians and other health care providers licensed and practicing in Florida have begun the process of fulfilling the education requirement mandated by the legislature, there is still much confusion regarding their duties, not only with regard to their legal liabilities, but from an ethical perspective as well.
The American Medical Association (AMA) Council on Ethical and Judicial Affairs has identified two ethical principles as forming the foundation of a physician’s ethical duty to recognize and respond to domestic violence.51
First, the medical ethical principle of beneficence requires physicians to intervene in cases of domestic violence. Some physicians may argue that their ethical obligation extends only to treating a patient’s physical injuries, and that, by doing more, the physician steps out of the medical role. Citing to a treatise on beneficence by noted bioethicists, the Council on Ethical and Judicial Affairs has concluded that a physician’s duties go far beyond merely treating a patient’s physical infirmities:
The aim of medicine is to address not only the bodily assault that disease or an injury inflicts but also the psychological, social, even spiritual dimensions of this assault. To heal is to make whole or sound, to help a person reconvene the powers of the self and return, as far as possible to his [or her] conception of a normal life.52
The obvious concern is that by treating only the injuries and physical symptoms, physicians fail to address the underlying family violence problem that is at the root of the patient’s physical injuries. ignoring the abuse, physicians allow it to continue and, in some cases, to escalate.53
The second ethical principle of nonmaleficence requires that a physician “do no harm.”54 This principle likewise requires a physician to diagnose domestic abuse and provide intervention. In fact, when a diagnosis of abuse is missed, treatment likely will be inappropriate and, sometimes, harmful. For example, physicians may prescribe narcotics and sedatives to abuse victims who are often at a greater risk for suicide and drug and alcohol abuse. The most important thing physicians can do to end the violence and protect the health of their abused patients is to be able to recognize and acknowledge the abuse.55 Only then can the physician hope to “heal” the patient. As discussed, the Florida Legislature has recognized this important goal and has acted upon it. Once a physician recognizes and diagnoses the abuse, however, how can he or she report it to law enforcement authorities without violating patient confidentiality concerns?
Legislature’s Responsibility to Ensure Adequate Reporting
Physicians often are concerned about reporting domestic violence incidents because of their ethical obligation to maintain patient confidentiality. In view of the present state of the law in Florida, this is a valid concern. Currently, Florida law requires a physician to report only suspected child abuse or elder abuse to local protective service or law enforcement agencies.56 Physicians in Florida also have an obligation to report to their local sheriff’s department when they treat persons suffering from a gunshot wound or “other wound indicating violence.”57 At the present time, however, there is no law that requires a physician to report suspected domestic violence of adult victims in Florida58 absent the presence of a “wound indicating violence.” Attorneys should therefore counsel their physician-clients that they should not notify spouses, partners, or other third parties, including law enforcement, of an abuse diagnosis without having first obtained the express consent of the adult victim, preferably in writing.
Some states have chosen to mandate statutorily that physicians report suspected domestic violence abuse to the authorities. California, for example, recently amended its statute to provide that any health care practitioner must report known and suspected abuse,59 and the statute is fairly specific in describing what constitutes “assaultive or abusive conduct.”60 The statute provides in pertinent part that:
(a) Any health practitioner employed in a health facility, clinic, physician’s office, local or state public health department, or a clinic. . . who, in his or her professional capacity or within the scope of his or her employment, provides medical services for a physical condition to a patient whom he or she knows or reasonably suspects is a person described as follows, shall immediately make a report in accordance with subsection (b):
(1) Any person suffering from any wound or other physical injury inflicted by his or her own act or inflicted by another where the injury is by means of a firearm.
(2) Any person suffering from any wound or other physical injury inflicted upon the person where the injury is the result of assaultive or abusive conduct.
The statute defines “assaultive or abusive conduct” to include murder; manslaughter; mayhem; aggravated mayhem; torture; assault with intent to commit mayhem, rape, sodomy, or oral copulation; administering controlled substances or anesthetic to aid in commission of a felony; battery; sexual battery; incest; throwing any vitriol, corrosive acid, or caustic chemical with intent to injure or disfigure; assault with a stun gun or taser; assault with a deadly weapon, firearm, assault weapon, or machine gun, or by means likely to produce great bodily injury; rape; spousal rape; procuring any female to have sex with another man; child abuse or endangerment; abuse of spouse or cohabitant; sodomy; lewd and lascivious acts with a child; oral copulation; genital or anal penetration by a foreign object; elder abuse; or an attempt to commit any of these specified crimes.61
The California law requires that the report be made immediately by telephone to a law enforcement agency,62 and that the verbal report be followed up by a written report within two working days of the verbal report.63 California further passed a separate law dealing specifically with physicians and surgeons, which requires not only the reporting of those acts outlined in Cal. Penal Code (West Supp. 1998) §11160,64 but further requires that the physician or surgeon make very specific findings in the patient’s medical record to include “the name of any persons suspected of inflicting the wound, other physical injury, or assaultive or abusive conduct upon the person”65 and “a map of the injured person’s body showing and identifying injuries and bruises at the time of the health care.”66 The physician also must include a copy of the law enforcement reporting form in the medical record.67 The law also “recommend[s] that the physician or surgeon refer the person to local domestic violence services if the person is suffering or suspected of suffering from domestic violence.”68 Finally, California provides immunity from civil and criminal liability for all health care practitioners who report in accordance with the law,69 and makes it a misdemeanor for failing to report an incident.70 Obviously, a statute this specific will provide physicians with the guidance they need to report domestic violence incidents in good faith and, because of the specific mandates regarding what information should be included in the medical record, will make it easier to prosecute the batterer.
Other states also have provided reporting requirements, although their laws are not as specific and do not go as far as the law in California. In Kentucky, a physician must report known or suspected domestic abuse of an adult patient to the Commonwealth’s Department of Social Services for investigation.71 The Kentucky statute provides, in pertinent part, that:
A nurse, social worker, department personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with the provisions of this chapter. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death.
(3) An oral or written report shall be made immediately to the department72 upon knowledge of the occurrence of suspected abuse, neglect, or exploitation of an adult. Any person making such a report shall provide the following information, if known: The name and address of the adult, or of any other person responsible for his care; the age of the adult; the nature and extent of the abuse, neglect, or exploitation, including any evidence of previous abuse, neglect, or exploitation; the identity of the perpetrator, if known; the identity of the complainant, if possible; and any other information that the person believes might be helpful in establishing the cause of abuse, neglect, or exploitation.
(4) Upon receipt of the report, the department shall take the following action as soon as practical:
(a) Notify the appropriate law enforcement agency;
(b) Initiate an investigation of the complaint; and
(c) Make a written report of the initial findings together with a recommendation for further action, if indicated.73
As in California, physicians practicing in Kentucky who report incidents in accordance with the statute are immune from civil or criminal liability so long as they report in good faith.74 Accordingly, the traditional physician-patient privilege is inapplicable.75 If a Kentucky physician fails to report, he or she shall be guilty of a misdemeanor.76
The state of New Mexico also has a reporting statute, although it is not as comprehensive as those in California or Kentucky. The New Mexico statute requires that anyone who has reasonable cause to believe an adult has been abused to report this knowledge or be guilty of a misdemeanor.77
In states like Florida where batterers can continue to frighten and subjugate their victims into submission, physicians’ hands are tied without statutory authority to contact law enforcement authorities. Attorneys, physicians, and other health care professionals should lobby their local legislators to enact legislation—as have the other states previously discussed—that requires all physicians licensed and practicing in the state to report suspected domestic abuse either to law enforcement authorities or, better yet, to a department created specifically for the purpose of handling the reporting of such incidents. The law should similarly immunize the physician from civil and criminal liability when the report is made in good faith. In addition, the law should impose criminal penalties against those physicians who fail to report. Until such time as the Florida Legislature imposes such a requirement, however, it is up to physicians to encourage their patients whom they suspect have been domestic violence victims to seek help.
Identifying Resources and Assisting in Making Referral
Notwithstanding the ethical and legal obligations previously discussed, physicians in Florida continue to be hesitant to inquire about domestic abuse. In one study, the majority of physicians surveyed who acknowledged that they did not effectively screen their patients for domestic abuse identified the time constraints of a busy practice as the major deterrent.78 Although other health care professionals may validate and empathize with this concern, physicians must recognize that their inactions will have serious consequences for their battered patients.
Accordingly, in order to provide the best assistance within the present bounds of the law, the physician should encourage the domestic violence victim to consent to having law enforcement authorities notified. Because victims often are embarrassed, ashamed, or frightened to reveal that they have been battered, however, they may be hesitant to give their consent. In those instances, the physician should maintain the patient’s confidentiality and provide the victim with the necessary referral information to other health care professionals trained to deal with such situations, such as social workers. If the patient continues to refuse to discuss the matter, the physician should provide the patient with information regarding resources that are available.
In Florida, a 24-hour domestic violence hotline is available for toll-free counseling and information. That number is 1-800-500-1119. The counselors answering the toll-free line may refer the victim to a local domestic violence center. Since implementation of the Governor’s Task Force recommendations, Florida has established at least 37 certified domestic violence centers across the state that will provide information and referral services, counseling and case management services, temporary emergency shelter for more than 24 hours, educational services for community awareness relative to domestic violence, and assessment and appropriate referral of resident children.79
Conclusion
Domestic violence will likely continue to be a major problem in Florida. If abuse is to be prevented, physicians in all settings must comply with the statutes and educate themselves and assess all patients for abuse during each visit. Moreover, and more importantly, the Florida Legislature must enact laws, as have other states before it, to require physicians to report acts of suspected abuse, and to relieve the physician of civil or criminal liability if the physician made the report in good faith. Only through these measures can physicians and legislators promote the health and well-being of Floridians. q
1 A triage nurse is that person of the emergency room staff who must obtain a brief history, perform a rapid physical assessment, assist in determining the severity of illness, and transfer the patient to the appropriate place of care. This screening and classification of patients generally is conducted in busy urban care hospitals to determine priority needs for efficient use of medical and nursing capabilities, equipment, and facilities.
2 “Hx” is a commonly used medical abbreviation for “history.”
3 “HTN” is a commonly used medical abbreviation for “hypertension.”
4 “EOMI” is a commonly used medical abbreviation for “extra ocular movements intact.”
5 “PERRLA” is a commonly used medical abbreviation for “pupils, equal, round, reactive to light and accommodate,” and generally is used to indicate that the nerves that innervate the eyes are healthy and without obvious signs of disease or injury.
6 The fundus is the posterior inner part of the eye as seen with an ophthalmoscope and, again, this examination would indicate that the eye examination was normal. Taber’s Cyclopedic Medical Dictionary 768 (17th ed. 1993).
7 A bruit is a sound of arterial or venous origin auscultated, or heard over the heart with the use of a stethoscope, which could indicate some abnormal condition.
8 This scenario was replicated from one described by Carole Warshaw in her article on domestic violence. Carole Warshaw, Domestic Violence: Challenges to Medical Practice, 2 J. Women’s Health 73, 75 (1993).
9 Statistics confirm that domestic violence is predominantly perpetrated by men against women; however, there is evidence to suggest that women also exhibit violent behavior against their male partners. Julia J. Chavez, Battered Men and California Law, 22 Sw. U. L. Rev. 239 (1992). The American Medical Association’s Council on Ethical and Judicial Affairs has argued persuasively that the impact on the health of female victims of domestic violence generally is much more severe than the impact on the health of male victims and, therefore, this article will focus primarily on the female and her family as the victim. Council on Ethical and Judicial Affairs, American Medical Association, Physicians and Domestic Violence, Ethical Considerations, 267 JAMA 3190 (1992).
10 Council on Ethical and Judicial Affairs, supra note 9, at 3191.
11 Karla Fisher, et al., The Culture of Battering and the Role of Mediation in Domestic Violence Cases, 46 SMU L. Rev. 2117, 2120 (1993).
12 Id. at 2121.
13 Diane F. Medley, Separating the Victim From the Abuser: Chapter 94-135 and the Florida Legislature’s Most Recent Attempts to Control Domestic Violence, 7 St. Thomas L. Rev. 169, 169 (1994).
14 Governor’s Task Force on Domestic Violence, Executive Office of the Governor, The First Report of the Governor’s Task Force on Domestic Violence (Jan. 1994).
15 Maryanne E. Kampmann, The Legal Victimization of Battered Women, 15 Women’s Rts. L. Rep. 101 (1993).
16 Governor’s Task Force on Domestic Violence, supra note 14, at 3.
17 The statute defines a family or household member as “spouses, former spouses, persons related by blood or marriage, persons who are presently residing together as if a family or who have resided together in the past as if a family, and persons who have a child in common regardless of whether they have been married or have resided together at any time.” Fla. Stat. §741.28(2) (1997).
18 Fla. Stat. §741.28(1) (1997). Obviously, the elements reflected in this definition combine to form a behavioral rather than a true “legal” definition of domestic violence. There are a number of other behavioral elements that are generally present and physicians should be cognizant of them. They include:
a) Conduct perpetrated by adults or adolescents against their intimate partners in current or former dating, married, or cohabitating relationships of heterosexuals, gay men, and lesbians.
b) A pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks as well as economic coercion.
c) A pattern of behaviors including a variety of tactics—some physically injurious and some not, some criminal and some not—carried out in multiple, sometimes daily, episodes.
d) A combination of physical attacks, terrorist acts, and controlling tactics used by perpetrators that result in fear as well as physical and psychological harm to victims and their children.
e) A pattern of purposeful behavior, directed at achieving compliance from or control over the victim.
Anne L. Ganley, Understanding Domestic Violence 15, 16, Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers (Debbie Lee et al. eds., 2d ed. 1995).
19 See Jay B. Rosman, Domestic Violence Recent Amendments to the Florida Statutes, 20 Nova L. Rev. 117, 161–65 (1995).
20 1995 Fla. Sess. Law Serv. 95-187 (West).
21 Although the legislature is to be commended for mandating these educational requirements, it can go much further to support and protect victims in Florida. These suggestions will be discussed infra.
22 Ronald A. Chez, Complications of Pregnancy: Medical, Surgical, Gynecologic, Psychosocial, and Perinatal 263 (1992).
23 Sue E. McClure, The Battered Woman Syndrome and the Kentucky Criminal Justice System: Abuse Excuse or Legitimate Mitigation?, 85 Ky. L.J. 169, 172–73 (Fall 1996–97).
24 Id.
25 Id.
26 Id.
27 Id.
28 Id.
29 The National Crime Survey analyzed the annual national morbidity associated with domestic violence to include 21,000 hospitalizations, 99,800 days of hospitalization, 28,700 emergency department visits, and 39,900 visits to physicians. Susan V. McLeer and Rebecca Anwar, A Study of Battered Women Presenting in an Emergency Department, 79 Am. J. Pub. Health 65, 65 (1989).
30 Council on Scientific Affairs, American Medical Association, Violence Against Women, Relevance for Medical Practitioners, 267 JAMA 3184 (1992). See also Jean Abbott et al., Domestic Violence Against Women: Incidence and Prevalence in an Emergency Department Population, 273 JAMA 1763, 1766 (1995) (revealing in a study that 11.7 percent of women who had current husbands or boyfriends attributed their emergency room visits to domestic violence); Jacquelyn C. Campbell et al., Battered Women’s Experiences in the Emergency Department, 20 J. Emergency Nursing 280, 286–87 (1994) (revealing that battering is the leading cause of trauma to women seen in emergency rooms).
31 McLeer and Anwar, supra note 29, at 66.
32 Ronald A. Chez, Woman Battering, 158 Am. J. Obstetrics and Gynecology 1, 4 (1988).
33 Chez, supra note 22, at 263; Judith McFarlane, Battering During Pregnancy: Tip of an Iceberg Revealed, 15 Women and Health 69 (1989).
34 Council on Scientific Affairs, supra note 30, at 3186.
35 Id. at 3187.
36 Susan V. McLeer and Rebecca Anwar, The Role of the Emergency Physician in the Prevention of Domestic Violence, 16 Annals of Emergency Med. 1155, 1158 (1987).
37 Council on Scientific Affairs, supra note 30, at 3186.
38 Id.
39 Id.
40 Id.
41 Id.
42 Id.
43 Carole Warshaw, Identification, Assessment and Intervention with Victims of Domestic Violence 49, 54, Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers (Debbie Lee et al. eds., 2d ed. 1995). For example, battered women may present with exacerbation or poor control of chronic medical conditions such as diabetes, hypertension, or heart disease. Id. Battered women may be prevented from obtaining or taking their medications or from seeking medical care. Id. Their medical conditions may be worsened as a result of the extreme stress of living with domestic violence, causing, for example, more frequent angina. Id.
44 Council on Scientific Affairs, supra note 30, at 3186.
45 Id.
46 Id.
47 Id.
48 Douglas D. Scherer, Tort Remedies for Victims of Domestic Abuse, 43 S.C. L. Rev. 543, 548 (1992). In many women, this constellation of symptoms has been labeled “battered women’s syndrome.” Id.
49 Council on Ethical and Judicial Affairs, supra note 9, at 3191.
50 Warshaw, supra note 8, at 74.
51 Council on Ethical and Judicial Affairs, supra note 9, at 3190.
52 Id.
53 Id.
54 Id.
55 Id. at 3191.
56 Fla. Stat. §§415.111, 415.504, 415.513 (1997). Failure to do so in each instance is a second-degree misdemeanor, which is punishable by a term of imprisonment not to exceed 60 days, and a fine of up to $500. Fla. Stat. §§415.111, 415.513, 775.082, 775.083 (1997).
57 Fla. Stat. §790.24 (1997).
58 The Florida Legislature did not pass a law mandating physicians and other health care professionals to report suspected domestic violence incidents during the recent 1998 Florida Legislative Session. Telephone interview with William A. Bell, Sr., vice-president/general counsel, Florida Hospital Association (March 28, 1998).
59 Cal. Penal Code §11160(a) (West Supp. 1998).
60 Id. §11160(d).
61 Id.
62 Id. §11160(b)(1).
63 Id. §11160(b)(2).
64 Id. §11161.
65 Id. §11161(b)(1).
66 Id. §11161(b)(2).
67 Id. §11161(b)(3).
68 Id. §11161(c).
69 Id. §11161.9.
70 Id. §11162.
71 Ky. Rev. Stat. Ann. §209.030 (Baldwin 1994).
72 The department is defined as: “the department for social services of the cabinet for human resources.” Id. at §209.020.
73 Id. at §209.030.
74 Specifically, the statute provides that: “Anyone acting upon reasonable cause in the making of any report or investigation or participating in the filing of a petition to obtain injunctive relief or emergency protective services for an adult pursuant to [§209.030], including representatives of the department in the reasonable performance of their duties in good faith, and within the scope of their authority, shall have immunity from any civil or criminal liability that might otherwise be incurred or imposed. Any such participant shall have the same immunity with respect to participation in any judicial proceeding resulting from such report or investigation and such immunity shall apply to those who render protective services in good faith pursuant to either the consent of the adult or to court order.” Id. at §209.050.
75 James T. R. Jones, Battered Spouses’ Damage Actions Against Nonreporting Physicians, 45 DePaul L. Rev. 191, 201 (1996).
76 Ky. Rev. Stat. Ann. §209.990(1) (Baldwin 1994) (“Anyone knowingly and willfully violating the provisions of KRS 209.030(2) shall be guilty of a Class B misdemeanor.”)
77 N.M. Stat. Ann. §§27-7-30, 31 (Michie 1997). This statute also grants immunity for physicians reporting in good faith. Id.
78 Nancy Kathleen Sugg and Thomas Inui, Primary Care Physicians’ Response to Domestic Violence, 267 JAMA 3157, 3159 (1992). As one physician in the study stated: “You don’t open a Pandora’s box for the same reason you don’t generally ask people, ‘Do you have sexual problems?’ Not because it is not important, but because you don’t have time to do that. You literally don’t have time to deal with all this.” Id.
79 Florida Coalition Against Domestic Violence, Florida Directory of Domestic Violence Centers (1994).
Marjorie Conner Makar is a risk management representative for the University of Florida Health Science Center/Jacksonville Self-Insurance Program. She received her J.D. with high honors from Florida State University in 1992 and her B.S.N. with high honors from the University of Florida in 1984. Prior to law school, Ms. Makar was a registered nurse. She clerked for Judge Wm. Terrell Hodges of the U.S. District Court for the Middle District of Florida from 1992–94.
The author thanks Mark Hulsey of Smith Hulsey & Busey, Timothy W. Volpe of Volpe, Bajalia & Wickes, and Judge Hodges for encouragement to write this article.
