Meeting Information

family_violence_council

2009 2008 2007 

Family Violence Council:

Addressing Violence throughout the Lifespan

 

MINUTES

Thursday, July 17, 2008

3:00 pm – 4:30 pm

400 McAllister St.Room 617

San Francisco, CA 94102

 

Members Present (denoted with x):

 

I.          CALL TO ORDER/ AGENDA CHANGES              

Beverly Upton called the meeting to order at 3:05 pm, and altered the agenda to include introductions (I. Call to Order, A. Introductions); to omit the update on the Animal Care and Control discussion under Old Business (IV. Old Business, A. Animal Care and Control Presentation) as that department’s representative could not be present; and to include a discussion of the Domestic Violence Death Review Team along with the presentation of child and elder death review teams (V. New Business, A. Death Review Teams).

Action: Approved agenda changes as stated. (m/s/c: Boyd/Roye/Unanimous)

No public comment.

 

A.        Introductions

Members and participants introduced themselves. Approximately 30 Council members and members of the public attended the meeting. 

 

II.        APPROVAL OF MINUTES            

Action: Approved the meeting minutes from April 17, 2008. (m/s/c: Shamji/Upton/Unanimous)

No public comment.

 

III.       ANNOUNCEMENTS

 

A.        Release of San Francisco Violence Prevention Plan

Department on the Status of Women Executive Director Dr. Emily Murase reported that the Mayor’s Office of Criminal Justice (MOCJ) released the Violence Prevention Plan in June 2008.  Many members of the family violence prevention community worked with MOCJ on this plan, but the final version did not include many sections related to family violence that had been proposed in previous drafts.  The Department on the Status of Women is in the process of drafting a letter to the head of MOCJ to express disappointment in this failure to recognize the importance of including family violence in the violence prevention plan.  At the request of Council members, the Department on the Status of Women will share this letter.  The Department encourages everyone to thoroughly read the Plan, available on MOCJ’s website (www.sfgov.org/mocj), to become fully apprised of its contents and how they might or might not relate to their agency’s work.  The Department encouraged the Family Violence Council to release an official statement as well.

 

B.        Child Support Services Automated System

Karen Roye of Child Support Services (CSS) reported that they are in the process of converting to an automated system for client records.  This system will be linked to the Human Services Agency for cross-reporting.  As they create the system, they are ensuring that it includes indicators for identifying domestic violence in a family system in order to link that family to appropriate resources and services.  CSS will continue to report back to the Family Violence Council on their progress with this system, and may call on the membership of the Council for technical assistance in the future. 

 

IV.       OLD BUSINESS                                                                                

 

A.        Animal Care and Control Presentation Update

Discussion tabled until October 16, 2008 meeting.

 

B.        Photo Documentation of Injuries

Since the April 17, 2008 meeting of the Council, Dr. Leigh Kimberg has begun research about an appropriate protocol for digital photo documentation of injuries, as digital photography is now the standard accepted by the courts.  She has visited the Keller Center in San Mateo, a forensics center that documents injuries for all 3 types of abuse in 1 office next door to the emergency room at the hospital.  Though the Keller Center does not have a finalized or documented protocol for using digital photography, the process works quite well.  Additionally, the Keller Center has put Dr. Kimberg in contact with a consulting firm that trains agencies about digital documentation protocols in California.  Dr. Kimberg will inquire about setting up a group training with this consultant and invite the Family Violence Council contacts.  Interested parties should contact Dr. Kimburg at lkimberg@medsfgh.ucsf.edu to receive additional information about this training. 

 

C.        Collaborative Training of 911 Dispatchers

Though no representatives from the Department of Emergency Management (DEM) attended the meeting, the group discussed the fact that many different agencies train 911 dispatchers on various aspects of family violence.  As DEM is a 24-hour operation and must often offer overtime in order to send staff to trainings, coordinating training efforts could be beneficial to that agency.  The Family Violence Council steering committee will arrange a meeting with DEM representatives to discuss the logistics of a combined training, and the type of information that could and should be included. 

 

V.         NEW BUSINESS

 

A.        Death Review Teams

The steering committee created a chart, “San Francisco Death Review Teams Summary,” provided at the meeting and available on the Family Violence Council website.  This chart summarizes the differences and similarities in protocols for the Death Review Teams operating in San Francisco.  The steering committee proposed releasing a Report on the State of Family Violence in San Francisco at the end of the calendar year.  This report would take into consideration statistics and data collected by the death review teams, analyzing trends in deaths and highlighting possible gaps in services or system response.  This data could also be used in relation to the Violence Prevention Plan (discussed above), with the number of deaths and other violent incidents showing that family violence is just as important to address in citywide prevention strategies as street violence. 

 

1.         Overview of the Medical Examiner’s Office:  Dr. Amy Hart, Chief Medical Examiner

The Medical Examiner’s (ME) Office is a unique department under the General Services Agency within the City government structure.  The purpose of the ME’s Office is to investigate sudden, unexpected, and violent deaths that occur in the City.  Approximately 8,000 deaths occur each year in San Francisco.  Of those, about half are referred to the ME’s Office, and about a quarter are investigated.  The 4,000 deaths that are not referred to the ME’s Office are generally for individuals that have known medical conditions, are attended at the time of death, and are in the care of a doctor who signs the death certificate, generally in a hospital or hospice setting.  Those deaths that are referred to the ME’s Office are deaths of individuals that die unattended; have an unknown identity; have any suspicious circumstances surrounding the death or any possibility of homicide, suicide or accident; or have no relatives to make arrangements for the body.  The ME’s Office also does live consults in cases where a victim sustained life-threatening injuries but lived, such as in cases of sexual assault or domestic violence, and the ME’s Office has a lab that processes specimens for the police department related to cases of date rape involving chemical impairment (i.e. date rape drugs).  Chief Medical Examiner Dr. Amy Hart serves as co-chair of both the Elder and Child Death Review Teams. 

 

2.         Child Death Review Teams

Except in cases of well-documented illness and physician-attended death, almost all child deaths are referred to the ME’s Office, and all of these referred deaths are reviewed by the Child Death Review Team (DRT).  A primary focus of the Child DRT is prevention, whether within that family or throughout the City.  For example, in cases of child abuse, the DRT is able to assess whether other children in that home may be at risk.  The DRT can also uncover citywide trends, such as SIDS or Shaken Baby Syndrome, and create an education campaign aimed at addressing the trend. 

 

The San Francisco Child DRT currently serves as a pilot site for a new assessment protocol aimed at standardizing assessment statewide.  The new protocol assesses for domestic violence in the home, as well, and should provide excellent data for a report on the state of family violence in San Francisco. 

 

3.         Domestic Violence Death Review Teams

The Attorney General mandates that Domestic Violence DRTs only review adjudicated cases, making the timeframe for these reviews much longer, especially taking into account the lengthy appeals process many domestic violence homicide cases go through.  This mandate was designed to protect the evidence and witnesses’ testimony in these cases.  There has been a recent reduction in domestic violence deaths in the past decade, which is a positive trend, but the result is that the DV DRT meets infrequently and can get “rusty” on protocols.  The Family Violence Council, in its original incarnation, oversaw the DV DRT.  Drafters of the new Council legislation removed this oversight responsibility.  Though not mandated to report to any body except the Attorney General, the DV DRT can provide general statistics to be included in a report on the state of family violence in San Francisco. 

 

4.         Elder Death Review Teams

The Elder DRT has 2 primary purposes: 1) to identify systemic issues or gaps in order to refine prevention efforts, and 2) to identify cases of elder abuse and neglect for possible prosecution.  Currently, there is only minimal prosecution of elder abuse cases, and the elder abuse community is conducting a significant amount of education to increase the rate that these cases are identified and charged.  One challenge that the Elder DRT faces is the high volume of cases.  As there are so many elder deaths, Adult Protective Services and the ME’s Office share information to flag cases for possible elder abuse or neglect.  This works fairly well for the 50% of cases that are referred to the ME’s Office.  APS is still trying to set up a similar system to flag suspicious deaths in the cases that do not get referred.  For example, the Elder DRT has not reviewed any cases of deaths at nursing homes.  These are often deaths of elders with documented illnesses in the care of a physician, but it is possible that these physicians have not been trained well enough to spot cases of abuse or neglect by staff at the nursing home.  Cases can also be referred to the Elder DRT by any member of the DRT, an agency that works with elders, or the District Attorney.  Additionally, agencies can flag a case for review by the ME’s Office pre-death if they suspect abuse or neglect is a factor in that individuals severe decline in health.  The Elder DRT only reviews cases of elder deaths (adults at least 65 years old).  Currently, there is no review of deaths of adults with disabilities aged 18-64 other than standard criminal justice investigations of suspicious deaths.  Legislation to include review of deaths of adults with disabilities is pending.  Elder victims of domestic violence may have 2 reviews of their death, first by the Elder DRT, and, once criminal proceedings have been finalized, by the DV DRT. 

 

The Elder DRT has been responsible for identifying trends in elder deaths.  Because of the review process, the elder abuse network created awareness campaigns, and has done significant work in educating caregivers about what constitutes neglect as a prevention mechanism.  Coroner and Medical Examiner investigators still need more training about what neglect looks like on the body of an elder victim. 

 

Doctors must screen for abuse in order to appropriately code a death as related to child, elder or domestic abuse.  Dr. Kimberg gave the example of a victim of domestic violence dying from an asthma attack.  Because the doctor treating that victim did not screen for domestic violence, he did not consider that that victim may have been prevented from accessing his inhaler or outside assistance by his abusive partner, leading to his death. More training of doctors about the importance of screening for abuse is necessary. 

 

B.        Topics for Future Meetings

The steering committee will consider the ideas suggested by participants in planning future meetings of the Family Violence Council:

• The role of mental health in family violence, and addressing mental health in prevention and intervention efforts
• Children of incarcerated parents
• Safeguards for family violence victims residing in homeless shelters and SROs
• A review of a San Francisco General Hospital study done about homelessness and domestic violence (by Dr. Beth Kaplan)
• A review of a Department of Public Health study done about deaths related to violence (by Deirdre Forte)
• Discussion about youth batterer intervention programs, such as the Youth Family Violence Court program
• A discussion about economic empowerment and self-sufficiency as a method of domestic violence and family violence prevention

 

C.        Current Trends in Family Violence

There was no discussion for this agenda item.

 

VI.       PUBLIC COMMENT                                                           

There was no public comment.

                                               

VII.      ADJOURNMENT                                                     

The Family Violence Council adjourned at 4:30 pm.

 

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