A woman came into an emergency room in a large metropolitan hospital complaining of a sore throat. She was treated and released. She was not screened for domestic violence. It didn't occur to anyone to screen someone with such an obscure complaint. Several months later she was killed by her partner in a domestic violence-related homicide. Could screening for domestic violence have prevented her death?
Bartlett Regional Hospital has instituted a program to make staff aware of domestic violence issues and to open the lines of communication about a topic that few wish to discuss. In fact, 95 percent of women who are physically abused have not discussed this issue with their physicians. Not only the victims, but the whole community suffers when we can't provide safe options for our members.
Domestic violence is a health care problem of epidemic proportions in Alaska and throughout the United States. National estimates range from 960,000 incidents of violence against a current or former spouse or partner to 3.9 million women who are physically abused per year. While violence between intimates can include women abusing men or abuse in same sex relationships, in 95 percent of cases, a male abuses his female partner. Domestic violence includes more than physical violence. It is isolation and emotional attacks, sexual and psychological attacks as well as economic coercion that adults use against their intimate partners. Victims often do not have the financial or psychological resources to leave a violent home. Coupled with the fact that there is often deep emotional bonds between the victim and abuser and the cyclical nature of abuse, many women find leaving extremely difficult and unsafe. In fact, most women who are killed by their partners are killed when they leave the relationship. Maybe by giving women living with violence support and resources, they can find the strength to create a safe home for themselves and their children.
The U.S. Department of Justice reports that 37 percent of all women who sought care in hospital emergency rooms for violence related-injuries were injured by a current or former partner. These injuries are sever and repetitive. One in five women victims reported they had been assaulted at least three times in the prior six months. Injuries can require hospitalization and major medical, long-term treatment. While having severe physical injuries focuses care on the issue of domestic violence, many women come into ERs complaining of a variety of other symptoms. These can be stress-related complaints including but not limited to headaches, anxiety, chronic bronchitis and chronic abdominal pain. With a complete workup and treatment given for the initial complaint, screening must be done to see if the woman is safe at home. A recent study that followed up on women seen in the ER for various complaints found that 20 percent later returned with domestic violence-related injuries. It is well known that living in a violent household is a chronic stressor that can have the same long-term effects as living in a concentration camp or being tortured over a long period of time. It is no surprise that stress symptoms show up in women living with violence. Mental health problems also commonly are seen in these women. These include depression, substance abuse, post traumatic stress disorder and suicide attempts.
By screening all women who are seen in the hospital, it can be possible to present those at risk with information and options before they are seen with serious or deadly injuries. Bartlett Regional Hospital has therefore instituted a policy of screening women over the age of 16 for domestic violence. The screening is simply asking the woman if she feels safe at home. If she answers that she is not safe, community resources are made available to her to obtain help and develop a safety plan. It is up to the woman to choose to use these resources. If you are asked about domestic violence on your visit to the hospital, don't be surprised. We want to send the message that ALL women deserve to be safe in their own homes and that as health care providers, we care about domestic violence.
Theresa Thibodeau is a registered nurse and member of the Bartlett Regional Hospital Task Force on Domestic Violence.