H E A L T H L A W When Urgent Care is the Safest Place to Turn ■ JOHN SHUFELDT, MD, JD, MBA, FACEP Note: While not a typical topic for a Health Law column, providing treatment to the victims of violence against women by definition sits at the intersection of crime and medicine. Hence, we present Dr. Shufeldt’s call to action in his usual space. L In retrospect, it was bound to happen: An estranged husband received information from his insurance company about his wife’s outpatient treatment. He called the patient ac- counting office to confirm the residential address his wife gave to the registration clerk. He thanked the woman who supplied him with the informa- tion profusely, then got in his car and drove to the domestic vi- olence shelter where his wife was recovering from the physi- cal and emotional wounds he inflicted on her the week before. He hunted her down and shot her four times in the face with his .357 magnum while she cowered in the corner. An estimated 4.5 million physical assaults are committed against women by their intimate partners in the United States every year. 1 Unfortunately, slightly more than half of the victims live in households with children under the age of 12 2 ; too often, those children witness and are forever scarred by these circum- stances. Each year, more than 13,000 of these assaults are com- mitted at the woman’s place of work, and an average of three women are murdered every day by their husbands or boyfriends. 1,3 Intimate partner violence (IPV) has replaced the older phraseology of domestic violence, wife battering, and spousal abuse. This change in terminology reflects that abuse can oc- cur in all types of relationships—dating or marriage, current or former, heterosexual or homosexual. A variety of different forms of abuse exist: verbal abuse, emotional abuse, isolation, use of the “male privilege,” economic abuse, sexual abuse, us- ing children to manipulate behavior, physical abuse, and threats of physical abuse. John Shufeldt is the founder of the Shufeldt Law Firm, as well as the chief executive officer of NextCare, Inc., and sits on the Editorial Board of JUCM. He may be contacted at JJS@shufeldtlaw.com. Victims of IPV are often very reluctant to disclose the actual nature of the abuse for a number of well-founded fears: they will lose their children, the perpetrator will seek retribution or deny the charge, embarrassment, lack of trust in the healthcare provider, or, finally, they may simply not be ready or able to leave the relationship for emotional or economic reasons. As a result, a woman may not want to go to the emergency department since the staff may be attuned to the pattern of injury. Instead, she may present to an urgent care center with a complaint of falling or tripping down the stairs. The most common sites of such injury are the head, neck, face, arms, and areas covered by clothing like the chest, breast, and abdomen. Stroke symptoms secondary to carotid artery dissection after choking are not uncommon. When my gut tells me something is not adding up, I say to the patient, “I don’t know if this is an issue for you, but a lot of people I treat are in an abusive or controlling relationship and may be uncomfortable bringing it up so I have started to ask everyone I treat.” Role of the Urgent Care Provider When confronted with a patient who is the victim of IPV, our role as urgent care providers is to: Ⅲ respond empathetically by validating her experience Ⅲ assess the immediate risk to the victim Ⅲ thoroughly document current and past events Ⅲ refer the victim to experts in IPV. Most states require healthcare providers to report known or suspected case of IPV to the police. In some states, the crimi- nal justice system’s response to the victim may actually place the victim at greater risk. Therefore, victims of IPV must be ap- prised of the duty to report. I suspect none of this information is news to you. I am also Continued on page 44. 42 JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | N o v e m b e r 2 0 0 7 w w w. j u c m . c o m