Asking the Question

Posted Dec. 19, 2008, at 5:58 p.m.

Domestic violence is a very private crime, typically perpetrated within the walls of a home. Its victims rarely call the police, and they even lie about their injuries to family, friends, neighbors, co-workers, clergy and health care providers. So with the state witnessing its 18th domestic homicide of the year in Belfast earlier this month — almost triple the number of such homicides in 2007 — the question of how to intervene before the violence turns deadly is urgent indeed.

One approach, urged by state officials, is for health care professionals to be more vigilant and assertive in screening patients for signs of domestic violence.

“National studies indicate that three-quarters of domestic violence-related homicide victims were seen in a health care setting for related injuries within a year of their homicide,” Dr. Dora Anne Mills, the state’s public health director, said in a recent press conference. “Effective screening may have saved their lives.”

Physicians and nurses treating people whose injuries they suspect are the result of violence by a partner will discuss their suspicions with the patient. They often will outline their options — counseling, a safe house, a protection-from-abuse order.

But there are other junctures at which domestic violence victims come into contact with health care professionals. And those interactions offer far more potential for effective intervention, Francine Stark of Spruce Run, the Bangor domestic violence agency, explained.

Because of the controlling nature of abusers, an unknown percentage of victims never get treatment for their injuries. But those same victims visit doctors for other reasons — a sick child, a pregnancy exam, a flu vaccine or other malady unrelated to domestic violence. If the doctor routinely asks the woman (or man) certain questions, she or he may admit the abuse, Ms. Stark said. Those questions include: Are you living in fear of violence at home? Does your partner cut off your communication with friends and family and not let you have access to money? Does your partner let you leave the house when you want? Is your partner verbally abusive, and accusing you of infidelity without cause?

Recently, physician offices in Maine asked such questions of patients, in a form patients completed anonymously. Ms. Stark said some 30 percent indicated they had at one time been subjected to domestic violence, while about 10 percent were currently suffering abuse at the hands of their partner. If a patient indicates that she or he is a victim, the nurse or physician must then have information ready to share about the options.

Enacting a mandatory reporting law for health care professionals, similar to the law that requires some professionals to report to the Department of Health and Human Services signs of sexual or physical abuse of children, would not work with domestic violence, Ms. Stark believes. Such laws have been tried in other states, and they result in victims not going to emergency rooms or physician offices for treatment of their injuries.

But encouraging a friendly question from a trusted doctor or nurse, followed by a frank discussion with some practical suggestions, could be a prescription to save lives.

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