Expert tells of strangulation’s long-term effects

Domestic violence police reports can be disturbing, if not predictable.
In Allen County, a domestic battery charge is often filed with one for strangulation, as it was in nearly half the cases filed between Monday and Thursday last week.
Court records documented 18 charges of domestic violence. Ten of those charges were felony domestic battery and eight charges of domestic battery included another felony charge of strangulation.
What researchers have found in the past 20 years is the effects of strangulation can be long lasting.
Strangulation “can cause injuries to the structures in the neck, principally the arteries in the neck, that will cause a person to stroke or die days, weeks or months after the assault,” said Dr. Bill Smock, police surgeon at the Louisville (Kentucky) Metro Police Department.
Every second the brain is deprived of oxygen, millions of brain cells die, Smock said during a telephone interview. “So by rendering someone unconscious, you are inducing brain damage.”
Smock, who led a training seminar last month in Fort Wayne organized by the Allen County prosecutor’s office, is on staff at the Training Institute on Strangulation Prevention, in San Diego. He is a faculty member and chairman of the institute’s medical subcommittee.
Allen County Prosecutor Karen Richards said about 100 people – sexual assault treatment nurses, Fort Wayne firefighters, emergency workers, victim advocates and others involved in emergency medical care – attended the lecture.
Founded in 2011 as part of the Alliance for HOPE International, the institute has created national guidelines for hospitals on how to evaluate someone who has been strangled so emergency room doctors, nurses and first responders will be better trained.
“You can be fatally strangled and have no marks on your neck. It all depends on how the pressure is applied,” Smock said. “You can have an injury and feel perfectly normal.
“Most physicians and nurses and police officers need more training on how to recognize and evaluate the victims of nonfatal strangulation,” Smock added.
He recommends a CTA, a special CAT scan of the neck, to detect tears in the arteries, principally the carotid artery, the larynx, the pharynx and the thyroid.
Lasting damage is a “ticking time bomb” in the neck, Smock said. A tear in the artery can cause a leakage of air that can adversely affect the heart years later.
Strangulation can cause maladies such as tinnitus, memory problems, early-onset dementia, personality changes, an inability to perform cognitive functions that could be related to your job, besides aneurysms and strokes, Smock said.
“When the doctors came out talking about the risks of concussions in sports, to me strangulation is a lot the same,”  Richards said.  “They’re discovering the same issues in sports as in strangulation.”
Victims are overwhelmingly women, Richards said, adding she has seen domestic battery and strangulation increase since she became prosecutor in 2002.
In 2016, the Allen County prosecutor filed 68 cases of domestic violence (with) strangulation last year out of the 99 cases filed, according to statistics provided by Catherine Maggart, domestic violence coordinator at the prosecutor’s office.
“Most strangulations also have domestic battery charges with them,” Maggart wrote in an email response. “We have found that if a case goes to Jury Trial, we often lose conviction on the strangulation charge but (we) are successful in domestic battery conviction.”
There is no national database tracking strangulation, Gael Strack, CEO and co-founder of the Alliance for HOPE International and the strangulation institute, said.
“Today, we have 47 states that have some form of felony strangulation laws. We have studies on prevalence in various settings. A lot depends if a particular jurisdiction has a law and/or protocol on strangulation, provides strangulation training and/or if it is a priority for them,” Strack wrote in an email response.
Richards said juries at domestic battery and strangulation trials expect victims to say they lost consciousness.
“But you get a very fuzzy memory,” Richards said. “Some people don’t know they were strangled.”
One example this week is a woman who called 911 just after 1 a.m. Monday to report domestic abuse.
The woman said her boyfriend of nine years was intoxicated and was threatening to kill her. The situation got worse when she grabbed a cellphone to call police.
“The defendant ran over to her, grabbed her by her neck and slammed her to the ground while he yelled ‘you’re gonna need the (expletive) police now!’” according to court documents.
The victim repeatedly attempted to call police “with the phone still in her hand while the defendant was on top of her choking her, with his hands around her neck … I thought he was trying to kill me because he just kept squeezing,” the victim told police.
Nowhere in the report does it say she blacked out or lost consciousness, but it does say the 27-year-old boyfriend continued to slam the woman into the floor “by her neck.” Finally, he let his victim go and ran out of the house.
“I think what’s so scary about strangulation is when you are cutting off somebody’s ability to breathe to the point they pass out, there’s a real danger you’re going to kill them,” Richards said. “Any time a woman is strangled, her possibility of becoming a homicide victim is 750 times greater.”
The Allen County coroner said the department was not able to access data last week on local strangulation victims because of computer problems.
Getting strangulation victims to go to the hospital can be difficult. In a training video posted online by the Institute, a “victim” interacts with emergency personnel relating where she has pain, but puts off a trip to the hospital.
She feels OK, she tells them, and she has no health insurance to cover what could potentially be a substantial expense. The first responders continue to plead with her, insisting a hospital visit would be best.
Smock recommends telling victims that they might have an injury and feel perfectly normal. “If you stroke,” he asks them, “who is going to take care of your children?”
Any stroke victim under 45 should be questioned to see if he or she once suffered strangulation, Smock said.
“At this point, we count on hospitals waiving fees, hospitals deferring to the victim’s comp fund, and in this day and age, I don’t know what’s left of Obamacare, everyone is supposed to have coverage,” Richards said. Richards said she was referring to a compensation fund that victims of violence can apply to with the help of Victim Assistance through the Fort Wayne Police Department.
Smock said some hospitals waive the fees for strangulation victims and suggested victims apply for costs to be covered from victim compensation funds. In some cases, if an individual is convicted of strangulation, a court could order hospital costs be part of restitution.
“Make them pay for it,” Smock said.

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