What is a Forensic Medical Exam?


What is the Purpose of a Sexual Assault Forensic Medical Examination?

The purpose of the sexual assault forensic medical exam is to assess a victim's health care needs, coordinate treatment of any injuries and collect evidence for potential use during case investigation and prosecution (U.S. Department of Justice, 2004, pp. 30-2). Since the body is the crime scene, evidence is time-sensitive and may only be present until the victim bathes, washes and/or urinates.


An examination by a health care provider is still recommended even if (1) there are no visible injuries as a result of the assault, (2) the victim does not wish to have evidence collected, or (3) the assault was not recent. In these cases, the victim may have injuries that are not apparent or acute or have related health concerns.



What Does the Forensic Medical Examination Include?

Specifically, the forensic medical exam includes:


  • Support and crisis intervention;
  • Information gathering from the victim for the forensic medical history;
  • An examination/medical assessment;
  • Coordination of treatment of injuries;
  • Documentation of biological and physical findings;
  • Collection of evidence from the victim's body;
  • Information, treatment and/or referrals for sexually transmitted infections, pregnancy and other non-acute medical concerns; and
  • Follow-up care as needed to facilitate additional healing, treatment or collection of evidence (U.S. Department of Justice 2004, p. 13).



How is the Forensic Medical Exam Different From a Medical Exam?

A medical exam is solely for health purposes, while a forensic medical exam addresses victims' health concerns related to a sexual assault and to collect and preserve forensic evidence. While most local health providers are able to provide general medical care, not just anyone can conduct a sexual assault forensic medical exam (as explained below). Sexual assault forensic medical examinations in West Virginia are typically performed at hospital emergency departments rather than other health care sites such as a physician's office, a clinic or campus health center.



Who Conducts the Forensic Medical Examination? What is a SANE?

The examination is conducted by a health care provider, ideally one who has specialized education and clinical experience in the treatment of sexual assault patients and the collection of forensic evidence (U.S. Department of Justice 2004, pp. 24 & 53). As a part of post-exam duties when the criminal justice system is involved, this health care provider (henceforth referred to as an "examiner") may also be called on to interpret, analyze and present exam findings and provide factual and/or expert opinion related to the examination (U.S. Department of Justice, 2004, p. 24).


Many health facilities use sexual assault nurse examiners (SANEs) to perform these examinations. SANEs are registered nurses with advanced education and clinical preparation in sexual assault forensic medical examinations. Many SANE programs utilize on-call nurses to provide around-the-clock coverage for one or more health facilities. When a victim of sexual assault seeks help at one of these facilities, the on-call SANE is contacted to perform the examination. The SANE typically begins the examination after the victim has been assessed and treated for serious injuries. Experienced SANEs provide compassionate care, expertise in identifying physical trauma and psychological needs, skill in coordinating care and referrals, and knowledge regarding how to document injuries and other forensic evidence. Thorough evidence collection and testimony by SANEs have helped prosecutors obtain increased numbers of guilty pleas from offenders and have increased the number of convictions (Littel, 2008; Hoffman & Lopez-Bonasso, n.d.).



Evidence Collection

Many variables affect the relevance of certain types of evidence in a particular case, including whether an assault was committed by a stranger, a known offender who claims no sexual contact with the victim, or a known offender who claims the victim consented to the contact. All available evidence is important, not just DNA evidence.


The examiner collects the following, as relevant to each case and based on jurisdictional policies:


  • Clothing evidence;
  • Debris (e.g., dirt, leaves, fibers, hair, fingernail swabs);
  • Foreign materials and swabs (e.g., bite marks) from the surface of the body;
  • Hair combings;
  • Oral and anogenital swabs and smears;
  • Known blood or saliva sample or buccal swab for DNA analysis and comparison;
  • Toxicology samples; and
  • Documentation of evidence.



Related Medical Concerns

While the risk of pregnancy, sexually transmitted infection and HIV/AIDs from a sexual assault is low, these are major concerns for victims.


The examiner does the following, based on facility and jurisdictional policies and as relevant to the victim's age and gender:


  • Informs the victim of the risk of pregnancy and sexually transmitted infections, testing for HIV/AIDs, and prophylactic steps to avoid pregnancy and infection;
  • Provides testing/prophylactic care as needed; and
  • Provides referrals for related follow-up health services.



How Long After an Assault Can the Forensic Medical Exam Be Conducted and Evidence Collected?

In general, the West Virginia State Police Forensic Lab indicates that 96 hours post-assault is the outside limit for conducting a forensic medical examination using the state Sex Crime Collection Kit.


Prompt examination following a sexual assault helps to quickly identify victims' medical needs and concerns. Evidence can be lost from the body and clothing through washing hands, bathing, brushing teeth, urinating, etc. Therefore the less time between the assault and the forensic medical exam, the more likely that evidence may be collected. With that said, however, recognize that evidence may be found on victims' bodies even in cases where the disclosure of a recent sexual assault is delayed. For example, signs of bruising or vaginal/anal tearing might be present past the 96-hour suggested evidence collection time period. Even when delayed disclosures are made, first responders may encourage victims to seek forensic medical care in some situations. Examiners can obtain the forensic medical history, examine victims and document findings. The history and documentation of exam findings can aid examiners in addressing any related medical issues and determining if and where there may be evidence to collect. Law enforcement can also interview victims to get an account of the assault, identify potential suspects and witnesses and find out if other evidence might be available (at the crime scene, suspect's home, victim's home, in a vehicle, etc.).



What If a Victim Is Undecided About Whether Or Not To Report the Sexual Assault? Should Forensic Evidence Still Be Collected?

Adult victims of a recent sexual assault can have the forensic medical exam conducted within 96 hours of the assault, whether or not they choose to report to law enforcement. If victims are children or are adults considered by West Virginia law to be "incapacitated," these crimes will be reported to the West Virginia Department of Health and Human Resources and law enforcement by health care providers. (See B5. Sexual Violence 101. Mandatory Reporting in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.)



What Happens to the Kit If a Victim Chooses NOT to Report to Law Enforcement?

Sexual assault evidence collection kits (SAECKs) collected from victims who choose not to report the assault to law enforcement will be sent to Marshall University Forensic Science Center (MUFSC), where the collected evidence will be stored for potential future use.


It is important to note that if liquid samples were collected as a part of the toxicology kit (blood and urine), the samples will have a limited life span and will degrade over time. All samples collected as a part of the forensic medical examination (e.g., swabs, smears, etc) will have an unlimited lifespan if collected and dried properly.


Should the decision be made later to initiate an investigation in a non-reported case, the victim would need to contact law enforcement and provide the kit tracking number for law enforcement to be able to secure the SAECK from MUFSC.


If an investigation has not been initiated within 24 months from the time of collection, the SAECK will be categorized as "non-active." Samples collected as part of the forensic medical examination in “non-active” kits may be used for training purposes once all identifying information has been removed.


If the “non-active’ SAECK has not been used for training purposes after the 24 month period, a victim can still request that an investigation be initiated.


There is no statute of limitations on reporting a sexual assault in West Virginia.



Who Pays For the Forensic Medical Examination?

Victims are often concerned about how the costs of the examination will be covered. The West Virginia Forensic Medical Examination Fund was established by the state legislature (WVC§61-8B-16) to pay for "all reasonable and customary costs of a forensic medical examination." For the medical facility and examiner to be paid for through this fund, the exam must be done within 96 hours of the assault. No payment from the fund is provided for non-forensic procedures or treatment—therefore, victims will most likely be responsible for any medical treatment, either through private pay or private insurance. Victims who report the assault to law enforcement within 72 hours (unless just cause exists) can apply to the West Virginia Crime Victims Compensation Fund for reimbursement of out-of-pocket medical costs. Rape crisis center advocates can assist victims in applying for these funds. (See B7. Sexual Violence 101. West Virginia Crime Victims Compensation Fund in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.)



What are Victims' Options If the Sexual Assault Was Not Recent?

Service providers should always validate victims' decisions to seek help to heal regardless of when they disclose sexual violence—whether it is hours, days, months, years or even decades later. If the sexual assault was not recent, victims can still access medical care, advocacy and other services to help them recover. They can report the crime to law enforcement. They can discuss with service providers the possibility of other existing evidence that could corroborate their account of the sexual assault.




Hoffman, N. & Lopez-Bonasso, D. (n.d.). West Virginia goes SANE. Unpublished article.


Littel, K. (2008a). Implementing SANE programs in rural communities: The West Virginia regional mobile SANE project, OVC E-Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime, 3. http://www.ovc.gov/publications/infores/WVA_Mobile_SANE_guide/welcome.html


U.S. Department of Justice (2004), A national protocol for sexual assault medical forensic examination, adult/adolescent. Washington, D.C.: Office on Violence Against Women, 13, 24, 30-2, & 53. Through http://samfe.dna.gov.