Hospital intervention could prevent injuries, death from domestic abuse

An 11-year-old girl wakes up from surgery. Someone at home who’s supposed to love her beat her up — and killed her mother.

Zita Surprenant remembers this.

Surprenant, a Kansas University clinical assistant professor of preventive medicine, remembers the indictment that came from the 11-year-old when she woke up. She raged against the pastor, the neighbors, the doctor who’d seen her and her mother in the emergency room on other occasions.

Why hadn’t they asked for details, she screamed, about their previous “emergencies”?

Medical professionals are supposed to do that. The American Medical Assn. and the professional ob-gyn organization advise doctors to ask women routinely whether a partner hits them.

One in four white women and one in three African-American women gets hit by a partner in her lifetime. Surprenant says that 2 to 4 percent of women wind up in emergency rooms because of partner violence.

That’s why last October the Family Violence Prevention Fund and other medical specialty groups said every woman in stable condition at an ER should be asked about partner violence.

And you don’t mince words. You don’t ask, “Are you the victim of domestic abuse.”

You name acts: “Have you been hit? Kicked? Threatened? By your partner? By someone close?”

Surprenant decided to see how often harried professionals in the harried ER unit at the Kansas University Medical Center were asking these hard questions. She had found only one other study focused on the percentage of women screened for violence in emergency rooms.

She says that she and her colleagues wanted to collect baseline data so they could measure progress toward the goal of asking every woman admitted to the ER whether she’d been hit. The Kansas attorney general’s office supported the work with a $50,000 grant.

Kim Richter, assistant professor of preventive medicine, examined 527 charts of patients admitted to the Med Center’s ER. The charts showed that 150 patients — around 29 percent — had been questioned about domestic violence. Of these, 23 patients — or 4 percent — had experienced domestic violence some time in their lives. Fifteen women said they were currently being abused.

The results will appear in the journal Violence Against Women.

The KU screening rate matched the rate turned up in the only other study, Surprenant says. Most hospitals across the country have poor screening and documentation rates. She says it takes time to build a program that routinely screens for violence. Medical students, nursing students and staff have to be trained.

And there must be administrative backing.

The Med Center hospital has all that going for it, Surprenant says.

A functional intervention system also requires good relations between hospitals and shelters for abused women. The Med Center is the first hospital in the Kansas City area to develop those ties. And now those shelters are starting to provide medical outreach to hospitals closer to them than KU’s, Surprenant says.

With a whole system in place, you can save lives, she says.

Without it, mothers can die and daughters wake up from surgery asking questions that have no answers.