FAQ - Answers and Resources

"Abuse" means intentionally or recklessly causing or attempting to cause bodily injury, or placing another person in reasonable apprehension of imminent serious bodily injury to himself or herself, or another.

Defining DV victims:

• Currently or formerly married
• Current or former Intimate Relationship
• Current or former Dating Relationship
• Child in common
• Co-habitant
• Relative

Citation: (California Penal Code 13700b) "Domestic violence" means abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship. For purposes of this subdivision, "cohabitant" means two unrelated adult persons living together for a substantial period of time, resulting in some permanency of relationship. Factors that may determine whether persons are cohabiting include, but are not limited to, (1) sexual relations between the parties while sharing the same living quarters, (2) sharing of income or expenses, (3) joint use or ownership of property, (4) whether the parties hold themselves out as husband and wife, (5) the continuity of the relationship, and (6) the length of the relationship.

Mandatory Reporters:

• Physician, surgeon, resident, intern, podiatrist, chiropractor
• Mid-level practitioner, Nurse practitioner/Physician Assistant
• Nurse
• Paramedic/EMT
• Dentist, dental hygienist, optometrist
• Medical examiners
• Public Health worker that treats STD or other minor illnesses

Exempt from Mandatory Reporting:

• Psychiatrists
• Psychologists
• MFCC
• LCSW

Any Health care provider working in their professional capacity, who treats a patient for a physical condition that is known or suspected to be a result of assaultive or abusive conduct must make a report to local law enforcement as follows

1. Immediate report by phone to the law enforcement agency where the crime occurred
2. A written report (for which this form is compliant and meets criteria set out PC Sec 11160.2) wit in 72 hours. Even if the patient has expired.
3. The include the following
   1. Name of the injured person
   2. The injured person’s whereabouts
   3. The character and extent of the person’s injuries
   4. The reported name and whereabouts of the assailant
4. If multiple health care providers are involved in the care of the patient, they can agree on one team member making the report.

LIABILITY

Immunity form Civil and criminal liability is provided health care practitioners who make required or authorized reports pursuant to these provisions (PC 11160).

PENALTY

Failure of a health care practitioner to comply with these reporting requirements is a misdemeanor.

Sensitivity and Awareness

Reassure the patient s/he is not alone and does not deserve to be treated this way. Be careful not to imply patient blame.

Be aware of the following:

• patients may be afraid of seeking care because they do not want police involvement.
• Some patients may fear reporting for other reasons (i.e immigration status, child custody)
• There may be potential barriers to leaving abusive situation i.e., threats from the batterer, fear of financial instability, failure of the police to effectively intervene, hope that the relationship can work out).

Patient Safety

The patient’s safety should be the primary focus. If the batter finds out that the patient revealed abuse, the patient may be in greater danger. (Note: separation is the most dangerous time for victims) Address directly the risk of retaliation by the batterer and discuss hoe the patient might protect her/himself from further abuse. Indicate on the reporting form any special concerns regarding how the report should be handled to maximize patient safety.

Open Communication

Discuss with patient your legal obligation to report which does not obligate the patient to talk to the police. Explain the sequence of events and potential consequences of reporting.

Documentation in the medical record

Include in the medical record: patient’s comments regarding injuries, identity of the suspected perpetrator and past domestic violence. Document referrals given and if seen by DV advocate or social worker. Include copy of reporting form

Confidentiality

Health care facilities must keep reporting forms confidential. Family, friends and other third parties should not have access with out patient consent.

Any Physician, as well as any non physician health care provider employed by a health facility, clinic, local or state public health department or Physician’s office is required to make a report if s/he provides medical services for a physical condition to a patient who s/he knows or reasonably suspects is:

• Suffering from any wound or other injury inflicted by his or her own act or inflicted by another where injury is by means of a firearm and/or
• Suffering from any wound or other physical injury that is a result of assaultive or abusive conduct.

Assaultive or abusive conduct is defined to include 24 criminal offenses among which are murder, manslaughter, torture, battery, sexual battery, incest, assault with a deadly weapon, rape, spousal rape, and abuse of spouse or cohabitant.

Other mandated reports can be found at the following links

Suspicious injury report OES 920 form

Sexual assault OES 923 form

Child sexual abuse OES 925 form/ OES 930

http://www.calema.ca.gov/PublicSafetyandVictimServices/Pages/Numeric-Forms-Listing------.aspxa

Child physical abuse SS 8572

http://oag.ca.gov/childabuse/forms

Dependent Adult/Elder abuse SOC 341

http://www.cdss.ca.gov/agedblinddisabled/PG1298.htm

Review with the patient

1. Shelter
   • Is it safe to go home?
   • Do you need shelter?
2. Support Systems
   • Where can I go if I need to?
3. Flight Bag and hotline numbers
   • Have you packed clothes and medications for you and your children?
   • Have you hidden them in a safe place?
   • Do you have keys to the house and car, cash, phone numbers, copies of important documents (birth certificates, marriage, and driver license)?
   • Do you know Domestic Violence hotline numbers you can call?
4. Legal Resources
   • Do want a restraining order
5. Workplace
   • Is your employer aware of the situation?

Script to use with patient:

“Research has shown that several risk factors are associated with murders of both victims and perpetrators of domestic violence. We cannot predict what will happen in your case, but we would like you to be aware of the danger of homicide, and for you to see how many of the risk factors apply to your situation.”

Ask the patient if there is….

• Increase in severity /frequency of abuse?
• Threats of homicide or suicide?
• Weapons present?
• History of choking or attempted strangulation?
• Threats to children and or pets?

The higher the number of “yes” responses, the greater risk of homicide to the patient

Adapted from the AMA, “ Case studies in disease prevention and health Promotion-Intimate Partner Violence” (2002) and the Kasier IPV toolkit

Another Important resource that is available for the reimbursement for Health care services is through provisions of the Victim of Crime Act (VOCA). This act provides VOCA funding through the Office of Victims of Crime to state agencies for the establishment of compensation programs to reimburse crime victims and to provide assistance programs to offer victim services.

Website for VOC

VOC application

ICD-9 Diagnostic Codes General Diagnostic codes for Domestic violence fall under the adult maltreatment and abuse (995.8) Specific ICD-9 codes you can use are:

• 995.81: physically abused person, battered person, spouse or woman
• 995.82: adult emotionally/psychologically abused
• 995.83: adult sexual assault
• 995.84: adult neglect (i.e. nutritional)
• 995.85: other adult abuse or neglect

CPT codes:

There are no codes specific to the evaluation and care of domestic violence patients. However, providing care and services to DV patients can be complex and time consuming so the following services and codes are often appropriate.

• Complex evaluation and management may be appropriate.
• Team Conferencing (99374-2) regarding referrals, case management, teleconferencing by patient with DV advocates and then advocate summarizes issues addressed with provider
• Care plan oversight (99374-5)
• Preventive medicine services (99381) for screening and assessment of issues that impact pt safety.
• Preventive medicine counseling (99401) safety planning and danger assessment, educational videos, educational materials.
• Services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic services (99058)