Sexual Assault Medical Forensic Examinations
Optimal site locations
Explore possibilities for optimal site locations. SARTs (or involved agencies) should determine where exams should be conducted. Some factors to consider when identifying sites include safety and security for patients and staff, physical and psychological comfort for patients, capacity to accommodate victims with disabilities,[6] availability of examiners with advanced education and clinical experience, access to a pharmacy for medication, access to medical support services for care of injuries, access to lab services, and access to the supplies and equipment needed to complete an exam.[7] Decisions about site location should reflect the needs of victims (e.g., for accessible care close to their home and local referrals), what is most efficient for the multidisciplinary response team, and the need to maintain the neutrality and objectivity of examiners. Designated facilities may be in hospitals, health clinics, mobile health units, or other alternative sites, including family justice centers.[8], [9] The majority of medical forensic exams are conducted in hospital emergency departments. This location typically offers some level of security, is open 24 hours a day, and provides access to a wide array of medical and support services. Clinical staff often have the experience and expertise to perform the exam and collaborate with appropriate disciplines. Some jurisdictions have or are developing specialized hospital or community-based examiner programs.[10]
SARTs may need to decide whether a local, regional, or State/Territorial system of designated facilities best serves community needs. Some issues that might impact this decision include community demographics and geography; the need for and availability of specialized services; availability of local health care facilities; local capacity to secure competent examiners and necessary space, equipment, and supplies; willingness of involved disciplines to coordinate with a local facility or examiner program; distance to/from regional or State/Territorial facilities; and service capacity of regional or State/Territorial facilities. Communities are encouraged to first consider using local designated exam sites. However, some may ultimately opt for regional- or State/Territorial-level facilities. For example, a small State or sparsely populated region may establish one or more designated facilities to serve all of its localities.
Exam facilities and examiners that serve at the local level may benefit from networking with examiners in other facilities or areas for support for peer review of medical forensic reports, quality assurance, and information sharing (e.g., on training opportunities, practices, and referrals for patients).
[6] Title II and Title III of the Americans with Disabilities Act explains requirements for facilities in accommodating persons with disabilities (which may vary depending on the type of facility). Title II prohibits discrimination against persons with disabilities in all programs, activities, and services of public entities. Title III requires places of public accommodation to make reasonable modification in their policies, practices, and procedures in order to accommodate individuals with disabilities. See www.ada.gov for related information and resources.
[7] Drawn from L. Ledray, SANE Development and Operation Guide, 1998, p. 35–36.
[8] Particularly on tribal land that is devoid of or a significant distance from a hospital, Indian Health Service (IHS) facilities should consider securing and maintaining examiners and necessary space, equipment, and supplies to conduct these exams. Ideally, all IHS facilities should have examiners and a minimum standard for examiner training.
[9] For more information on the President's Family Justice Center Initiative, see http://www.usdoj.gov/ovw/pfjci.htm.
[10] The pros and cons of developing hospital versus community-based examiner programs are discussed in more detail in L. Ledray's SANE Development and Operation Guide, 1998, p. 35–9; L. Ledray's Sexual Assault: Clinical Issues, SANE Program Pros and Cons, Journal of Emergency Nursing, 23(2), p. 183; and in K. Littel's SANE Programs: Improving the Community Response to Sexual Assault Victims, pp. 10–1.
