For victims of domestic violence, a hospital can be a safe haven: a place for compassionate treatment, a place for respite from abuse, and perhaps more importantly, a place to devise a way out of an abusive situation. Research reveals that women of color and transgender individuals disproportionately experience violence at the hands of a partner. When African-American physician Tamara O’Neal, MD, was gunned down by her former fiancé in the parking lot of the hospital where she worked, her colleagues committed to finding ways to reduce domestic violence against minorities.
An area that’s often overlooked during medical training, domestic violence has traditionally been associated with heterosexual relationships, primarily with the male as the aggressor and the female as the victim. However, intimate partner violence—which includes physical violence, emotional abuse, sexual violence, isolation of the victim, economic abuse, stalking, and intimidation—can affect anyone. This “spectrum of violence” occurs in all types of relationships, including same-sex and heterosexual couples and former couples, after relationships end, or during a separation.
“I’ve seen patients come into the ED with extremely brutal injuries,” explains Rebecca Miller Gonsalves, MD, a fourth-year emergency medicine resident at Highland General Hospital in Oakland, Calif. “The stories they tell about controlling behaviors, physical violence, and rape … a lot of people live this every day.”
Minorities Are Disproportionately at Risk
Research shows that interpersonal violence disproportionately affects minorities. In fact, intimate partner violence affects:1
- Nearly half of American Indian and Alaskan Native women
- More than four in 10 African-American women
- More than one in three Hispanic women
Sexual orientation also increases a person’s risk: The lifetime prevalence of intimate partner violence among LGBTQ people is as high as or higher than the general population.2 More than half of transgender people (54%) have experienced some form of intimate partner violence, including acts involving coercive control and physical harm.3
Compounding the issue, transgender victims may delay care for injuries enacted by their partners because hospitals are not always welcoming to transpeople, according to Dr. Gonsalves, and many fear unnecessary questions and exams, which may be driven by provider curiosity rather than addressing the reason for coming to the hospital.
When Intimate Partner Violence Turns Deadly
As we’ve seen, domestic violence can end in homicide, and for most abusers, a firearm is often the weapon of choice. In fact, women killed by their partners are more likely to be murdered with a firearm than by all other methods combined.4 Alarmingly, the presence of a gun in a domestic violence situation can ratchet up the risk of femicide by as much as 500 percent.5
“The presence of a gun isn’t just about the risk of homicide; it’s a tool for intimidation and control,” says Dr. Gonsalves. “A person may be less likely to leave a partner if they have a gun. The highest risk of serious injury or death is after separation, according to the National Domestic Violence Hotline6.”
This was true for Tamara, who had broken off her engagement to her killer two months before her death. The glue that kept her circle of friends together, Tamara was known for cracking jokes, organizing study groups, planning celebratory dinners, and baking brownies for friends and colleagues. When she was killed in November 2018, her family and friends were stunned; this was not a person who appeared to be in an abusive relationship.
Recognizing the Signs of Domestic Violence
The truth is only about 11 percent of victims of intimate partner homicide experience some form of violence in the month before their deaths.4 Unlike what we see portrayed in the media the signs of domestic violence aren’t always easy for friends—or physicians—to spot.
“Most of my training has centered on identifying and reporting child abuse,” explains Tamara’s friend Garth Walker MD, MPH, attending emergency physician at Jesse Brown Veteran Affairs Hospital and co-investigator at Northwestern Ann-Lurie Hospital Illinois Violent Death and Reporting Systems Lab. “There isn’t a good screening measure for intimate partner violence, but there should be. The ER can be a difficult place—and a busy one—to capitalize on the moment and provide appropriate intervention, but there is an opportunity.”
Signs of domestic violence can include bruises in different stages of healing, an explanation doesn’t match the injury, or an overbearing partner who doesn’t let the patient speak.
“Often, we ask additional questions based on our own suspicions,” says Tamara’s colleague Ameera Haamid, MD, an emergency medicine attending physician at Cook County Hospital in Chicago. “We try to persuade the partner to leave the room to get the patient to open up. We ask if the patient feels safe at home, if there are guns in the home, and if they feel threatened by their partner.”
However, according to Dr. Haamid, the process isn’t perfect: “More research is needed to develop a better screening protocol and learn what evidence-based interventions work best for diverse patient populations.”
Affirming Our Commitment to Helping Communities of Color
Empowering diverse populations was important to Tamara, so it’s fitting that the Dr. Tamara O’Neal Memorial Research Fund will fuel studies to examine gun violence and intimate partner violence, particularly as they affect people of color. The goals of the fund are to better understand the warning signs of abuse and to develop evidence-based methods to prevent it. Service grants will support those addressing intimate partner violence against women of color through community-based projects in urban areas or studying violence-reduction initiatives. Mentorship grants will support underrepresented scientists and academic physicians, like Tamara, who are dedicated to supporting and enhancing communities of color.
“What I remember most—and what I hope others remember, too—is how devoted Tamara was to helping others. She uplifted communities of color through her faith, service, and mentorship,” says Dr. Haamid. “Our grants will further her legacy.”
1 U.S. Department of Health & Human Services Office on Women’s Health. (2018, September 17). Signs of domestic violence. Retrieved November 4, 2019, from https://www.womenshealth.gov/relationships-and-safety/domestic-violence/signs-domestic-violence.
2 Brown, T. N. T., & Herman, J. L. (2015). Intimate Partner Violence and Sexual Abuse Among LGBT People: A Review of Existing Research. A Review of Existing Research. Los Angeles, CA: The Williams Institute – UCLA School of Law. Accessed November 4, 2019, at https://williamsinstitute.law.ucla.edu/wp-content/uploads/Intimate-Partner-Violence-and-Sexual-Abuse-among-LGBT-People.pdf.
3 James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive Summary of the Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. Retrieved November 26, 2019, from https://www.transequality.org/sites/default/files/docs/usts/Executive%20Summary%20-%20FINAL%201.6.17.pdf.
4 Mervosh, S. (2019, July 22). Gun Ownership Rates Tied to Domestic Homicides, but Not Other Killings, Study Finds. Retrieved November 4, 2019, from https://www.nytimes.com/2019/07/22/us/gun-ownership-violence-statistics.html.
5 National Domestic Violence Hotline. (n.d.). Firearms & DV. Retrieved November 4, 2019, from https://www.thehotline.org/resources/firearms-dv/.
6 National Domestic Violence Hotline. (2019, April 12). Why Do People Stay in Abusive Relationships? – The Hotline. Retrieved November 26, 2019, from https://www.thehotline.org/is-this-abuse/why-do-people-stay-in-abusive-relationships/.