By Pamela Miller, OD, FAAO, JD, FNAP
March 6, 2019
An OD spends much of the day in close range of patients–close to their faces, where injuries to both eyes and face can be apparent. There also is time spent conversing with patients about lifestyle needs and difficulties.
What happens when what you see, and hear, leads you to suspect domestic violence? Here is your legal responsibility, and ideas for how you can guide patients to get the help they need.
On average, nearly 20 people per minute are physically abused by an intimate partner in the U.S. During one year, this equates to more than 10 million women and men, according to statistics cited by the National Coalition Against Domestic Violence. And every year more than 3.6 million referrals are made to child protection agencies involving more than 6.6 million children (a referral can include multiple children), according to the advocacy group Childhelp.
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When You Legally MUST Report
Most states, if not all, have laws that mandate the reporting to local law enforcement or child and family protective services when a doctor suspects child or elder abuse. You can encourage an adult patient to seek help when you suspect abuse, and can help guide them in the right direction, but for an adult who is not elderly, you do not have a legal responsibility in most states to report the suspected abuse to the police or protective services.
You can contact your state optometric board, or state Chamber of Commerce, for directions on the proper protocol in your state for reporting domestic abuse. The report must be made immediately on the phone, and then followed-up a day or two later in writing, so both you and the local authorities have a record of your report.
The report should include the injuries you observed during your examination, along with comments made by the patient, and responses the patient gave you to questions about how they got the injuries.
In a small town, in which everyone knows everyone else, it may be safest for the patient if you make the report to a state, rather than local, welfare or protective services agency.
Visible injuries that may lead you to suspect abuse include black eyes, and other bruises to the face with no other plausible explanations, such as a recent car accident, along with conjuctival hemorrhages and retinal detachments. Those conditions can occur many times without domestic abuse, but if they occur along with other indications of domestic abuse, a red flag should be raised in your mind.
When You Should Counsel
There are times when you don’t notice signs of physical abuse, but an adult patient shares with you that they are being abused by a domestic partner. In those circumstances, you should be ready to e-mail, text, or hand to the patient, a list of local resources that can help them, such as local shelters for battered women.
Sometimes the patient won’t directly tell you they are experiencing physical, or emotional abuse, but will tell you in so many words, expressing fear about their home. For example, they become fearful and panicky in discussing the need to be home by a certain time, or make troublesome comments about fear of telling a partner about health or vision needs, as if they fear physical, or other damaging, repercussions for something as simple as buying a pair of glasses, or returning for follow-up care.
In those cases, you don’t have to push the patient to admit to you that they are experiencing abuse. You can simply let them know of shelters they can go to, and counseling they can receive, if they want to make a change in their living arrangement.
If the patient shares with you that they are experiencing abuse, you should then inquire if there are children in the house because, in that case, you would be legally required to report the abuse. You also can inquire whether there are animals in the house, as some people will stay in an abusive household because they fear leaving pets behind. You can educate the patient about local shelters that will allow them to take pets, or charities that will temporarily take a pet while an abused person figures out where they will live long-term.
There are web sites, like this one, domesticshelters.org, in which you can type in your zip code to be directed to local shelters for domestic abuse victims. In addition, there is the RedRover organization, which helps abuse victims find shelters where they can also take their pets. Your state, and local, child protective and family welfare agencies, and your town’s Chamber of Commerce, may also be able to be provide you with resources for patients experiencing domestic abuse.
Keep Yourself and Your Staff Safe
There are times when a person who has been abusing a patient may come after you if they suspect that you were the one who reported the abuse. For that reason, it’s best not to alert any of your support staff of the report you are making. File your report on the phone and in writing, and then, otherwise, keep the abuse to yourself.
In addition to enhancing safety by getting fewer people involved, keeping the information to yourself also protects the patient’s privacy. The more people in the office who know about the suspected abuse, the more chance that someone will mention something to another person. Especially in a small town, a seemingly innocent comment could get back to the abuser and further endanger both you and the person experiencing the abuse.
If the suspected abuser contacts you, or any of your staff members, alert the police. If the threat is significant enough, protection may be arranged outside your office.
Importantly, don’t ask the patient which shelter, or whose home, they are going to. It’s safer for you not to have that information, so an abuser has less reason to contact you.
It also is sometimes necessary to take your own precautions after reporting physical violence, such as having a staff member, or another person, leave the office with you at night, so you are not isolated in a parking lot, or parking garage, walking to your car. If a person has been physically violent to a family member, it is reasonable to suspect that they are capable of being violent to others.
Pamela Miller, OD, FAAO, JD, FNAP, has a solo optometric practice in Highland, Calif. She has a law degree, holds a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: email@example.com.