There is no excuse for domestic abuse--reflections on violence.

I could comment for hours about victims I’ve seen over my 25 years in the Emergency Room (ER) who were battered by those they trusted, about swollen, pulpy, fractured faces; about broken limbs, multiple bruises, stab wounds and gunshot wounds that were meant to maim; about panic, fear, hopelessness and about the deaths of some of the victims. I could comment about the horrific effects on children who witness domestic violence. Instead, I want to make the same confession I made publicly at a recent conference on domestic violence in Hilo. I am ashamed to admit for the first 7 or 8 years of my ER career, I was one of the health care providers who were ignorant of the dynamics of domestic violence. I, along with many others in the ER, police, rescue teams, victims’ families, etc., felt that battered women “asked for” this treatment. That this was their fault for not just leaving the relation ship. “Guess who the medics are bringing in again?” “Hawaiian love,” “What fools these women are,” etc. Some ER staff to this day, feel that way. Something happened to me in the late 70s that changed my outlook. I asked a big violent man why he had beaten his wife, who was a frail, retarded, Japanese woman. His reply was to savagely attempt to attack me to show me “what a real beating was.” In that instant, I realized what horrible terror these victims must feel on a daily basis. So now, 20 years later, many of us have changed our misguided attitudes, and there is a push across our state and nation to deal with the issue of violence in our society. Dedicated people like the members of the Hawaii Medical Association Domestic Violence Committee, Dr Bob McAffee and Dr Lonnie Bristow of the Ameri can Medical Association (AMA), our HMA staff, judges, prosecu tors, police, paramedics and most importantly, victim advocates, have come together to attempt to solve the domestic violence problem. We have immensely dedicated people, many themselves former victims, who run the support groups, shelters and the advocacy agencies that are so critical to the survival, emotionally and physically, of victims. So why, with the tremendous re-tooling of thinking and multidisciplinary efforts to deal with domestic violence, is this such a gut wrenching issue for me? The answer is simple: Domestic violence continues to rear its ugly head on a daily basis. This past weekend mid-Mav. 1996) in the Hilo ER. within three hours I cared for two young women who had been so savagely beaten by partners, that bones were broken. One had been a victim multiple times, and had a long-standing temporary restraining order (TRO) in place against the hatterer. Both were asked the question by ER staff and police that Mr Casey Gwinn, the prosecutor for the city of San Diego, says should never be asked: “Do you want to press charges?” Mr Gwinn says. “You don’t ask hank employees after a holdup if they want to press charges.” I’m going to free associate and express a number of thoughts. quotes. ideas and questions about this issue. I have had the privilege of attending. with my wife Diane. two very powerful conferences recently in Hilo. Both were at New Hope Church and sponsored in part by the Transition Network of Hilo and the Hawaii County Medical Society Alliance (HCMSA). The first meeting involved Mr. Casey Gwinn of San Diego along with a number of local experts. On May 24th, Ms. Denise Brown, the sister of Nicole Brown Simpson, was the keynote speaker at a conference that included a welcome by County Council chair Keiko Bonk Abramson; Gail Pincus, domestic violence expert from Los Ange les; Alana Bowman, a Los Angeles city attorney and expert on the subject; and Stephanie Launiu, Executive Director of the Bay clinic on the Big Island. There was not a dry eye in the meeting hail when Judith Fox-Goldstein of Hilo presented a moving and courageous dedication to her murdered son. On display in the room were photos and memorial displays of murdered victims of domestic violence. Diane had known personally one of the victims and her family, Lynn Kotis, from Honolulu, and I knew Steven Nagao and his family from Hilo. Both had been murdered by partners. At the opening of the session, all the victims of domestic violence were asked to stand. A huge majority of those in the room stood, including most of the speakers and Diane who had been in a brief abusive relationship many years ago. I mention all of this to emphasize how pervasive this problem is in our society and how it affects us all. The Big Island has some particularly troublesome statistics. Hawaii County leads the state in unemployment and poverty, in the rate of abuse of alcohol and other drugs and in the rate of cases of abuse of dependent adults and children. The Big Island has nearly three times Oahu’s rate of temporary restraining orders (TROs) against perpetrators of domestic violence. More than one domestic violence complaint per day is filed on the Big Island, and I’m sure many other incidents are never reported. The HMA has sent a resolution to the upcoming AMA House of Delegates meeting asking: 1) that the AMA work in conjunction with victim advocacy groups to evaluate the safety and effectiveness of policies such as mandatory reporting and 2) the AMA evaluate the desirability of uniform national stan dards for the prosecution of domestic violence cases. We are all aware of the controversy mandatory reporting creates and of the need for a secure safety net for victims. Casey Gwinn points out that this issue should not be about a dispute between two adults, but about the state or other jurisdiction arresting and pros ecuting perpetrators of the crime of battering. At the May 24th meeting, even Gail Pincus and Alana Bowman took opposing positions on mandatory reporting to police. It seemed that a majority of victims were in favor of mandatory health care provider reporting as long as there was a safe place for them to go. Another area ofcontroversv regarding violence is how much ofan association there is between domestic violence and the use and abuse of alcohol and other drugs. I have been at many meetings over