Documentation Documenting injuries may be critical to later efforts to obtain relief through the legal system. Evidence establishing a pattern of violence can play an important role in civil protection order proceedings, criminal prosecutions, and child custody disputes. Evidence can consist of notes in the patient's medical file, sketches or drawings, and photos.
Consistent documentation of injuries and health problems related to domestic violence can also have considerable health benefits for the patient. Documentation allows the health care provider to take into account the health effects of abuse over time, and can help ensure that patients receive continuous care even if they later see a different doctor. Finally, documentation can be used to establish the prevalence and scope of the problem, which can then be used to apply for grants to help address the specific needs of battered women.
Adapted from William J. Rudman, Coding and Documentation of Domestic Violence (2000). The United States Department of Justice's National Institute of Justice offers specific advice on documenting domestic violence in PDF and text formats.
Mandatory Reporting Both in the United States and in certain CEE/FSU countries, health care workers may be subject to mandatory reporting laws. Although these laws vary substantially, they often require reporting of injuries that are caused by weapons, reporting of injuries that are the result of a crime (such as domestic assault), or reporting specifically on domestic violence. From Domestic Violence Victimization: National Consensus Guidelines, Family Violence Prevention Fund 33 (September 2002).
Advocates of mandatory reporting legislation maintain that such laws improve data collection on domestic violence, enhance the care provided to victims, and assist the legal community in holding batterers accountable. They argue that health care professionals are not sufficiently trained to provide patients with the information and support they need, and that it is therefore better to connect patients with specialized services. Mandatory reporting laws also relieve the victim of the burden of filing a report with the police.
Opponents of mandatory reporting legislation argue that these laws place women in danger of retaliation, and that women who fear retaliatory violence against themselves or their children, or who for any other reason do not want to report the violence, may forego necessary medical care. Concealing the cause of the injuries may also impede proper treatment. Advocates in Moldova, for example, expressed concern that because doctors are required to report all cases of domestic violence to the police, women who do not want the police to intervene may conceal the real cause of their injuries. From MAHR, Domestic Violence in Moldova 14 (2000). In Azerbaijan, doctors must inform police of reports of rape or face criminal proceedings. From International Helsinki Federation for Human Rights, Women 2000: An Investigation into the Status of Women's Rights in Central and South-Eastern Europe and the Newly Independent States 59 (2000).
Batterers may also prevent women from seeking medical care, knowing that the doctor would be required to report suspicions of abuse. Victims may have been told by their abusers that they would lose custody of their children if the abuse is reported. Opponents also maintain that mandatory reporting laws undermine patient autonomy by denying women the ability to make their own decisions about the safest and most appropriate courses of action.
Many also argue that these laws conflict with patient privacy rights. For example, doctors in Armenia strongly expressed the belief that when women conceal the cause of their injuries, the doctors have no right to investigate further. From MAHR, Domestic Violence in Armenia 19 (2000). Medical privacy policies must be addressed in the health care system's response to domestic violence because they affect a patient's willingness to disclose information about abuse to a provider.
Adapted from Sherry Currens, "Kentucky Coalition's Concerns About Mandatory Reporting," Violence Against Women 24-2 (Joan Zorza ed., 2002); Travis A. Fritsch & Kathy W. Frederich, "Mandatory Reporting of Domestic Violence and Coordination with Child Protective Services," Violence Against Women 24-4 (Joan Zorza ed., 2002); Janet Nudelman & Helen Rodriguez Trias, Building Bridges Between Domestic Violence Advocates and Health Care Providers (1999).