An Unhealthy Situation

Twenty years ago, Denver led the way in dealing with domestic violence. While other cities were just beginning to recognize the plight of battered women--hell, in some states it was still legal for a husband to rape his wife--Denver was funding safehouses, establishing police protocols and reconfiguring courts to provide prompt legal recourse.

Last Thursday, to mark the start of Domestic Violence Awareness Month, Denver celebrated two decades of progress--and progressive thinking--at a City Hall ceremony saluting local people and programs that have worked to stop domestic violence. The Denver Domestic Violence Coalition handed out awards to Denver County Court judge Brian Campbell, Denver coroner Dr. Tom Henry and Project Safeguard, which does legal advocacy work for battered women.

The fourth recipient was the Denver Police Department's Victim Assistance Unit, which has professional crisis mediators on call 24 hours a day, ready to do advocacy work for victims of sex assaults and domestic violence.

It's a trendsetting unit whose work is honored everywhere--everywhere, it seems, but at its hometown hospital.

Denver Health Medical Center's emergency room has a national reputation for its proficiency in dealing with physical traumas. But when it comes to a victim's emotional traumas, the hospital has fallen woefully--and willfully--behind the times.

Although other local hospitals welcome the Denver Police Department's victim advocates, Denver Health does not.

If a member of the DPD's Victim Assistance Unit responds to a domestic-violence or sexual-assault call and then accompanies the victim to Denver Health, that advocate is denied access to the emergency room. If a patient at the hospital asks to see a DPD victim advocate, that request is denied.

These public servants have not been allowed to serve where they are needed most.

The problem, says one cop, is turf wars. Denver Health is "very territorial," another service provider complains. "Since they broke free from the city, they're doing their own thing," adds a former hospital employee. "The social workers [at the hospital] feel threatened. It's a matter of control."

Dr. Hannah Evans worked at this hospital, then known as Denver General, from 1972 until 1977. In 1974, when Denver had the highest rape rate in the world, Evans and another DGH psychologist created a program to train crisis-intervention volunteers, who would then work with rape victims admitted to the hospital emergency room. The procedure wasn't easy to implement, but it soon became a national model.

And almost as quickly, an obsolete model. As violence against women was increasingly recognized as a major mental-health issue, more advanced counseling programs were introduced. Not at Denver General, however. Evans herself was raped in 1982; when she arrived at DGH, she was stunned to find the procedure essentially the same as it had been when she'd been an employee there.

And the situation has not improved much with time. This spring Evans learned that not only was Denver Health failing to participate in the extensive local community of victim service providers (a network so strong it's been awarded a Department of Justice demonstration grant to create a national prototype), but the hospital also was not allowing DPD victim advocates to counsel patients. And at the same time, victim groups were complaining that Denver Health social workers often weren't available when they were needed--and sometimes weren't effective when they were available. Whereas volunteers had been cutting-edge in 1975, the services currently provided at Denver Health were "below community standards," Evans determined.

On April 2 Evans took her complaints to Dr. Patricia Gabow, CEO of Denver Health, and Dr. Michael Earnest, the hospital's medical director of quality review and improvement. And she kept repeating them through the summer. "Your anti-victim policy represents bad medicine, bad social work and bad social policy," she wrote Earnest on July 23. "It violates the Hippocratic Oath: First do no harm. By refusing to allow the crime victim her choice of companion in the hospital, you retraumatize the victim by separating her from her first source of support, validation and information (in the body of the DPD victim advocate). This separation is arbitrary and serves no one."

Adding insult to actual injury, Evans continued, the hospital's social-services department then failed to recommend specialized treatment for patients. "The victim is being revictimized, this time by Denver Health," Evans concluded. "And for what? Territoriality and protectionism."

In August Evans sent Earnest a letter noting that over three months had passed since she'd pointed out a flawed policy that could have been changed in a day. She included an article from the August 5 edition of JAMA. "Since 1992," the piece noted, "the Joint Hospital Commission on Accreditation of Healthcare Organizations has required the emergency departments and ambulatory settings of all accredited hospitals to implement policies and procedures to identify victims and to treat or refer victims for treatment...When abused women are not identified, they are susceptible to increased health problems compared with women who are not abused as measured by more frequent [emergency room] visits, additional hospitalizations, and increased use of outpatient health-care facilities."

At Denver Health, however, the director of social services is not even a state-licensed social worker. Evans took note of that in a September 1 letter. "Your failure to change your policy continues to defy logic and rationality," she wrote. "I'm incensed, and I'm not going away until you join the community of service providers to crime victims."

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