Some of the most violent and lethal attacks in domestic violence cases often go unnoticed and unreported, putting the health of victims at risk and allowing assailants to avoid prosecution. But a coalition of local nonprofits and law enforcement agencies are looking to change that.
Santa Clara County is expanding a pilot program countywide to provide better care and free medical exams for victims who have been strangled by their intimate partner. The damage choking victims can suffer can be serious and sometimes fatal, but may go overlooked in the aftermath of an attack.
What's more, the exams give prosecutors a much stronger case against violent offenders, making a felony conviction more likely, according to early data from the pilot, which took place between January and December last year.
The pilot follows years of research that showed survivors of strangulation often have no visible markings or signs of being choked, but can still have bruising and internal damage. The victims, mostly women, can suffer a long list of injuries including cervical spine injury, seizures, stroke, fractured bones and scarring of the larynx or trachea. Yet many of the survivors decline a medical exam or are never offered one in the first place.
Strangulation is also a well-known precursor for future violent attacks. Those who strangle their partner are far more likely to either kill or attempt to kill them later.
"The physical consequences of being strangled by a partner are really dangerous. It can be lethal," said Perla Flores, program manager for the nonprofit Community Solutions. "Maybe not at that moment, but there are long-term physical repercussions that can lead to significant health issues for survivors."
Under the pilot, select police departments and victims' advocacy nonprofits like Community Solutions redoubled efforts to get suspected victims of strangulation to the hospital for a medical exam. Survivors are offered a full suite of free support services including counseling, food, transportation and emergency housing. Once at the hospital, victims undergo a rigorous hourslong exam focused on collecting forensic evidence, in which photos are taken of all injuries, including those inside the throat.
The partnership mirrors the county's response to sexual assault, which requires a close partnership between hospitals, police departments and victim advocacy groups, all of whom play a key role in encouraging victims to cooperate. Often victims are reluctant to work with prosecutors or undergo the exam, either because they are afraid of the suspect, don't want to see them get arrested or worry about losing the breadwinner of the family.
Sometimes those roles are blurred, and police officers have to serve as both detectives -- searching for subtle signs of strangulation following an attack -- as well as being an advocate for the victim, said Capt. Saul Jaeger of the Mountain View Police Department.
"Switching from an investigator kind of role to being an advocate is a big piece of that," Jaeger said. "When we can work with a victim to help hold people accountable for what they do, that's ideal."
Unlike sexual assault exams, which are paid for by the state of California, strangulation exams have no source of funding and can create a costly barrier for survivors -- particularly those who are low-income, uninsured and undocumented. The exam alone costs about $1,500, but treatment to fully recover can be as much as $10,000 per incident, according to county staff.
Domestic violence affects people of all backgrounds, Flores said, but the people who are served by nonprofits like Community Solutions can't afford to pay for these services out of pocket. As many as 70% of the clients are considered extremely low-income, and don't have options for emergency shelter for themselves and their children. The pilot program filled that funding gap, she said.
Prosecutors say the pilot's early results show they are far more likely to press serious charges against attackers in strangulation cases. The Santa Clara County District Attorney's office filed felony charges in 86.6% of the 30 cases in which victims consented to a medical exam, compared to only 28.8% prior to the pilot. In cases where the victim declines to testify or work with prosecutors, evidence from the medical exam becomes crucial in convincing a jury that a crime had been committed.
It is still difficult for cases to even get that far, however, and convincing victims to disclose that they have been strangled is a difficult task that isn't best handled by cops, Flores said. In cases she reviewed over about a one-year span, she said 40% of survivors revealed to domestic violence advocates that they had been strangled. In the same cases, only 13% had disclosed that information to the police.
And while Flores said she supports the county's goal of holding assailants accountable and filing felony charges when possible, it's not the top priority for victim advocates.
"Our main focus is to support survivors in a way that is addressing all of their needs," she said. "Sometimes the survivor, for many reasons, does not want their partner to be arrested, and that's where our goals diverge a little bit."
The Santa Clara County Board of Supervisors agreed at its March 23 meeting to expand the pilot countywide and extend it through 2022, albeit with some tweaks. Right now all victims must be transported to Santa Clara Valley Medical Center for lengthy strangulation exams, whereas supervisors pushed to expand those services to Stanford Hospital and a South County site.
The impact of COVID-19 on domestic violence incidents appears to be mixed. Flores said her agency initially saw a big decline in crisis calls and new clients, but has since seen an increase that now surpasses pre-COVID levels. She also warns that the severity of the cases -- ones that involve violence and strangulation -- have increased.
In Mountain View, the number of domestic violence calls for service decreased from 127 in 2019 to 110 in 2020. As of March 29, the department received 41 calls this year.