Domestic Violence, with a special focus on Human Trafficking

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Characteristicsof domesticviolenceE vi dence of Dome st ic<strong>Violence</strong> in F lori da’sMedical PracticesA woman who is abused suffersemotionally, psychologically, physically andfinancially, which can result in physicaland mental illness and injury. However,most women who are victims of domesticviolence continue to go unrecognized bythe medical profession.Up to 90 percent of battered women do not inform theirphysician of their problem and until recently, few physiciansroutinely asked patients direct questions about abuse in arelationship. This is inconsistent <strong>with</strong> the physician’sresponsibility to provide comprehensive care.Many physicians feel they do not have to be concerned becausethey believe that they do not see victims of domestic violence intheir practices. However, the prevalence of domestic violenceseen in a practice is determined by how many patients are seenand how often the physician asks about the problem. In fact,“the federal Agency for Healthcare Research and Quality(AHRQ) estimates that 2 percent to 4 percent of all womenseen in hospital emergency departments have acute traumaassociated <strong>with</strong> domestic violence and another 10 percent to 12percent of women have a recent history of domestic violence.” [22]The AHRQ further notes that even though most domesticviolence injuries are classified as “superficial,” they estimatethat 73,000 hospitalizations and 1,500 deaths among womenare attributed to domestic violence each year [22] In other words,the percentages of women who are there because of acute orimmediate trauma on account of domestic violence is relativelysmall; however, a much larger percentage of women seekingemergency care have recent histories of domestic violence butare not there because of an immediate domestic violence relatedinjury. For example, a domestic violence victim seekingemergency care due to a stroke is there for treatment of thatcondition, even though she is also a victim of domestic violencewhose health and ability to access care were directly related toabuse. This study also raises the question about whetherdomestic violence is being evaluated correctly as domesticviolence-related injuries are classified as “superficial” eventhough serious injury, and sometimes death, result.Characteristics of <strong>Domestic</strong> <strong>Violence</strong> VictimsVictims of domestic violence are found in every socioeconomiclevel of society and in all educational, racial, ethnic and agegroups. Every survivor is different and the patient you areseeing may not always exhibit these characteristics, althoughthese are the most common.Victims:• Are often fearful of their partners• Are often not allowed access to family, friends, or othersupport networks• Often experience reduced autonomy and/or when theyexercise autonomy, there are negative or abusiveconsequences• Often feel guilty or wonder if they are to blame for theirpartner’s violence• May experience problems sleeping, chronic pain, GIdisorders, nervousness, depression, or signs of Post-Traumatic Stress Disorder (PTSD)10 <strong>Domestic</strong> <strong>Violence</strong> in Florida: <strong>special</strong> <strong>focus</strong> on human trafficking www.fmaonline.org
• Are more likely to have more serious injuries (injuries tothe head, neck and torso)• Can often articulate what precipitated specific incidentsor the progression of violence, or• Others (family, friends, etc.) have expressed concern forthe patient’s safety [23]Characteristics of <strong>Domestic</strong> <strong>Violence</strong>PerpetratorsAbusers or perpetrators are also found in all socioeconomiclevels of society, in all educational, racial, ethnic and age groups.Abusers:• Often control access to money, property and other sharedcommodities• Are often notably jealous of friends, family, co-workers,and others• Are often scornful of their partner’s perspective• Can use various forms of status to claim authority,knowledge or power. (e.g., profession, citizenship, age,family background, education, etc.)• Often minimize or explain their behavior, make excuses,or become defensive• Are often vague about violent incidents• May have a documented prior use of violence• Often have offensive wounds (i.e. scratches or bite markswhen injuries are present), or• Use physical force against people or property. [24]Characteristics of Trafficked Persons“As I learned more about trafficking, I realized in retrospect,I saw folks who were trafficked (in my practice) and I didn’tknow to identify them as such. I saw situations <strong>with</strong> ‘mailorder brides’ and their husbands or overbearing employersthat refused to leave the exam room, answering questionsfor the patients. When I learned more about trafficking, itseemed clear that this is another source of adverse lifetimeexperiences that we (physicians) have an obligation to helpin the same way we help child abuse and domestic violencevictims.”David McCollum, MD, Chair of the American Medical Association’sNational Advisory Council on <strong>Violence</strong> and Abuse (March 2005) [25]It is more difficult to construct a similar set of descriptors forthe likely characteristics of a victim of human trafficking. It ismost common that trafficked persons are:• Vulnerable. Victims may have a host of vulnerabilitiesincluding age (either very young or very old), disabilities(developmental, physical, mental), or economic status (mostare desperately poor, in search of work to support theirfamilies).• Isolated by language and culture. Many traffickingvictims do not speak English and do not understandAmerican culture. Traffickers lure their victims into theUnited States <strong>with</strong> promises of good work but then forcethem into prostitution, menial service jobs, sweatshops orfarm work. Victims often have no friends and have noidea what city or country they are in because they aremoved frequently to escape detection.• Distrustful of government and law enforcement. Therisk of being deported leads victims to fear and distrustgovernment and the police e<strong>special</strong>ly when these systemsare corrupt in their country of origin. Also, rarely does thegovernment provide any help or assistance to those inneed. As a coping or survival skill, victims may evendevelop loyalties and positive feelings toward theirtrafficker – a kind of traumatic bonding – and protectthem from authorities.• Unable to see themselves as “victims.” Unlikehomeless people or drug addicts who rely on shelters andpublic assistance, abused individuals do not see themselvesas victims because they have a place to live, food to eat,medical care and what they think is a paying job.Like victims of domestic violence, confidentiality is paramountin human trafficking cases. Victims’ lives and those of theirfamilies are often at great risk if they try to escape theirservitude or aid in criminal investigations of their captors.Therefore, physicians should minimize the number of staffmembers who come in contact <strong>with</strong> the victim. Ensure that allstaff members who have contact <strong>with</strong> the victim, includinginterpreters and advocates, understand the importance ofconfidentiality for the safety of the patient. Physicians alsoshould ensure that interpreters do not know the victim or thetrafficker and do not otherwise have a conflict of interest. [26]Ot her Impor tan tLaws and ResourcesAddress Confidentialit yThe 1998 Florida Legislature passed an address confidentialitylaw. This created a program in the Florida Attorney General’sOffice to grant certain domestic violence victims a confidentialaddress so that they cannot be stalked through public records.The Attorney General’s office forwards all first class mail tothe victim at a new address, thus providing an extra layer ofprotection to victims of abuse.www.fmaonline.org<strong>Domestic</strong> <strong>Violence</strong> in Florida: <strong>special</strong> <strong>focus</strong> on human trafficking11
Page 3: Contents4CME Information and Instru
Page 9: Florida Law on Mandatory ReportingF
Page 14 and 15: The Dynamics ofDomestic</st
Page 16 and 17: Physician InvolvementDome st ic vio
Page 18 and 19: According to a recent article poste
Page 22 and 23: • The American College of Obstetr
Page 24 and 25: Appendix A24 Domestic</stro
Page 26 and 27: Appendix DAbuser’s PatternsAbuser
Page 29: Safety PlanWhat You Can Do Prior To

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