Document 6: Statement of John Nelson, M.D., Deputy Director, Dept. of Health, Salt Lake City, Utah. Senate Hearing 103-726, 13 April 1993. Hearing Before the Committee on the Judiciary, United States Senate, 103rd Congress, First Session on The Problems of Violence Against Women in Utah and Current Remedies, Salt Lake City, Utah. Serial No. J-103-11.

Introduction

       Dr. John Nelson was a practicing obstetrician/gynecologist, the Deputy Director of the Utah Department of Health, and a leader of the American Medical Association. His testimony discussed the high proportion of women who are treated at emergency rooms for domestic violence.

STATEMENT OF DR. JOHN NELSON

       Dr. NELSON. Thank you, Senator, very much. It's an honor for me to be here. For the record, my name is John Nelson, and I'm wearing several hats today. I am a practicing obstetrician gynecologist, which is how I first came in touch with this subject, unfortunately. I'm also the Deputy Director of the Utah Department of Health on a part-time basis right now, and of course a parent and husband as well. I think that the scope of this problem has been pretty well laid out for you.

       Senator HATCH. And you're also one of the leaders of the American Medical Association; is that right?

       Dr. NELSON. Well, thank you. It does not surprise me and it does not surprise most of us that you would be the kind of person that would lead this kind of effort, and I thank you for your sensitivity as well as your courage to bring forth this very difficult issue. It's difficult for all of us to talk about. The statistics are overwhelming. The amazing part is probably 37 percent or so females who come to the emergency room are there directly or indirectly as a result of abuse of some sort. Domestic violence is the leading cause of injury to females between the age of 15 and 40.

       Senator HATCH. Do you think it might be higher than that?

       Dr. NELSON. Yes; I do.

       Senator HATCH. You think that's really a low percentage?

       Dr. NELSON. There's no question that there are people coming in for things that are not verbally that. If someone comes in with a broken bone, the first thing--

       Senator HATCH. And a lot of women are afraid to say.

       Dr. NELSON. Absolutely. There's no question. And it's also very difficult, I might add, as a physician to ask those kinds of questions.

       Senator HATCH. Yes.

       Dr. NELSON. I point out to you something that has been submitted to you. Dr. George Lundberg, who was in the Journal of the American Medical Association, asked for articles a year ago and got several hundred, which have now been complied after having been proofread very carefully. One entire issue of JAMA was on the battered female, a very impressive thing to read. I think my concern today and the focus I'd like to give you--

       Senator HATCH. JAMA being the Journal of the American Medical Association?

       Dr. NELSON. Yes. The thing I would like to point out today is that this issue, in my opinion as well as the opinion of Dr. C. Everett Koop, a former Surgeon General, of Dr. Lundberg who was the editor of the Journal of the American Medical Association, that this is a public health issue as well as the other things you've heard about today and, therefore, lends itself to epidemiological research and the public health model. I think that's something we need to keep in mind very clearly.

       Hopefully, also, as we go through this tremendous change in health system reform, this will not be lost in that large millet. We certainly hope that there will be an increased knowledge on the part of the general public, the clergy, medicine, law, the legislature and law enforcement officers.

       One simple example to show you how difficult this problem is. Physicians tend to be able or feel that they're able to solve things. We have the story of a young woman who was in a terrible situation and was told by her physician repeatedly just to leave. She finally did leave, and after having gone across seven States, changing her name and so forth, one morning sitting at the breakfast nook with her 18-month-old child, a gunshot rang out hitting the child squarley in the head and killing him. The domestic violence perpetrator, in fact, was her husband who said well, if I can't have the kids neither can you, the point being that this goes on and on and continues on.

       One of the things we're trying to do is come up with some answers. These people who are victims and admit they're victims, 68 percent want to tell their physician. Unfortunately, physicians are not skilled in this area. They don't document it, they don't ask the right questions we don't know how to ask the questions, so we're trying to do that. In the Department of Health we're trying to bring together the local health officers so that we can use the existing resources to help us get where we need to get. We hope to be able to use organizations that are already in place, not make new ones, thereby costing more money. We also are trying to do a couple of things. There's so much to do, but we're trying to categorize and chronicle in a scientific way the victims of domestic violence. But more importantly from a medical standpoint, we are attempting to teach the young physicians, the students and the residents, how to ask these difficult questions. Example: If I were to ask a patient "Have you been raped?" the likely answer might be no. If I ask the question "Have you been forced to have sexual relations against your will?" a more likely answer would be yes. But if I were to ask "Are you frigtened to go home?" or in some other general way asked the question correctly, you can appreciate that if we ask the question correctly we're more likely to get the answer.

       We also want to point out to you the tremendous work that's currently being done by the American Medical Association and the Utah Medical Association auxiliaries. Among the things that these wonderful people are trying to do are to make money available for volunteer coordinators to start hospital programs to support a team where physicians can help referred patients. We also want to mention that we recognize these things are in all strains of society.

       Finally, as I conclude, I'd like to point out that this is not just the problem of other people. This is a problem of all people, Senator. This goes across all social or economic stratum, all walks of life, all races, everything you could think of demographically it goes across them stratum. We hope, therefore, that we're going to be able to come up with a meaningful way, along with your bill, to make sure that we recognize the problem, find it much earlier and prevent it. The goal obviously is to detect, if we could, to whom these things may occur and prevent them before they occur. I thank you very kindly for your attention and I'll answer any questions.

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