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Groundbreaking programs at San Francisco General Hospital may well change the way the entire U.S. health care system deals with domestic violence. To understand why, you have to understand Dr. Beth Kaplan.

Wednesday, Apr 18 2001

Page 3 of 4

It sounds simple, but -- outside of the hospitals in the Family Violence Prevention Fund's pilot program -- this type of intervention was almost unheard of in hospital settings.

It may not be a stretch to say there has been more research about the lack of domestic violence programs in health care than there has been about the programs themselves. One of the most significant of those studies was conducted at S.F. General by Michael Rodriguez, a family physician and researcher there. In 1999 he found that only about 10 percent of primary care doctors bother to ask patients who are not already injured about violence in their lives. At most emergency rooms, the number is almost certainly lower.

S.F. General is only one of a tiny handful of hospitals to screen for and intervene in domestic violence cases; it is the first to try to assess the effectiveness of medical intervention in domestic violence cases. Researchers -- led, again, by Kaplan -- interviewed 120 people about changes in their quality of life after they were confronted about their abuse during hospital interventions. Almost 90 percent of them returned for a follow-up interview four to six months later, an astonishing statistic considering the high-stress environments most of the patients were coming from.

Other domestic violence experts say the return rate alone is nearly proof the intervention succeeded. That trust in the health care setting isn't lost on Kaplan.

"For a lot of these women, [the intervention] is the first time they realize that what's happening to them is an issue," Kaplan says. "And because they feel safe in a hospital, and because they trust their doctors and nurses, they're willing to talk about things they might not anywhere else."

Deirdre Anglin, a renowned domestic violence researcher at the University of Southern California, says that Kaplan's follow-up work on health care intervention in domestic violence is unprecedented and could change the way victims of partner violence are treated throughout the health care system.

"We've been pushing very hard to get health care providers to do DV survivors," Anglin says. "But, if you're going to intervene -- these are expensive programs -- what you need to know is: Does it work? If it does, then we'll replicate it all over the country."

The higher-ups at S.F. General have been moved enough by the anecdotal evidence from the intervention study (a formal analysis won't be finished until sometime this summer) to act on the results. The hospital's psychiatry department has already received $1.4 million in state budget grants for an off-site recovery center tailored to the needs of victims of violent crime.

Because about half of the people injured during violent crimes develop psychological or social difficulties in the months and years that follow, the center is intended to provide what psychiatry department head Robert Okin calls "treatment and wraparound services," which link victims not only with medical staff, but also with relevant city services. The center will also let victims avoid the stigma attached to battered-women's shelters. It is not unusual, in San Francisco and around the country, to find hospital-affiliated centers dedicated to rape and sexual assault victims. The new center planned by S.F. General apparently will be the first to also screen for and serve domestic violence patients.

Her Saturday shift is over, and Beth Kaplan is soaking up what's left of the early spring sunlight over an Israeli beer outside the metal-hued Universal Cafe, a few blocks from the hospital. She's wearing a black leather jacket with a red alligator purse slung over her shoulder, a body-hugging white waffle-knit shirt tucked into her scrub pants.

Beneath a boxy pair of gold-rimmed shades, she's laughing about how, just 24 hours earlier, she was almost paralyzed in bed thanks to her occasionally crippled back. The pain kicked in, this time, after 12 hours in the ER on Wednesday (7 a.m. to 11 a.m., followed by 11 p.m. to 7 a.m., with a full slate of meetings in between), followed by an appointment-filled Thursday. To cope with the pain, she uses a Middle Eastern therapy called Feldenchrist, which essentially involves the relearning of the body's most basic movements. The way she holds her head talking on the telephone or leans over a patient, for instance, can have an effect that is subtly crippling.

This, of course, isn't the first time she's worn herself down. Her days in Boston, juggling the emergency work with the groundbreaking ectopic pregnancy research, took their toll as well. But she's quick to point out that "it was good work," valuable fodder, as it turned out, for a bunch of medical niche publications, including emergency room pamphlets. Which was nice. But this domestic violence project might just land her in the über- prestigious Journal of the American Medical Association.

And that thought gets her grinning.

"The ectopic pregnancy stuff was, umm, kind of, uh ..."


"Yeah," she laughs. "This work should appeal to a more general audience."

But that audience will have to wait a bit longer: Even though the data from her follow-up interviews is all gathered, she says it'll take her a month or two longer to write up the findings. And, having finished the reporting, Kaplan suggests the piece will, in the end, include as much human interest as hard science. "We meant for this to be a scientific study, but we kind of got involved," she says.

No one in San Francisco General Hospital's emergency room -- at least, no one who worked on Tony Zachary's wife -- will ever forget what he did to her that March night in 1999. After stripping off her clothes, shoving a sock in her mouth, and tying her to her bed with electrical chords, he repeatedly burned her with a curling iron. "He took his time," a police investigator told a San Francisco Chronicle reporter at the time, noting that the victim would be scarred for life. "This is an evil, evil act."

About The Author

Jeremy Mullman


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