How mandated reporting threatens the safety of California’s domestic violence survivors

I remember only a few things from the days following my sexual assault. One of them was the compassion my primary care physician showed me as I told her what had happened. I was a medical student in Cincinnati in the midst of one of the most difficult parts of my second year of school.

I am grateful that Ohio — like most states but unlike California — did not require that my care provider report my assault to law enforcement. I would not have disclosed my assault to my provider if she had been mandated to report it, and I would not have received the compassionate care that I needed.

As a health care provider in California, I find it deeply disturbing that our state denies patients the autonomy that was so important to me and that I know is critical to patient health and safety.

While I was learning from my experience with intimate partner violence, I was also learning in medical school that allowing a survivor of such violence to decide when to leave and when to involve law enforcement is of utmost importance. I was taught that a patient should always be given the right to make a decision about involving law enforcement, as the decision might result in unintended consequences such as escalating violence.

In a survey of survivors of intimate partner violence, 83% of respondents said mandated reporting made their situation worse or did nothing to improve it. I was taught that involving law enforcement against a patient’s will was a violation of one of the core ethical principles of medicine: autonomy.

Beyond being a violation of autonomy, mandated reporting can prevent survivors from seeking health care. Immigrant survivors have reported not seeking care due to concerns that law enforcement involvement may result in deportation. A study of survivors found that roughly 23% of those who were advised of mandated reporting requirements stopped seeking help. When survivors stop seeking help, the risk of death and disability increases, contributing to increasing health inequities.

I left Ohio and moved to California to train in a combined family medicine and psychiatry residency program with the hopes of supporting both the physical and mental health of survivors of violence. I was honored to provide care at a clinic in a homeless shelter in San Diego where many of the patients I cared for had experienced violence.

One day, a woman entered the clinic for an evaluation following a sexual assault. I will never forget the distressed look on her face when I spoke of my role as a mandated reporter. Through tears, she begged me not to involve law enforcement. Unlike my primary care physician in Ohio, who was able to create a safe and compassionate environment for me to disclose what had happened to me, I felt that I was being asked to put reporting the assault to law enforcement above my patient’s emotional and even physical safety.

As a health care provider, it is my duty to provide care and “do no harm.” By requiring that providers disregard patient autonomy, particularly when a patient is seeking care after an extreme violation of bodily autonomy, California law compounds the trauma and denial of agency.

Because of these experiences, I wholeheartedly encourage the California Legislature and Gov. Gavin Newsom to center survivor safety and health by supporting Assembly Bill 2790, by Assemblywoman Buffy Wicks, D-Oakland. This bill would update California’s mandated reporting laws to align them with core principles of medical ethics. It would require providers to offer supportive resources and, critically, allow survivors to make their own decisions.

This story was originally published August 24, 2022 at 5:30 AM.