Domestic Violence, with a special focus on Human Trafficking

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the experiences of males who are abused and/or raped. They,along <strong>with</strong> the elderly and children, are included in the generic“she.” Although violence can occur from either partner, themotives of males and females generally are different. Most maleabusers batter their partners as a means of power and control;women who are violent are most often reacting in self-defense [6]or retaliation. <strong>Domestic</strong> violence is also seen in gay and lesbianrelationships.According to the U.S. government, between 14,500 and 17,500people are trafficked into the U.S. annually, <strong>with</strong> over 27 millionpeople enslaved as human trafficking victims around the worldat any given moment. [7] U.S. citizens as well as those who areforeign born are trafficked in the U.S. As human trafficking isa clandestine operation, it is impossible to know the full extentof human trafficking in the U.S. or in Florida. However, manyhave said that Florida is third in the nation as a “destinationstate” for human trafficking victims. [8] About 80 percent ofhuman trafficking victims are women and children;approximately 20 percent are adult males.Approximately 1/3 of injured female rape and physical assaultvictims receive medical treatment: 35.6 percent of the womeninjured during their most recent rape and 30.2 percent of thewomen injured during their most recent physical assault receivedmedical treatment. [9] Most experts agree that statistics aboutdomestic violence and human trafficking in our society are vastlyunderstated.• In 2008, the Florida Department of Law Enforcementreported a total of 113,123 incidents of domestic violence. [16]• In addition to injuries sustained during violent episodes,physical and psychological abuse are linked to other adversephysical consequences including arthritis, chronic neck orback pain, migraine or other frequent headaches,stammering, problems seeing, sexually transmittedinfections, chronic stomach pain and ulcers. [17]• Children who witness domestic violence are more likely toshow behavioral and physical health problems such asanxiety, depression and violence toward peers. They also aremore likely to attempt suicide, abuse drugs and alcohol, runaway from home, engage in teenage prostitution and commitsexual assault crimes. [18]• <strong>Domestic</strong> violence is the leading cause of injury towomen, causing more injuries than muggings, strangerrapes, and car accidents combined.Victims of <strong>Domestic</strong> <strong>Violence</strong> in FloridaYear Total Number of Victims Total Number ofDeaths2008 113,123 1942007 115,150 2142006 115,170 1832005 120,386 1932004 119,772 198<strong>Domestic</strong> violence is one of the largest epidemics the UnitedStates has ever faced.• Nearly one-third of American women (31 percent) reportbeing physically or sexually abused by a husband or boyfriendat some point in their lives. [10]• Seventeen percent of adult pregnant women are battered.Women experiencing abuse in the year prior to and/or duringa recent pregnancy are 40 to 60 percent more likely than nonabusedwomen to have high-blood pressure, vaginal bleeding,severe nausea, kidney or urinary tract infections andhospitalization during pregnancy and are 37 percent morelikely to deliver preterm. [11]• Children born to abused mothers are 17 percent more likelyto be born underweight and more than 30 percent more likelythan other children to require intensive care upon birth. [12]• Leaving the abuser (or taking any act of separation such asobtaining an injunction for protection from the court)significantly increases the danger of being seriously harmed orkilled by the abuser. [13]• 21.7 percent of pregnant teens experience abuse as opposedto 15.9 percent of pregnant adults. [14]• In Florida, there is at least one death at the hands of afamily member every 48 hours. [15]SOURCE: Florida Statistical Analysis Center: FDLE. Crime in Florida, Florida uniformcrime reports, 1992-2008. Tallahassee, FL. http://www.fdle.state.fl.us/Content/getdoc/a324add7-5dd6-4201-9696-93bfd76bc36c/UCR-Home.aspxPrimary Offense 2007 2008 PercentchangeMurder 189 180 -4.8Manslaughter 25 14 -44.0Forcible Rape 979 931 -4.9Forcible Sodomy 353 290 -17.8Forcible fondling 919 744 -19.0Aggravated Assault 19,629 20,462 4.2Aggravated Stalking 234 193 -17.5Simple Assault 89,381 87,303 -2.3Threat/Intimidation 3,041 2,655 -12.7Simple Stalking 400 351 -12.3Total 115,150 113,123 -1.8SOURCE: Florida Statistical Analysis Center: FDLE. Crime in Florida, Florida uniformcrime reports, 1992-2008. Tallahassee, FL. http://www.fdle.state.fl.us/Content/getdoc/4f6a6cd0-6479-4f4f-a5a4-cd260e4119d8/CIF_Annual08.aspx8 <strong>Domestic</strong> <strong>Violence</strong> in Florida: <strong>special</strong> <strong>focus</strong> on human trafficking www.fmaonline.org
Florida Law on Mandatory ReportingFlorida law does not require the specific reporting of “domesticviolence” or “human trafficking.” However, Chapter 790.24,Florida Statutes, requires that a physician who is “knowinglytreating any person suffering from a gunshot wound or lifethreateninginjury indicating an act of violence, or receiving arequest for such treatment, shall report the same immediatelyto the sheriff’s department of the county in which saidtreatment is administered or request therefore received.” Thephysician must have had actual knowledge of the violence asopposed to mere suspicion. This means that if a domesticviolence or human trafficking victim has a gunshot or lifethreatening injury as described, physicians must report thatinjury, just as they would for any other person suffering thesame injury. Should the physician knowingly treat such awound, he or she is obligated to report this fact to the sheriff’sdepartment.One of the important things to remember is that it is critical fora physician to screen for and identify domestic violence. If aphysician does not feel comfortable responding in detail to apatient who discloses domestic violence, a staff person shouldbe trained to work <strong>with</strong> that patient, to support her, and toprovide her <strong>with</strong> information about the local domestic violencecenter, where counseling and other services are available.One case was successfully settled by a domesticviolence survivor/plaintiff who sued the hospital aftera physician and the hospital failed to properly screenthe domestic violence victim and, among other things,notice evidence of repeated physical abuse. She alsoalleged that they failed to assess the abusive behaviorof her boyfriend while at the hospital which wouldhave allowed them to see that she was in imminentrisk of danger. After the hospital discharged her, theboyfriend doused her <strong>with</strong> gasoline and set her onfire. She suffered severe injuries, and lived. In short,she alleged that the hospital neither met numeroussafety standards nor did it comply <strong>with</strong> appropriatedomestic violence hospital protocols. [19] Also, in a2009 case, the court determined that a suit couldproceed against a hospital for discharging a husbandwho killed his wife soon after being discharged. Thehospital had potential liability for failing to screen orstabilize the husband in violation of the EmergencyMedical Treatment and Active Labor Act. [20]Even though these cases were not in Florida,physicians must be aware of potential legal problemsassociated <strong>with</strong> the failure to comply <strong>with</strong> a legalobligation to report domestic violence.Regarding the reporting for child, elder or vulnerable personabuse, Chapter 415, Florida Statutes, states that any physician“who knows or has reasonable cause to suspect” that a child orelderly person is abused must report this fact to the Departmentof Children and Families. (The number for reporting is 800-96-ABUSE.) An elderly person is defined as anyone aged 60 orolder. The physician’s name will not be given to the accusedbut may only be used by the Department of Children andFamilies and the State Attorney as they investigate theallegations of abuse. Again, it is possible that a domesticviolence or human trafficking victim will be reported in thesecases, too. For instance, many victims of human trafficking areminors and if a physician suspects that a child under his/hercare is being trafficked, he/she must call that abuse into theHotline.Some states have passed laws that require a physician to reportdomestic violence when he or she becomes aware of it in arelationship. However, mandatory reporting of suspected orconfirmed abuse is strongly opposed by many and can haveunintended consequences, including the following:1. Deterring a woman from confiding in her physician orfrom seeking care.2. Inhibiting providers from screening patients for abuse.3. Impairing a woman’s ability to plan and negotiate a safeexit for herself and her children. [21]4. Threatening the essential tenet of a physician-patientrelationship - confidentiality.For contact information about <strong>Domestic</strong> violence resources in your area, go to www.fmaonline.org/domestic_violence_info.aspxwww.fmaonline.org<strong>Domestic</strong> <strong>Violence</strong> in Florida: <strong>special</strong> <strong>focus</strong> on human trafficking9
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Page 16 and 17: Physician InvolvementDome st ic vio
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Page 26 and 27: Appendix DAbuser’s PatternsAbuser
Page 29: Safety PlanWhat You Can Do Prior To

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