Domestic violence has reached epidemic proportions in this country, and yet it remains one of the least reported and most misunderstood health issues facing our society today. If fully recognized and treated like other illnesses, domestic violence would likely be as common, if not more so, than breast cancer, and far more prevalent than hypertension, colon cancer, hepatitis and many other medical conditions which healthcare providers routinely screen and treat. (1)

According to a study by the Bureau of Justice Statistics, released in May 2000, as many as 850,000 women each year are victims of violent crimes committed by an intimate partner. Clearly, domestic violence has an enormous health impact on the victims and their families, as well as the entire healthcare system. It is estimated that direct medical expenses for the care of battered women is around $1.8 billion per year(2) a cost hospital administrators must manage. Fortunately, great strides are being made to expose and treat this epidemic.

Healthcare Providers Lead The Fight

In the medical arena, the challenges of fighting domestic violence are significant. Especially since many healthcare providers have not been trained to identify and respond to victims of domestic violence. In response, charitable, non-profit organizations such as Physicians for a Violence-free Society (PVS) have formed to help stop the cycle of violence by promoting leadership and advocacy in violence prevention in the healthcare community.

PVS acknowledges that it takes training, courage, time and sensitivity to recognize, inquire and properly document the results of a domestic violence situation. And, armed with the proper skills presented in the PVS Assessment Response Course: Systems Approach to Partner Violence Across the Life Span, a Polaroid Spectra Close-up Instant Camera Kit and film, and the desire to make a difference, many health and law professionals nationwide are embracing a simple philosophy -- ask the question, take the picture and break the cycle.

Breaking The Cycle

To effectively break the cycle of domestic violence, healthcare providers must acquire an understanding of its repetitive and escalating nature. What starts as a push or shove today, becomes a kick or a head-blow tomorrow. The injuries worsen as the cycle continues.

The more quickly police, hospital staff, employers and other service providers intervene in a domestic violence situation, the sooner the victim will realize that they need not be victimized. This realization is a critical link in breaking the cycle.

Good Documentation Is Key

Through collaborative efforts between law enforcement, healthcare providers, and other community-based programs, many metropolitan areas across the country are taking a stand against domestic violence. One of the more effective weapons in this fight is the Polaroid Spectra Close-up Camera Kit that police and medical personnel typically use for documenting injuries. Toward this end, Sergeant Andrea Perez, who heads up the Family Violence Unit for the Dallas Police Department, turned to the Violence Intervention Prevention (VIP) Center of Parkland Hospital to train police officers from major precincts to document domestic violence. Utilizing the PVS Assessment Response Course and Polaroid Spectra cameras, instructors from the Polaroid company and the VIP Center trained police officers to document domestic violence injuries in the field and in follow-up visits.

The use of instant photography for evidence documentation in domestic violence cases can be extremely effective in helping with prosecutorial efforts to obtain guilty pleas. Through photographic documentation, victims feel more empowered to support the prosecution; abusers are often more likely to plead guilty, or in those cases where they contest the charges, the pictures significantly enhance evidence to support the prosecution.

By the time the trial takes place, the victim's injuries have healed, and the bruises have faded. Presenting photos of the injuries can preserve the extent of those injuries, dramatizing them for both judge and jury.

While various types of photo and video documentation exist, many healthcare providers rely on the Polaroid instant camera and film because of its ease-of-use, close-up capability and the ability to obtain solid, tamper-proof evidence, available for review instantly. Capturing a good, clear picture of the injuries, on the spot, is critically important. Digital cameras also offer instant results, but present a more complicated issue when it comes to the important chain of evidence issue stipulated by the legal system. Because digital images can be manipulated through computer programs, it becomes necessary to painstakingly maintain the chain of evidence to assure that no modifications that have been made to the digital images before presenting them to the district attorney.

The Cost of Caring

Healthcare costs in this country continue to skyrocket. National health expenditures in 2002 are expected to reach $1.5 trillion.(3) And, the sheer magnitude of the domestic violence problem makes it one of the mostly costly to our healthcare system.

The multibillion-dollar burden domestic violence places on taxpayers and the medical community is only the beginning when one considers the following: 22 to 35 percent of women visiting emergency departments in the U.S. are there for symptoms related to ongoing abuse.(4) In addition, families in which domestic violence occurs use doctors eight times more often, seek emergency room treatment six times more often, and use six times more prescription drugs than the general population. (5)

Hospital administrators are quickly becoming aware of the tremendous value that intervention efforts can yield. Time spent identifying domestic violence victims may actually result in time and cost savings, since many of these patients will continually return to the medical setting with abuse related symptoms throughout their lifetime - unless the cycle can be broken.

Administrators, while caught in a balancing act with precious healthcare resources, have started to see the importance of screening for family violence, just as they do for alcohol abuse, drug abuse and mental illnesses. Through early detection it is possible to reduce the impact on healthcare budgets.

Programs that utilize instant photography and written documentation have been effective in reducing hospital cost by helping victims take a legal stand against their abusers, thus breaking the cycle of violence before additional injury can be inflicted. In addition, detailed documentation can help decrease expenditures by eliminating the need for medical personnel to appear in court - a huge benefit for practitioners, nurses and other hospital personnel. Proper documentation can also be beneficial in protecting healthcare providers from possible liability for failure to screen and provide safety assessment and referrals of victims.

A Matter Of Conscience

Domestic violence is not simply a personal matter, nor is it just a law enforcement or criminal justice concern. Because it profoundly affects patients' health, as well as their children's health, healthcare professionals need to identify, document, treat, and refer victims of domestic abuse.

Fitting with the social mission of healthcare organizations, the ultimate goal of providers should be to empower the victim with knowledge and resources so she can make her own decisions and take the necessary steps to break free from the violence in her life.

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(1) Sassetti MR: Domestic violence. Primary Care 1993; 20

(2):289-305 Wisner, et at, Journal of Family Practice, 1999; 48(6):439-43

(3) Heffler et al, Health Affairs, 2002

(4) Colorado Domestic Violence Commission: Domestic Violence for Healthcare Providers, 3rd Edition, 1991

(5) Domestic Violence Intervention Calls for More than Treating Injuries, Journal of the American Medical Association, 1990