Sexual Assault Medical Forensic Examinations
Operational Issues
- Sexual assault forensic examiners
- Facilities
- Equipment and supplies
- Sexual assault evidence collection kit (for evidence from victims)
- Timing considerations for collecting evidence
- Evidence integrity
1. Sexual assault forensic examiners
These are the health care professionals who conduct the examination. It is critical that all examiners, regardless of their discipline, are committed to providing compassionate and quality care for patients disclosing sexual assault, collecting evidence competently, and testifying in court as needed.
Recommendations for jurisdictions to build the capacity of examiners performing these exams:
- Encourage the development of specific examiner knowledge, skills, and attitudes.
- Encourage advanced education and supervised clinical practice of examiners, as well as certification for nurses who are examiners.
2. Facilities
Health care facilities have an obligation to provide services to sexual assault patients. Designated exam facilities or sites served by specially educated and clinically prepared examiners increase the likelihood of a state-of-the-art exam, enhance coordination, encourage quality control, and increase quality of care for patients.
Recommendations for jurisdictions to build capacity of health care facilities to respond to sexual assault cases:
- Recognize the obligation of health care facilities to serve sexual assault patients.
- Ensure that exams are conducted at sites served by specially educated and clinically prepared examiners. A designated facility may employ or have ready access to examiners to conduct the exam. Some jurisdictions have examiner programs that serve one or multiple exam sites within a specific area.
- Explore what is best for the community regarding locations for exam sites. It is critical to consider how accessible facilities are to patients disclosing sexual assault, as well as the facility’s capacity to properly conduct these exams and treat related injuries.
- Recognize that exam facilities and examiners may benefit from networking with examiners in other facilities or areas for support with peer review of medical forensic reports, quality assurance, and information sharing (e.g., on training opportunities, practices, and referrals for patients).
- Consider developing basic jurisdictional requirements for exam sites.
- Promote public awareness about where exams are conducted. Use specially educated and clinically prepared forensic examiners to conduct the exam, ensuring dissemination of relevant information to appropriate agencies and community members. Encourage first responders to work together to assist victims in using these sites.
- If a transfer from one health care facility to a designated site is necessary, use an established protocol that minimizes time delays and loss of evidence while addressing a patient’s needs. However, avoid transferring these patients whenever possible.
3. Equipment and supplies
Certain equipment and supplies are essential to the exam process (although they may not be used in every case). These include a copy of the most current exam protocol used by the jurisdiction, standard exam room equipment and supplies, comfort supplies for patients, sexual assault evidence collection kits, an evidence drying device/method, a camera, testing and treatment supplies, an alternate light source, an anoscope, and written materials for patients. A microscope and/or toluidine blue dye may be required, depending on jurisdictional policy. A colposcope or other magnifying instrument is strongly suggested. Some jurisdictions are also beginning to use advanced technology (telemedicine), which allows examiners offsite consultation with medical experts by using computers, software programs, and the Internet.
Recommendations for jurisdictions and responders to ensure that proper equipment and supplies are available for examinations:
- Consider what equipment and supplies are essential.
- Address cost barriers to obtaining equipment and supplies.
4. Sexual assault evidence collection kit (for evidence from victims)
Most jurisdictions have developed their own sexual assault evidence collection kits or purchased premade kits through commercial vendors. Kits often vary from one jurisdiction to another. Despite variations, however, it is critical that every kit meets or exceeds minimum guidelines for contents: broadly including a kit container, instruction sheet and/or checklist, forms, and materials for collecting and preserving all evidence required by the applicable crime laboratory. Evidence that may be collected includes, but is not limited to, clothing, foreign materials on the body, hair (including head and pubic hair samples and combings), oral and anogenital swabs and smears, body swabs, and a blood or saliva sample for DNA analysis and comparison. The instruction sheet and/or checklist should guide examiners on maintaining the chain of custody for evidence collected.
Recommendations for jurisdictions and responders when developing/customizing kits:
- Use standardized kits (across a local jurisdiction, region, State, Territory, or tribal land) that meet or exceed minimum guidelines for contents, as described above.
- Make kits readily available at any facility that conducts sexual assault medical forensic exams.
- Periodically review the kit’s efficiency and usefulness and make changes as needed.
5. Timing considerations for collecting evidence
Although many jurisdictions currently use 72 hours after the assault as the standard cutoff time for collecting evidence, evidence collection beyond that point is conceivable. Because of this, some jurisdictions have extended the standard cutoff time (e.g., to 5 days or 1 week). Advancing DNA technologies continue to extend time limits because of the stability of DNA and sensitivity of testing. These technologies are even enabling forensic scientists to analyze evidence that was previously unusable when it was collected years ago. Thus, it is critical that in every case where patients are willing, examiners obtain the medical forensic history, examine patients, and document findings. Not only can the information gained from the history and exam help health care providers address patients’ medical needs, but it can guide examiners in determining whether there is evidence to collect and, if so, what to collect. /div>
Recommendations for health care providers and other responders to maximize evidence collection:
- Whether or not evidence is collected, examiners should obtain the medical forensic history as appropriate, examine patients, and document findings (with patients’ consent). Patients’ demeanor and statements related to the assault should also be documented.
- Promptly examine patients to minimize loss of evidence and to identify medical needs and concerns.
- Decide whether to collect evidence and what to collect on a case-by-case basis, remembering that outside time limits for obtaining evidence vary.
- In any case, where the need for evidence collection is in question, encourage dialogue about the potential benefits or limitations of collection. Avoid basing decisions about whether to collect evidence on a patient’s characteristics or circumstances (e.g., the patient has used illegal drugs).
- Responders should seek education and resources that aid them in making well-informed decisions about evidence collection.
6. Evidence integrity
Properly collecting, preserving, and maintaining the chain of custody of evidence is critical to its subsequent use in criminal justice proceedings.
Recommendations for health care providers and other responders to maintain evidence integrity:
- Follow jurisdictional policies for drying, packaging, labeling, and sealing the evidence.
- Follow jurisdictional policies for documenting exam findings, the medical forensic history, and the patient’s demeanor/statements, and packaging, labeling, and sealing such documentation.
- Follow jurisdictional policies for consistent evidence management and distribution. A duly authorized agent should transfer evidence from the exam site to the appropriate crime lab or other designated storage site (e.g., a law enforcement property facility).
- Make sure storage procedures maximize evidence preservation. Ensure that storage areas are kept secure and at the proper temperature for the evidence. Also, make sure jurisdictional policies are in place to address the secure storage of evidence in cases in which patients are undecided about reporting.
- Maintain the chain of custody of evidence. All those involved in handling, documenting, transferring, and storing evidence should be educated regarding the specifics of their roles in properly preserving evidence and maintaining the chain of custody.
