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

8

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.

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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, nbradl@midwestern.edu. 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

1. American Pet Product Manufactures Association (APPMA). 2007-2008 APPMA Pet Owner Survey. Greenwich, CT: Author, 2007-2008

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.

6. Arkow P, Lockwood R. Defining animal cruelty. In: Reyes CL, Brewster M, eds. Animal Cruelty: A Multidisciplinary Approach to Understanding. 2nd ed. Durham, NC: Carolina Academia Press; 2016: 3-23.

7. Ascione FR. Children who are cruel to animals: a review of research and implications for developmental psychopathology. Anthrozoos. 1993; 6(4):226-247.

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11. Boat BW. Abuse of children and abuse of animals: using the links to inform child assessment and protection. In: Ascione FR, Arkow P, eds. Child abuse, domestic violence, and animal abuse: Linking the circles of compassion for prevention and intervention. West Lafayette, IN: Purdue University; 1999:83-100.

12. Bradley N, Rasile K. Recognition and management of animal sexual abuse. Clinician’s Brief. 2014; April:73-75.

13. Carlisle-Frank P, Frank JM, Nielson. Selective battering of the family pet. Anthrozoos. 2006; 17(1):26-42.

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14. Child Welfare Information Gateway, https://www.childwelfare.gov/topics/systemwide/laws-policies/can/reporting/.

15. Creevy KE, Shaver SL, Cornell KK. Domestic violence shelter partnership and veterinary student attitudes at North American Veterinary Schools and Colleges. J Vet Med Educ. 2013;40(2):184-191

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17. DeViney E, Dickert J, Lockwood R. The care of pets within child abusing families. Int J Stud Anim Prob. 1983; 4:321-329.

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19. Edelson JL, Mbbilinyil F, Beeman SK, et al. How children are involved in adult domestic violence: results from a four-city telephone survey. J Interpers. 2003; 18: 18-32.

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23. Kellart SR, Felthous AR. Childhood cruelty to animals among criminals and now criminals. Hum Relat. 1985; 38:1113-29.

24. Levitt L, Patronek G, Grisso T. Animal Maltreatment: Forensic Mental Health Issues and Evaluations. Oxford, NY: Oxford University Press; 2016.

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26. McMillian F, Duffy DL, Serpell JA. Mental health of dogs formerly used as “breeding stock” in commercial breeding establishments. Appl. Anim. Behav. Sci. 2011; 135:86-94.

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28. National Domestic Abuse Hotline. http://www.thehotline.org/is-this-abuse/abuse-defined. Accessed June 12, 2017.

29. Phillips A. Sheltering animals and families together: start up manual. SAF-T Program; 2012.

30. Phillips A. Understanding the Link between Violence to Animals and People: A Guide for Criminal Justice Professionals. ASPCA, U.S. Department of Justice: 2014.

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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.