When domestic violence arrives at the clinic door

Staff members at DeLand Animal Hospital in DeLand, Florida, received an unusual request in late May. A client slipped them a note that said: "Call the cops. My boyfriend is threatening me. He has a gun. Please don't let him know."

Carolyn Reichle had allegedly been held in her home for two days, beaten and threatened by her boyfriend, Jeremy Floyd. She eventually convinced him that her dog needed to go see the veterinarian, according to a police report.

Floyd insisted on going with her, and on the car ride over, he pointed a loaded gun at her and threatened to kill her and her family, according to the report.

The receptionist at the animal hospital called police, who arrested Floyd. He was found to be carrying a loaded gun. Reichle was taken to an area hospital and treated for a head injury, a black eye, and bruised arms.

As evidenced in this situation, veterinarians and other practice staff members have the potential to play a lifesaving role in the prevention of and response to domestic violence. Although their primary responsibility is to the animal, they also have an opportunity to be both educators and witnesses.

In fact, veterinarians, veterinary technicians, and front-office staff have a unique advantage in ensuring successful prosecution of domestic violence perpetrators, according to Michele Laaksonen, PhD. She is executive director of Madeline's House, a nonprofit in Virginia that provides services for individuals and families experiencing domestic and sexual abuse. She gave a presentation at AVMA Convention 2018, July 13-17 in Denver, on domestic violence and how veterinary practices can address the issue.

Bearing witness

Abusers of children, intimate partners, and the elderly often have histories of committing animal cruelty.

There is no patient-doctor confidentiality. The pet is the patient, not the client. Your role is basically with the pet. You go as far as you can preparing the human and animal to leave the situation and hope other systems come into play with whatever human services are available.

Michele Laaksonen, PhD, executive director, Madeline's House, a nonprofit in Virginia that provides services for individuals and families experiencing domestic and sexual abuse

In a study published in 1983 in the International Journal for the Study of Animal Problems, a survey of pet-owning families with substantiated child abuse and neglect found that animals were abused in 88 percent of homes where physically abused children were present. Further, a study published in 1998 in the Journal of Emotional Abuse found that, among women seeking shelter at a safe house who also owned pets, 71 percent affirmed that their partner had threatened, hurt, or killed their companion animals.

Years ago, when Dr. Laaksonen was running a domestic violence shelter in New York, she helped create a task force on animal abuse. The task force looked at the intersectionality of pet abuse and various forms of domestic violence. One of the reasons the task force came about was because Dr. Laaksonen found that perpetrators of abuse weren't being convicted or even prosecuted, with a unique exception.

"Judges and juries do not like when Fido is hurt," Dr. Laaksonen said. "While it's a little easier for people to question why a person didn't leave or acted the way they did, animals are innocent, and people get emotional when someone is cruel to an animal. Those cases often got the victim away from the perpetrator more successfully than a sexual assault case."

Animal cruelty and protection laws can sometimes result in greater success in having cases go to court, as well. Felony animal cruelty provisions exist in all 50 states. And frequently there is a mandated psychology assessment and treatment for those convicted of pet abuse, although that's not necessarily the case for those convicted of domestic abuse.

"So going from the angle of pet abuse can be more successful in the short term getting (victims) out of the home and then long term for (perpetrators) getting away from those tendencies," Dr. Laaksonen said.

She added that many times when people think about violence toward animals, they only consider dogs and cats, but it could be toward other species as well. Dr. Laaksonen gave the example of a case in which a man stepped on a pet fish in front of a child, and prosecutors charged him with animal abuse.

Educational materials

With regard to preventing domestic violence in the first place, education has an important role, both for veterinary staff and for potential victims. According to a 2017 JAVMA article (J Am Vet Med Assoc 2017;250:42-45), in an ideal world, staff members would receive formal training in recognizing and addressing domestic violence and animal abuse. Short of that, veterinary practices can take three approaches that could save human and animal lives by potentially reducing the amount of time women experiencing domestic violence delay in seeking help.

"Veterinarians and others could be of assistance in this area by helping to disseminate information about (intimate partner violence) and local resources that help victims and their pets, developing a relationship-centered care model, and establishing partnerships with local violence protection agencies," the authors wrote.

Specifically, types of information that could be incorporated into flyers, brochures, or a clinic website might include findings from studies exploring the relationship between domestic violence and animal abuse, advice for establishing an emergency plan of action that includes one's pets, signs of animal abuse, legal requirements for establishing pet ownership, and contact information for local animal organizations and domestic violence shelters that accommodate pets, according to the article.

Further, Dr. Laaksonen recommends veterinarians familiarize themselves with not only the state laws on animal cruelty and domestic violence but also with the policies and people at local domestic violence shelters and animal control. The National Link Coalition has a regular newsletter that gives legal updates on animal cruelty and domestic violence at the state and national level.

The Pet and Women Safety Act of 2017 has been added to the Senate version of the 2018 Farm Bill. The PAWS Act would amend the federal criminal code to broaden the definition of stalking to include conduct that causes a person to experience a reasonable fear of death of or serious bodily injury to his or her pet. Additionally, an interstate violation of a protection order would include interstate travel with the intent to violate a protection order against a pet that is included within the scope of the protection order. The act would specify the applicable criminal penalty—a prison term of up to five years, a fine, or both—for a person who commits an interstate violation of a protection order against a pet.

With respect to a defendant who commits a domestic violence offense or an interstate violation of a protection order, mandatory restitution in the "full amount of victim's losses" would include costs incurred for veterinary services related to the pet.

The House and Senate have both passed their own versions of the farm bill and were moving to conference the two into one bill as of press time; the House version does not include PAWS.

Taking note

Veterinarians also can prevent and address domestic violence by making screening a part of their everyday work. Dr. Laaksonen recommended starting with intake of new clients.

"Just establish this is something you talk about. If you do it later on, the victim might be defensive about being labeled a victim," she said. "It's also nice to show evidence of behavior beforehand than just evidence of what's happening later" with regard to animal abuse.

She says to look for inadequate grooming, medical care, and provision of basic needs for the animal as well as limited social interaction with other animals or fearful interactions with humans.

"When we see animals abused, it could be there isn't a human victim yet," she said. Signs that the risk is heightened include the frequency and type of injuries to the animal along with how close the partner or child was when the pet was injured. Injuries by fire and mutilation are red flags.

Notably, a recent literature review suggests children who abuse animals may have been abused themselves.

While the review did not prove a cause-and-effect link between child abuse and animal abuse, kids ages 10 and older who intentionally hurt animals were found to be two to three times as likely to have been abused as kids who treat animals with respect, said the British researchers who conducted the review.

The association appears to increase with age. For example, the odds of cruelty to animals being an indication of physical abuse are about three times as high in 5-year-olds but five times as high in 12-year-olds. In addition, the researchers found that children who witness violence between their parents are about three times as likely to abuse animals.

"Asking about a history of animal abuse in a safeguarding history should be commonplace, and information sharing between veterinary and child services should be promoted to protect vulnerable children and animals," the authors wrote.

The study was published in August in the journal Archives of Disease in Childhood (Arch Dis Child 2018;103:801-805).

For adult clients, Dr. Laaksonen recommends referencing the Power and Control Wheel when there is suspected abuse. The wheel is based on the Duluth Model, which is a program developed to reduce domestic violence against women. She said clinic staff could have the wheel handy and ask the client if any of the categories apply to her.

"When you ask, make sure it's face-to-face in a confidential space. Be direct and nonjudgmental. Give resources and referrals" to other agencies that can help, Dr. Laaksonen said.

She continued, "There is no patient-doctor confidentiality. The pet is the patient, not the client. Your role is basically with the pet. You go as far as you can preparing the human and animal to leave the situation and hope other systems come into play with whatever human services are available."

In addition, she encourages veterinarians to reach out to domestic violence shelters to form a collaborative relationship. Veterinary professionals could train shelter staff on screenings for pet safety, putting together safety plans for pets, and how to spot signs of pet abuse.

A guide for veterinarians and other practice staff members asking questions related to domestic violence

When to ask questions:

• Intake of new clients.
• Routine history or health assessment.
• When abuse is suspected.

What to ask:

• What are family members' attitudes toward the pet?
• Is there an order of protection?
• Are there any safety concerns you have?
• Are there any obstacles in providing care for the pet?
• Questions about signs of abuse and interpersonal violence, using the Power and Control Wheel.

How to ask:

• Face-to-face in a confidential space.
• Directly and nonjudgmentally.
• With resources or referrals.
• With appropriate responses:
  - "I believe you."
  - "No one deserves to be hurt."
  - "There are resources available."

Source: Michele Laaksonen, PhD