UCSF studies abused women and state mandatory reporting law

By Twink Stern

A UCSF study of mandatory reporting of domestic violence to the police examined
the attitudes of female emergency department patients and found that nearly
half (44.3 percent) of abused women in the study do not support this state

The UCSF study, published in the August 1 issue of the Journal of the American
Medical Association (JAMA), examines patient attitudes toward mandatory
reporting of domestic violence injuries to the police, and how these attitudes
may differ by abuse status and other socioeconomic and demographic factors. 
The study is one of the first to examine this issue among large patient
populations in two states.

The UCSF study included 1219 women patients who visited 12 emergency
departments in California and Pennsylvania.  Female nurses collected data from
eligible women patients after informing them that the questionnaire was
anonymous and voluntary, had no impact on the care they would receive, and
would not be seen by the clinicians treating the patients.  Among abused
respondents, 44.3 percent opposed mandatory reporting of domestic violence to
police, while 36.4 percent supported reporting but only with patient consent.
Among nonabused respondents, those opposed to reporting dropped to 19.3

Currently, most states require clinicians to report injuries due to criminal
acts or deadly weapons. Recently, states have expanded these laws by passing
measures that require health care professionals to specifically report intimate
partner violence (IPV) to the police.  Since 1994, California has required
clinicians to report suspected IPV to the police, even if contrary to a patient’
s wishes.  Non-complying clinicians face penalties of up to $1,000 in fines and
/or jail sentences up to six months.

Patients, clinicians and domestic violence prevention advocates are deeply
divided on this issue, according to lead author of the study Michael A.
Rodriguez, MD, MPH, UCSF professor in the Department of Family and Community
Medicine.  Supporters of mandatory reporting of IPV argue that these laws will
facilitate the prosecution of batterers, encourage health care clinicians to
identify domestic violence and improve data collection. Opponents contend that
this legislation may increase violence by the perpetrators, diminish patient
autonomy and compromise patient-clinician confidentiality.

“Patients frequently look to police for help during acute episodes of violence
but clinician reporting may raise fears of increased violence, loss of control
and family separation.  These effects may lead some abused patients to avoid
seeking help from health care clinicians,” Rodriguez said.

“A significant number of women opposed the law because of the potential dangers
that it reflects.  If we do anything, we need to weigh in on the side of
patient safety before any intervention that might threaten the patient,”
Rodriguez said.
Women who opposed the mandatory reporting tended to be young (18-39 years
old); non-white; non-English speakers at home and abused, Rodriguez explained. 
With 41.7 percent of the abused women primarily non-English speakers, this
finding is consistent with a previous study that explored sociopolitical
factors that hinder abused immigrant women from seeking help.  Some of these
factors include social isolation, language barriers and fear of deportation.
“Because the impact of police involvement in immigrant women’s lives may be
different than for US-born women, changes in welfare and immigration laws may
interact with the reporting policy, resulting in further disempowerment of the
female patient,” Rodriguez explained. 

One clinical alternative is to encourage the assessment of danger and yet leave
the final decision about calling the police with the patient. Results of the
study revealed that a majority of the same patients do support reporting that
has the consent of the patient.  “Further research with abused women is needed
to distinguish their preference among several options,” Rodriguez. said. 

Options suggested include:

* a law requiring reporting unless the patient objects;

* reporting law requiring patient consent; or

* no reporting laws, but physician responsiveness to IPV and assistance with
criminal justice interventions when desired.

The UCSF study suggests that policy makers consider development of IPV
reporting policy options that combine respect for patient autonomy with the
greatest potential for protection from abuse, Rodriguez said.

Co-authors of the study include Elizabeth McLoughlin, ScD, and Gregory Nah, MS,
at the San Francisco Trauma Foundation; and Jacquelyn C. Campbell, PhD, RN,
FAAN, from The Johns Hopkins University School of Nursing.

Funding for the study was provided by the American Academy of Family Physicians
Advanced Research Training Program; the San Francisco Centers for Disease
Control Injury Center, Picker-Commonwealth Scholars Program; and the Centers
for Disease Control and Prevention, National Center for Injury Prevention and