Women's Health Issues
State Of New York - Department Of Health Memorandum
Series: Health Facilities Series: H-8 95-12
Subject: Compliance with New Domestic Violence Legislation
Date: August 9, 1995
This memorandum clarifies the responsibilities of hospitals in complying with the requirements of the Family Protection and Domestic Violence Prevention Act, Chapter 222 of the Laws of 1994. The new law requires hospitals to provide a written notice (attached) to all suspected or confirmed adult domestic violence victims including emergency patients, inpatients and outpatients. The law became effective on January 1, 1995. On December 27, 1994 hospitals were initially notified via a "Dear Administrator" letter of their responsibilities to comply with this law. The Department of Health considered amending regulations in Part 405 to conform the regulations to statute, but determined that the legislation is fully self-implementing and further regulations are not required.
The "Victim's Rights Notice," was prepared by the New York State Office for the Prevention of Domestic Violence, the Division of Criminal Justice Services, the Office of Court Administration and the New York State Police. This notice informs victims of their legal rights and remedies available under the law. Copies of the revised notice, both in English and in Spanish are enclosed. Please replace the original version of this notice enclosed with the letter of December 27, 1994, with this newly revised notice and ensure that the sections for the local domestic violence programs and courts are completed prior to distribution to patients. Hospitals are responsible for reproducing the document and, consistent with current requirements set forth in paragraph 405.7 (a)(7) of Part 405 hospital standards, ensuring the appropriate translation for patients who do not speak English or Spanish. Hospital administrators should ensure that this information is widely distributed to all hospital staff who may interact with such victims.
The Department distributed to every hospital and diagnostic and treatment center in the State a model adult domestic violence protocol in March of 1990. This protocol, "Identifying and Treating Adult Victims of Domestic Violence", serves as a guide to health care facilities in identifying, treating, documenting and referring victims of adult domestic violence. The protocol urges hospital staff to screen all adult female patients for domestic violence routinely.
An updated and revised protocol is under development but until the new version is completed and distributed, the 1990 protocol continues to be recommended for use. Hospitals seeking further guidance for the treatment of victims of domestic violence are encouraged to review guidelines produced by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists.
In order to distribute the "Victim's Rights Notice" in a manner that is consistent with the intent of the law and most helpful to victims of adult domestic violence, the Department strongly suggests that providers of direct patient care provide a copy of the "Victim's Rights Notice" in a private and confidential manner to all patients who they suspect or have confirmed are domestic violence victims. (Refer to the protocol, "Identifying and Treating Adult Victims of Domestic Violence," for clinical indicators and identification tools.)
Victims of domestic violence are frequently accompanied to the hospital by companions, often their batterers, who seek to prevent them from interacting privately with clinicians, in order to intimidate or prevent the victim/patient from disclosing the battering and getting appropriate treatment and referrals. For that reason, patient care providers should make every effort to interact with the patient privately and to give suspected and confirmed adult domestic violence victims the "Victim's Rights Notice" in a confidential manner, out of sight and hearing of the companion. Provision of the "Victim's Rights Notice," in a confidential manner helps to ensure the safety of both the patient and staff.
Hospital staff can often find creative ways to promote confidentiality, privacy and safety. For example, some hospitals have taken female victims to a ladies room where the companion cannot follow "to obtain a urine specimen". During the private encounter, if the victim does not wish to keep possession of the notice for any reason, that wish should be honored. The refusal of the patient to keep the notice should be documented in the medical record. Under such circumstances staff might attempt to provide the patient with an alternate domestic violence resource such as a palm/wallet card with the state or New York City domestic violence hotline number (see enclosed cards available from the Department), the phone number for the local domestic violence service provider, and/or the hospital social work department's phone number.
If all attempts to provide the notice to the victim in private fail, and if hospital staff believe that provision of the notice could jeopardize patient or staff safety, staff may refrain from such action and document the reasons for not providing the notice. The law holds a hospital harmless when it cannot comply with the notice requirements if the hospital has made good faith efforts to do so.
When a hospital finds it cannot provide the notice to victims confidentially, a less preferred alternative would be to provide a copy of the notice to all patients being discharged. When distributing the notice in this manner, hospitals may wish to attach a statement that distribution to all patients is general hospital policy and is intended to reach not only the patient, but also any suspected victims of domestic violence with whom the patient wishes to share the notice. Such non-specific distribution could also help to defuse a confrontational situation.
Hospitals are also encouraged to post the notice, along with other domestic violence posters and materials in patient examining areas, patient and public lavatories and lobbies or other public waiting areas. These postings alone, however, do not meet the hospital's responsibility to provide the "Victim's Rights Notice" to all patients being evaluated or treated who are suspected of being victims of domestic violence.
To assist hospitals in responding to the needs of domestic violence victims, the Department suggests that specifically designated hospital representatives contact their local domestic violence service providers in order to ascertain services available and develop or improve collaboration. True collaboration will result in improved rates of identification, appropriate treatments, documentation, and referrals for victims of domestic violence and their children, and therefore, assist victims in finding a safe environment and restoring health. As stated in the domestic violence protocol, hospital staff should, at a minimum, refer victims of adult domestic violence to local domestic violence services. Referrals should include a brief description of the services available to assist battered women and their children. The referral should also include information regarding the confidentiality of domestic violence services and should clarify that victims do not have to enter or reside in the shelter in order to obtain assistance and services. Referrals to couples counseling, marital counseling and mediation are contraindicated in cases of suspected or confirmed adult domestic violence because they could delay locating a safe environment for, and thereby further endanger, the victim.
To assist providers in addressing the needs of victims, attached to this DOHM are sample palm/wallet cards, a physician's desk reference card and posters. The revised domestic violence protocol will be distributed as soon as it is available.
Additional copies of domestic violence "tools" including the Physicians' Desk Reference Card (4602), "No One Deserves to be Abused" poster (4603) and the palm/wallet card (4604) can be obtained by writing to: Publications, NYS DOH, Box 2000, Albany, New York 12220.
Questions regarding this memorandum or hospital responsibilities should be directed to the Bureau of Hospital Services at (518) 474-5013. Training and technical assistance for hospital staff on adult domestic violence identification, treatment, documentation and referral are available from the New York State Office for the Prevention of Domestic Violence outside New York City at (518) 486-6262 and in New York City at (212) 613-4381. In addition, local domestic violence service providers may be available to provide on-site training and technical assistance for hospital staff. For the telephone number of the domestic violence program nearest to you call (800) 942-6906.
Thomas W. Hartman, Deputy Director
Health Care Standards & Surveillance
Endorsement: Barbara DeBuono, M.D., Commissioner of Health
New York State Department of Health
Posted: February 6, 1996