4.4.1 Pre-Exam Considerations
Priority: It should be given to examine the sexual assault patient.
Initially, triage the patient for medical needs, safety and comfort before proceeding with the forensic exam.
Medical stability is the priority; the sexual assault exam is secondary to any necessary medical response.
Please note that medical stability is an on-going process during the sexual assault exam.
Advocate: Call your local advocacy program to provide the patient with someone to be present during the forensic interview and exam.
The advocate’s role is essential during this procedure.
The trained advocate can help with referrals, case management, long-term recovery and psychological healing of the patient.
If you are responding to a patient who came from a facility, do not use an employee of the facility as an advocate.
Consent: After reading these instructions, explain the forensic examination to the patient and obtain consent for the following, specific procedures, allowing the patient to decide what procedures they will permit:
A full exam (evidence collection and medical treatment) or a limited exam (just medical treatment);
Documentation of injuries, which may include photography or colposcopy;
Pregnancy testing, STI prophylaxis and emergency contraception;
Urine collection in the potential case of drug-facilitated sexual assault;
Release of evidence or reporting to law enforcement; and
Referral to a child safe house or an appropriate pediatric medical agency for age appropriate patients.
The patient is under no obligation to report the assault to the police or to undergo the sexual assault exam.
Counsel the patient that collection of evidence is recommended even if they do not think that they want to press charges.
Ensure that the patient realizes that the preservation of evidence is time sensitive and that now is the optimal time to collect.
In the event the patient wants evidence collected but at the time of the exam, does not wish to have the case investigated by law enforcement, it’s important to inform the patient how any collected evidence will be stored.
It’s often the case that for crime labs to accept evidence, an information report must be filed with the appropriate law enforcement agency responsible for transferring the evidence.
The information report will include, at least, the patient’s name, date of birth and most likely a reference to sexual assault.
Like all police reports, the information report is public record.
The patient is under no obligation to speak to law enforcement at the time of the exam or participate in an investigation.
The information report does not automatically result in an active investigation but rather facilitates the transfer and storage of evidence.
If the patient decides to pursue an active investigation, they must contact the appropriate law enforcement agency to initiate the investigation. The advocate may be able to help the patient with initiating the investigation.
If the patient decides against evidence collection, a limited exam can be offered.
A limited exam includes medications for STI prophylaxis and emergency contraception, and you would not need a Sexual Assault Evidence Collection Kit.
With patient consent, pregnancy testing with subsequent emergency contraception and STI prophylaxis may be provided.
The patient still has the option to return within five days, post-assault, for a full sexual assault evidence exam.
If the patient wants to file a police report, notify law enforcement.
The advocate should remain with the patient during the investigative interview with police.
As part of the informed consent process, before sample collection, survivors should be informed of:
The purpose of collecting samples for the kit by the medical examiner,
How the kit may be used in the investigative process by the survivor’s legal counsel or law enforcement,
The processes and associated time frames for law enforcement’s testing of kits; and
The processes and associated time frames for law enforcement’s notification of kit testing results (e.g. DNA).
Exam payment: Inform the patient of whether or not the evidence collection portion of the exam will be paid in full by the government and which portions of treatment, if any, are covered.
If additional medical treatment charges are incurred, inform the patient that they may be held responsible for the medical portion of the charges (injury repair, prescriptions, etc.).
If the patient may apply for additional funding to cover the medical treatment from a fund or commission, inform them that this is available if a police report is filed.
The advocate will likely have contact information for the fund or commission, if one exists in your area.
Chain of custody: READ THIS! IMPORTANT!
Chain of custody refers to the examiner’s ability to testify under oath that the evidence could not have been tampered with or compromised in any way during its collection, packaging, storage or transfer.
The chain of custody must be maintained at all times once the Sexual Assault Evidence Kit is opened.
This means the examiner must stay with the evidence collected during the exam until all evidence has been properly sealed and secured.
The chain of custody includes an integrity seal, which is the assurance that the examiner is responsible for collecting and packaging the evidence.
The integrity seal is the examiner’s initials and the date of collection written over the taped seal of the evidence kit’s small and large white envelopes and large brown bag.
Once sealed, evidence should be signed over to law enforcement.
If this is not possible, evidence may be signed over to the next person on shift at your medical facility. The next individual must take full responsibility for the evidence until law enforcement is able to retrieve the evidence kit’s white envelopes and brown bag.
Every individual who assumes responsibility for any evidence must document the handling and transfer of that evidence.
It’s acceptable to keep the kit in an area that is locked securely.
Ideally, law enforcement should obtain the completed kit as soon as possible following the exam.