Operational Issues- Facilities (cont)

 

Communities may wish to consider developing basic requirements for designated exam sites.

Examples of such requirements include:1

  • The site will be within a reasonable distance from any point in the area it serves (“reasonable” is locally defined).

  • The site will promptly alert a SART/SARRT member, if one exists, when sexual assault patients arrive.

  • Urgent or emergent physical injuries (or other acute medical needs) will be treated immediately.

  • Responding examiners will be competent in their knowledge and skills.

  • The site will ensure that admissions staff have the necessary resources and knowledge to best accommodate the patient until the examiner or victim advocate arrives.

  • The site will arrange for interpretation as needed in patients’ preferred languages and/or obtain devices that facilitate communication for individuals with sensory or communication disabilities.

  • Patients will be provided with a comprehensive medical forensic exam and resources to address their immediate emotional and psychological needs.

  • The site will provide a private, secure, and quiet waiting area for patients and for personal support persons accompanying them.

  • The site will provide a private and secure setting for the investigative interview.

  • The site will provide a private exam room and other measures to assure patients’ privacy.

  • The site will have a bathroom (preferably with shower facilities) available for patients’ use following completion of the exam.

  • The site or examiner program that serves the site will have/provide proper equipment and supplies to facilitate a comprehensive exam (“proper equipment and supplies” are locally defined).

  • The site or examiner program that serves the site will have a mechanism to ensure that evidence collection kits are available and up to date.

  • Patients will be offered medications for possible exposure to sexually transmitted infections.

  • Patients will be assessed for pregnancy risk, informed about treatment options, and offered treatment.

  • Patients will be offered information about how exams are paid for in their jurisdiction and reimbursement sources (if they exist) for related expenses that are their responsibility.

  • Site billing departments will adhere to proper coding and billing practices for sexual assault cases, as determined by the facility and informed by jurisdictional policy.

If designated facilities or sites served by examiner programs are selected, their success depends on getting information about them to victims and agencies that provide immediate response or refer victims for treatment and evidence collection. At a minimum, the list of designated exam sites should be provided to all local hospitals, law enforcement agencies, emergency medical services, sexual assault victim advocacy programs, and protective services. Promoting community public awareness about these sites is also important given that victims may first disclose an assault to family members, friends, teachers, faith-based leaders, employers, coworkers, and others. In addition, success will depend on interagency cooperation in explaining facility options to victims and transporting them to designated exam sites (with their permission). Law enforcement representatives and advocates may need guidance on how to recommend an exam location to victims without mandating that they go to a specific site.

If a transfer from one health care facility to a designated exam site is necessary, use a protocol that minimizes time delays and loss of evidence and addresses patients’ needs.2

Avoid transferring sexual assault patients whenever possible. If transfer is necessary, explore options to ensure that the patient’s comfort is prioritized. Every transfer can destroy evidence and cause patients further stress. However, if a sexually assaulted individual arrives at a health care facility that, for some reason, is not able to provide a medical forensic exam, interagency transfer procedures must be in place to transfer that individual to the nearest designated exam site. Evidence should be preserved when examining, treating, or transferring patients and providers should take care to preserve the chain of custody of such evidence. If there are acute medical or psychological injuries that must be treated immediately, treatment should be provided at the initial receiving facility. It may be helpful to offer patients support and advocacy from advocates at both the receiving facility and exam site. A copy of all records, including any

X-rays taken, should be transported with patients to the exam facility. (However, it may not be necessary to send all medical records if patients’ medical needs are met before they are transferred to a nonmedical exam site for evidence collection.) All health care facilities receiving federal funds, including Medicare and Medicaid payments, are required to screen patients medically before transferring them to another exam site.3 Patients have a right to decline a transfer. They should be aware, however, of the impact of refusing transfer, as it may negatively affect the quality of care, the usefulness of evidence collection, and, ultimately, any criminal investigation and/or prosecution. They should understand that declining a transfer might also be used to discredit them in court. Providers should carefully discuss with patients the benefits of the transfer, the possible benefits of refusing the transfer and the drawbacks of both options, so that patients can make an informed decision. Providers should avoid pressuring patients to accept a transfer.

 

 Table of Contents Equipment and Supplies
1 Adapted from Pennsylvania’s SART Guidelines, 2002, p.21.
2 This section was drawn from the North Dakota Sexual Assault Evidence Collection Protocol, 2005, p. 12, and the Texas Evidence Collection Protocol, 1998, p. 14. 3 Emergency Medical Treatment and Active Labor Act, 42 U.S.C. 1395dd.