By recognizing indications of animal cruelty and reporting suspected cases for investigation, veterinarians may not only save the lives of animals but also human family members living in the same environment.
Since the 1990s, veterinarians have recognized that innovative One Health responsibilities may include the response to abuse and neglect of animals and, by extension, humans. The
“Link” movement describes areas in which animal abuse and interpersonal violence intersect, with animal abuse often predicting or indicating co-occurring child maltreatment, domestic violence, and elder abuse. Veterinarians can take a leadership role in these
innovations — albeit a role tempered by the practitioner’s fear of unknowns, lack of training, and financial and liability concerns.
A six-step process is helping innovative practitioners become as proactive in responding to animal maltreatment as physicians have long been with regards to child abuse. These six steps, which remove personal, professional, peer, and organizational normative barriers, parallel earlier processes in the human medical fields.1
STEP 1: BUILD AWARENESS THAT ANIMAL ABUSE IS A SIGNIFICANT PROFESSIONAL CONCERN
In 1996, Munro identified a “battered pets” syndrome,2 analogous to the 1962 “battered child” syndrome which described child maltreatment as a definable, preventable clinical condition which physicians have a duty to fully evaluate and ensure that such trauma will not be repeated. This laid the groundwork for the medical professions to examine responsibilities regarding other types of interpersonal violence, notably domestic violence4-7 and elder abuse.8,9
More than 1,600 publications address animal abuse and neglect as linked to human health and safety, and as worthy of multidisciplinary, multi-species response.10 Over 260 of
these publications are specific to veterinary recognition and reporting.11-22 Surveys of veterinarians in the U.S., Canada, New Zealand, and elsewhere have measured practitioners’ awareness of non-accidental injury (NAI) and its intersectionality with interpersonal violence.23-28 The research is augmented by training programs in colleges of veterinary medicine and continuing veterinary medical education.
STEP 2: ASSIST PRACTITIONERS IN RESOLVING CONTENTIOUS ETHICAL DILEMMAS
Animal maltreatment is one of the most challenging diagnoses in clinical work, requiring time, experience, emotional energy, sensitivity, tact, and not a small measure of courage.29 While animal cruelty cases may be infrequent, they are invariably problematic and difficult to diagnose and resolve.13 Practitioners may be reluctant to admit that a client
would present abused animals for treatment. They may base the differential diagnosis on the incorrect assumption that the client’s account of the animal’s history is accurate. Most
practitioners will be presented with animal victims of NAI, neglect, abuse, cruelty, or torture.15,24-26,28,30-35 In rural areas, the public may more likely refer a case of suspected cruelty to their veterinarian rather than to a humane society or law enforcement.27
Ethical dilemmas in animal cruelty cases can give veterinarians reservations about becoming involved. Reasons for this reluctance include: inadequate understanding of
statutory definitions of animal abuse; insufficient training on the diagnosis of animal cruelty; lack of correlative literature offering veterinary pathology support; and
practice management concerns over confidentiality, client base erosion, personal safety, community reputation, and liability.1
Veterinary guidances published in the U.S., Canada, the U.K., and New Zealand help navigate the challenging responses, client communications, and diagnostic indicators of potential animal abuse and neglect.36-45 These guidances help resolve these concerns and what Rollin46 called a fundamental dilemma of veterinary medicine: whether the primary responsibility is to the patient or the client.
STEP 3: PROVIDE GUARANTEES OF LEGAL PROTECTION
National veterinary associations and legislative bodies have taken significant steps to permit or mandate veterinarians to report suspected animal maltreatment to appropriate authorities, without fear of civil or criminal liabilities or administrative sanctions. While veterinarians remain divided on whether reporting suspected abuse should be mandated,1
it may be argued that a statutory or administrative mandate eliminates this moral dilemma36 by making the decision automatic and explainable to the client. Once a decision has been made, the issue becomes how to appropriately implement a reporting process to comply with the duty.
Currently, 20 U.S. states and ten Canadian provinces mandate veterinarians to report suspected animal abuse to humane or law enforcement authorities for further investigation and possible prosecution; 20 additional states permit veterinarians to make such reports. In 33 states, veterinarians enjoy immunity from civil and criminal liability for reporting in good faith, and the release of confidential client records may be allowed (see Figure 1).47 Reporting mandates improve animal welfare; reports to the Massachusetts SPCA of suspected abused animals increased 46% following a new state law requiring veterinarians to report.48
Veterinarians are reminded that they are medical, not legal, experts. They do not have to “know” if a condition is cruelty. Their role is to be the animals’ first line of defense; to report and document findings for further investigation; and to present them in a court of law if necessary.49 Whether a situation is prosecutable can be determined only by the courts.
STEP 4: PROVIDE TRAINING TO IDENTIFY CLINICAL INDICATORS OF ABUSE AS A DIFFERENTIAL DIAGNOSIS
The definitions of animal cruelty, abuse and neglect vary across geographic jurisdictions, cultural traditions and professional boundaries. Statutory language is necessarily vague: e.g., a law may require that animals have non-specific “adequate” shelter, allowing the investigator to make a common-sense judgment based upon ambient environmental conditions and an animal’s metabolic needs.50 Statutes generally proscribe socially unacceptable actions or omissions that inflict “unnecessary” pain or distress. What constitutes “unnecessary” varies in any given culture and the prevailing standard can be determined only by the courts.51
Numerous guides can assist the practitioner in raising an index of suspicion by recognizing clinical signs, client profiles and behaviors, and environmental considerations of the more common presentations of NAI, neglect, hoarding, and abuse,36-38,45,52-56 and in learning about forensic processing, collection and preservation of evidence.57-60
No single incident necessarily raises the index of suspicion, but rather a combination of factors, a pattern of actions and behaviors, or injuries that are not adequately explained. The person presenting the animal may not be the perpetrator or may be under coercion from the person who caused the injury.61 The situation is best handled by an experienced clinician with a firm policy in place. It is important to remain calm, polite and objective,
indicating that your inquiries are in the animal’s best interests. A client questionnaire36 describing family members’ relationships with their animals may uncover patterns of abusive behaviors and inability to provide proper animal husbandry. It could be administered when welcoming a new client to the practice or whenever an abusive etiology is suspected.
STEP 5: DEVELOP STANDARDIZED PRACTICE MANAGEMENT RESPONSES THAT BALANCE THE INTERESTS OF THE PRACTICE, STAFF, CLIENTS, PATIENTS, AND OTHER ANIMALS IN THE HOUSEHOLD
The complexities of animal cruelty cases and their inherent ethical dilemmas challenge junior members of the team if senior members do not believe abuse has occurred. A practice-specific decision-making protocol should be established in advance. Several guidances review these procedures in detail.36-45 The National Link Coalition has
compiled veterinary hospital policies and forms that may serve as models.62
Findings and notes should be signed, dated, and entered in the patient’s file, including base information, assessments undertaken, diagnoses, and advice and treatment given. Documentation should be more detailed than normal in case you are asked to testify in court. Another veterinarian could conduct a second examination to review your findings.61
Maintain all records and notes as a “chain of evidence” for potential prosecution. Keep a chronological record of the movement or transfer of any ante- or post-mortem physical
evidence from the diagnostic processes, including any courier services utilized, from the time it was taken until the production of the evidence in a courtroom. Evidence must be securely packaged and stored, including in a freezer or refrigerator for necropsy by a forensic pathologist, so as to not be contaminated or degraded.60
The decision around whether to report suspected abuse, educate the owner, or monitor the situation may be guided by several criteria, including whether reporting is mandated by the state or province; the severity, frequency and duration of injuries; whether it’s an isolated incident or recurrent problem; the client’s intentionality or willingness and ability to correct adverse conditions; the history of the patient and client’s other animals; information from family and witnesses; and indications of co-occurring child, elder or domestic abuse.61
When in doubt, seek clarification from your veterinary association or legal counsel. Staff members should be fully briefed on the situation.
STEP 6: KNOW HOW TO REPORT
Unlike standardized systems for investigations of child, elder and domestic abuse, animal maltreatment cases are handled exclusively by independent local agencies with varying degrees of enforcement powers, training, and organizational capacity. They may be local humane societies or SPCAs (none of which are affiliates of national organizations with similar names); municipal or county animal control agencies, which may or may not be empowered to investigate animal abuse charges; or police and sheriffs for whom animal cases may not be prioritized. Wildlife and livestock cases are often handled by departments of agriculture or wildlife conservation.
To reduce this confusion, the National Link Coalition’s National Directory of Abuse Investigation Agencies lists telephone numbers for reporting animal, child, elder, and domestic abuse in over 6,500 U.S. communities.63
RESPONSES TO SUSPECTED CHILD AND ELDER ABUSE
What is a practitioner’s response to possible cases of child maltreatment or abuse of elders and vulnerable adults? Veterinary training in these areas has been minimal.
The adverse impact upon children who witness or commit animal cruelty can be significant.76 Child protection originated within local humane societies and SPCAs, many
of which had dual functions in child and animal protection from the 1870s until the enactment in the 1970s of a national network of state and county child welfare agencies.
There are four distinct types of child abuse: physical, sexual and emotional abuse, as well as child neglect. Guidances can help medical professionals recognize the most common indicators of each type.77
In all U.S. states, professionals who work with children or in healthcare or law enforcement are mandated by law to report suspected child maltreatment to the aforementioned agencies. While only Colorado and California specifically name veterinarians as mandated reporters, in 18 states all residents are required to report.63
All Canadian residents have a duty to report child abuse and neglect to provincial and territorial child welfare agencies, social service ministries or police; professionals who work with children and youth have an added responsibility to report.78
Elder abuse includes physical and emotional abuse, neglect, isolation, financial exploitation, sexual abuse, abandonment, and self-neglect; specific definitions vary by jurisdiction. Guidances can similarly help medical professionals recognize the most common indicators of each type.79
Seven animal welfare issues can co-occur with abuse of seniors or the disabled:80
1. Neglect of animals when financial, physical, transportation, cognitive, or social isolation situations impede the ability to provide veterinary and grooming care.
2. Self-neglect by elders who spend their limited financial resources on their pets rather than on their own medical or nutritional needs, or who defer going into hospitals or long-term care facilities because they have no one to care for their animals.
3. Financial exploitation by children holding their elderly parents’ animals hostage in order to extort money.
4. Animal hoarders, who can come from any demographic cohort but who tend to be elderly and socially isolated.
5. Compromised service delivery by caseworkers or home health aides unwilling to enter homes overrun with animal waste and vermin resulting from hoarding or neglectful pet care.
6. Depression over the death of a pet, which may be the person’s last link with a deceased spouse, or the only motivation for daily exercise and responsibilities. (Veterinarians should call a suicide prevention hotline when a client unexpectedly requests that all of his or her pets be euthanized.)
7. Jealousy over a disabled partner’s emotional and physical dependence upon a service animal.
All states have Adult Protective Services agencies and ombudsmen who review alleged elder abuse in long-term care facilities. All states mandate a variety of professionals
to report suspected elder abuse; Colorado and Illinois are the only states that specifically name veterinarians, although 16 states require all individuals to report. 81
In Canada, adult protection is primarily addressed at the provincial and territorial level. Various jurisdictions have taken different approaches and definitions to address adult abuse and neglect.82
The National Link Coalition’s National Directory of Abuse Investigation Agencies lists hotlines for reporting suspected child and elder abuse in all 50 states.63 In most states, anyone may report suspected child or elder abuse to the appropriate authorities, generally without fear of civil or criminal liability for a good-faith report.
DOMESTIC VIOLENCE AND THE DVM
The latest innovation in this area is veterinary response to situations of potential domestic violence. In addition to physical and emotional harm to humans in intimate partner violence, animals often become collateral damage when abusers exploit their victims’ emotional attachments to pets, as depicted in Figure 2.
American awareness of this phenomenon accelerated in 2018 when a woman in DeLand, Florida, being held at gunpoint by her boyfriend, convinced him that their dog needed to see the veterinarian. She sneaked a note to the staff reading, “Call the cops. My boyfriend is threatening me. He has a gun. Please don’t let him know.” The couple were separated, police were called, the boyfriend was arrested, and the surveillance video of the incident
Active discussion is occuring on how veterinarians and their staff, the majority of whom are now women,65 should respond to suspected domestic violence among clientele.66-71 The U.K. and New Zealand have been the most proactive. Medics Against Violence, a Scottish collaborative of human and veterinary healthcare professionals, created a Domestic Abuse Veterinary Initiative to train practitioners to help pet owners escaping domestic violence.43 In 2015, a £115,000 national campaign in Scotland trained 100,000 frontline professionals in three fields identified as most likely to encounter domestic violence survivors: veterinarians, dentists and hairdressers.72 The U.K.’s Code of Professional Conduct for Veterinary Surgeons states, “Given the links between animal, child and domestic abuse, a veterinary surgeon or veterinary nurse reporting suspected or actual animal abuse should consider whether a child or adult within that home might also be at risk.”73
The New Zealand Veterinary Association supported a national response to family violence by describing veterinary medicine as a “three-dimensional profession” with a unique voice in animal life, human life, and the environment. NZVA called for domestic violence protection-from-abuse orders to specifically include animals, and for a change to the definition of domestic violence to include “coercive control”, which would include emotional
and psychological abuse to family members through threats or harm to pets or farm animals.74 The Veterinary Council of New Zealand, whose Code of Professional Conduct recommends that veterinarians confronting animal abuse should consider whether people within that home might also be at risk, suggested preparing the practice to respond to domestic violence.39
Veterinarians wary of entering such uncharted waters might consider adding a veterinary social worker to the practice from the collaborative Veterinary Social Work Certificate Program in the College of Veterinary Medicine and the College of Social Work at the University of Tennessee-Knoxville.75
Unlike animals, children or vulnerable adults (see sidebar on page 45), victims of domestic violence are considered to have the capacity to report or escape their situations. Consequently, there are no mandates for professionals to report these situations to authorities.
By recognizing the significance of animal cruelty and by reporting suspected cases for
further investigation, veterinarians may not only save the lives of animals but also of
humans living in the same environment. A British model of the One Welfare paradigm
includes several references to medical response to animal and interpersonal violence, as
shown in Figure 3.
The canary in the coal mine of an abusive home may literally be an abused canary. By
responding to the injury or death of that canary, we can potentially save many other
pets and people.83