Medical Examinations of Sexual-Assault Victims

Part of collecting evidence during a sexual-assault investigation involves a medical examination of the victim. A registered nurse (RN) who has additional education and clinical experience in forensic examinations of sexual-assault victims typically conducts these examinations (Littel, 2001). As of 1997, fewer than 100 Sexual Assault Nurse Examiner (SANE) programs existed. These programs were developed from a need among nurses to have specialized knowledge and training when conducting forensic examinations. The Office of Victims of Crime (OVC) has provided substantial support to increase the number of SANE programs. Their support led to the development of a practical guide to SANE programs. Today there are more than 700 SANE programs in the U.S., Canada, and Australia (International Association of Nurses, 2015). SANE programs provide valuable knowledge to those who administer forensic examinations to sexual-assault victims. The goals include providing victims with prompt, compassionate care while collecting comprehensive forensic evidence.

Sexual assault victims have obviously been traumatized during the assaults, and, in many instances, victims are re-traumatized during the investigation (Lit- tel, 2001). This is especially true for an invasive medical examination. Many experts in the field have recognized that collecting medical evidence from a victim shortly after the assault encompasses many problems. For example, victims have had to wait for long periods of time to be examined. It is not uncommon for victims to wait four to ten hours. Victims are often denied food, water, and bathroom access while they are waiting for their examinations—as this may destroy evidence. Sexual-assault victims are often seen at local hospitals in the emergency room.

Most SANE programs rely on a group of SANEs who are available any time of day or night. Most respond to a sexual assault report within a short period of time (usually within 30 to 60 minutes). After serious injuries are treated and no immediate medical concerns exist, the SANE begins to assess, treat and collect evidence, which includes the following:

  • • Obtain information about the victim's pertinent health history and the crime.
  • • Assess psychological functioning sufficiently to determine whether the victim is suicidal and is oriented to person, place, and time.
  • • Perform a physical examination to inspect and evaluate the body of the victim (not a routine physical examination).
  • • Collect and preserve all evidence and document findings.
  • • Treat and/or refer the victim for medical treatment (a SANE may treat minor injuries, such as minor cuts and abrasions, but further evaluation and care of serious trauma is referred to a designated medical facility or physician).
  • • Provide the victim with prophylactic medication for the prevention of sexually transmitted diseases (STDs) and other care needed as a result of the crime.
  • • Provide the victim with referrals for medical and psychological care and support (Littel, 2001, p. 3).

During the collection of evidence, many jurisdictions have sexual-assault victim advocates present to provide support to the victim and ensure victims receive necessary crisis support (Littel, 2001). These services will vary from community to community.

Those who examine the victim may lack experience and training, causing additional stress to the victim (Littel, 2001). Many physicians avoid sexual assault examinations, as they do not want to testify in court. The staff and doctors at emergency departments often view sexual-assault victims as less of a priority than those with life-threatening injuries (Ledray & Simmelink, 1999). They may also not have an understanding of victimization; this could include holding stereotypes or false assumptions, such as the victim may have done something to instigate the sexual assault (Littel, 2001). This can subsequently affect their willingness to collect and document all forensic evidence, especially in non-stranger sexual assaults. SANE programs attempt to address problems experienced by sexual-assault victims (Littel, 2001).

SANE programs provide many benefits to processing sexual-assault cases and responding to sexual-assault victims (Littel, 2001). As one detective in Alexandria, Virginia noted, SANE programs "have taken response to sexual assault victims at the emergency department out of the dark ages" (Littel, 2001, p. 7). SANE programs provide more thorough forensic evidence and more extensive documentation that adds to the information detectives collect. Local and state prosecutors are typically supportive of SANE programs, as they impact the outcome in sexual-assault cases (Littel, 2001).

The efficacy of SANE programs has not been fully assessed. A few studies have been conducted on limited samples of SANE programs. For example, in an assessment of 71 residency program directors in emergency medicine, 52% were not aware of how their sexual-assault examination requirements were established. Thus, increased awareness of SANE requirements is needed (Sande et al., 2013).

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