Realities of Sexual Assault

Realities of Sexual Assault.

Check out what the producers of Law and Order:SVU have to say about VINE.  When Mary Byron was murdered in 1993, her family  knew that she could have been kept safe had she known he was on the street.  Because of this well publicized murder, VINE was invented and put into use first in Louisville, KY – and then it spread to almost every state in the US.

Knowledge and use of this service has saved lives.  Most of the millions of viewers of last night’s episode will never need VINE, but for those who will, NBC has made sure they are aware.  And on behalf of all those victims, we thank them.

Ky Supreme Court v. Ky General Assembly: Who Makes Law in KY?

Remember in high school civics when you learned about “separation of powers?”  You know the drill:   The legislative branch makes the laws, the judiciary interprets the laws, and the executive branch enforces the laws.  Well, in the context of protective orders, it looks like the Kentucky Supreme Court may need to go back to school.

A little background might be useful here.  Protective orders are the legal remedy domestic violence victims use to access the court system and seek protection from their abusers.  The remedy was created by statute – KRS 403.715 et. seq.  In the very first part of the statute, Kentucky’s legislative body, the General Assembly, declared that the intent of the statute is to “[t]o allow persons who are victims of domestic violence and abuse to obtain effective, short-term protection against further violence and abuse in order that their lives will be as secure and as uninterrupted as possible . . . .”

The process of obtaining an order of protection, very simply put, goes something like this:  A victim goes to the courthouse, or intake center, or clerk’s office and completes a petition for an emergency protective order (EPO).  The petition is presented to a judge and, if it establishes the existence of domestic violence and abuse, the EPO is entered.  The order is then served on the batterer, along with a summons ordering the batterer’s appearance at a full hearing.  If, after the hearing, the court again finds the existence of domestic violence, a more permanent order, known as a domestic violence order (DVO), is entered.[1]

But what happens if the court, on reviewing the petition for an emergency order, does not find the existence of domestic violence or abuse?  Does she still get to go forward to a full hearing to try and convince the court of her need for protection?  In KRS 402.745(1), the General Assembly answered this question with an unequivocal yes:

If, upon review of the petition as provided for in KRS 403.735, the court determines that the allegations contained therein do no indicate the presence of an immediate and present danger of domestic violence and abuse, the court shall fix a date, time, and place for a hearing and shall cause a summons to be issued for the adverse party.

Protective orders are akin to civil lawsuits.  In a civil suit, say a trespass case, the process is initiated with the filing of a complaint.  In a trespass case, the complaint may be accompanied by an order seeking an emergency injunction preventing the defendant from entering onto the plaintiff’s property.  Even if the emergency order is not granted, the plaintiff still gets to go forward and prove that he is a victim of trespass.

The General Assembly thought the same should hold true for domestic violence victims.  If the petition for an EPO is denied, the petitioner still gets the opportunity to be heard by the court.  The court still must issue summons to the respondent and hold a hearing with both parties present before dismissing the case.  Like our trespass case, the suit does not end only because petition for emergency relief was not granted.

Makes sense?  To me it does and, apparently, it did to the General Assembly.  Not so much to the Kentucky Supreme Court.  Last year, the Kentucky Supreme Court adopted new rules of criminal and civil procedure, as well as new rules governing Family Courts.  In FCRPP 10 (Family Court Rules of Practice and Procedure), the Court stated, in relevant part:

FCRPP 10 shall read:  If an emergency protective order is not issued . . .for failure to state an act or threat of domestic violence between the parties, the finding of the . . . failure to state an act or threat of domestic violence shall be noted on the petition by the judge, and no summons shall be issued.

What’s a judge to do?  The Kentucky General Assembly has said a judge must issue a summons if the emergency order has been denied.  They made this very clear when they said a court “shall cause a summons to be issued to the adverse party.”  In legal speak, “shall” is a mandatory term that means the judge doesn’t have another option.  The Kentucky Supreme Court, however, says “no summons shall be issued.”  Again, the word shall means a judge doesn’t have a choice – under the rule, they can’t issue a summons.

Here’s where separation of powers problem occurs.  Both the Supreme Court and the General Assembly are legislating – that is, making law.  What the Supreme Court is ignoring is their high school civics lesson – only the state’s legislative body can make the law.  The Supreme Court only gets to interpret it.

The irony here comes in at the end of the process, regardless of what a family court judge chooses to do.[2]  Say a victim seeks an EPO, it’s denied, and a judge issues a summons, holds a hearing, finds domestic violence exists and enters a DVO.  The respondent appeals the DVO, saying, in part, no summons should have been issued pursuant to FCRPP 10.  The case goes first to the Court of Appeals, but for a final resolution, guess where it will end up?  That’s right, the Kentucky Supreme Court!  Are they going to follow the General Assembly’s pronouncement or their own rule?

Sadly, the bigger problem is not what will happen if a case ends up before the Kentucky Supreme Court.  The bigger problem is the countless victims who will essentially be kicked out of court all over the state by judges who choose to follow the erroneous rule of the Supreme Court.  We’ve all heard stories of judges who will do nearly anything to erect barriers to victims seeking protection.  The Kentucky Supreme Court has handed these judges a huge barrier to use at will.


[1] Obviously, this is the way the protective order process is supposed to work in a perfect world.  If anyone knows where that is, let us know; we want to relocate there.

[2] If I were a judge, I would follow the statute because the pronouncement of a legislative body trumps the statement of a Court that is exceeding its constitutional authority.  Incidentally, I aced high school civics.

The Medical Cost of Domestic Violence

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As health care legislation continues to face challenges in Washington, medical reform is on everyone’s mind. After years of debate, the statistics are well-known: the USA, despite spending nearly $2.5 trillion on health care in 2009, a higher portion of its gross domestic product than any other country, ranks only 37th out of 191 countries in overall health care. In fact, the only place that we take #1 in terms of health care is spending per capita; we are 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.

Whether or not you believe in “universal” health care, we all have a stake in wanting these numbers to change. Stronger efforts to screen for and address domestic violence in hospitals could provide an unlikely solution, ultimately saving billions of dollars along with lives.

Take infant mortality, for example.

As reported by e! Science News, the United States currently ranks 27th out of 33 developed countries for life expectancy at birth. Domestic violence (dv) has been identified as a major barrier to fetal health in the recently released government health plan, Healthy People 2020, following studies showing that two of the leading causes of infant mortality, namely complications related to pre-term birth or low birth weight-outcomes, are linked with domestic violence. In fact, many adverse pregnancy outcomes, including maternal mortality and infant mortality, are significantly more likely among abused than nonabused mothers. For example, Seattle residents who reported a domestic violence incident to the police during pregnancy were significantly more likely than their peers to have a low birth weight infant, a very low birth weight infant, a preterm birth, a very preterm birth, and a neonatal death.

Furthermore, as the authors of the second study point out, this likely dramatically underestimates the health cost of intimate partner violence (IPV) during pregnancy, since women who were being abused but didn’t report the abuse to the police would have been accidentally included in the non-abused comparison group. The Center for Disease Control reports that three out of four victims don’t report abuse. These rates may go up during pregnancy, when the financial, emotional, and quality of life cost to the victim of leaving is greater. Abusers utilize domestic violence as a means of excerising control, and because pregnant women are trapped in the relationship as well as increasingly focused on the changes they are undergoing, it is unsurprising that victimization studies find that pregnancy is a particularly dangerous time for victims of abuse. Abuse often begins or escalates during pregnancy, and pregnant women are three times more likely to be killed by an intimate partner than their peers who are not pregnant. In fact, homicide is the leading cause of death for pregnant women.

DV is more common than other recognized obstetric complications such as pre-eclampsia, placenta praevia, or gestational diabetes, for which women are routinely screened. The March of Dimes, a politically neutral public health organization that provides information to expectant mothers, reports that 1 in 6 pregnant woman suffer from domestic violence during pregnancy. This increased likelihood of abuse comes at a time of particular vulnerability; both physical and psychological abuse can have massively detrimental effects to mother and child. Physical attacks on pregnant women often center around the stomach area, causing direct injury to the fetus. Psychological abuse causing stress, fear and anxiety during pregnancy is associated with increased pre-term birth, lower birth weight and emotional and mental problems in children. Dv is also associated with alcohol and drug dependence, suicide attempts, depression and post traumatic stress disorder, the effects of which harm both the mother and her future child. Reproductive abuse is also a factor; victims of abuse are significantly less likely to receive adequate prenatal care, and 40% of abuse victims report that their pregnancy is unwanted, as opposed to 8% of the general population.

Screening pregnant women for domestic violence and providing more support for victims during pregnancy are important steps that we must take to ensure the health of women and their future children. Although effective screening for dv is still worryingly infrequent, 70-80% of victims of abuse say that they would like their provider to talk to them about abuse. And there are promising new developments on the horizon; new screening tools such as the one developed by Planned Parenthood of New York capture far more accurately the actual prevalence of dv, and have been utilized to connect expectant mothers with services more effectively.

Stopping Violence in the Next Generation

Ensuring that pregnant women are aware of their resources when it comes to intimate partner violence is particularly necessary because children born into households in which the woman is abused are significantly more likely to be abused themselves. About 50% of men who abuse their wives also abuse their children. Furthermore, merely witnessing domestic violence is so psychologically damaging to a child that it is considered child abuse. In these situations, recognizing that both mother and child are victims—rather than merely removing the child—is crucial to creating a healthier future. Children who grow up in households in which there is any kind of abuse are significantly more likely than their peers to be depressed, anxious, suicidal, truant, and have conduct and physical health problems.

They are also significantly more likely to be abusers themselves; growing up in a household in which abuse occurs is the single greatest risk factor for being abusive yourself; a boy’s likelihood of being an abuser jumps 157%.

Which, of course, only perpetuates the cycle, preserving it for the next generation and helping to explain why rates of abuse are epidemic in some communities. Even if you escape abuse in your own life, domestic violence is truly everybody’s problem; supporting efforts to intervene may protect your daughters and sons down the road.

But What Are The Actual Numbers?

Pregnant women are a unique group who are particularly likely to be abused, and who face particularly detrimental effects from abuse. But is the overall cost to the medical system of abuse really that large? Do that many victims seek emergency services?

The US Department of Justice finds that 37% of women admitted to emergency rooms for care for violence-related injuries were injured by a current or former intimate partner. At the same time, however, the CDC reports that only about 4% of women admitted to the emergency room were admitted for injury resulting from violence; accidental falls, for example, or illness claim much larger numbers.

Even this seemingly fractional percentage, of course, is extremely costly to the health system. In 2003, the CDC, examining costs from the 700,000 reported incidents of domestic violence in America in 2001 (all included in the 1/3 of 4% violent victimizations), placed the annual estimated direct health care cost associated with domestic violence at around $4.8 billion.

Yet these numbers dramatically underestimate the cost of abuse to our health care system. A recent University of Pennsylvania study found that although about 80% of domestic violence victims who report incidents to the police seek health care in emergency rooms, nearly three out of four are never identified as victims of abuse during any hospital visit. This is despite the fact that most sought ED care frequently; an average of 7-8 times each in the four year study period.

How it is possible that so many victims of severe abuse slipped through the cracks? One reason: 78% of the visits were for medical complaints other than injuries associated with abuse. In fact, assault was the main documented cause in only 3.8% of the victims’ ED visits.

Clearly, by focusing only on when IPV is disclosed, the CDC misses a massive amount of harm.

Finally, even the numbers found in the University of Pennsylvania study are a conservative estimate because they describe only women who were harmed enough—and willing enough—to go to the police. As a group, then, these women were particularly likely to be flagged as dv victims, yet the study found that only 28% were ever identified. And even in the cases in which they were identified as victims of abuse, fewer than 35% of ERs made any documented assessment of whether they had a safe place to go after discharge, and they were referred to services only 25% of the time. Considering that these statistics are limited to a group of particularly brutalized victims who are trying to seek help, it’s certain that many more victims are being overlooked, their injuries not recorded because they result from secondhand effects of dv or are disguised in other categories such as that old cliché, “accidental falls.”

Is it possible that victims of abuse are just particularly unlucky?

Of course, an alert reader could identify a problem in the statistics above; perhaps the 78% of medical problems not categorized as abuse-related really weren’t abuse-related. Could it be just normal that victims of abuse visit the emergency room an average of 7-8x in four years? (How frequently do women in non-abusive relationships visit the emergency rooms?)

The answer is: a lot less frequently. Over a 3-year study period, health care costs for women who disclosed a history of physical, sexual, and/or emotional abuse were on average $1,700 higher than those of their cohorts who had never been abused. In short, being a victim of any kind of abuse—note the inclusion of “emotional abuse”—results in higher health care costs. These findings, by the way, are neither unique to the study nor confined to a small number of victims experiencing exceptionally terrible harm. A 2007 longitudinal cohort study of over 3000 female patients found that 44% of the sample reported a history of IPV. These women had significantly higher healthcare utilization and costs both during and after the abuse than women who had never been abused. And although medical costs decreased over time after the IPV ceased, healthcare utilization for previously abused women was still 20% higher 5 years after their abuse had ended. Ultimately, the excess costs due to IPV were estimated to be $19.3 million per year for every 100,000 female enrollees aged 18-64. The study concluded that IPV has a major impact on medical care resource utilization and that preventative efforts should be taken.

And yes, you read that right: the health care costs of domestic violence don’t stop after the violence ends. In fact, they may even go up. Another study involving 2,026 women patients found that although abuse victims’ health care costs average $585 per year higher than normal during the period of abuse, their health care costs rise to more than $1,200/yr above non-abused women for the first two years after abuse, and $444 after the third year. One explanation for the continuing increase in cost is that women may still be exposed to abuse after the conclusion of the relationship; as we’ve reported before, a significant amount of IPV harm takes place after partners separate. It’s also possible that women are not able to access the health care services that they should be receiving when they are with a controlling or abusive partner. And once again, the study’s findings are conservative, because it did not distinguish between severity or type of abuse and because some victims participating in the study may not have admitted to being abused and so were not included among the abuse victims. Ultimately, the researchers stressed the importance of screening and prevention efforts: “Victims of abuse require more health care resources for years after their abuse ends. If we can prevent domestic violence, we are not only helping the women involved, we are also saving money in our health care system.”

So…

As mentioned before, none of this harm is included in current cost estimates of domestic violence, which already amount to billions of dollars, even in 2003 dollars unadjusted for inflation.

And the costs keep coming; abuse is already linked to depression, anxiety, substance abuse, and suicide attempts, and negative physical health consequences including migraines, asthma, chronic pain, arthritis. New research suggests that it is a major risk factor for heart disease and that children in abusive households are at greater risk for cancer later in life. That’s right: cancer.

The surprise with which you’re likely reading that is only evidence of the way that the massive cost of IPV has been is still being uncovered, after too many years of silence.

The Bright Side

Yet despite the still epidemic prevalence of abuse, domestic abuse is a solvable public health problem. In 2006, the Justice Department reported that intimate partner violence rates had fallen by more than 50% between 1993 and 2004. Among some segments of the population, namely males and black females, intimate partner homicides have fallen sharply as well. The number of services for victims, mostly due to funding from VAWA, have skyrocketed since 1994. In an increasingly computerized age, steps to screen victims for abuse can and should be taken, and community support systems equipped to communicate effectively with hospitals. Hospital workers must develop and learn protocols to better serve victims of abuse. And the systems already in place in hospitals must be refined; as the UPenn study shows, current screening procedures are worryingly ineffective—particularly for victims who may not identify as victims—and women who are being abused must be given information about support services. Ultimately, there are many steps that are within our power that we can take to reduce domestic violence.

Emphatically, they are steps worth taking.

Selected Resources:

3 in 4 domestic violence victims go unidentified in emergency rooms, Penn study shows

Domestic violence victims have higher health costs for years after abuse ends

Health Costs Associated with Domestic Violence

Impact of police-reported intimate partner violence during pregnancy on birth outcomes [Abstract Only]

Fact sheet: Domestic Violence and Futures without Violence

Further citations provided upon request

A Note

To all those who have been reading this blog and wondering, “Who’s writing this stuff?” allow me to introduce myself.

My name is Emily, and I have spent the past 10 weeks interning at The Mary Byron Project in Louisville, Kentucky. I am originally from New York, and I am currently an undergraduate at Yale University in Connecticut.

I am from the suburbs. I attend a top-tier university. My parents are still married. I am white. I don’t do drugs. Yet, I see sexual harassment, sexual assault, dating violence and domestic violence all the time. It’s everywhere. If you just open your eyes and unclog your ears, you will start to see and hear it, too. Intimate partner violence affects all of us, no matter our age, our race, our socioeconomic status, our religion, or our region of residence. And it affects every aspect of our lives.

An advocate in the Jefferson County Domestic Violence Intake Center, Cammie Sizemore, told me that working in DV changes you. She told me I ought to think really hard before I decide this is what I want to do. She told me to consider what I like about myself, and ask myself if I’m willing to let that change. Cammie, the perceptive woman she is, knew within five minutes of meeting me that I am a cock-eyed optimist. She knew within five minutes that I like to think everyone has good intentions. She knew within five minutes that I simply cannot figure out why people can be so mean! And maybe she thought to herself, this girl is not cut out for this sort of work. After my first day at the Intake Center, I certainly had that thought, anyway.

But my thoughts didn’t stop there. Who’s to say that my hopefulness and sensitivity are necessarily disadvantages? And who’s to say that working in this field or that field will change me? Despite the placid picture I painted of myself above, I have gone through some rough times; I have faced adversity; I have struggled with my identity and my purpose; I have been passive and let bad things happen to me; I have seen bad things happen to other people and stood there knowing there was nothing I could do.

I am aware of the world around me. I never outgrew the childish tendency to ask too many questions and try to truly understand and relate to everyone I encounter. I like to analyze people and their interactions, whether they are characters in novels, my own family members, or strangers on the subway. Relationships have always fascinated me. The connections that people make with one another are vast and complex. As I’ve grown older, I have become both more independent and more involved with other people. I have been in healthy and unhealthy relationships, and have learned the difference the hard way. Not all relationships are rooted in love and trust. Many are much more twisted.

Domestic violence is nothing new. Men are physically more powerful than women and they historically have been given more societal power than women. This unbalanced power dynamic is at the crux of most domestic violence cases. Intimate partner violence is not about a need for anger management; in fact, batterers are in full control of their anger. Batterers manage their anger quite well; they deliberately direct it at the person or people most vulnerable to attack.

Additionally, outsiders (like the police) tend to stay out of private affairs more so than public ones. If you threaten a stranger on the street, people will intervene. But if you hit your wife in the home you share, people will not only fail to intervene, but they will often go further and blame the victim. They will ask “well, why doesn’t she just leave?” Domestic violence victims are the only class of victims held responsible for the abuse they suffer. People are more willing to fault the woman for staying with her abuser than fault the man for being abusive. No one ever asks why, if the man hates his wife so much, he doesn’t just leave.

Let’s back up for a second. Let’s take a look at people my age, the ones who don’t typically cohabit with their intimate partners. There’s a different name for the violence that may occur in these relationships: dating violence. And dating violence is where it all starts. After all, those women who are deemed victims of domestic violence were once dating the guy.

Dating is rife with insecurities, leaps of faith and second-guessing. And yet, most everyone dates. To be in a relationship, you need to date. And we’re brought up to believe (and it seems to be our biological destiny) that we should be in romantic relationships. And the worst part is that once emotions are involved, it is quite difficult to perceive whether or not your relationship is healthy or not. Who is to judge whether or not he loves you or he loves controlling you? Who is to determine when he crosses the line from protective to possessive? It’s a cycle. When you’re dating, you may not realize the pattern. And when you’re married, it may be too late. You can’t change someone else any more than you can totally understand someone else. He chooses to hit you. He chooses to demean you.

You can’t make his choices; you can only make your own.

My final blog entry for my internship is about song lyrics. I did not plan for this post to coincide with the rising popularity of an Eminem song that features Rihanna, but it has worked out that way. The song, which is now #1 on Billboard’s Hot 100 chart, focuses on domestic violence, a topic with which Eminem is quite familiar (see his autobiographical songs “’97 Bonnie and Clyde” and “Kill You”). In “I Love The Way You Lie,” Eminem very accurately breaks down the cycle of violence, but I have no idea what sort of message the song is supposed to send. The music video premiered Aug. 4 on MTV.