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 percent.
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. Rodríguez, 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," Rodríguez 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," Rodríguez said.
Women who opposed the mandatory reporting tended to be young (18-39 years old); non-white; non-English speakers at home and abused, Rodríguez 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," Rodríguez 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," Rodríguez. 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, Rodríguez 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 Control.