development of a forensic physical exam protocol …
TRANSCRIPT
DEVELOPMENT OF A FORENSIC PHYSICAL EXAM PROTOCOL FOR COMPANION ANIMALS ENTERING DOMESTIC VIOLENCE SHELTERS WITH THEIR OWNERS TO
EVALUATE FOR PATHOPHYSIOLOGICAL SIGNS OF ANIMAL ABUSE
By
NANCY BRADLEY-SIEMENS
A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILMENT OF THE REQUIREMENTS
FOR THE DEGREE OF MASTER OF SCIENCE
UNIVERSITY OF FLORIDA
2017
© 2017 Nancy Bradley-Siemens
3
ACKNOWLEDGMENTS
I would like to thank my advisory board: Dr. Randall Lockwood, Dr. Beverly
McEwen, and Dr. Sarah Kirk for their guidance and patience with me through this thesis
process. I would also like to thank Dr. Jason Byrd for his support and calming effect.
Special thanks go to my graduate veterinary student Tiffany Riddle for her support in
this project. Special thanks also to Dr. Melissa Thompson, Lead Veterinarian, of the
Arizona Humane Society, Second Chance Animal Trauma Hospital.
4
TABLE OF CONTENTS page
ACKNOWLEDGMENTS .................................................................................................. 3
LIST OF TABLES ............................................................................................................ 6
LIST OF FIGURES .......................................................................................................... 7
ABSTRACT ..................................................................................................................... 8
CHAPTER
1 INTRODUCTION ..................................................................................................... 10
2 DOMESTIC VIOLENCE AND COMPANION ANIMALS .......................................... 12
The Link .................................................................................................................. 12
Domestic Violence Animal Sheltering ..................................................................... 14
Case Example ........................................................................................................ 16
Notes ...................................................................................................................... 17
3 COMPANION ANIMAL FORENSIC PHYSICAL EXAMINATION ............................ 18
Forensic Physical Exam .......................................................................................... 18
Diagnostic Laboratory Testing ................................................................................ 21
Radiographs ........................................................................................................... 21
Examination of a Deceased Animal ........................................................................ 22
Note ........................................................................................................................ 22
4 DOMESTIC VIOLENCE SHELTERS ....................................................................... 24
Survey ..................................................................................................................... 24
Animal Accommodations .................................................................................... 24
Veterinary Care .................................................................................................. 24
Animal Abuse ..................................................................................................... 25
Summary Findings .................................................................................................. 25
5 PROTOCOL PARAMETERS ................................................................................... 26
Procedures and Cost .............................................................................................. 26
Protocol Evaluation ................................................................................................. 28
6 NEXT STEPS .......................................................................................................... 30
5
Notes ...................................................................................................................... 32
7 CONCLUSIONS ...................................................................................................... 33
APPENDIX
A RESEARCH SURVEY ............................................................................................. 36
B DOG AND CAT PHYSICAL DIAGRAMS ................................................................. 41
REFERENCE LIST........................................................................................................ 43
BIOGRAPHICAL SKETCH ............................................................................................ 46
6
LIST OF TABLES
Table page 3-1 Recommended series of forensic radiographs of entire body ............................. 22
5-1 Time and cost of protocol procedures ................................................................ 27
A-1 Survey Questionnaire with tabulated responses................................................. 37
7
LIST OF FIGURES
Figure page 3-1 Forensic Physical Exam Flow Chart ................................................................... 23
B-1 Dog Physical Diagram with the permission R. Riesman DVM of ASPCA ........... 41
B-2 Cat Physical Diagram with the permission R. Riesman DVM of ASPCA ............ 42
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Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Sciences
DEVELOPMENT OF A FORENSIC PHYSICAL EXAM PROTOCOL FOR COMPANION ANIMALS ENTERING DOMESTIC VIOLENCE SHELTERS WITH THEIR OWNERS TO
EVALUATE FOR PATHOPHYSIOLOGICAL SIGNS OF ANIMAL ABUSE
By
Nancy Bradley-Siemens
December 2017
Chair: Jason H. Byrd Cochairman: Bruce A. Goldberger Major: Veterinary Medical Sciences
Domestic violence in the United States is a national problem. It involves the
entire family, of which companion animals are an integral part.32 The family pet is used
as a pawn to coerce and cause submission of victims in the process of domestic
violence. The animal is threatened with harm, is harmed, or even killed to facilitate
control by an abuser within a family unit. When the abused plan to seek refuge in a
domestic violence shelter, the pet may delay their departure from the abusive
environment due to limited accommodations and care for animals in a domestic
violence shelter.
Through innovative programs and collaborative efforts between domestic
violence shelters and animal welfare agencies, these issues are beginning to be
addressed. However, unlike their human victim counterparts, the initial veterinary care
that is provided to companion animal victims of domestic violence is often minimal at
best. Injuries sustained acutely or chronically may not be obvious during a cursory
physical examination and vaccination. The companion animal requires a forensic
physical examination to rule out animal abuse. This thesis discusses a forensic physical
9
examination protocol of companion animals entering domestic violence sheltering with
their owners. The protocol is designed to be utilized by any qualified veterinarian,
regardless of prior forensic training or experience. The procedure is assessed and
evaluated based on actual application and cost.
An anonymous survey of Arizona Domestic Violence Shelters was conducted.
The focus of the survey was to determine organizational awareness of animal abuse
and domestic violence issues, types of animal accommodations, veterinary care within
domestic violence shelters, and willingness to participate in a forensic physical
evaluation of companion animals entering these shelters with their owners. The majority
of respondents (10/12: 80 percent) were aware that the lack of animal accommodations
may delay entry into a domestic violence shelter.
Funding and educational proposals are discussed to facilitate the protocol as an
initial program at a state level among domestic violence shelters within the state of
Arizona. The future ramifications and benefits of such a program are discussed in
relation to domestic violence and a One Health System of medical care that will
enhance both human and animal health and safety.
10
CHAPTER 1 INTRODUCTION
Domestic violence is a national problem. It encompasses interpersonal violence,
child abuse, elder abuse and animal abuse. Currently only 36 percent of domestic
violence shelters nationally offer any form of pet accommodation.29 These
accommodations include on site pet sheltering at the domestic violence shelter and off
site sheltering effected by collaborative efforts with animal welfare agencies, veterinary
clinics, boarding facilities, and fostering programs. These pet accommodations are
important because they may mean the difference between a woman entering or
delaying entry into a domestic violence shelter. Depending on the source, between 18
and 48 percent of women delay entering a domestic violence shelter because they may
not be able to enter with their companion animal.21,22
In answer to this there are multiple programs being developed, assisting
domestic violence shelters with pet sheltering in progress. More effort is necessary, but
the movement is present and growing.
In the state of Arizona there are thirty-three domestic violence shelters.5 Eleven
of these shelters offer some form of accommodation for animals.4 Two offer onsite
animal shelters and the other 9 have offsite amenities consisting of partnerships with
animal shelters, veterinary clinics, boarding facilities, and fostering programs.4 Certainly
more is needed, but Arizona’s existing domestic violence shelters are in statistically
speaking better shape than the national levels.4,5 This makes the state of Arizona a
favorable forum to evaluate any companion animals entering these facilities with their
owners for signs of abuse.
11
Available sheltering for companion animals, is essential, but so too is the
veterinary care necessary for these potential victims of domestic violence. Women and
children entering a domestic violence shelter in many instances will receive a medical
examination and psychological evaluation even when outward injuries are not visible.
This is based on interviews with medical and psychiatric directors at a local domestic
violence shelter. Companion animals entering the various animal sheltering programs at
best will receive vaccines, a cursory exam, and surgical sterilization. There aren’t
currently any mandatory veterinary care requirements for domestic violence facilities
that shelter animals in place. It is up to the individual organization. Many try to mirror
local animal shelter practices such as vaccinations and sterilization.
Companion animals are considered to be part of the family unit.32 Dogs and cats
are uniquely involved in domestic violence in the family unit; animals are threatened,
injured and even killed in the course of domestic violence episodes. No matter what
type of pet sheltering is utilized by a domestic violence shelter, each companion animal
should require a thorough forensic physical examination upon entry to rule out animal
abuse and neglect.
This thesis proposes a forensic physical examination (FPE) protocol that can be
performed by a qualified veterinarian regardless of forensic training or experience, to
evaluate a companion animal for animal abuse. A pilot study evaluating the use of this
protocol was completed. Consideration of an initial program at a state level within
domestic violence shelters offering any form of animal accommodation within that state,
potential funding opportunities, and future applications and benefits of data acquired is
also discussed.
12
CHAPTER 2 DOMESTIC VIOLENCE AND COMPANION ANIMALS
The Link
Companion animals are an integral part of human life in today’s society. Pets are
in 63 percent of United States households.1 Over 70 percent of United Sates
households with children have pets.2 Having a pet is associated with more chances of
social interaction and health benefits.33
Domestic violence is the interpersonal violence caused by the behavior of one
partner against another in an intimate relationship to control and to maintain power over
the other partner.28 These types of behaviors are assaultive and coercive in nature,
encompassing physical, sexual, and psychological abuse used against an intimate
partner.31 Animal abuse is defined by Frank Ascione as: “Socially unacceptable
behavior that intentionally causes unnecessary pain, suffering, or distress to and/or
death to an animal.”7 There are a wide breath of definitions of animal abuse and
diversity across many states.6
In Arizona Revised Statutes animal abuse is defined as:
“A. R. S. § 12-1011; § 13-2910 - 09. A person commits cruelty to animals if he or she intentionally, knowingly or recklessly subjects any animal under the person's custody or control to cruel neglect or abandonment, fails to provide medical attention necessary to prevent protracted suffering to any animal under the person's custody or control, inflicts unnecessary physical injury to any animal, or recklessly subjects any animal to cruel mistreatment, among other things. Animal is defined as a mammal, bird, reptile or amphibian. Exclusions include hunting and agricultural activities in accordance with those laws and regulations in Arizona. Intentionally attending a dogfight is a felony under this provision whereas attendance at a cockfight is a misdemeanor.”
Arizona is a mandatory reporting state for animal abuse and animal fighting.3
13
Actual reasons or motivations for intentional animal abuse are diverse; however
nine typologies have been consistently observed and documented by Kellbert and
Felthous.23 These include: to control an animal, to retaliate against an animal, to
retaliate against another person, to satisfy a prejudice against a species or breed, to
express anger through an animal, to enhance one’s own aggressiveness, to shock for
amusement, to displace hostility from a person to an animal, and to perform non-
specific sadism. Their study illustrated the multiple dimensions of animal abuse and that
only rarely was a single reason or motivation encountered.21
Studies that investigate experiences associated with child, adolescent, and adult
abuse of animals are categorized into four areas composed of: personal experience of
child abuse, witnessing abuse directed at humans and animals, the simultaneous
occurrence of human directed violence and animal abuse, or other criminal acts
observed from childhood to adulthood.21 One of the most replicated findings
establishing a link between human violence and animal cruelty is the consistent
simultaneous occurrence observed in domestic violence and animal abuse.11,13,16 In
many instances the primary abuser is a male within the family unit. A more appropriate
term is primary aggressor.18 Throughout the literature women and children appear to be
the predominant victims of a primary aggressor. However, either sex may be the
primary aggressor in a domestic violence incident18 resulting in some form of animal
abuse. Data from the past decade indicates more than half of domestic violence victims
have companion animals.29 In up to 50 percent of these cases, animals are abused by
the primary aggressor as a means of injuring and/or controlling the victim of domestic
14
violence. The domestic violence victim may delay leaving a dangerous abusive
environment out of concern for their companion animal’s safety.21
In a national study by Ascione, more than 71 percent of battered women reported
their abusers had threatened to harm, harmed, or killed animals in the household and
32 percent reported their children had harmed or killed family pets.6,9,10 One of the
earliest studies to evaluate a relationship between animal abuse and child abuse
reported that 88 percent of homes with physically abused children also had an abused
or neglected pet.17 Research has also confirmed 62 to 76 percent of animal abuse in the
home occurred in front of a child.20 Children may make attempts to protect their mother
or pet from the abuser incurring injury to themselves.19
Children who experience domestic violence are three times more likely to exhibit
abusive behavior towards animals than children not exposed to domestic violence,16
and these traits can be indicative of future abuse toward other animals and humans.11
Animal abuse episodes were concurrent with violent altercations towards human family
members 51 percent of the time.13
The link between people and animal abuse is well documented by research.
According to Phillips, “violence to animals is a predictor that an abuser may become
violent to people and vice versa. Abuse is abuse no matter what the form or whom the
victim.”30
Domestic Violence Animal Sheltering
There are only 36 percent of domestic violence shelters nationally that have any
form of accommodations for companion animals.29
Two of the most well-known domestic animal sheltering documents are Safe
Havens for Pets: Guidelines for Programs Sheltering Pets for Women Who are Battered
15
and Sheltering Animals and Families Together (SAF-T Program): Start-Up Manual.8.29
Both documents provide crucial pet sheltering information to domestic violence shelters.
These documents discuss housing companion animals on site at the domestic violence
shelter and off-site through partnerships with animal welfare agencies at their animal
shelters or utilizing foster resources. Additional offsite placement is usually with local
boarding facilities or veterinary clinics, but could be as simple as finding animal
accommodations within the community.
There are various ingenious efforts underway in all 50 states within domestic
violence facilities to accommodate animals. There are Safe House programs initiated by
nonprofit and municipal animal shelters that will house the companion animals in their
shelters for a finite period of time without charge to the domestic violence victim. This
gives advocates at the domestic violence center crucial time to obtain the victim pet
friendly housing. There are nonprofit groups such as the Animal Welfare Institute and
Red Rover (nationally) and local groups that act as conduits to find domestic violence
and animal welfare agencies to facilitate placement of companion animals involved in
domestic violence episodes. A unique program that offers fostering by veterinary
students is the Pet Safe Program. This is run by the Center for the Human-Animal
Bond, School of Veterinary Medicine, Purdue University. Other veterinary colleges in
the U.S. are offering similar programs to foster animals effected by domestic violence.15
In addition to housing, these companion animals are given limited veterinary
care; consisting of vaccines and sterilization surgery. This may be done by veterinarians
from emergency and private practice, animal shelters or academia. These types of
services are provided through donations, grants and foundation contributions to
16
domestic violence shelters, animal welfare agencies and other nonprofit entities
assisting in these efforts.
All of the efforts discussed above are commendable, however only the SAF-T
document by Phillips discusses the need for an in-depth physical for each companion
animal to rule out animal abuse in these animals exiting violent family environments.
When the human victim counterpart enters a domestic violence shelter they will receive
a physical and psychological evaluation unless declined. * The companion animal may
not be looked at for several days if at all. The animal will usually be updated on its core
vaccines and only receive a physical by a veterinarian if the pet needs to be surgically
sterilized. *
Case Example
In May 2016, I was involved in an animal abuse investigation. The animal was a
feline domestic shorthair, neutered male, approximately two years of age. A woman
who was a victim of a domestic violence relationship for over two years decided to
report her abuser. In the course of her interview with a domestic violence police
detective she stated her abuser had killed her cat three months prior. Additionally, she
stated her abuser had choked and thrown the cat against walls in the home on multiple
occasions.
I assisted with the exhumation of the cat’s body from the victim’s parents’
backyard approximately three months after death. The remains were necropsied by a
board-certified veterinary pathologist. Radiographs and computed tomography (CT)
were performed prior to the necropsy. There was blunt force trauma to the ribs and
coccygeal vertebrae. There was a pericardial rupture with acute and sub-acute pleural
effusion consistent with recent trauma and was suspected to be the cause of death.
17
This case resulted in a felony plea agreement for animal abuse and additional domestic
violence charges.
The significance of this case is accentuated in the diagnostic tests that were
performed as well as the gross necropsy. The cat had eight rib fractures with callus
formation at various stages of healing and some had completely healed. There were
additional vertebral fractures with callus formations at various stages of healing. These
findings were consistent with the cat having sustained a long history of multiple abusive
episodes in the past. If the victim had entered a domestic violence shelter with this cat
three months earlier these injuries may not have been apparent without a forensic
physical examination. A forensic exam encompasses a thorough physical exam,
incorporating diagnostic blood work, whole body radiographs, extensive documentation
of injuries via diagrams/photography, and evidence identification and collection.
Notes
1. The author had personal communications with Sojourner Center medical and psychology managers about care for human victims.
2. The author personally experienced working with veterinary students on a shelter rotation at a community domestic violence facility with an onsite animal shelter. Unfortunately the above is standard practice currently.
18
CHAPTER 3 COMPANION ANIMAL FORENSIC PHYSICAL EXAMINATION
A forensic physical examination (FPE) is essentially an extension of the physical
exam veterinarians are already trained to perform. A physical exam report should
always be an accurate and thorough document dictated by a state’s veterinary practice
act. A FPE expands this to produce a report that will stand as a legal document in a
court of law.
A FPE has three basic components routinely performed together: a physical
exam, diagnostic laboratory tests, and radiographs. Any history or additional evidence
pertaining to the animal will be obtained and evaluated. (Figure 3-1) The animal’s entire
body will be scanned for a microchip.
Forensic Physical Exam
The physical exam will begin with overall photographs of the individual animal.
There will be nine photos minimum identifying the animal in total. The photographs will
start with a marker board with identifying information or some type of identifying card
taken with the animal. This information should contain the animal information
(signalment; i.e. age, sex, color, breed), the case information (i.e. case number, police
agency), and date and time. The marker board or placard should be photographed with
the face (head) of the animal and the side of the animal. Basic photographs will begin
with a frontal head photo and of the teeth on one side. Only one side of the teeth need
be photographed unless the teeth are the area of interest. Both the left and right side,
and the front and rear of the animal will be photographed. The dorsal area of the dog
and ventral (elevate animal on its hind quarters) area will be photographed. Any injuries
will be photographed before and after treatment, both with and without measurement.
19
Video with and without sound provide additional documentation of the animal
patient.25,27 This will document any abnormal behavior, sounds, or injuries effecting
ambulation or neuropathies. Video is invaluable if the veterinarian is allowed access to
the animal’s environment (crime scene) for assessment of injuries and relevance of any
evidence found on the animal during the FPE.
Photograph (Summary):
• Head with Placard
• Side View with Placard
• Front/Back Views
• Teeth on one side
• Left and Right Side Views
• Dorsal/Ventral (elevate animal) Views A thorough external exam is conducted to identify any obvious injuries or healed
injuries. Special consideration should be given in identifying any abnormal odors,
foreign objects and substances on the fur. These may need to be collected for further
evaluation or analysis. During this initial process, diagrams of the cat or dog (Appendix
Figures B-1 and B-2) may be very beneficial and will compliment and photographs
obtained. Additionally, at this initial stage the animal’s entire body may be examined
with an alternative light source (ALS), i.e. an ultraviolet light 360 nano-meters, in a
darkened room looking for any human bodily fluids especially, around the animal’s
genital areas. Initially a Wood’s Lamp may be used as a screening ALS source. If
samples are suspected and considered for collection more advanced ALS units can be
used.12 This type of equipment may need to be considered based on caseload. An oral
exam, specifically the teeth, and the feet (claws) should be evaluated for any foreign
material that may be present if the animal defensively bit or scratched an abuser.25
Special care should be taken to collect any potential forensic evidence as soon it is
20
identified. If this is done by the veterinarian, insure proper techniques are adhered to
according to local law enforcement or forensic laboratory specifications. Local law
enforcement if involved, may want their crime scene (forensic) analyst to collect
suspected forensic evidence. This should be decided prior to this type of investigation.
The animal’s Body Condition Score (BCS) needs to be assessed. The most
common scoring system used is the Purina Condition scoring system for dogs and cats.
The Purina Scale uses a BCS of 1 through 9. A BCS 1 is emaciated, 2 very
underweight, 3 thin, 4 lean, 5 ideal, and 6-9 indicates overweight.24 The physical exam
will record the weight, temperature (contraindicated if urogenital fluorescence is
observed), pulse, respiration, mucous membrane color, and capillary refill time. The
hydration status will be assessed. The remaining physical examination will assess each
system: cardiovascular, respiratory, gastrointestinal, urogenital, neurological,
integumentary, and musculoskeletal. An otoscopic and optic exam is performed. Other
orifice exams need to be evaluated dependent on the course of the examination
findings.25
Although subjective, document the animal’s state of comfort, attitude, demeanor,
and pain level during the initial assessment. Pain levels can be assessed using the
Colorado State University Acute (Canine or Feline) Pain Assessment Scale or the
Glasgow Composite Measures Pain Scale. Behavioral traits should be explored either
through history or animal care provider observations pertaining to toileting habits,
reactions to noise, disobedience, feeding (eating) problems, and general
destructiveness. Additional behavioral evaluations may be necessary, but are beyond
the scope of this thesis.
21
Diagnostic Laboratory Testing
A complete diagnostic workup should be performed by an accredited veterinary
diagnostic laboratory. This is similar to a standard diagnostic workup encompassing a
complete blood cell count (CBC), complete blood chemistries, urinalysis, and fecal.
Additional blood work depending on the region might include testing for; Ehrlichia,
Coccidiomycosis, Heartworm, Babesia (prevalent with Pit-bull fighting) etc. These need
to be included to rule in or out the presence of significant diseases or define lack of
treatment for them. Most laboratories will have a panel that can address the above
pathogenesis. In addition to common companion animal abnormalities observed via
fecal and urine diagnostics, these analyses may become critical in the event of sexual
assault for identification of human semen and other venereal diseases specific to
humans. This needs to be considered in the collection process and these samples will
have to be sent to a forensic laboratory.
Additional diagnostic screening may be needed for toxicants. This might be in
suspected poisoning cases or in the event an animal has ingested or has been given an
illegal substance. This may beyond the scope of a local diagnostic laboratory; however,
they can offer additional recommendations for further diagnostic testing at a university
or other laboratory.
Radiographs
Whole body radiographs are essential. The use of sedation is at the
veterinarian’s discretion and considered on a case by case basis. Dr. Elizabeth
Watson, a forensic board-certified radiologist, advocates a minimum of 10 to 18
radiographs encompassing the entire animal’s body. * (Table 3-1) The number of
radiographs required depend on the animal’s size. The radiographs starting from the
22
head should overlap. The lateral views will begin with the head extending from the nose
to the middle of the cervical vertebrae, then the chest, abdomen, pelvis and tail, whole
leg each side, then ventral/dorsal views obtained of the listed items, placing the animal
on its back. In small dogs and cats, the lateral and ventral/dorsal views may incorporate
the limbs. In larger breed dogs each limb may have to be divided in half for each lateral
and ventral/dorsal view to evaluate each limb in its entirety. Whole body radiographic
examination is the minimum. If more evaluation is required and can be obtained,
computed tomography (CT) and ultrasonography can offer additional forensic
information, via local specialist or universities.
Table 3-1. Recommended series of forensic radiographs of entire body
Body Region Views of Body
Head Thorax Abdomen Pelvis/Tail Individual Limbs
Caudal-Rostral, Dorsal-Ventral, or Ventral-Dorsal, Lateral Ventral-Dorsal, Right/Left Lateral Ventral-Dorsal, Lateral Ventral-Dorsal, Lateral Ventral-Dorsal, Lateral
Examination of a Deceased Animal
An external examination of a deceased animal with suspected non-accidental
injury is similar to a forensic physical examination. It will consist of an external
examination and radiographs. The guidelines discussed for a FPE can be applied prior
to a forensic necropsy by a board certified veterinary pathologist. A forensic necropsy
should be performed when a companion animal is found deceased in connection to a
domestic violence altercation.
Note
1. The author had personal communications with Dr. Elizabeth Watson, Forensic Boarded Veterinary Radiologist, regarding number of radiographs and recommended views to be obtained.
23
Figure 3-1. Forensic Physical Exam Flow Chart
24
CHAPTER 4 DOMESTIC VIOLENCE SHELTERS
According to the Arizona Department of Economic Security there are 33 licensed
domestic violence shelters within the state.5 There are 11 facilities with some form of
accommodations/resources for animals; 2 with onsite animal shelters and 9 with offsite
resources.3
Survey
A confidential survey was sent to the 33 domestic violence centers within Arizona
inquiring about animal accommodations, knowledge of animal abuse and its link with
domestic violence, legislative issues and veterinary care of companion animals beyond
basic sheltering. The survey was conducted voluntarily through Survey Monkey
(Appendix A-1, A-2) from June to July 2017. Twelve (36 percent) of the domestic
violence shelters responded to the survey. The survey was approved by the Institutional
Review Board at Midwestern University, Glendale, AZ, IRB AZ #1038. A follow-up of
non-respondents was not done.
Animal Accommodations
Not all of the respondents had accommodations for animals; only 25 percent did.
Over 50 percent of the respondents were aware of the severe shortage of animal
sheltering capabilities in domestic violence facilities. The majority of respondents (80
percent) are aware the lack of animal accommodations may delay entry into a domestic
violence shelter.
Veterinary Care
Those facilities that have animal accommodations use a contract veterinarian (25
percent), partner with rescue/shelter group veterinarians (38 percent), or have no
25
access to veterinary care (37 percent). The majority of these types of domestic violence
facilities have no or only minimal requirements for animal care, when animals enter their
scope of care and control. Some requirements may consist of core vaccines or
sterilization. Over 80 percent of those with animal accommodations do not perform a
basic physical exam on the companion animal upon entry into their facility or scope of
control.
Animal Abuse
The majority of respondents do not or are currently unwilling to pursue (bring)
animal abuse charges in cases of suspected animal abuse. If protocols were in place,
approximately 55 percent of the organizations would proceed with animal abuse
prosecution. Approximately, 90 percent of the respondents are willing to cooperate with
intake protocols to insure an animal abuse case could be pursued by a partnering
animal welfare agency. None of the respondents were aware of current legislative
attempts or statutes such as the Pets and Women Safety Act (PAWS) and additional
funding it might provide.
Summary Findings
Many organizations did have some potential access to veterinary care or were
aware of some resource. Not all domestic violence shelters surveyed had animal
accommodations, but with assistance would be willing to participate in protocols where
companion animals were involved, with animal abuse prosecution, in conjunction with
domestic violence investigations.
26
CHAPTER 5 PROTOCOL PARAMETERS
The FPE protocol proposed in this thesis is the application of a physical work-up
for companion animals all veterinarians are qualified to perform, but with increased
attention to detail and documentation. At minimum, this protocol will ensure the correct
information is collected to establish if an act of animal abuse is suspected to have
occurred recently or in the past. The protocol was described in detail in the previous
chapter. This chapter address the individual procedures and cost involved. Additionally,
the actual use of the protocol in a local humane society that routinely participates in
animal abuse investigations was tested.
Procedures and Cost
A fifty-pound dog was being sedated for a general work-up and provided an
opportunity to accumulate relevant protocol information regarding times to perform
individual components of the forensic work-up.
The dog was photographed using the nine different views for description and
documentation previously described. The task was completed in just less than ten
minutes. The physical exam from nose to tail was accomplished in approximately five
minutes. The dog was given a pre-anesthetic, then sedated with a general anesthetic,
intubated, and maintained on isoflurane within a span of twenty minutes. The entire
body was scanned with an alternative light source (black light) in a darkened room
within four minutes.
The next stage involved acquiring diagnostics. Blood was drawn via the jugular
vein (two minutes), a cystocentesis was performed (one minute), and fecal material
collected (one minute).
27
Continuing under sedation whole body radiographs were obtained as previously
described. For a dog this size eighteen radiographs were required. The task was
completed within twenty minutes. Recovery from sedation required approximately
twenty minutes.
The entire FPE protocol was completed in one hour and twenty-three minutes.
(Table 5-1) These times may be much shorter with a small breed dog or cat. Sedation
should be utilized at the discretion of the veterinarian on a case by case basis with the
health of the animal and clinical staffs’ safety being considered.
The radiographs were taken with a digital x-ray machine at the participating
humane society. The cost of the radiographs and interpretation would have been
$640.00 as charged to the public. The usual charge for an abuse case exam is billed as
an emergency exam at $60.00. The actual cost to the humane society considering each
digital radiograph and technician time was $44.00. The diagnostic tests were sent to
IDEXX. The cost for the lab work as previously described was $200.50. The actual total
cost for a basic forensic physical work up was $265.50.
Table 5-1. Time and cost of protocol procedures
Procedure Time Actual Cost to Clinic/Facility
Photographs Physical Exam Pre-Anesthesia/Anesthesia Alternate Light Scan Blood Draw (Jugular) Cystocentesis/Free Catch Fecal Collection Whole Body Radiographs Recovery from Sedation
10 minutes 5 minutes 20 minutes 4 minutes 2 minutes 1 to 5 minutes 1 minute 20 minutes 20 minutes
$21.00 *** *** *** $44.00
*** IDEXX Laboratory $200.50. Test conducted on 50-pound mix breed dog < 1.5 hours, total cost $265.50.
28
Protocol Evaluation
A local humane society that actively participates in animal cruelty investigations
offered assistance in using the proposed forensic physical exam protocol. I provided
shelter clinicians there with a one page description and procedural flow chart of the
forensic physical protocol and asked that they use the proposed protocol in three cases
and offer feedback for review and consideration. An additional three cases were utilized
with the proposed protocol with any suggested changes and/or recommendations.
Their first concern was the behavioral questions. A normal animal abuse case is
worked up immediately in their facility where it might be delayed a few days for an
animal being admitted with its owners to a domestic violence shelter. They can consult
with the humane investigator about what was observed on scene, but that would only
provide limited information versus an animal that was observed by kennel staff over a
longer period. However, it was agreed these types of questions, even observed briefly,
warrant asking and consideration. Photographs of the animal are usually performed by
the humane investigator in their facility. It was a bit cumbersome for the medical staff
having to alter their normal procedure; however the clinicians agreed a veterinarian
unfamiliar with this process or not associated with humane investigation should follow
the photographic guidelines.
Alternative light sources (ALS) were usually only used in suspected animal
sexual abuse cases. This addition to their basic forensic exam was well received. Whole
body radiographs were routinely used in forensic cases. The one difference from the
protocol was that their skull series utilized oblique views in addition to ventral-dorsal or
dorsal-ventral and lateral views. The suggested caudal rostral view from the protocol
29
instead of the oblique views was well received. It more clearly defined skull fractures
than the oblique views in the absence of computerized tomography.
Addressing diagnostic testing, currently the humane society veterinary clinicians
order a complete blood cell and chemistry panel with regional diseases such as
Coccidiomycosis and Erhlichiosis. Usually a urinalysis and fecal diagnostics are not
collected or pursued with the exception of an animal sexual abuse case due to cost.
The veterinary clinicians agreed it would be good practice to collect these samples on a
more routine basis in the event they might be required or utilized. During the course of
research for this thesis the author was asked to consult on a possible animal sexual
abuse case. It was discussed and recommended in addition to a urinalysis collected via
cystocentesis that a free-catch urine sample be collected as part of the forensic work
up. This is certainly a valid concern for potential sperm collection in the case of
suspected animal sexual abuse.
In summary it was suggested a free-catch urine sample be added in the
diagnostic portion of the forensic exam protocol. It was agreed that all diagnostic
samples suggested in the protocol should be collected as early as possible for
consideration, dependent on organizational financial resources. It was also advised that
the radiographs be obtained as soon as possible to insure any injuries documented
were sustained prior to entering the domestic violence shelter sphere of control. In
discussions with the shelter veterinary clinicians’ additional advice was to ensure
veterinarians involved in these types of forensic examinations are familiar with evidence
collection techniques in the event evidence is identified on the animal, and where these
samples would go for analysis and interpretations.
30
CHAPTER 6 NEXT STEPS
The next step is the implementation of this FPE protocol in those animals coming
from a domestic abuse environment, no matter what type of facility they will be
sheltered in, as their owners enter a domestic violence facility. This is best achieved
through training of the suggested forensic exam protocol. The veterinarians assisting or
responsible for companion animal care while their owners are in a domestic violence
shelter can be diverse. These veterinarians may be contract veterinarians in general or
emergency practice, shelter veterinarians, faculty veterinarians with students from a
state veterinary college, or forensic veterinarians. The protocol was readily adopted by
humane society veterinarians in the test group.
In Arizona, where the author is located, the veterinary college, Midwestern
University College of Veterinary Medicine, is located in the central portion of the state,
Glendale, Arizona. The University would be willing to host at minimal or no cost, a
training conference dedicated to implementing a forensic based protocol for animals
entering a domestic violence shelter with their owners. This type of conference can be
underwritten by organizations such as American Society for Prevention of Cruelty to
Animals (ASPCA), Humane Society of the United States (HSUS), or Pet Smart Charities
(located in Phoenix, AZ). An amount of $5,000 to $10,000 would cover a 1.5 or 2-day
conference for 15 to 30 veterinarians in a 200-mile radius already working with
companion animals in some form having been in domestic violence environments.
According to the Arizona Department of Economic Security (DES) the predominant
demographic areas of domestic violence in Arizona are the most populated regions of
31
Arizona, the Phoenix and Tucson metro areas.4 These are also where many of the
state’s current domestic violence shelters are located.
The main agenda of the conference would be training and application of the
physical forensic exam and applications of its use in both live and deceased animals.
There would be discussion about relationship of domestic violence and animal abuse.
Discussions about current animal abuse and state domestic violence statutes would be
explored. Additional information would be presented on possible funding sources
(grants) for the coverage of veterinary cost of the forensic exam (workup) from
organizations such as Red Rover and Veterinary Care Foundation that provide funding
to veterinarians for care of animals related to a domestic violence episode. * Local
animal shelters and domestic violence shelters could be invited to an organized panel
discussion with veterinarians to brainstorm collaborative efforts to raise awareness and
funding for this type of veterinary care and its importance to the One Health System
benefitting both animals and humans. The conference might end with a round table or
panel discussions with veterinarians, and personnel from animal welfare agencies,
domestic violence agencies, and state social agencies discussing current issues and
future directions in a collaborative manner to address domestic violence and animal
abuse.
The Arizona Veterinary Medical Association issued a statement in regards to this
proposal and training: “The AZVMA supports further research to develop a standardized
physical examination of companion animals that enter a domestic violence shelter with
a victim and the potential impact on animal and human health and safety.” *
32
Notes
1. Red Rover and Veterinary Care Foundation are both national organizations that currently provide funding for veterinary care to animals injured in as a result of domestic violence. (http://www.redrover.org/redrover-relief-domestic-violence-resources) (http://vetcarefoundation.org/content.php?type=HOW)
2. Personal communications with the AZVMA by the author led to their potential future support.
33
CHAPTER 7 CONCLUSIONS
The thesis discussed the link between domestic violence and animal abuse.
There are direct implications that animal abuse committed in conjunction with domestic
violence whether it is used as coercion to control a family member, animal abuse
directly witnessed by children, its long-term effects on them as adults, or the sheer
totality of interpersonal violence affecting all family members including the family pet.
Companion animals are victims and can sustain physical harm and injuries in episodes
of domestic violence. These events need to be identified, documented, and addressed
in the totality of domestic violence.
Companion animals require the same attention both for medical and
prosecutorial reasons as humans do as victims of domestic violence. This can only be
accomplished via a thorough forensic physical examination and diagnostic testing. As
animal sheltering coinciding with domestic violence sheltering continues to increase in
momentum to facilitate human and animal exodus from abusive situations, so too does
the need to perform forensic physical examinations. This collaborative effort in
sheltering provides an opportunity to perform forensic physical examinations on
companion animals. There is a potential to obtain more data from these examinations
for better understanding and documentation of animal abuse as it relates to domestic
violence. The forensic physical examination protocol described in this thesis will assure
this occurs. Any veterinarian regardless of background or training can perform this type
of examination and acquire the necessary diagnostics to support the finding of past or
present animal abuse in a companion animal entering a domestic violence shelter with
its owner.
34
The recommendations for training of this FPE protocol discussed within the
thesis can be an effective initial process to implement this procedure. Beyond this a
state level pilot program can be initiated if the initial phases demonstrate progress and
the accumulation of relevant pathophysiological documentation of animal abuse
associated with domestic violence. This information can be analyzed in a multitude of
ways, for example: the prevalence of animal abuse, the types of injuries sustained by
the animals involved in domestic violence, the direct connection with human
interpersonal violence, and better identification of the primary aggressor within the
family unit. These types of raw data will facilitate future research.
One area of research expansion is identification of primary aggressors initiating
acts of domestic violence. The primary aggressor in many instances is assumed to be
the adult male in the family unit. Adult males can and do sustain intimate partner
violence.18 This effects a male victim’s ability to obtain refuge and assistance in a
system with assumed bias toward men as primary aggressors. A male victim of
domestic violence with a companion animal should receive the same considerations as
a female victim. Forensic physical examinations of all companion animals involved in
domestic violence can assist with more concise identification of primary aggressors
within a family unit and offer additional support for the primary victim no matter their
gender.
There is a newly proposed Forensic Animal Maltreatment Exam.24 This is a court
mandated mental evaluation of defendants in cases of animal abuse being used in
Denver, Colorado. The potential importance of this type of mental evaluation along with
other psychological evaluations can be invaluable for prosecution of domestic violence
35
abusers. The one component essential for a FAME analysis is a complete forensic
physical workup of the animal abuse victim.24
Another area is animal behavior or psychological abuse inflicted on animals. It is
only recently that emotional or psychological abuse has been recognized in children.14
Asking the questions proposed in the protocol may suggest behavioral exams be
conducted on these animals. Recent animal behavioral research has shown
psychological effects from animals subjected to hoarding and puppy mill
environments.26 This may lead to animal abuse statutes addressing emotional abuse in
animals especially when directly linked to domestic violence.
On all fronts, a basic forensic physical examination protocol needs to be
implemented in animals that enter into a domestic violence shelter. In the current
veterinary forensic literature there are generic recommendations, such as whole body x-
rays, but no source to the author’s knowledge has effectively written, proposed, and
implemented a forensic physical examination protocol for companion animals to
determine or evaluate animal abuse. This thesis provides a protocol to develop a
consistent baseline for this type of information especially coexisting with known abuse
to humans perpetrated in the form of interpersonal violence (domestic violence). This
will truly allow the concept of a One Health System, as medical professionals in multiple
disciplines, effectively work together in order to enhance both animal and human
welfare.
36
APPENDIX A RESEARCH SURVEY
Research Survey Letter Domestic Violence Shelter Survey Dear Arizona Shelter for Domestic Violence Victims CEO/President: I am Dr. Nancy Bradley, an Assistant Professor of Shelter Medicine at Midwestern University’s College of Veterinary Medicine. I am completing a thesis covering accommodation of household pets within shelters for victims of domestic violence. You are being invited to participate in a research study. The purpose of the study is to determine the prevalence of and types of animal accommodations within Arizona domestic violence shelters. The study is voluntary, and there is no penalty if you do not participate. In order to participate, you must be listed with the Arizona Domestic Violence Directory listed with the Arizona Department of Economic Security. If you agree to participate, you will be asked to fill out a three-page survey regarding housing and care of companion animals that enter a domestic violence shelter with their owners. The survey will take approximately 15 minutes to complete. Your responses will be anonymous. By completing this survey you are indicating your consent to participate in the study. If you have any questions about this research study, please contact Dr. Nancy Bradley, 623-806-7511, [email protected]. If you have any questions regarding your rights as a research subject, please contact the Midwestern University ORSP (623-572-3728). This study has been approved by the Midwestern University Glendale Institutional Review Board. I hope to reveal a cooperative and willing community with this research, giving opportunity to change and improve the services domestic shelters offer animal victims of domestic violence. Please complete this on-line survey, in the following link. Thank you for your consideration. Tiffany K. Riddle Research Assistant on behalf of: Dr. Nancy Bradley DVM, MNM IRB APPROVAL # AZ1038
37
Table A-1. Survey Questionnaire with tabulated responses
Did you know that only 3% of domestic violence shelters in the United States offer pet accommodation to domestic violence victims?
Answer Choices Responses
Yes 58.33%
No 41.67%
Did you know that 48-76% of domestic violence victims will delay entering a shelter due to concern for their pets without accommodation at the shelter?
Answer Choices Responses
Yes 83.33%
No 16.67%
Are you aware that there is a link between domestic violence offenders and animal abuse/cruelty?
Answer Choices Responses
Yes 91.67%
No 8.33%
With the evidence-based link between animal and human violence, would you be willing to add accommodations for household pets to your intake process?
Answer Choices Responses
Yes 16.67%
We currently accommodate household pets 25.00% Only if we received extra funding from the state/federal government 25.00%
Only if we partnered with a county shelter or rescue group 33.33%
No 0.00%
Do you ask about current household pets/animals as part of initial intake?
Answer Choices Responses
Yes 41.67%
No 58.33%
Do you ask about past household pets and abuse?
Answer Choices Responses
Yes 16.67%
No 83.33%
Do you offer accommodation for DV victims’ household pets?
Answer Choices Responses
On-site shelter for animals 8.33%
Animals can stay with family in shelter housing 8.33%
Off-site shelter 25.00%
38
Off-site foster program 25.00%
Other 0.00%
No 33.33%
Other (please specify) 25.00%
Do you offer medical care for DV victims’ household pets? Yes – choose all that apply.
Answer Choices Responses
Contract veterinarian 25.00%
Full-time veterinarian on-site 0.00%
Partnership with county shelter 12.50%
Partnership with rescue group 25.00%
No 50.00%
Other (please specify) 0.00%
Do you have a protocol for initial intake of household pets?
Answer Choices Responses
Yes 50.00%
No 50.00%
Do you require pets to be sterilized (spayed/neutered)? Answer Choices Responses
Yes 12.50%
No 87.50%
Do you require the pet to be registered in AZ with their rabies vaccine?
Answer Choices Responses
Yes 50.00%
No 50.00%
Does your protocol include a physical exam?
Answer Choices Responses
Yes 12.50%
No 87.50%
Does your protocol include a behavioral evaluation?
Answer Choices Responses
Yes 0.00%
No 100.00%
Does your protocol include diagnostics? Yes- choose all that apply.
Answer Choices Responses
Bloodwork 0.00%
Fecal exam 0.00%
Snap Test 0.00%
X-rays 0.00%
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No 66.67%
I don't know 16.67%
Other (please specify) 16.67%
If standard protocols were available to your organization for the intake process of household pets, would it be more helpful for you to implement accommodation?
Answer Choices Responses
Yes 45.45%
No 36.36% We won't consider accommodation of household pets. 18.18%
What would be MOST helpful to increase the availability of accommodation for domestic violence victims in our Arizona shelters? Please Order (1- most important to 4- least important)
Answer Choices 1- Most 2- Less 3- Neutral 4- Least
Standard protocols to follow for pet intake 0.00% 0 14.29% 1
14.29% 1
71.43% 5
Community Support (Veterinarians, Volunteers, Universities, Local veterinary clinics, etc.) 0.00% 0 28.57% 2
42.86% 3
28.57% 2
Funding Support (State/Government)
75.00% 6 12.50% 1
12.50% 1 0.00% 0
Partnership with County Shelter or Rescue Group
45.45% 5 36.36% 4
18.18% 2 0.00% 0
Do you currently (or are you willing to) bring charges for known animal abuse or cruelty in a domestic violence case?
Answer Choices Responses
Yes 36.36%
No 63.64%
Are you more likely to pursue charges of animal abuse or cruelty if you have protocols to help you build a case?
Answer Choices Responses
Yes 54.55%
No 45.45% Would you be willing to cooperate with intake protocols to ensure that a case could be built by a partnering agency?
Answer Choices Responses
Yes 90.91%
No 9.09%
40
Are you aware of the Pet and Women Safety (PAWS) Act?
Answer Choices Responses
Yes 36.36%
No 63.64% IRB APPROVAL # AZ1038
41
APPENDIX B DOG AND CAT PHYSICAL DIAGRAMS
Figure B-1. Dog Physical Diagram with the permission R. Riesman DVM of ASPCA
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Figure B-2. Cat Physical Diagram with the permission R. Riesman DVM of ASPCA
43
REFERENCE LIST
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2. American Veterinary Medical Association (AVMA). U.S. pet ownership and demographic source book. Shamburg, IL: Author, 2007.
3. American Veterinary Medical Association (AVMA) Website. https://www.avma.org/KB/Resources/Reference/AnimalWelfare/Pages/Arizona-Animal-Abuse-Resources-for-Veterinarians.aspx. Accessed September 26, 2017.
4. Animal Welfare Institute (Safe Havens for Pets), https://awionline.org/content/safe-havens-mapping-project-pets-domestic-violence-victims. Accessed June 12, 2017.
5. Arizona Department of Economic Security Domestic Violence Map. http://azdes.maps.arcgis.com/apps/webappviewer/index.html?id=dbfd2b9983164961ae475d0954ec5b2e. Accessed June 1, 2017.
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14. Child Welfare Information Gateway, https://www.childwelfare.gov/topics/systemwide/laws-policies/can/reporting/.
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BIOGRAPHICAL SKETCH
Nancy’s major was veterinary medical science with a concentration in veterinary
forensics. Prior to her pursuance of her current master’s degree Nancy completed her
undergraduate course work at the University of Arizona. She earned her Bachelor of
Science degree in veterinary science in 1990 from Colorado State University. She
earned her Doctor of Veterinary Medicine degree in 1993 from Colorado State
University. After veterinary college Nancy entered the Glendale Community College
Law Enforcement Training Academy to become a reserve police officer in May 1995.
She was a patrol officer for the city of Glendale, Arizona, for nine years and an animal
crimes detective for the Maricopa County Sheriff’s Office Animal Crimes Unit in Arizona,
for 3 years while practicing veterinary medicine. Nancy received a master’s degree in
Nonprofit Management from Regis University in 2006.
She has divided her time between her personal academic efforts in veterinary
forensics and consulting with her institution’s pathology department in animal abuse
cases. During this time, she has been a full time assistant professor of Shelter Medicine
at Midwestern University College of Veterinary Medicine teaching surgery, veterinary
forensics, shelter medicine and shelter rotations to second, third and fourth year
veterinary students. She received her master’s degree in the fall of 2017.