Health Care Providers

Hospital Care

Hospital medical staff are uniquely suited to documenting the condition of the victim carefully and objectively reporting these findings as evidence in criminal cases. The immediate and appropriate treatment of the victim is paramount; however, in the course of treatment, appropriate documentation provides useful information for prosecutors and victims. Of particular importance is the use of appropriate kits for collecting evidence in sexual assault cases for later use at trial. The exam needs to be done sensitively but competently, so that the trauma it can trigger is minimized and evidence is accurately collected.

Read on for information about—

• Hospital guidelines.
• Victims' practical needs.
• Crisis intervention.
• Followup care.

Hospital Guidelines

Hospitals certified by the Joint Commission on Accreditation of Healthcare Organizations must develop services that identify and document cases of sexual assault and refer victims to agencies that can provide further support and advocacy. ²⁴ According to the commission's guidelines, appropriate patient management requires a standardized clinical evaluation, effective interface with law enforcement for the handling of forensic evidence, and coordination of the continuum of care with a community plan. It also requires health care providers to address the medical and emotional needs of the patient while addressing the forensic requirements of the criminal justice system.

Victims' Practical Needs

Hospitals also should consider victims' practical needs, such as for food, clothing, and transportation. To help maintain the privacy of victims and their families who are in public emergency or waiting rooms, many hospitals have developed codes for personnel to use when referring to sexual assault cases. Consider working with hospitals in your jurisdiction to create similar policies.²⁵

Crisis Intervention

Cases of acute sexual assault are medically urgent even in the absence of noticeable physical injuries. During intake, hospital personnel should provide a private setting to ensure confidentiality. The intake process should include activating victim advocates without providing any personally identifiable victim information. Crisis intervention is most effective when it is offered as quickly as possible following the victim's request for services.

Emergency department personnel must manage victims' intakes and transfers in accordance with state and federal laws. For example, according to the Ohio Protocol for Sexual Assault Medical and Forensic Examination—

• The patient should be seen by a health care provider within 15 minutes of arrival, or as soon thereafter as possible.
• The patient should be given priority for room assignment in a private area.
• Regardless of whether the patient chooses to proceed with legal prosecution or talk with law enforcement personnel, health care providers need to provide swift and immediate medical care to the patient.
• Medical personnel need to inform patients of their rights about whether or not to speak to law enforcement personnel.
• Rape crisis advocates are contacted at the same time physicians or medical forensic examiners are called and should be present when advocate support is offered to patients.
• To ensure that the patient feels safe about saying who he or she would like present during procedures, medical personnel should ask everyone accompanying the patient to leave the room and then should ask the patient to name the people he or she would like present, if any.
• Speaking to law enforcement can never be a precondition to the collection of evidence.

Followup Care

According to A National Protocol for Sexual Assault Medical Forensic Examinations, hospital personnel should make sure that patients are aware of available followup care and should arrange for such care before discharging them from the hospital. For example, personnel can²⁶—

• Provide referrals to other professionals.
• Provide discharge instructions.
• Arrange followup appointments.
• Coordinate with advocates and law enforcement to discuss a range of other issues with victims prior to discharge, including safety planning, well-being, physical comfort, information needs, the investigative process, and advocacy and counseling options.