The Forensic Nurse

It may sound like a simple question, “Does mandatory reporting help?”, but it’s one that can be a much more difficult than most health care providers think under the surface.

As a health care provider, you can provide documenation of current injuries, and in many cases in past injuries as well. As a Forensic Nurse, you have the training to collect evidence that may be used in trial to prove the types of offenses that happened. Your medical charting of events can provide a detailed interpretation of facts and injuries than the victim himself/herself would have been able to provide on their own.

Obviously, by reporting that an event of domestic violence or sexual violence against a patient has occurred brings the situation out into the open where other agencies like law enforcement, DFACS, counciling services, and others can offer help and support to the victim, and even counciling to the perpetrator.

What if the patient doesnt want to report?

Informed consent is one of the principle foundations of modern medicine. This empowerment of patients to make informed decisions over their treatments and what happens to their bodies.  For a victim of sexual assult, or domestic violence, this control has been taken away from them. As a mandatory reporter, you are again taking away any sense of control away from the victim. They have no choice in the matter, since you are obligated to notify proper authorities.

The knowledge of confidentiality and essense of trust can be critical components in getting any successful intervention of a sexual assult or domestic violence. Mandatory reporting may directly affect that relationship though, since in effect a mandatory reporter must violate that patient confidentiality to inform proper authorities. Here is an excerpt from a battered woman focus group

“What made it difficult for me to confide was the fact that I feared for my life, you know. And I knew that if I was to tell them what actually happened, that they would call the police and I would have to file a report and they couldn’t guarantee me that they would be there 24 hours to protect me from this maniac. So, therefore, I wasn’t taking that chance on my life. … What would make it easier for me would be….to be my choice….[I] f this happened to me but I don’t want the police involved, can you please treat me and keep my confidentiality? There’s supposed to be a law that they keep confidentiality between the patient and the physician.”

Because of this violation of trust, some will argue that in order to get an accurate story from a patient that you should not tell the person that you are a mandatory reporter until after they have given their recount of events. Others will say that is ethically wrong, and that you should tell that person up front about your reporting status and in effect, give them the choice of reporting what actually happened, or just receiving their medical care and moving on.

Mandatory reporting laws were developed to provide a safety outlet for individuals who may be too afraid or unable to seek help (children, elderly, controlled spouse ,etc). The question that many of these victims ask is that “what are you going to do to protect me?”. Law enforcement can’t be in a home 24 hours a day. So what happens when the victim goes home, and the victimizer gets released from custody in a few hours or days? Is that person(s) safer now?

“Abused women hare had their autonomy taken away by their abusive partners. Forcing me to report her abuse again takes that autonomy and control away from her. She is a better judge than I of the consequences to her of reporting.” - PhysicianSurvey Statement

Right or wrong, mandatory laws exist for many health care providers.  What do you think ?? 

Addtional Resources:

http://www.endabuse.org/

October is National Domestic Violence Awareness month.  Here are some events from around the country listed from EndAbuse.org

Capitol Hill Event
The Sheila Wellstone Institute’s 18th Annual DVAM Reception & Art Exhibit on Capitol Hill will be in the Russell Senate Office Building rotunda the week of September 22, with a reception on September 25 from 5:30 to 8:00 pm. Sheila Wellstone organized the first annual commemoration when she and the late Senator Paul Wellstone arrived in Washington in 1990. She launched the exhibit as a way to speak for women who were victims of domestic violence who could not speak for themselves, because she believed that art is a powerful way to convey the impact that domestic violence has on women and families. The Sheila Wellstone Institute continues this event to raise awareness for domestic violence policy and to honor her legacy.

Break the Silence on Domestic Violence
The Body Shop and the National Coalition Against Domestic Violence (NCADV) are teaming up again this year during DVAM. The Body Shop is selling a new “For Me, For You” shea lip care duo packaged with the message “Break the Silence on Domestic Violence” that is meant to be shared with a friend.

New research from The Body Shop shows that as many as 64% of women claim they would choose to confide in a friend rather than family or police if suffering from intimate partner violence. The “For Me, For You” duo is an extension of The Body Shop’s “Stop Violence in the Home” Campaign. Approximately $9 from the sale of each lip duo will be donated to NCADV.

This week a 911 operator in  Nashville, Tennessee was been fired after he was recorded on a taped 911 call stating that he didn’t “give a s—” about what happened to a woman who had just called to report her ex-boyfriend was threatening her.

Frank Roth, the man who made the statement didnt actually utter those words to the woman who called in. According to Emergency Communications Center spokeswoman Amanda Sluss said, Roth was in training during the February incident and was fired a month later.

Roth made the comments after promising to the woman that police would arrive shortly to assist the woman who was reporting her ex-boyfriend held her at knifepoint and later was threatening her.

The statement was made after hanging up with her but while still being recorded, he said, “I really don’t give a s— what happens to you.”

It took the police nearly three hours to respond to the scene after the initial 911 call.

So why should you give a s—?

According to the American Institute on Domestic Violence, health-related costs of rape, physical assault, stalking, and homicide by intimate partners exceed $5.8 billion each year.

Intimate partner violence victims lose nearly 8.0 million days of paid work each year - the equivalent of more than 32,000 full-time jobs and nearly 5.6 million days of household productivity!

Indirectly we are all shouldering a much greater burder than many of us realize. As a result of domestic violence, you will pay greater cost in health care coverage, longer wait times in the Emergency room, police diversion to respond to these domestic assaults, other co-workers in the office need to work harder to pick up the slack when victims are hospitalized, or unable to attend work.

More Statistics on Domestic Violence from AIDV:

Your Corporate Peers

68% of senior executives surveyed agreed that their company’s financial performance would benefit from addressing the issue of domestic violence among its employees.

94% of corporate security directors rank domestic violence as a high security risk.

78% of Human Resource Directors identify domestic violence as a substantial employee problem.

56% of corporate leaders are personally aware of specific employees who are affected by domestic violence.

60% of senior executives said that domestic violence has a harmful effect on their company’s productivity.

The Human Factor

85-95% of all domestic violence victims are female.

Over 500,00 women are stalked by an intimate partner each year.

5.3 million women are abused each year.
1,232 women are killed each year by an intimate partner.
Domestic violence is the leading cause of injury to women.

Women are more likely to be attacked by someone they know rather than by a stranger.

Domestic Violence in the Workplace

Homicide is the leading cause of death for women in the workplace.

Of the approximately 1.7 million incidents of workplace violence that occur in the US every year, 18,700 are committed by an intimate partner: a current or former spouse, lover, partner, or boyfriend/girlfriend.

Of Battered Workers:

96% experience problems at work due to abuse

74% are harassed while at work by their abuser

56% are late to work

28% leave work early

54% miss entire days of work

Program: The purpose of this program is to develop and strengthen victim services in

Eligibility: Institutions of higher education as defined under the Higher Education

Application Guidelines/Submission: Visit the website for complete application

Program: The purpose of this solicitation is to support programs that provide assistance

Award: Applicants may apply for an amount equal to or less than a previous award that

Eligibility: States, units of local government, Indian tribes, and other organizations, that

Application Guidelines/Submission: Visit the website for complete application

RAINN, or the Rape Abuse & Incest National Network is one of the most nationally recognized names when it comes to rape and sexual assualt . They are the nations largest anti-sexual assault organization.

They are currently championing the “rape can happen any time” 24/7 campaign to help educate the public about the crime of rape.

 “Rapists don’t take off nights and weekends. Neither can we.”

National Sexual Assault Hotline
Among its programs, RAINN created and operates the National Sexual Assault Hotline at 1.800.656.HOPE. This nationwide partnership of more than 1,100 local rape treatment hotlines provides victims of sexual assault with free, confidential services around the clock. The hotline helped 137,039 sexual assault victims in 2005 and has helped more than one million since it began in 1994.