Frequently Asked Questions About Wis.Stats. sec. 146.995
Reporting of wounds and burn injuries and its relevance to reporting of domestic violence by health care providers
The following information does not constitute legal advice.
Many health care providers continue to ask whether they are required to report suspicions of domestic violence to law enforcement or any other investigative authority. The Wisconsin Coalition Against Domestic Violence (WCADV) has drafted many informational documents explaining relevant Wisconsin laws, including those related to child abuse, certain situations involving adults at risk and Wisconsin’s caregiver reporting laws.
Too often, health care providers assume that their only intervention with patients who are victims of domestic violence is a question of whether to report the abuse to law enforcement or other authorities. However, reporting domestic violence without the victim’s consent rarely makes a victim safer; indeed, it can very often increase her danger. Reporting also removes a competent victim’s autonomy. Rather than focus on reporting, research confirms that what is most valuable to the patient is for health care professionals to screen for domestic violence, listen to the patient, believe the patient, affirm the patient’s experiences, offer support and assistance, offer safety planning, address clinical impacts of abuse and connect the patient to local resources.
This FAQ focuses exclusively on section 146.995 of Wisconsin Statutes, which is included in Ch. 146’s “Miscellaneous Health Provisions.” The actual section is entitled “Reporting of wounds and burn injuries.”
1. What does the Wis. Stats. sec. 146.995 provide?
The law states that any person licensed, certified or registered under chs. 441, 448 or 455, Wis. Stats., who treats a patient suffering from any of the following, is to report to the local police department or county sheriff’s office for the area where treatment is received:
- A gunshot wound
- Any other wound if the person has reasonable cause to believe that the wound occurred as a result of a crime 
- Second or third degree burns to at least 5% of the patient’s body, or, due to inhalation of superheated air, swelling of the patient’s larynx or burn to the patient’s upper respiratory tract, if the person has reasonable cause to believe that the burn occurred as a result of a crime 
The statute requires that the health care provider report “the patient’s name and the type of wound or burn injury involved.” The health care provider is to make the report “as soon as reasonably possible.” Note that it does not require any reporting of a suspect perpetrator.
Like the majority of states, Wisconsin does not have any general mandatory reporting of domestic violence.
2. When did the statute pass and what was its purpose?
This statute was enacted in April 1988 and has been Wisconsin law for over twenty years. It is believed to have been developed to assist law enforcement in solving stranger crimes that involved firearms and other dangerous weapons, e.g., an individual who had robbed a bank and sustains injuries in the process of the robbery who then seeks medical care for those injuries in an Emergency Department. If the Emergency Department staff believes there is something suspicious about his injuries and his explanation, they should contact law enforcement.
3. Is Wisconsin unique?
No. Most states have laws similar to Wisconsin’s, requiring reports only in situations involving firearms, burns and other instruments where a crime is suspected. As in Wisconsin, those states have no general mandatory reporting requirement. For example, Tennessee “encourages” any health care practitioner who suspects patient injuries are a result of domestic violence to make an anonymous report of the injuries monthly to the state’s Department of Health, Office of Health Statistics. Texas requires medical professionals who suspect that a patient is a victim of domestic violence to provide the patient with information about the nearest domestic violence shelter, document reasons for the suspicion in the patient file and give the patient written notice that domestic violence is a crime that the victim can report to law enforcement.
As of 2003, only six states have mandatory reporting laws for injuries resulting from domestic violence. Wisconsin is not one. These laws have stirred much ethical debate in the medical literature. Concerns are that mandatory reporting may increase violence by the perpetrators, diminishes patients’ autonomy, and compromises patient-physician confidentiality. Because of the uncertain benefits of these mandatory reporting laws, the National Research Council has recommended a moratorium on such laws until more research is conducted on the advantages and disadvantages of mandatory reporting policies for partner abuse.
4. Are there immunities for reporting?
Yes. Under the statute, anyone who makes a report is presumed to be doing so in a good faith and is immune from all civil and criminal liability that may result from the report.
5. Is there a penalty for not reporting?
A district attorney could, theoretically, charge the health care provider who did not make the report with a fine. The amount that could be assessed is $500 or less.
6. Have many Wisconsin health care providers been fined for not reporting under this section?
In the more than 20 years that this provision has been part of Wisconsin law, WCADV is not aware of any situations where a district attorney has ever assessed any fine against any health care provider in Wisconsin, nor of any health care professional receiving any discipline related to licensure for not reporting a situation under this section.
7. What is recommended practice for health care providers when patients disclose domestic violence?
Health care provider interventions should include:
- Listen to victims. Believe them. Tell victims it’s not their fault and you are concerned about their health and safety.
- Ask about the safety of the patient and any children.
- Respect the victim’s life choices.
- Provide phone numbers of hot lines, health care, legal and other local domestic violence resources.
- Schedule follow-up appointments and flag the file to continue inquiry and assistance.
- Carefully and discretely document patient’s disclosures and your response.
- Encourage a safety plan for the future.
In addition to clinicians' individual actions, there are several other ways of creating a supportive environment in the health care setting: (1) hanging posters about preventing domestic violence in waiting areas and patient rooms; (2) placing victim safety cards in the bathroom and exam rooms for patients who need information but may not be ready to disclose; and (3) wearing "Is someone hurting you? You can talk to me about it" buttons. See: http://fvpfstore.stores.yahoo.net/healthposters.html
Ideally, health care providers’ questions about reporting should be addressed before domestic violence victims are in emergency rooms, hospitals, clinics and other health care facilities. Communities should address questions by convening work groups to develop protocols and memoranda of understanding (MOUs). These groups might include representatives from health care provider units or departments, local non-profit domestic violence/sexual assault advocates, health care provider counsel, the local Coordinated Community Response (CCR) Team, the prosecutor’s office, police or sheriff’s office, health care provider social workers or social service, and emergency response personnel. With victim safety and empowerment foremost, the health care provider protocol should address provider procedures for: screening for domestic violence; appropriate responses; assessing for safety issues; addressing clinical issues; making appropriate referrals; and documentation. MOUs with law enforcement can address cross-trainings, referrals, confidentiality and other issues.
Safety planning is crucial. Regardless of a health care provider’s decision to report the situation to an investigative authority, health care providers should discuss safety planning with victims before the police are called. Health care providers should also discuss their decision to report to victims. Studies confirm that involving law enforcement and/or leaving an abuser can be the most dangerous times for victims. Abusers stalk and seriously injure or kill victims when they are trying to leave. Reporting a situation to law enforcement without the patient’s consent can dramatically escalate a situation.
There are many advantages to having a domestic abuse advocate at the health care facility to assist with issues such as: a decision to leave and if so, what to take with her; exploring shelter and other emergency housing; any legal advocacy needed (e.g., restraining orders, legal separation or divorce, financial issues); safety of any children; safety for emotional health.
For more information, sample protocols and procedures, training for health care professionals or other assistance, please contact the Health Care Project at the Wisconsin Coalition Against Domestic Violence: 608-255-0539. http://www.wcadv.org/?go=whatwedo/health/resources
Prepared by: WCADV Health Care Project
 Nurses, Physical Therapists, Dietitians, Athletic Trainers, Occupational Therapists, Podiatrists, Psychologists, Physicians, Physicians Assistants, Perfusionists, Respiratory Therapists.
 This phrase has never been defined by a Wisconsin administrative agency or court.
 Consider the “rule of 9’s for burns.” E.g., http://www.emedicinehealth.com/burn_percentage_in_adults_rule_of_nines/article_em.htm. For demonstration purposes, a couple of cigarette burns would not qualify but cigarette burns to half of a patient’s arm or all over her face or half her leg would be reportable.
 This could result from, for example, inhaling chemicals like ammonia.
 Chalk R, King PA, eds, Committee on the Assessment of Family Violence Interventions, National Research Council, Institute of Medicine. Violence in Families: Assessing Prevention and Treatment Programs. Washington DC: National Academies Press; 1998, as reported in Virtual Mentor. November 2003, Volume 5, Number 11, a commentary by Michael A. Rodriguez, MD, MPH, and Tracy Battaglia, MD, MPH, “Asking Patients about Intimate Partner Abuse.”