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This section focuses on victim exams. The purpose of the victim sexual assault forensic medical exam is to address a victim’s related health care needs and collect evidentiary samples for potential use during case investigation and prosecution (U.S. Department of Justice, 2013).
An examination of a victim by a health care provider is 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 and/or have related health concerns.
Overview
Exam Components
Specifically, the victim forensic medical exam includes (drawn from U.S. Department of Justice, 2013):
- Support and crisis intervention
- Information gathering from the victim for the forensic medical history
- An examination/medical assessment
- Evaluation and treatment of injuries
- Documentation of biological and physical findings
- Collection and preservation of evidence from the victim’s body
- Information, treatment and/or referrals for sexually transmitted diseases (STDs, also referred to as sexually transmitted infections or STIs), pregnancy and other non-acute medical concerns
- Follow-up care for medical and emotional needs as well as further forensic evaluation
Medical Exam vs. Forensic Medical Exam
These exams have different purposes. A medical exam is solely for health purposes, while a forensic medical exam addresses victims’ health concerns related to a sexual assault and collects, preserves and documents forensic evidence.
Who conducts these exams are different. 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). They require specialized training and experience.
Locations where these exams are conducted can be different. Victim sexual assault forensic medical examinations in West Virginia are typically performed at hospital emergency departments. A medical exam can be conducted in a wider variety of health care sites (e.g., physicians’ offices, clinics, college campus health centers and hospitals).
Forensic Examiners
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. It is expected as a part of post-exam duties when the criminal justice system is involved that this health care provider (henceforth referred to as an “examiner”) may be called on to testify in court as either fact and/or expert witness. (U.S. Department of Justice, 2013)
Many health facilities rely on 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
- Documentation of evidence (photographic and written)
Related Medical Concerns
While the risk of pregnancy, STDs, including 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 STDs, testing for HIV/AIDs, and prophylactic steps to avoid pregnancy and infections
- Provides testing/prophylactic care as needed
- Provides referrals for related follow-up health services
Timing Issue: For pregnancy prevention, emergency contraception optimally is taken within the first 12 hours after an assault, but it can be effective up to 120 hours (5 days) post-assault.
Frequently Asked Questions
How Long After an Assault Can an Exam Be Conducted?
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 West Virginia sexual assault evidence collection kit (SAECK).
- Prompt examination following a sexual assault helps to quickly identify victims’ medical needs and concerns.
- Evidence can be lost from the body through washing hands, bathing, brushing teeth, urinating, etc. Evidence on clothing can be lost when it is washed. Thus, 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 and clothing 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. DNA evidence in sexual assault cases has been in certain locations of the body and on clothing (even when washed) well beyond 96 hours post-assault (Speck & Ballantyne, 2015; U.S. Department of Justice, 2013). So, even when delayed disclosures are made, first responders may encourage victims to seek forensic medical care in situations where potential evidence collection is a possibility. 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 Reporting? Can 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.
What Happens to the Evidence Collection Kit If a Victim Chooses NOT to Report?
- 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.
- The non-active sex crime evidence collection kit will be held for a period of 20 years and if it has not been used for training purposes, the 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 Exam?
Victims are often concerned about how the costs of the examination will be covered.
The West Virginia Forensic Medical Examination Fund (WVC§61-8B-16) was established 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, as well as victims who have a forensic medical examination conducted within 96 hours of the assault (regardless of their reporting status), 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.
Also see WV Related Legislation, Forensic Medical Exams, for more on payment of costs.
What are Victims’ Options If the 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.
Resources
References
Hoffman, N. & Lopez-Bonasso, D. (n.d.). West Virginia goes SANE. Unpublished article.
Littel, K. (2008). 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.
Speck, P. & Ballantyne, J. (2015) Post-coital DNA recovery study. Final report for U.S. Department of Justice Grant.
U.S. Department of Justice. (2013). A national protocol for sexual assault medical forensic examination, adult/adolescent, 2nd edition. Washington, D.C.: Office on Violence Against Women.