Over the last four years, St. Joseph's Regional Medical Center in Passaic County, N.J. has helped 90 victims of domestic violence get 39 restraining orders, all from the emergency room and without their ever needing to set foot in a courthouse. That's thanks to off-the-shelf Polycom videoconferencing technology and a partnership with a local Passaic County judge's office.
That number may seem really low -- barely even a drop in the ocean, when you consider that nonprofit Safe Horizon estimates one in four American women (and more than three million men) will face domestic violence in their lifetimes. And it is low. But it's also a light pointing the way forward, even as it spotlights how far the law has to go to intelligently apply technology to real problems faced by millions of Americans.
Domestic violence is a serious American problem -- a U.S. Department of Justice study in 2000 found that 1.3 million women and 835,000 men were physically assaulted by a partner every year. There's little to suggest those numbers have gone down in the intervening decade and a half. If anything, they may skew low.
A major tool for victims to fight back is the restraining order, which ideally provides a legal protection against the perpetrator. But they can be hard to get, and harder still to enforce; the kinds of people with restraining orders against them aren't exactly rule-abiders, according to Psychology Today.
Even so, it's helpful when hospitals like St. Joseph's allow patients to get restraining orders. When victims are in the emergency room, and the trauma is still fresh, there's a higher likelihood they'll take the extra step and confer with a judge. At the same time, once a victim is in the hospital and talking to health workers, the perpetrator has a nasty tendency to get scared that their crime will be made public -- putting the victim at even greater risk.
"We know the most dangerous time for a victim is when they get help," said Roberta Valente, vice president of policy at the National Domestic Abuse Hotline.
The setup at St. Joseph's -- up and running since mid-2010 -- is simple: There's a webcam at the hospital and a matching one in a conference room at a Passaic County courthouse, where a judge talks the victim through their complaint. The advantage of using video conferencing is that the judge can get a better sense of the victim's state of mind and the situation at hand. For younger victims, especially, talking to a judge via video chat is mundane. Similarly, the staff sees the system as another tool in their arsenal, not complicated technology that requires special training.
"From my perspective, the technology is the easy part," said Jane Tsui-Wu, CIO of the St. Joseph's hospital system.
The much bigger challenge comes from the specificity of Passaic County law. If the victim is still around -- during business hours, 8 a.m. to 4 p.m. -- and the patient lives in Passaic County, and the perpetrator lives in Passaic County, and the incident took place in Passaic County, and the victim is sheltered in Passaic County, then a judge can maybe discuss issuing a temporary restraining order (TRO). In New Jersey, a TRO can be upgraded to a full restraining order with the presentation of more evidence, as a New Jersey law firm helpfully lays out.
It's not exactly the nail in the coffin of domestic violence, but it gives victims more legal avenues to protect themselves. If nothing else, Tsui-Wu said, just making the call to a judge can be helpful in building a case down the line.
"It takes certainly more than one intervention by a health service worker" before most are even willing to make that call, Tsui-Wu said.
The next step, Tsui-Wu said, is to work more closely with the court system to make the program available around the clock, with someone always on call to issue TROs. More TROs served means more victims protected. But that will depend on increased engagement by the justice system; the technology is already available.
In the meantime, Tsui-Wu likes having this tool in her hospital's toolbox, as health workers, nonprofits, the police, and the court system work to stem the problem of domestic violence. Tsui-Wu's team is working with more hospitals in New Jersey to get similar setups elsewhere, and she noted that other hospitals in the U.S. have similarly small, modest programs in place.
St. Joseph's has been able to take advantage of local laws that allow flexibility when seeking TROs. While laws vary from state to state and county to county, most jurisdictions require a victim to actually go to a courthouse, which can place a victim at risk.
Historically, police and medical professionals have teamed up to help domestic abuse victims using technology, according to the Hotline's Valente. In the 1990s, police officers in rural Washington State counties who got called out to answer a domestic dispute -- and who wanted to make sure a perpetrator actually left the house -- would call a local judge, who then faxed a court order to the police precinct, she said. The cops would drive back to town, pick it up, and return to the scene with more legal leeway to ensure the safety of the victim.
This is just the "logical outgrowth" of those kinds of initiatives, Valente said.
But a major advantage to the St. Joseph's approach, Valente said, is that the judge can actually see the victim and make a more informed decision, without additional intervention by police. And while it may seem like St. Joseph's isn't making a much headway if you just look at the raw numbers, Valente said it's an important step forward.
"If other jurisdictions see it, they're going to want to roll it out," she said.
In the meanwhile, Valente urged technology companies to engage with local health workers and get them up to speed on similar technologies that can save lives. St. Joseph's and the hospitals it's working with to deliver TROs via telepresence could well point the way to a new model for the whole country.
"I'm very proud that we have the technology to help these patients," Tsui-Wu said.