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Home / Articles / Identifying Abuse / Why Medical Mandated Reporting of Domestic Violence Still Matters

Why Medical Mandated Reporting of Domestic Violence Still Matters

Medical mandated reporting for domestic violence improves survivor outcomes

doctor with clipboard chart sitting with woman who has hands anxiously folded

This article originally ran in Domestic Violence Report Vol 29, No. 1 for October/November 2023. It is being reprinted with permission from the authors.

“I grew up with domestic violence. I lived with it for many years. And I almost lost my life to it,” Isabel said to a reporter in San Diego in July 2023 in the midst of a debate in California about a bill seeking to repeal medical mandated reporting of domestic violence by healthcare professionals. Isabel was in an abusive relationship for 15 years. The violence escalated to include strangulation and her husband managed to avoid consequences for his abuse throughout their relationship. Isabel was too scared to report his abuse and says she never would have been able to “press charges” herself. Ultimately, in January of 2018, Isabel’s husband grabbed a knife, threatening to kill her. She ran into her children’s room thinking he would not stab her in front of her kids. But he did. He stabbed her in the neck and her neighbors heard the fight and called the police. Paramedics came and kept her alive as they rushed her to the hospital. She was not able to speak but when doctors asked her who did this to her, she pointed at her husband who was in the next room being treated himself (for superficial, self-inflicted knife wounds).

Under California’s Suspicious Injury Reporting Law (Penal Code § 11160 et. seq.), police officers were notified, and her husband was arrested and prosecuted for felony domestic violence. Isabel was not able to “press charges'' or authorize a report to law enforcement the day she almost died. She was terrified and seriously injured. She needed doctors and nurses to follow California’s Medical Mandated Reporting Law and “do their job.” In Isabel’s words, “When they did their job, they saved my life.” 1

Few topics garner a more visceral reaction in the domestic violence and sexual assault movements than the issue of medical mandated reporting by medical professionals. Advocates and professionals who support reporting argue that it provides for early intervention before serious injury or death even if the victim is too injured or terrified to make a report. Those who oppose mandated reporting argue that some victims do not want doctors and nurses to report their abusers and therefore may not seek needed medical attention. Proponents of reporting argue reporting is homicide prevention. Opponents argue that mandated reporting violates “victim autonomy.” There is validity to the arguments on both sides of the debate. The question becomes how to make the public policy decisions about mandated reporting particularly when there is a split on this issue among professionals working in the violence prevention movement.

Medical mandated reporting of domestic violence currently exists in almost all states with varying levels of reporting required. Some states specifically use the term “domestic violence” while other states encompass domestic violence by using other terminology or include domestic violence under other types of crimes and injuries. One state, Kentucky, eliminated medical mandatory reporting to the Cabinet for Family and Children’s Services in 2017 with very mixed and debatable results 2. We argue that it is part of the cause for Kentucky’s large increase in domestic violence homicides since 2017. Others argue that Kentucky has made healthcare access easier for victims of domestic violence by ending all mandated reporting and offering voluntary referrals to services. Some states have updated their laws in the last five years, including Colorado 3, Tennessee 4 and Ohio 5. But they have each maintained medical mandated reporting for certain types of offenses (Colorado: “serious bodily injury”; Tennessee: “serious bodily injury”; and Ohio: “all  felony offenses producing injury”). 

California’s Medical Mandated Reporting Requirement

California has had one of the most specific medical mandated reporting laws on domestic violence in the country since 1994 6. Penal Code § 11160 requires a health care practitioner who treats a person brought into a healthcare facility or clinic who is suffering from specified injuries to report that fact immediately, by telephone and in writing, to the local law enforcement authorities. The duty to report extends to physicians and surgeons, psychiatrists, psychologists, dentists, medical residents, interns, podiatrists, chiropractors, licensed nurses, dental hygienists, optometrists, marriage and family therapists, clinical social workers, professional clinical counselors, emergency medical technicians, paramedics, and others. The duty to report is triggered when a health practitioner knows or reasonably suspects that the patient is suffering from a wound or other physical injury that is the result of assaultive or abusive conduct caused by another person, or when there is a gunshot wound or injury regardless of whether it self-inflicted or one caused by another person. Health practitioners are required to report if these triggering conditions are met, regardless of patient consent. Failure to make the required report is a misdemeanor.

California’s law has been criticized by some as too broad while supporters argue that mandated reports provide documentation of the violence of an abuser and the injuries they cause and ensure that a victim can connect with an advocate or other social services once local law enforcement receives the mandated report. In 2022, Futures Without Violence (Futures) and the California Partnership to End Domestic Violence (CPEDV) sponsored AB 2790 (Wicks) 7 to repeal California’s long-standing Suspicious Injury Reporting Law. They gathered a significant number of organizations in support of the bill, making representations about the views of survivors, seeking legislative findings on the detrimental impacts of reporting to survivor health and healthcare, and initially representing that there was “consensus” on the need to end reporting in the domestic violence movement. AB 2790 sought to eliminate the duty of healthcare practitioners to report known or suspected assaultive or abusive conduct and instead provide that they should, whenever medically possible, provide the person with “brief counseling”, a “warm handoff”, or a referral to local domestic violence services. 

AB 2790 sought to:

1. Limit a health practitioner’s duty to make a report of injuries to law enforcement to instances where: the injury is by a firearm, either self-inflicted or not; the wound or physical injury was the result of child abuse; or where the wound or physical injury was the result of elder abuse; 

2. Require health care practitioners who, in their professional capacity or within the scope of their employment, know or reasonably suspect that their patient is experiencing any form of domestic violence or sexual violence, to provide brief counseling and offer a referral to domestic violence or sexual violence advocacy services;

3. Provide that the health practitioner shall have met the requirement when the brief counseling, education, or other support is provided and a warm hand off or referral is offered by a member of the health care team;

4. Provide that, if the health practitioner is providing medical services to the patient in the emergency department of a hospital, the practitioner shall also offer assistance to the patient in accessing a forensic evidentiary exam or reporting to law enforcement, if the patient wants to pursue these options;

5. Allow the health practitioner to offer a warm hand off and referral to other available services including legal aid and community-based services;

6. Provide that, to the extent possible, health practitioners must document all nonaccidental violent injuries and incidents of abuse in the medical record 8.

Alliance for HOPE International, the California Sexual Assault Forensic Nurse Examiners Association, the Academy of Forensic Nursing, the California District Attorneys Association, the California Police Chiefs Association, the VOICES Survivor Advocacy Network, the Training Institute on Strangulation Prevention and many others sought to negotiate a compromise to ending virtually all mandated reporting but Futures, CPEDV, and the bill’s author, Assemblymember Buffy Wicks, were not willing to allow any mandated reporting to remain except for injuries resulting from gunshot wounds. AB 2790 passed through the Assembly but failed to move forward in the Senate. Once the bill failed, our opposition coalition sought to negotiate a compromise, consensus bill. This effort failed. Proponents of the bill would not agree to continue mandated reporting of “serious bodily injury” and would not support funding for bedside advocacy in the bill.

In 2023, Futures and CPEDV brought the same bill forward again, and California Assemblymember Tina McKinnor introduced it as AB 1028 9. The same organizations joined in support and opposition to AB 1028 as they had done with AB 2790. The California Board of Registered Nursing also came out unanimously against the bill in 2023; however, most healthcare organizations in California remained neutral on the bill. All efforts by our opposition coalition to find a compromise with the proponents of AB 1028 failed. On September 1, 2023, AB 1028 was held in committee and therefore failed. While our opposition coalition successfully stopped the repeal of California’s Suspicious Injury Reporting Law for the second time in two years, it saddens us that we could not find a compromise. 

We strongly support medical mandated reporting of domestic violence to law enforcement agencies (and/or Family Justice Centers) and bedside advocacy for seriously injured, high-risk victims of domestic violence. We do not support voluntary referrals as the only action of medical professionals. We do not support putting all responsibility on the victim for reporting the abuser and the injuries caused, particularly with seriously injured, high-risk victims such as strangled victims with traumatic brain injury. The core arguments against the repeal of medical mandated reporting of domestic violence in California are going to be relevant in debates across the country in the years ahead. We believe mandated reporting increases accountability for offenders and provides a greater likelihood of direct advocacy for victims.

Arguments and Responses

We enumerate here the arguments propounded by our opposition coalition in California during our recent debate with deference and respect to those who sought and may still seek to end medical mandated reporting of domestic violence, child abuse, elder abuse, human trafficking, or dependent adult abuse: