Medical Forensic Response in Minnesota How Are We Doing? Frequently Asked Questions About Sexual Assault Examinations in Minnesota

Transcription

1 Medical Forensic Response in Minnesota How Are We Doing? Frequently Asked Questions About Sexual Assault Examinations in Minnesota 1) Why did MNCASA conduct a survey of the medical forensic response in Minnesota? Over the years the Minnesota Coalition Against Sexual Assault (MNCASA) has responded to hundreds of technical assistance questions about access to sexual assault examinations in the state. The organization is of the opinion that there are many problems within the system as it is currently operating. MNCASA has received funding in three separate grants from the Office of Justice Programs at the Minnesota Department of Public Safety to provide technical assistance, study best practices, make recommendations and survey the field. MNCASA created the Medical Forensic Exam Access Project through this funding. The survey report, Medical Forensic Response in Minnesota How Are We Doing? summarizes the many issues MNCASA and professionals responding to sexual assault victims have encountered statewide. 2) How was the data collected? The survey was ed to all of MNCASA s stakeholders as well as the Minnesota Hospital Association s contacts, and individuals were encouraged to share the survey within their networks. Respondents were able to submit responses for two weeks, and the survey closed with a total of 139 respondents. A wide variety of disciplines were represented within the 139 respondents (42% sexual assault nurse examiner/healthcare, 38% advocacy, 13% law enforcement, 6% prosecution, 1% corrections). 3) Where can I go to have a sexual assault examination? Most hospitals offer a sexual assault examination but not all hospitals have Sexual Assault Nurse Examiners (SANE). According to the Minnesota chapter of the International Association of Forensic Nurses (MN-IAFN) out of the 147 hospitals in the state approximately 40 hospitals have a SANE program and SANEs responding to sexual assault patients. Approximately 20 other hospitals have one or two SANEs on call. There are approximately 200 SANEs in Minnesota. 1

2 4) What is the difference between a sexual assault examination provided by a SANE and one provided by a doctor or emergency room nurse? SANEs are specially trained to provide medical care, interview a sexual assault victim, document the reported experience, collect forensic evidence and secure chain of custody for law enforcement purposes. Sometimes SANEs testify about the victim s sexual assault examination during trial. Sexual assault examinations are also known as forensic examinations. A SANE is a nurse who has undergone an additional 40 hours of certification training. Shadowing experienced SANEs is highly recommended in order to build skills. SANEs primarily provide care to adolescent and adult victims but they can also specialize in pediatric victims. 5) Who can get a sexual assault examination? Sexual assault examinations are available to anyone who is a victim of sexual assault regardless of gender identity. In general sexual assault examinations are conducted up to 120 hours after a sexual assault however special circumstances may warrant an examination after that period of time. In some parts of the state, hospitals will conduct an exam up to 72 hours after the sexual assault. 6) What happens during a sexual assault examination? An interview helps the SANE or health care provider determine what happened to the victim. The victim s account is carefully documented. An examination will focus on the areas of the body where the patient reports sexual penetration or sexual contact. The SANE or health care provider will take photographs as needed and use swabs to collect DNA evidence from areas of the body where the victim reports contact with semen, saliva or sweat. Blood and urine samples may be taken when the victim indicates potential drug or alcohol involvement in the sexual assault. The evidence collected from the victim s body is packaged into a sealed sexual assault kit to preserve chain of evidence for law enforcement purposes. The SANE may also collect other relevant evidence such as a victim s clothing. Certain techniques are used throughout the examination to preserve evidence in order to maximize its effectiveness. The SANE or health care provider will also document any physical injuries. Prophylactic medications are provided for sexually transmitted infections and emergency contraception is offered if pregnancy is a concern. Emergency contraception is not given to women who are already pregnant. 7) How long does a sexual assault examination take? The entire examination, depending on the victim s needs, can last approximately 3-4 hours. Some cases may require a longer period of time. 2

3 8) What if a victim seeking a sexual assault examination is turned away by the hospital? This happens sometimes when a hospital does not have staff to conduct a sexual assault examination or is not willing to assign staff to provide this service. A hospital is not supposed to turn away a patient without providing at least brief care and hopefully a hospital will assist the sexual assault patient in accessing care elsewhere. Victims who are turned away often do not continue to seek help and they may not have transportation or other means to travel to another hospital. All hospitals should have a plan to serve sexual assault victims. Increased access to Telemedicine would be one way to connect hospitals without SANEs to assistance statewide. 9) What about aftercare? Often sexual assault victim advocates are called to the hospital to support the victim. The advocate may be present during the exam if the victim wishes and provide resources to the victim for ongoing help. The SANE and advocate will also make sure that the victim is aware of community resources and discuss the victim s safety plan. 10) How much does a sexual assault examination cost? A sexual assault examination is free of charge to a victim under Minn. Stat as required by the federal Violence Against Women Act (VAWA). The county where the sexual assault occurred is responsible for the cost of the examination. A victim s insurance may be used for payment only if the victim consents. VAWA requires that a victim incur no out-of-pocket costs for a sexual assault examination. In general, SANE programs offer STI prophylaxis and emergency contraception free of charge but that is not always the case. The victim is responsible for any costs related to treating physical injuries from the sexual assault such as wounds or broken bones. 11) Do victims receive bills for sexual assault examinations? Yes, they often do, even though the law states that they should not be billed. State and federal law requires that a victim never have to pay for the cost of a sexual assault examination. Victims who receive bills may not know about their rights and they may face safety concerns if the bill is seen by the perpetrator. The victim s confidentiality is also compromised if others see the bill. 12) Are billing practices inconsistent across the state? Yes they are. Every county has a different process with different payors including law enforcement and county attorneys offices. Because practices differ victims cannot be assured equitable treatment from county to county. Minnesota is one of the few states in the country with a county-based system. Inconsistencies make it difficult to predict billing practices and hospitals are not always clear how much they will be reimbursed by a county 3

4 for providing services. Sometimes hospitals or even victims are stuck with a bill if a county denies that a sexual assault occurred in its jurisdiction. 13) Does a victim of sexual assault have to report to law enforcement in order to get a sexual assault examination free of charge? No. VAWA requires that all states offer sexual assault examinations to victims free of charge without a requirement of reporting to law enforcement. The public policy reason is that victims should be able to obtain medical care without the pressure of making a police report. The first VAWA passed in 1994 did allow states to require a report by the victim to law enforcement in order to receive an exam at no cost however there were several reports of a chilling effect on victims seeking care because they were either not ready to report or did not want to report. Subsequent versions of VAWA were changed to reflect victim choice. Minnesota Statute , amended in 2003, states that victims do not have to engage with the criminal justice system in order to receive an exam free of charge. Many victims want time to decide whether or not they want to engage the criminal justice system. Ensuring that they have immediate access to medical care and a forensic examination ensures that their health needs are met and evidence is collected in a timely fashion should they decide to report the sexual assault. Victims who are undecided at the time of an exam who then receive quality exam with access to advocacy services are more like to report to law enforcement afterward. If those victims were required to report to law enforcement first, it is likely they would neither receive an exam nor report to law enforcement. 14) What happens once a sexual assault examination is completed? It depends on the wishes of the victim. If the victim does not want to report the sexual assault kit will be stored until such time as the victim decides to release the kit to law enforcement. The kit will be destroyed after a certain period of time (made known to the victim) if the victim decides not to report to law enforcement. Only the victim can release the kit for testing. Authorizing the release of the kit for testing is a freely made, voluntary choice by the victim. A kit is only tested if a victim has reported to law enforcement, and law enforcement has submitted it to a crime lab for testing. Experience has shown that requiring victims to release the kit to law enforcement would have a chilling effect on victims seeking care. If the victim wants to report the sexual assault to law enforcement the victim will sign a release form and the SANE or health care provider will contact law enforcement. Law enforcement will pick up the sexual assault kit and submit it to one of the state s forensic laboratories for processing. 4

5 15) What is forensic compliance? The aforementioned federal requirements under VAWA are typically referred to forensic compliance. States that are not compliant with these requirements are at risk of losing important federal STOP funding. STOP grants support projects by law enforcement, prosecution, victim advocacy and others in response to violent crime. The Office of Justice Programs at the Minnesota Department of Public Safety is responsible for administering STOP funds in the state. 16) What is the difference between unsubmitted kits and a backlog of untested kits? A recent inventory by the Bureau of Criminal Apprehension found that some law enforcement agencies in Minnesota had kits in storage that, for various reasons, had not been submitted to a forensic laboratory tested even though the victim had signed a release. These are called unsubmitted kits. A backlog occurs when kits sit untested at a forensic laboratory after being submitted by law enforcement. The majority of the kits in the BCA s 2015 report were unsubmitted kits but it is not known how many were kits that were in law enforcement storage awaiting a victim s report and release of the kit. Sometimes unreported kits are held by hospitals and sometimes they are held by law enforcement using anonymous identifiers. Practices vary across the state. 17) Where can I find additional information? Contact the Medical Forensic Exam Access Project at the Minnesota Coalition Against Sexual Assault ( and 5