When Cat Otway talks about strangulation, she ticks off the world’s most depressing set of trivia about the act she refers to as “the quickest way to kill someone without leaving a mark.”
“It takes 4.4 pounds of pressure for 10 seconds on the jugular and you’re unconscious. Eleven pounds for 10 seconds on the carotid and you’re unconscious,” she said. “It takes 20 pounds of force to open a can of soda.”
The nurse and forensic examiner at Providence St. Patrick Hospital’s First Step Resource Center said that in recent years she’s seen a rise in the number of domestic violence situations in Missoula in which a victim has been strangled. She doesn’t believe that is because it is happening more often, but rather that law enforcement has become much better at recognizing the signs of strangulation and making sure victims are brought in for medical evaluations.
Missoula Police Detective Jamie Merifield said that in more than half of all strangulations, there are no external markings, such as bruising around the neck. Both she and Otway said police have gotten better at looking for the less-obvious signs, including what Merifield calls the “thyroid storm.” Otway explained that when the thyroid gland is compressed during a strangulation, it squeezes a hormone into the rest of the body, creating an elevated amount of activity and agitation.
“Perpetrators will often use that to say ‘See? She’s crazy, I had to restrain her, I was protecting myself,' ” Merifield said.
Officers are also being trained to look for other physical signs, such as a change in the voice, difficulty breathing or pain when swallowing. Merifield said they are also taught to look for fingernail marks around the chin and neck of a victim, or on the outside of an assailant’s hands and forearms as the victim clawed at the attacker’s face and arms to try to regain the ability to breathe and get blood back to the brain.
“With strangulation, you are literally holding someone’s life in your hands,” Merifield said.
Like all forms of domestic violence, Otway said strangulation isn’t as much about causing damage as it is about asserting control over a victim. In her experience, Otway said, strangulation is not something that happens in the first incident of partner violence, and usually means there has been a long history that started with isolation and verbal abuse and led to escalating incidents of physical assault. Strangulation is just another tool reinforcing that level of control.
“He lords it over her head all the time that he has the ability to kill her,” she said.
More than any other form of manual partner assault, Otway said strangulation is the one where victims tell her they truly believed they were going to die.
“They look at me and tell me, when he had his hands around her neck, ‘I was worried about who was going to take care of my babies,’ ” she said.
Otway was one of a group of six professionals from western Montana who recently attended a special workshop in San Diego put on by the Training Institute on Strangulation Prevention that focused on assessing, documenting and prosecuting strangulation.
In addition to regularly visiting both the Missoula Police Department and the Missoula County Sheriff’s Office to educate local law enforcement about the dangers of strangulation, Otway was recently given a two-hour time slot to present to each cohort of new officers going through the Montana Law Enforcement Academy.
Otway said it’s critically important that there be an immediate medical examination and continual follow-up with victims of strangulation. In the days that follow an attack, burst blood vessels can cause the whites of the victim's eyes to fill with blood, or show themselves as a series of small red dots called petechiae that form on the skin around the face.
Otway also serves an an expert witness during court trials, helping juries to understand that strangulation often doesn’t leave marks, but can cause a broad variety of damage.
The danger of strangulation goes far beyond the immediate health risk. Otway said a tear in the carotid artery can lead to the formation of a clot. If not found and treated, that clot can break loose even years later, travel to the brain and cause the victim to have a stroke.
“That person is not out of the woods for the rest of their lives,” the nurse said. “When you see someone under the age of 50 have a stroke, it’s very common that they’ve been strangled.”
She then goes back to listing things off on her fingers. When blood is cut off, brain cells die at a rate of 32,000 per second. Strangulation can also lead to miscarriages in pregnant women, hearing loss and changes to the voice, as well at post-traumatic stress disorder and early signs of dementia.
“I have one patient that to this day sounds like Minnie Mouse, and to this day she can’t eat solid food,” Otway said.
Suzy Boylan is one of the prosecutors in the Missoula County Attorney’s Office’s Special Victims Unit. She focuses on crimes including domestic violence, sexual assault and child abuse.
The prosecutor said that about 10 percent of all of the cases she’s handling are aggravated assaults by strangulation. At any point, she said, between 40 and 50 percent of her cases include strangulation as a factor, whether secondary to the primary offense or as part of a history between a victim and perpetrator. What used to be a rare situation to cross the desk of the Missoula County Attorney’s Office has now become nothing out of the ordinary.
“I don’t think it would be too hyperbolic to say we’ve seen an explosion,” she said.
Every other year, the Montana Domestic Violence Fatality Review Commission, established in 2003, provides a report to the Legislature that includes recommendations for legal changes. The most recent report, issued in September 2015, included a call to pass legislation specifically relating to strangulation through a stand-alone statute or by enhancing current laws.
While 38 states have a dedicated strangulation statute on the books, Montana is not one of them. Boylan said prosecuting the crime did become slightly easier in 2007 when the Montana Legislature amended the felony aggravated assault law to include the causing of “reasonable apprehension” of serious bodily injury rather than just the actual injury itself.
Boylan said that as a result of the change, there was a rise in the number of strangulation cases tried as felonies rather than partner or family member assault, the first two convictions of which are misdemeanors.
Still, the situation is still far from ideal. Boylan said the system is very still very reliant on victims to show that level of reasonable apprehension of injury in cases where strangulation doesn’t leave damage, even under the revised aggravated assault statute.
Many victims either reach a point where they don’t want to cooperate with prosecutors anymore or have a broad variety of reasons why they don’t or can’t say in front of a jury something to the effect of ‘“I thought I was going to die,” Boylan said.
“The current situation only best serves a certain segment of victims,” she said.
A dedicated strangulation statute could clarify the conduct that is prohibited. Brian Lowney, another of the prosecutors in the Special Victims Unit in Missoula County, was one of the people who went to the training institute with Otway. He said that while strangulation laws can be written in different ways, a possible way to write the statute in Montana could be prohibiting impeding breathing or blood flow and, in his opinion, it needs to be a felony charge.
A 2009 study found that victims of non-fatal strangulation were seven times more likely to be killed in a domestic homicide. Boylan said the way strangulation is prosecuted needs to take into account not just the damage caused but the prevention of future violence and the amount of control the act exerts over a victim.
“Strangulation tells a victim 'I am in control of whether you breathe or not. I am in control of whether you live or not,' ” she said. “They don’t necessarily intend to cause death, they intend to show they could.”