[Congressional Record Volume 141, Number 18 (Monday, January 30, 1995)]
[Senate]
[Pages S1790-S1791]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                         ADDITIONAL STATEMENTS

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                DOMESTIC VIOLENCE AS A HEALTH CARE ISSUE

 Mr. SIMON. Mr. President, one of the finest things that has 
happened in the U.S. Senate since I've been here was the election of 
Paul Wellstone.
  I was reminded of that the other day when I was catching up on my 
reading and read in the magazine Tikkun his article on domestic 
violence as a health care issue.
  It really goes beyond discussing it as a health care issue.
  He talks about the necessity to have education and be sensitive and 
to protect all of our citizens better than we are now protecting them.
  I ask to insert into the Record the Paul Wellstone article.
  The article follows:

                Domestic Violence as a Health-Care Issue

                            (Paul Wellstone)

       Domestic violence is a crime. Surely this statement is not 
     a matter of contention or debate anymore--or it certainly 
     should not be.
       But it wasn't too long ago that we did have to make the 
     argument, because domestic violence was a secret, something 
     that happened behind closed doors, a ``family matter.'' 
     Police would be called; they would arrive; and they would 
     leave. And then they would be called again. And again.
       Now, of course, it's different, because everyone knows that 
     domestic violence is a crime as pervasive--if not more so--
     than murder, armed robbery, or drug dealing. The only 
     argument now involves what to do about this seemingly 
     intractable problem.
       Domestic violence is a health-care issue. Now this is 
     something new. Once this perspective on the problem is 
     introduced, however, informed opinion-makers pause a moment, 
     think about it, and say, ``Oh, yes, of course it is.''
       But what are the implications of approaching domestic 
     violence in this way?
       Evidence indicates that domestic violence is the leading 
     cause of injury to women, more common than auto accidents, 
     muggings, and rapes by strangers combined. Indeed, it is the 
     most frequent cause for women to seek attention at hospital 
     emergency rooms. Not surprisingly, the health consequences of 
     domestic violence include bruises, broken bones, birth 
     defects, miscarriages, and emotional distress, as well as 
     long-term mental health problems.
       Although domestic violence touches men as well as women, we 
     know that women and children are the primary victims. We know 
     that the very place in which a woman and her children should 
     feel the safest and most protected--their home--is all too 
     often the most violent, dangerous, and even deadly place. The 
     emotional and physical well-being of women and children is 
     compromised when they suffer or witness abuse. And the costs 
     are staggering.
       As a member of Congress, steeped in the current health-care 
     debate, I can't and won't let this information simply be 
     stored away to be trotted out as factoids for rhetorical 
     purposes: Congress is on the threshold of actually doing 
     something to address the domestic violence health issue.
       In the course of the national debate over health care, we 
     have been hearing the arguments for comprehensive reform. The 
     prevalence of domestic violence and the toll it takes on the 
     nation's heath are two of the reasons we need health-care 
     reform that includes universal coverage, and a good, 
     affordable package of benefits.
       The victims of domestic violence are living, breathing, 
     suffering women and children. They, along with other 
     Americans who need care, give a soul to this debate that goes 
     beyond technical discussions of ``employer mandates,'' ``hard 
     and soft triggers,'' and all the other process jargon that so 
     easily takes center stage in a Washington debate.
       Health-care reform--to meet the needs of victims of 
     domestic violence--needs to include universal coverage, 
     elimination of preexisting condition clauses, public-health 
     efforts to prevent domestic violence, and training for 
     health-care providers to identify, treat, and refer victims. 
     It should contain a benefits package that includes a visit to 
     a doctor who will routinely ask about abuse and violence in 
     the family just as she asks about a history of smoking or 
     heart disease.
       Universal coverage would mean that a woman who stays in a 
     relationship because she is dependent on an intimate partner 
     for health coverage for herself and her children would know 
     that coverage was guaranteed even if she left the 
     relationship.
       Leaving an abusive relationship is already terribly 
     difficult; many of the women involved worry about not being 
     able to support their children or themselves. Many are 
     ashamed to let relatives know of the abuse. And, when women 
     do leave abusive partners, they must worry that the rage 
     behind the abuse will become homicidal. A woman seeking to 
     leave an abusive relationship should not have to worry about 
     loss of health insurance for herself and her children--
     especially when experience shows that victims of abuse are 
     heavy users of the health-care system.
       When congressional discussion turns to ``universal 
     coverage'' as being only a goal, or meaning 95 percent (or 
     so) of the population, I will be reminding my colleagues 
     about these women and their children.
       Along with universal coverage, we need to prohibit 
     insurance companies from denying coverage to people because 
     of preexisting conditions. Eliminating preexisting condition 
     clauses would protect women who are now denied coverage 
     because their medical records explicitly indicate they have 
     been battered, or because of repeated health problems that 
     have occurred as a result of domestic abuse and violence.
       The federal government should be a leader in developing and 
     implementing innovative community-based strategies to provide 
     health promotion and disease prevention activities for the 
     prevention of violence by training providers and other 
     health-care professionals to identify victims of domestic 
     violence, to provide appropriate examination and treatment, 
     and to refer the victims to available community resources.
       This should include the development and implementation of 
     training curricula that teach health-care providers to 
     identify and name the symptoms, the promotion and importance 
     of developing a plan of action should the abuser return, and 
     how to refer their patients to safe and effective resources. 
     Already we have taken some steps in this direction by 
     adopting my Violence Reduction Training Act, which is now 
     being implemented by the Centers for Disease Control and 
     Prevention.
       A comprehensive benefits package would include clinic 
     visits that gather a complete medical history and entail an 
     appropriate physical exam and risk assessment, including the 
     screening for victims of domestic violence, targeted health 
     advice and counseling, and the administration of age-
     appropriate immunizations and tests.
       This type of clinic visit would mean that a doctor would 
     ask about a history or incidents of violence as part of her 
     regular medical history interview. Doctors already ask about 
     their patients' medical history with cancer, smoking, diet, 
     or heart disease. Sadly, family violence is not something 
     about which doctors, or other health professionals, often 
     inquire.
       Some of my congressional colleagues and my constituents 
     will continue to remind me that passing this type of health-
     care reform is going to be expensive. Of course it is. But we 
     are already spending the money one way or the other. The 
     annual medical costs alone of reported domestic violence 
     injuries are astounding: A study conducted at Chicago's Rush 
     Medical Center found that the average charge for medical 
     services provided to abused women, children, and older people 
     is $1,633 per person per year. This would amount to a 
     national cost of $857.3 million. Many of these costs are 
     borne by emergency departments--the most expensive way to 
     provide these services.
       As with the current discussion surrounding the criminal 
     nature of domestic violence, we are now at the point of 
     asking: given that domestic violence is a health issue, what 
     do we do?
       One of the important things that we can do is to pass 
     comprehensive health-care reform that is universal, 
     comprehensive, and affordable. By passing comprehensive 
     reform, Congress will be taking an important step to prevent 
     and reduce the incidence of domestic violence.
       Passing health-care reform will not be a panacea for the 
     victims of family violence. In the same way that police 
     cannot solve the crime of domestic violence, health-care 
     professionals are not going to solve this problem.
       If we are to break this cycle of violence, we must 
     recognize that all of us in the community are stakeholders. 
     We all need to be involved: health-care providers, educators, 
     business people, clergy, law enforcement officers, advocates, 
     judges, media, and community residents.
       [[Page S1791]] But there is another level in this debate. 
     Even if Congress enacts health-care reform and even if 
     communities start to deal with this escalating problem, as a 
     country we are still faced with a whole host of problems that 
     we are only beginning to comprehend. For instance, we now 
     have to ask about the responsibility of the healthcare 
     community to provide leadership for community collaboration. 
     And how should the role of health-care providers intersect 
     with others in the community?
       Furthermore, the provider is now confronted with serious 
     ethical questions such as whether physicians should be 
     mandated to report information about abuse and if so, to 
     whom? Is the obligation to notify the law enforcement or 
     legal systems greater than the responsibility to respect the 
     victim's autonomy? If a victim asks that there be no action, 
     should a doctor or nurse or therapist honor the request? And 
     what are the responsibilities of health professionals with 
     regard to the perpetrators? What is the role of neighbors who 
     hear much too much through thin walls?
       I don't have all the answers to these types of questions. 
     Indeed, since we have just opened the door to this 
     discussion, I'm not sure anyone does. But that, in part, is 
     the point. We have now initiated this debate, and we have 
     begun talking as a community--knowing full well that because 
     of this conversation we will begin solving one of the most 
     devastating social and medical problems facing every one of 
     us.
       For the last two years, my wife Shelia and I have been 
     traveling throughout Minnesota, convening gatherings and 
     attending events where such issues are being discussed. The 
     conversations are having an impact. We are seeing community 
     action throughout the state, and we are seeing a tremendous 
     number of providers, judges, and police getting involved. My 
     own experience in Minnesota makes me believe that similar 
     efforts nationwide will also be successful.
       We must begin this discussion with a sense of urgency--
     peoples' lives and safety are at stake.
     

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