Mandatory reporting endagers domestic violence survivors

California is one of only several states — along with Nebraska and North Dakota — that explicitly require doctors and nurses to make police reports of adult domestic violence-related injuries, even when doing so is contrary to their patients’ wishes. While doctor-patient confidentiality and patient autonomy are basic tenets of medical ethics, California law criminalizes medical professionals who fail to report adult domestic violence to law enforcement.

Untreated injuries, decreased safety and criminalized survivors and healthcare providers are just some of the consequences of California’s outdated medical mandatory reporting law.

When it was proposed 30 years ago, the law which requires California doctors and nurses to be mandated reporters for domestic violence was opposed by the American Medical Association and domestic violence advocates. Yet it was enacted in a time of few services for survivors of abuse and scarce research about domestic violence interventions.

Now that we know better and can do better, it’s time to end mandatory police reporting by health providers that, in actuality, prevents the most vulnerable from accessing healthcare, often decreases safety for survivors and wrongly presumes police reporting as the solution to abuse.

Instead of mandated police reporting, Assembly Bill 1028 – Centering Health and Safety, introduced by Assemblymember Tina McKinnor (D-Inglewood), mandates advocacy support.

AB 1028 recognizes multiple pathways to safety, centers patient care and directs abuse survivors to vital services, including advocates who work with survivors to address safety planning, children’s needs, finances, civil restraining orders, emotional and spiritual support and emergency shelter and housing.

As domestic violence service providers, we see the harms of medical mandatory reporting firsthand.

Jenesse Center, which provides services to abuse survivors in Los Angeles County, recently had a client experience horrific acts of abuse. She entered the program with multiple untreated injuries because she avoided going to the hospital for fear of losing her children due to California’s medical mandatory reporting law. Because her healthcare was so delayed, doctors feared she could lose her leg.

Another organization in California’s Culturally Responsive Domestic Violence Network, Mujeres Unidas y Activas, worked with a client who sought healthcare following abuse but was arrested and faced deportation when her healthcare provider contacted law enforcement.

Clients of the UC Irvine School of Law Domestic Violence Clinic who seek medical care often do not disclose the cause of harm they have suffered due to fears of unwanted police contact. Without patient disclosure, doctors cannot provide early intervention in domestic violence, offer safety resources or document the abuse.

Over the last few decades, research has shown that mandatory reporting often endangers survivors. In one study, 83% of abuse survivors who experienced medical mandatory reporting said it made their situation much worse, somewhat worse or did nothing to improve it. In addition to medical mandatory reporting interfering with patient confidentiality and choice, it has been noted to “result in case identification which is biased against minorities.” Extensive research has established that mandated police involvement disproportionately harms survivors of color, LGBTQ survivors and immigrants who lack secure immigration status, and it particularly escalates homicide rates for Black survivors.

In contrast, when survivors are able to openly disclose abuse to their nurses and doctors, research by the University of Pennsylvania has shown they are four times more likely to utilize domestic violence resources and agencies, which is key to their safety.

Like domestic violence, mandatory reporting to police removes survivors’ autonomy and self-determination in deciding what is best and safest for them. Instead, our organizations are focused on health and survivor services, believing medical providers can be powerful allies for domestic and sexual violence victims and that survivors should have access to healthcare separately from criminal legal systems.

Jane Stoever is a professor at the UC Irvine School of Law and director of the UCI Law Domestic Violence Clinic and the UCI Initiative to End Family Violence. Karen Earl is the CEO of Jenesse Center, Inc. and co-lead of the Culturally Responsive Domestic Violence Network.