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Five Considerations for the Intersection of Health Care and Domestic Violence

For a number of years, domestic violence was viewed as a private matter only concerning a man and his wife; however, in recent decades, domestic violence is now being recognized as a public health problem.

For a number of years, domestic violence was viewed as a private matter only concerning a man and his wife; however, in recent decades, domestic violence is now being recognized as a public health problem. This is in part due to the lasting health effects endured by survivors of domestic violence. It is estimated that more than one million people seek medical treatment for injuries deliberately inflicted upon them by their current or former partner. But beyond the adverse health outcomes resulting from direct injuries sustained, survivors are at risk for long term health effects, including arthritis and chronic neck or back pain, and experiencing higher rates of suicide attempts, and substance abuse issues. 

In hopes of addressing this public health crisis, many states have enacted mandatory reporting laws requiring health care professionals to report specific injuries and wounds and suspected abuse. While the goals of mandatory reporting are to enhance patient safety, improve health care providers’ response to violence, hold abusers accountable, and improve domestic violence data collection and documentation, there are several considerations to highlight.

Deterrence to Seeking Care

While the goal of mandatory reporting is to keep patients safe and hold abusers accountable, mandatory reporting can sometimes have the opposite effect and deter victims from seeking treatment. For many victims, calling the police is not a safe option, for example, individuals who are part of the LGBTQ+ community or undocumented individuals, who fear that involving the police could subject them to deportation.

It is important to acknowledge the validity of the client’s concerns while also emphasizing the importance of obtaining necessary medical treatment. Attorneys can share options to minimize potential harm, including safety planning and referring clients to safe community resources and supports.Risk of Retaliation

There is also serious concern that mandatory reporting and police involvement could put the victim at risk of retaliation from their abuser.

 Limited Response to Reports

In addition, mandatory reporting has the potential to decrease the trust the patient has toward the health care provider and the justice system overall. Mandatory reporting can cause victims to develop certain expectations of protection that often cannot be met by legal and other systems.


Documentation of domestic violence is vital to addressing the problem; however, mandatory reporting may not be the most effective way to achieve useful documentation. Documentation of domestic violence in medical records can better preserve patients’ privacy and confidentialityand may also be more reliable sources of evidence for legal cases as they provide a more thorough assessment of the abuse.Ethical Issues

Finally, mandatory reporting infringes on a competent and informed patient’s ability to determine the course of action that is best suited for them. This raises numerous ethical concerns such as patient autonomy, privacy, and informed consent. In particular, mandatory reporting interferes with the confidential nature of the provider-patient relationship and in turn, decreases trust in health care providers. 

Attorneys should familiarize themselves and their clients about when HIPAA (The Health Insurance Portability and Accountability Act) allows for health care providers to disclose protected health information. Health care providers can disclose a patient’s health information to a government authority when the patient gives their consent or when the disclosure is required, as is the case with mandatory reporting laws. In most cases, HIPAA mandates that the provider inform the victim that a report has been or will be made. However, under HIPAA, health care providers do not have to inform the victim if they believe that informing the victim would place them at serious risk of harm, or if the provider would be informing a personal representative and the provider believes that the representative is responsible for the abuse.

Additional Resources

Future Without Violence National Health Resource Center on Domestic Violence

The National Health Resource Center on Domestic Violence supports health care professionals, survivors, policy makers, and domestic violence experts with the goal of improving the health care system’s response to domestic violence.