Training

Just ten states have enacted laws addressing domestic violence training. They are Alaska, California, Florida, Kentucky, New Hampshire, New York, Ohio, Oklahoma, Pennsylvania and Washington state.

Two Points: For a state to receive two points in this category, its law must apply to all health care professionals and involve regular and comprehensive training on screening, identification and referral for domestic violence.

One Point: For a state to receive one point in this category, its law must do one of the following:

1. Provide for training specific to domestic violence for health care professionals (can be mandatory or discretionary) at some level. May be for only public employees, all health care professionals, or another specific group. It is preferred that the training be regular (e.g. upon licensure and upon biennial re-licensure), or at specific intervals;
2. Provide one-time training only
3. Provide for establishment of training centers, or pilot programs within the state to train professionals on domestic violence;
4. Direct medical or nursing schools to develop course work to be carried out within the state; or
5. Direct a state agency to make training on domestic violence available to health care professionals;
6. Fund training centers and/or fund training efforts.

Zero Points: States with no laws on domestic violence training received zero points in this category.

Screening

Just three states have enacted laws addressing domestic violence screening. They are California, New York and Pennsylvania.

Two Points: For a state to receive two points in this category, its law must require all health care facilities to establish and adopt written policies to screen patients for the purpose of detecting spousal or partner abuse.

One Point: For a state to receive one point in this category, its law must do one of the following:

1. Require that any or certain health care facilities establish and adopt written policies to screen patients for the purpose of detecting spousal or partner abuse, or
2. Require domestic violence screening within any special population.

Zero Points: States without any laws addressing domestic violence screening received zero points in this category.

Protocols

Just eight states have domestic violence protocols in law. They are Alaska, California, Iowa, New Hampshire, New York, Ohio, Pennsylvania and Texas.

Two Points: For a state to receive two points in this category, its law must:

1. Require identification of partner abuse as part of medical screening.
2. Require documentation in the medical record of patient injuries or illnesses attributable to spousal or partner abuse.
3. Provide referral list of appropriate services and agencies to patients.

One Point: For a state to receive one point in this category, its law must:

1. Require identification of partner abuse as part of medical screening;
2. Require documentation in the medical record of patient injuries or illnesses attributable to spousal or partner abuse; or
3. Provide referral list of appropriate services and agencies to patients.

Zero Points: States without laws on domestic violence protocols received zero points in this category.

Reporting

Thirteen states have enacted domestic violence reporting laws or reporting laws for gunshot and/or life threatening injuries only. They are California, Colorado, Florida, Kansas, Kentucky, Maine, Minnesota, Missouri, New Hampshire, Rhode Island, Texas, Vermont and Washington state.

Two Points: For a state to receive two points in this category, its law must:

1. Require health care professionals to report an incident of domestic violence to law enforcement only in cases of a life-threatening injury, gunshot wound, or both;
2. Prescribe procedures for working with a domestic violence advocate or with the patients directly to explain and coordinate the patient’s safety planning with the health care practitioner’s call to law enforcement; and
3. Allow the patient to object to the release of information to law enforcement.

One Point: For a state to receive one point in this category, its law must:

1. Allow for reporting of domestic violence (or non-domestic violence) cases to law enforcement or to any other governmental agency only in cases of life-threatening injury, gunshot wounds, or both; or
2. Give the patient information that would inform the patient on how to make a report to law enforcement (not require any official reporting).

Zero Points: States received zero points in this category if they:

1. Have failed to enact laws about reporting domestic violence crimes to law enforcement or any other governmental entity;
2. Enacted a law requiring health care professionals to notify law enforcement when they treat: any injury such as a burn, any violent crime, a knife (unless the law specifies that only life-threatening knife injuries would be included), or other “dangerous weapon,” unspecified object; or injuries that are a result of any criminal “injurious conduct” or criminal activity; or an injury that would “seriously maim or render the person unconscious.” Most of the laws in this category have been on the books as part of a general policy that health care professionals must report persons who had any injuries where it appeared a crime was implicated. These laws were designed to assist law enforcement in solving crimes, and not in any way specific to domestic violence; or
3. Mandate the reporting of adult (elder) or child abuse.

Negative Grade: In this category only, a state received a negative grade if it enacted a law mandates that health care professionals report to law enforcement (or other governmental entity) any person whom he or she knows or reasonably suspects is suffering from any “wound or physical injury that is the result of abusive or assaultive conduct,” without informing the victim or obtaining the victim’s consent received a negative grade in this category.

Insurance

Twenty-two states have enacted adequate domestic violence insurance discrimination protections. They are Alabama, Arizona, California, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Maine, Massachusetts, Montana, Nebraska, New Mexico, Oregon, Pennsylvania, Utah, Virginia, Washington state, West Virginia and Wisconsin.

Two Points: For a state to receive two points in this category, its law must:

1. Apply to all lines of health, life and disability insurance;
2. Prohibit insurers from using domestic violence as a basis for underwriting or rating insurance including: denying, canceling, limiting or excluding coverage; charging a higher premium or denying claims because and individual is, has been or is perceived to be a victim of domestic violence. (This prohibition must not be limited to actions based “solely” on domestic violence because “solely” permits actions based on domestic violence with other reasons); and
3. Prohibit insurers from underwriting or rating on the basis of mental and physical conditions or claims resulting from domestic violence or, at a minimum, provide safeguards if insurers are permitted to consider abuse-related medical conditions and claims including written explanation to the applicant or insured. (Specific criteria for the written explanation can be obtained from the Women’s Law Project or the PA Coalition Against Domestic Violence) and have at least two among items listed below as number four through seven;
4. Prohibit all of the actions outlined above because of an association with victims of domestic violence including: individuals and organizations that provide shelter and other services to victims; employers and others such as family and friends;
5. Require that abuse-related information and location information be kept confidential including not transferring the information to insurance databases or other entities and that insurers develop protocols for employees, agents and contractors to ensure that interactions do not endanger the safety of the victim or result in disclosure of confidential information;
6. Provide for an enforcement mechanism that permits an individual to obtain a meaningful remedy for a single violation of the law; or
7. Provide for a private right of action.

One Point: For a state to receive one point in this category, its law must:

1. Apply to all lines of health, life and disability insurance; and
2. Prohibit insurers from using domestic violence as a basis for underwriting or rating insurance including: denying, canceling, limiting or excluding coverage; charging a higher premium or denying claims because and individual is, has been or is perceived to be a victim of domestic violence. This prohibition must not be limited to actions based “solely” on domestic violence because “solely” permits actions based on domestic violence with other reasons.

Zero Points: To receive no points in this category, a state must either:

1. Have no laws on insurance discrimination and domestic violence; or
2. Have enacted a law that fails to meet criteria one and two above. If the law discusses domestic violence and insurance discrimination, but allows for actions by insurers unless they are limited “solely” or “only” account of domestic violence, the state will get a “0" as that language is a clear loophole in the law which could allow discrimination.