Focusing on Strangulation, a Deadly form of Domestic Violence

By: Lyndsay Winkley
SAN DIEGO, CA – A countywide protocol is being developed to address strangulation, a crime that has proven to be one of the deadliest forms of domestic violence.
San Diego County Deputy District Attorney Tracy Prior, who is spearheading the effort, said the goal is to better detect and document strangulation cases to ensure victims receive the assistance they need and offenders are held accountable.

Gael Strack is a former San Diego prosecutor whose work on strangulation cases kick-started decades of research. She said the only way to crack down on strangulation cases is to ensure all the stakeholders involved — first responders, police, medical professionals, prosecutors and advocates — are on the same page. When a similar protocol was put in place in Maricopa, Ariz., 60 percent of strangulation cases were successfully prosecuted, up from less than 15 percent.
“It needs to be institutionalized,” Strack said “We need to create mechanisms, like we did with DUI and other crimes, where you’re regularly training people…Otherwise, you’ll continue to have gaps and people will die.”
Strangulation is a particularly dangerous form of domestic violence, experts say. Dr. William Smock, a clinical professor of emergency medicine at the Louisville School of Medicine, has worked with strangulation cases for 30 years. He said victims can fall unconscious in 6.8 seconds and be dead in minutes.
“I’ve taken care of thousands of gunshot victims, and most of them live, but when you stop blood flow to the brain, you die,” Smock said.
According to a study published in 2014, women who had been strangled were nearly eight times more likely to end up victims of homicide than women who suffered some other form of abuse. In San Diego County, 15 percent of domestic violence-related homicides between 2008 and 2016 were strangulation cases.
If victims do survive, they can be left with serious, long-term injuries that include memory loss, Post Traumatic Stress Disorder, traumatic brain injury, stroke and blindness.
The first time Tanika Lee was strangled by her new husband, one of her most intense emotions, rivaling even fear, was disbelief. She couldn’t believe what was happening. The next morning, she didn’t recognize herself in the mirror.
“My face, my entire neck, were so swollen and bruised,” Lee said. “I looked like a monster.”
The second time he did it, it nearly killed her, and without prodding by a San Diego police detective to seek treatment, it probably would have.
Lee said the memory of her battered reflection gave her the strength to fight back and call police. Det. Sylvia Vella insisted she go to a hospital to get checked out. When she finally relented, six days later, doctors discovered she had suffered serious internal injuries to both carotid arteries.
“She’s lucky to be alive,” Smock said. “If she hadn’t been treated, she would have stroked, and depending on the severity of the stroke, she could have died.”
Lee’s reluctance to seek treatment is common among strangulation victims. According to a study published in 2001, only 29 percent of strangulation victims sought medical help in the aftermath. And while Lee was clearly bruised, strangulation injuries are often invisible. In a review of 300 strangulation cases forwarded to the San Diego District Attorney’s Office, half of all victims showed no outwardly signs of injury.
Prior, the deputy district attorney, said invisible injuries are just one challenge in prosecuting strangulation cases. They often happen behind closed doors, so there are rarely witnesses or surveillance footage. Victims may later minimize what happened, and officers or first responders may not ask the right follow-up questions.
“We need proof to prosecute these cases and we’re rethinking how to establish that proof,” Prior said. She said she is hopeful the protocol will be ready to put into practice next year.
Over the years, advocates have pushed to train those on the front lines to better understand and document strangulation. They went from giving 15-minute talks to offering a four-day course through San Diego’s Training Institute on Strangulation Prevention.
Thankfully, Strack said, Det. Vella had gone through that training. Stakeholders working on the protocol want the same principles that saved Lee’s life to be taught across the board, ensuring every victim gets the help she did.
The 39-year-old nurse now lives in Chico, Calif., with her two teenage boys and her new partner. Lee doesn’t think police or prosecutors could have worked harder on her case. It was an arduous road, but her ex-husband was eventually sentenced to 365 days in jail. It was a victory, despite the short sentence. She hopes a protocol helps officers and prosecutors collect better evidence that would lead to stiffer penalties.
“I think having a protocol will mean people that do this will be looking at serious time,” she said. “I think part of the reason it’s such an epidemic is that it doesn’t get prosecuted like it would have if he had a knife in his hand.”
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