Domestic abuse a question for hospitals Pilot effort here finds hundreds of victims by asking at ER, OB entry


When women go to a hospital in Maryland, along with the routine queries about family history and medicinal allergies, they may soon hear another question: Have you ever been the victim of domestic abuse?

The question has been asked of all female patients as young as 14 in three state hospitals as part of a pilot project started in 1995. The hospitals say they have been able to identify hundreds of women who otherwise might have fallen through the cracks. Many have gotten help.

Maryland health officials hope to get it on the routine query list of all state hospitals.

"Sometimes just asking the question will elicit a response," said Joan Stine, director of the Office of Health Promotion, Education and Tobacco-Use Prevention at the Department of Health and Mental Hygiene. "Just the fact you asked it . . . you have opened an important door.

"It is our hope that other hospitals will do this," Stine said. Maryland hospitals can decide whether to put the procedure in place.

Such a question is part of an emerging trend in health care to fold identification and intervention for domestic violence victims into standard medical procedures.

"This is a very new area that we are starting to see -- domestic violence issues as a health issue," said Lisa James, senior program specialist for the California-based Family Violence Prevention Fund. "So many people don't want to contact the police for a variety of reasons but they come to their health care providers regularly."

Advocates say that though hospitals are often the front lines in the fight against domestic abuse, medical staff have missed cases because signs are often far less obvious than a black eye or other bruises. Chronic head pain and gastrointestinal problems can be a lasting sign of beatings or stress. Sexually transmitted diseases also are associated with domestic abuse.

The simple act of asking can elicit an honest answer, advocates say, because women feel more comfortable talking about abuse in a hospital, a setting that does not have the stress of a police station nor the stigma of a domestic violence shelter.

So far the Maryland hospitals in the pilot program have focused on emergency rooms and obstetrics patients, but are planning expanding the screening hospital-wide.

A soon-to-be published Johns Hopkins study concludes 38 percent of all female emergency room patients have been victims of physical or emotional domestic abuse in their lifetimes. Abuse victims will come back over and over again with repeat complaints, the study's author said.

"Ultimately we want to see women being more safe and women having fewer health problems so they don't have to return [to the hospital] so often," said Jacquelyn Campbell, a professor at Johns Hopkins School of Nursing.

What is not clear is how many hospitals here will start routinely asking the domestic abuse question. Advocates say some hospitals are resistant because the question can be uncomfortable to ask -- especially when there are no obvious signs of abuse. Over-taxed nurses already already ask incoming patients many questions.

But, said James of the Family Violence Prevention Fund, other hospitals staff "are hungry, really, for some way to better respond" to victims.

In California, hospitals and medical clinics are required by law to develop programs to identify domestic abuse and assist victims. The country's largest agency that accredits hospitals now includes domestic violence training and protocols for abuse identification as criteria to assess a hospital's performance.

In Maryland about five of the state's 52 hospitals are now routinely questioning all female patients about abuse. The most recent hospital to begin the procedure was Howard County General Hospital. The hospital began screening all females over 14 in the emergency room in April and will begin screening women in the obstetrics unit next week.

"It meets a community need and a health care need to identify these victims," said Judy E. Brown, director of nursing/nurse executive at Howard County General Hospital. "Hopefully it enhances our care."

Unlike mandatory reporting of suspected child abuse, medical staff are not required to report domestic abuse. Patients who answer affirmatively are referred to a hospital counselor and the information goes into their medical history. Patients can accept or decline the aid.

Those who decide to meet with the counselor are told about their legal rights and work with the counselor to assess how much danger they may be in. They can also develop plans to protect themselves -- such as signaling a neighbor to call police when a beating starts.

All victims are given information about programs.

The questions usually follow a preface about increasing violence in society so as not to offend or scare a patient. In Howard and other places, nurses ask:

"Are you afraid of or are you being threatened by a current or former partner?"

"Within the last year have you been hit, slapped, kicked, forced into sexual activity, or otherwise physically hurt by a current or former partner?"

The pilot-program hospitals in Maryland identified a large number of victims. At Anne Arundel Medical Center, 6 percent of all patients asked responded positively. About half those patients -- 467 in 1997 -- agreed to talk with the in-house counselor.

The Western Maryland Health System -- two Cumberland-based hospitals -- identified 402 victims in 1997.

At Baltimore's Sinai Hospital, 500 victims were identified last year. About 340 of the women at Sinai sought help from the in-house advocate who also runs a group counseling program for battered women once a week.

That counseling program -- which health officials say is a critical part of follow-up -- helped a 23-year-old Baltimore secretary who was identified as a victim when at the hospital.

The woman, who did not want her name used, said she was skeptical when Sinai's coordinator for the family violence program, Tammy Spengler, told her about the group. The woman had been in the hospital with a broken wrist after her ex-boyfriend attacked her. She didn't like the idea of women sitting around and talking about their problems. But she went.

And all the women there spoke a language she understood.

"If I wouldn't have gone to that group I probably would have gone back to him," the woman said.

Because nurses asked the domestic abuse question, counselors say they are now able to intervene before the women come back to the hospital again with far worse injuries.

Said Spengler: "We've had patients say, 'I wish you would have asked me three years ago.' "

Pub Date: 6/19/99

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