National and State Responses to Domestic Violence Challenge

After a significant delay, the U.S. Congress passed the Victims of Trafficking and Violence Prevention Act of 2000 (H.R. 3244) last October. The act was to provide support and services to domestic violence victims. Most states have yet to adopt laws to improve the health care response to domestic violence, according to a study by the Family Violence Prevention Fund (FVPF).

Built on the Violence Against Women Act of 1994, H.R. 3244 helps courts improve interstate enforcement of protection orders and train judges on violence against women, in addition to funding shelter services and the National Domestic Violence Hotline. The law also authorizes a civil legal assistance program for victims of domestic violence, sexual assault and stalking, and it directs some financial resources toward underserved populations, such as older women and women with disabilities. The law requires the U.S. attorney general to develop a recommended national standard for training licensed health care professionals who perform sexual assault forensic examinations. It also asks the attorney general to recommend sexual assault forensic examination training for all health care students to help improve the recognition of injuries suggestive of rape and sexual assault and expand the baseline knowledge of appropriate referrals in victim treatment and evidence collection.

Meanwhile, legislation at the state level has proved disappointing. The FVPF assessed each state's progress in passing laws that help physicians and nurses aid victims of domestic violence and that prevent insurance discrimination against abused women. The State-by-State Report Card on Health Care Laws and Domestic Violence (available online at <www.fvpf.org>) evaluated state laws in five categories:

Training on domestic violence. Helps health care professionals treat domestic violence victims effectively and get them the help they need (11 states have enacted laws addressing this issue).

Screening. Helps health care providers ask all patients about family violence (four states).

Protocols. Requires health care systems to develop written policies on screening for family violence, recording patient injuries, making referrals to community agencies and related issues (nine states).

Reporting. Requires health care professionals to report an incident of domestic violence to law enforcement only where there is life-threatening injury and/or gunshot wounds (13 states).

Insurance. Forbids insurers from discriminating because someone is a victim of domestic violence (19 states).

Health care and domestic violence experts used the existence or absence of such laws as a basis for giving states zero to two points for each of the five categories. The number of cumulative points determined the grade the state received. Most states received grades of "C" or "D." Pennsylvania was the only state to receive an "A"; California, Maryland, New Hampshire, New York and Washington received "B"s; and Colorado failed.

"Every day that a doctor fails to screen a battered patient for domestic violence or a nurse fails to record information that can help a victim win a restraining order is another potentially life-saving opportunity lost," said FVPF executive director Esta Solar in a news release. "Every state lawmaker should make it a priority to pass laws that will help battered women and their children."

(For more information on domestic violence, please see "Physician Training Improves Domestic Violence Outcomes" in this issue and the PT Online Exclusive article, "Where Can Your Patients Turn for Help?"-Ed.)