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/