The role of the veterinarian in handling animal abuse (Proceedings)

The American Veterinary Medical Association (AVMA), Canadian Veterinary Medical Association, American Animal Hospital Association (AAHA), and Royal College of Veterinary Surgeons in the UK have all taken the basic position that when education fails, it is the responsibility of the veterinarian to report cases of suspected animal abuse to the appropriate authorities. According to the AVMA position, documentation of the cases is invaluable and it is acknowledged that reporting may save human and animal lives.

There are many reasons why the veterinary profession is addressing the issue of animal abuse now. Aside from the veterinary oath to protect animal health, relieve animal suffering, and promote public health, many experts believe that animal abuse is closely associated with human violence, including domestic violence, child and elder abuse. This is commonly known as the "Link". The "Link" states that when animals are at risk for abuse, so are humans and vice versa. Many experts also believe that a history of animal abuse may be a strong predictor of subsequent criminal and violent behavior in adolescents. As veterinarians are the best- trained professionals to recognize animal abuse, neglect and substandard care, they have a unique role to play in keeping animals, and in some cases, humans, safe from violence. Therefore, veterinarians should report good faith suspicions that an animal has been abused, assist animal cruelty investigations and prosecutorial efforts and establish relationships with other agencies for cross reporting, training, and provision of services.

The primary role of the veterinarian in investigating animal cruelty is to serve as the medical expert for the case. It is important to note that veterinarians do not define animal cruelty. Animal cruelty is defined by state law and the judicial process. As cruelty cases become more complex and there are more severe penalties, the role of the medical expert is expanding to include crime scene investigation. Veterinarians who are concerned about becoming involved in these situations should remember that there are many other people involved in both the investigation and prosecution of the case, and other elements of the criminal justice system determine the ultimate disposition of the case.

Studies have shown that despite their skepticism, private practitioners do see cases of animal abuse and neglect. It is believed that most cases are neglect and can often be handled through client education. However, when education fails, would be inappropriate or would clearly make matters worse, a report should be filed with the appropriate authorities for investigation. In order to develop a comfort level with the process of reporting, it is a good idea to try to establish a relationship with a law enforcement or humane agent in advance of filing a report.

Filing a report of suspicions of abuse is seldom an easy or clear-cut decision. At least one study has shown that the factor that most affects the practitioner's decision whether or not to report their suspicions is whether the client expresses remorse. However, it should be remembered there might be other at- risk pets, children and family members in the household needing assistance. Filing a report may be the only way to uncover and assist these other victims. Filing a report often does not lead to an arrest or punitive action, but it may be the best way to help a troubled family receive counseling and intervention services. Furthermore, a report that does not lead to charges may still have a positive effect on the situation and does not mean the report was a false one. This represents a significant way veterinarians can help reduce community violence, improve the quality of life of humans and animals, and enhance the stature of the profession by taking an ethical leadership role as animal welfare advocates.

In order to engage responsibly in handling animal abuse cases, veterinarians should know the laws pertaining to animals and be familiar with the state anti-cruelty statute, including how cruelty and animal are defined, and any exemptions. One must also know the veterinary practice act, including whether the state mandates reporting of abuse, provides immunity for good faith reporting, requires confidentiality of medical records, and so on. It is important to know any exceptions or exemptions. It is recommended that every hospital establish an in-house policy regarding handling of animal abuse cases that describes circumstances that may be suggestive of animal cruelty and outlines appropriate procedures for acting on such suspicions. Training, support and information on handling animal abuse cases should be provided for all staff. It would be advantageous to determine which agency investigates animal abuse ahead of time, i.e., animal control, police department, or the local humane society, for example. One should establish contacts with several agencies and individuals, including law enforcement, humane society/animal control, social services (domestic violence, child protection, elder services), department of health (hoarding), diagnostic laboratories, medical examiners and other specialists who will work on abuse cases- forensic pathologists, radiologists, etc. The local veterinary medical association and state board may also be able to provide some guidance on difficult cases.

Forensics refers to medical answers to legal questions. Veterinarians involved in handling abuse cases will be asked to answer certain questions not normally considered in the course of everyday practice. Some questions to be answered include:

How did this injury or condition occur? How long ago? What is the exact cause of death or the condition? Did the owner or caregiver meet the standard of care? (The standard of care is often regional.) Were there underlying contributing factors to the animal's condition or death? Did this animal suffer? How long? Was the suffering needless?

Information should be gathered from the owner/caregiver in a non-confrontational manner. Think about and ask yourself the following questions, then pose appropriate questions to the owner: How could this have happened? When did this happen? Who was involved? Does the history make sense? Do the injuries match the history? Does the animal have behavioral problems? Is there a bite history? Who has access to the animal? Are there other animals in the household and what is their condition? What is their history of ownership of animals in the past? The history, coupled with the physical examination, plays a large part in determining the correct way to proceed with the case.

Part of the decision making process for handling these cases includes determining whether to educate the client about the situation or report to the authorities. A successful resolution may be obtained through education in some cases, and may be the only course of action in jurisdictions that simply will not investigate cases. One should look at the number of problems, severity and duration of the problem, review the medical records of client's other animals, review the entire medical record of this patient for previous injuries, and assess the attitude of the client(s). Are they indifferent, concerned, resentful, angry or remorseful? If present, evaluate the appearance and attitude of family members, children and friends-Do they seem uneasy? Evasive? Cooperative? Ask if they can add any information to the history. In cases that are deemed appropriate for education, implement procedures for follow up on questionable cases- call-backs, letters, etc. and insist that they return for follow up evaluations.

The terms abuse and cruelty are often used interchangeably, but the statutory definitions refer to cruelty. Every state has an anti-cruelty statute. To reiterate a point made earlier, cruelty is defined by statute and the court, not by the veterinarian. In common terms, cruelty is often defined as a wide range of behaviors that are harmful to animals, ranging from unintentional neglect to malicious killing. In a broad sense, it can be considered any act, omission or neglect that results in unnecessary or unjustifiable suffering to an animal.

Most cruelty statutes impose a specific duty to provide food, shelter, water, etc. and they prohibit certain acts, such as abandonment. Older anti-cruelty statutes refer to overdriving, overloading, overworking, etc, referring largely to a time when animals were mainly considered beasts of burden. Individual statutes may include neglect, failure to provide sustenance or veterinary care necessary to prevent suffering.

Animal hoarding constitutes a special category of animal cruelty. The statutory definition of a hoarder in the state of Illinois is "someone who has more than the typical number of animals, has shown an inability to provide even minimal standards of nutrition, sanitation, shelter, and veterinary care, with this neglect often resulting in starvation, illness, and death. This person also displays a denial of the inability to provide this minimum care and the impact of that failure on the animals, the household and human occupants of the dwelling." Veterinarians should be aware of concerns for the mental health of these individuals and that the successful handling of these cases often requires a multi disciplinary approach involving law enforcement, medical and social services and animal welfare agencies. Animals are often found dead, dying or in dire need of veterinary care in hoarder situations. Although it is easy to sympathize with some of these individuals, veterinarians should not attempt to resolve these serious cases of animal abuse on their own. Without intervention from various agencies, counseling and follow up monitoring, the recidivism rate for these cases is invariably 100%.

There are many warning signs that an animal may have been deliberately abused. Some of these warning signs include: injuries that could not logically have occurred in the manner that the owner has described, discrepancies in the description of how injuries occurred; lack of concern about the disposition of previous pets; constantly changing parade of animals; lack of concern about their (in)ability to care for animals, including repeated refusal to either acknowledge the seriousness of a condition or provide treatment for clearly painful conditions, such as a fracture; indifference to or lack of awareness or concern about how the animal was injured; repeated failure to follow-up on the treatment of serious medical conditions that cause pain and suffering; use of several veterinarians to cover one's trail of abuse and neglect and so on. The "Battered Pet Syndrome", similar to the "Battered Child Syndrome", consists of multiple fractures (especially ribs) or wounds in various stages of healing.

Obvious physical signs of neglect include severely matted hair, overgrown, avulsed or ingrown nails, emaciation, heavy ectoparasite infestation, general filth, muscle atrophy, wounds in various stages of healing, etc. Severe matting is painful and can even cause gangrenous lesions on extremities due to circulatory compromise. Behavioral problems that may lead to abuse include aggression, inappropriate elimination, barking, destructiveness, disobedience, etc. Puppies, kittens and young male animals appear to be at most risk. In the mistaken belief that abusing or treating dogs in a mean fashion will make them better guard dogs, dominant breeds such as Pit bulls and Rottweilers and other "guard dogs" may be cruelly mistreated.

After gathering all the evidence, reviewing the history and physical findings, the veterinarian should determine if non- accidental trauma or deliberate abuse should be on the list of differentials. If unsure about the circumstances and education seems inappropriate, the proper authorities should be contacted. Reports can be anonymous but they are much more effective if the source of the report is identified, and anonymity can seldom be guaranteed long-term.

For successful prosecution, the evidence must be properly gathered, preserved and accurately documented. The physical examination must be complete, including a detailed and accurate description of the animal with estimates of breed and age, accurate weight and all normal as well as abnormal findings. Signs of head trauma-episcleral hemorrhage, ruptured or hemorrhagic tympanic membranes, retinal detachment, etc, should be noted. For consistency, it is recommended to use a body condition score such as Purina's or the Tufts Animal Care and Condition Scale that was developed specifically for cruelty cases. Pay particular attention to wounds in various stages of healing, and describe them thoroughly (number, appearance, location, age, etc.). The American Society for the Prevention of Cruelty to Animals (ASPCA) routinely takes whole body radiographs in all suspected cases of animal abuse to look for fractures in various stages of healing that are indicative of the Battered Pet Syndrome. Behavioral information, such as assessment of mental attitude, overall demeanor, appetite, etc. should be included. As cruelty statutes often refer to unnecessary pain or suffering, it is important to assess the animal's pain level. Perform all clinical pathology and imaging tests that are necessary to determine the exact cause of death or a condition. Diagnostics should be performed as would be necessary to work up any case, including obtaining appropriate owner consent, and then expanded as needed. Photographs should be taken throughout the treatment period that clearly depict the injuries and condition of the animal.

The role of the veterinarian in handling animal abuse cases has been evolving steadily over the years. Veterinarians did not believe their clients would abuse pets and then bring them to their clinics for veterinary care, nor were they provided training or tools to identify and handle cases. The profession should adopt the position of the American Animal Hospital Association policy statement on animal abuse that concludes by asserting "In order to encourage veterinarians and practice team members to be responsible leaders in their communities and to assist in the detection and reporting of animal abuse, the profession should educate its members to recognize, document and report animal abuse, develop forensic models, promote legislation concerning reporting by veterinarians and collaborate with other animal and human welfare groups and professionals within communities to eliminate the incidence of animal abuse."

References provided upon request.