2012-03-28 08:00:00

Domestic Violence? Don’t Call the Sheriff—Look to Health Reform

SAN FRANCISCO -- The text message that the wife of San Francisco’s newly elected Sheriff Ross Mirkarimi sent her neighbor and confidante, Ivory Madison, clearly shows how a doctor’s examination room is often perceived as a safe haven, a sanctuary, to a victim of domestic violence.

“Hello Ivory,” said the message from Eliana Lopez, which San Francisco Assistant District Attorney Elizabeth Aguilar-Tarchi read out in court, while seeking a restraining order against Mirkarimi. “I’m not going to call the police. I’m going to open a record with my doctor.”

When emotional and physical trauma eats away at the souls of domestic-violence victims, they often do not know where to turn. It’s not uncommon for recent immigrants such as Lopez, who have not yet built up a social network around them, to turn to a female neighbor for sympathy.

Law Offers Health Approach to Abuse

A provision in the Affordable Care Act (ACA), the health care reform law before the Supreme Court this week, could help establish a public-health approach to family abuse, rather than one based strictly on law enforcement.

“For some women,” observed Lisa James, director of health at Futures Without Violence, a national nonprofit working to end violence against women and children, “going to the police is not the right choice at the moment.”

This is especially true for immigrant women, many of whom come from countries where law enforcement officials are not necessarily viewed as their protectors. Lopez, especially, could not be blamed if she had little faith in the police, given that her husband was the sheriff himself.

A couple of decades ago, the Pennsylvania Coalition Against Domestic Violence (PCADV) figured that domestic-violence victims are more likely to open up to their doctors in the confines of a medical setting.

That led to the launch of its domestic-violence screening program through its Medical Advocacy Project. The project trains medical staff on how to screen, counsel and refer victims to domestic-violence programs.

ACA to Cover Screening and Counseling

Starting this August, women nationwide will benefit from the preventive services provision in ACA that will do just that -- provided, of course, that the Supreme Court justices don’t upend the law.

ACA requires that all insurance plans provide free preventive services with no copayments, which means it will also have to cover screening and counseling for domestic abuse.

Health care providers will be able to screen women and help identify unsafe situations. They will be able to provide women with tools and resources for escaping dangerous relationships.

“Catching domestic violence early can save a woman’s life and those of other family members, as well,” noted Dania Talanker, senior health policy advisor with the National Women’s Law Center, in Washington, D.C.

Advocates for preventing domestic violence say that when a victim at a high risk of being reassaulted or killed receives intervention services, her risk declines by 60 to 70 percent.

Because the head and face are among the most common targets of intimate-partner assaults, victims of domestic violence should be provided early intervention to curtail the incidence of traumatic brain injury, as well as suicide. Research has shown that 90 percent of all injuries related to domestic abuse involve the head, neck and face.

Domestic Violence No Longer A “Pre-Existing Condition”

The other provision in the ACA that women’s rights advocates are lauding prohibits insurance companies from viewing pregnancy or domestic violence as a “pre-existing condition.” That’s something insurers have done for years.

Insurance companies defined domestic violence as a pre-existing condition on the grounds that victims tended to use emergency room services more frequently. Thus, argue insurers, these victims are at “high risk”-- and more expensive to insure.

Under ACA, an insurance firm can no longer discriminate against — and re-victimize — a domestic violence survivor by denying health insurance coverage.

Nicole Lindemyer of the Pennsylvania coalition called these provisions in ACA a “victory for women.”

“It’s a paradigm shift from seeing domestic violence as simply a criminal justice issue and now recognizing it for what it is: a public health issue.”

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