Key Points

This protocol offers basic information for examiners. However, the key points are highlighted below. Each point is covered extensively within this protocol document.

  1. Sexual assault is a trauma, regardless of the presence of physical injuries. Health care providers can help reduce the neurobiological response to trauma by providing trauma-informed and person-centered care that restores safety, security, and control to patients. Individuals who experience sexual violence deserve to be seen, heard, and respected.
  2. Treat emergent medical conditions before, or concurrently to, addressing forensic issues such as evidence collection.
  3. Non-fatal strangulation is a life-threatening event that requires specialized assessment and close patient monitoring.
  4. Patients are integral health care team members who guide the assessment process and have the right to decline any part, or all, of the examination and evidence collection.
  5. Use open-ended questions that allow patients to provide their medical forensic history of what occurred.
  6. In all patient interactions, it is important to maintain confidentiality of medical forensic information and documentation (Michigan Legal Publishing, 2021). The Health Insurance Portability and Accountability Act (HIPAA) applies to this patient population.
  7. Offering access to a sexual assault advocate during the medical forensic assessment is mandated by Texas law. A sexual assault advocate is distinct and separate from health care, law enforcement, and judicial personnel.
  8. Mandatory reporting is required “without exception” for suspected abuse of children, the elderly, or persons with disabilities, regardless of the wishes of the patients, their families, or friends (Texas Family Code §261.101).
  9. Child patients should always be seen by a practitioner with forensic expertise (sexual assault nurse examiner, forensic nurse examiner, child abuse pediatrician or specially trained medical forensic professional). Child patients should have care coordination through a children’s advocacy center, with specialized resources and referrals or child specific support services (Office of the Texas Governor, Greg Abbott, n.d.).
  10. Patients who are suspected perpetrators should always be seen by a practitioner with forensic expertise (SANE, forensic nurse examiner, child abuse pediatrician or specially trained medical forensic professional). Ensure patients who are suspected perpetrators and patient who reports being sexually assaulted are separated to ensure psychological and physical safety for all.
  11. During the examination and evidence collection process, avoid contamination of potential evidentiary items. Label bags and complete all information requested on bag. After all the evidence and clothing have been collected by the health care provider and sealed appropriately, evidence should be opened only by crime laboratory personnel.
  12. All patients deserve person-first, culturally responsive, trauma-informed, quality, and non-biased health care.
  13. It is critical that adult military-affiliated survivors receive information about their reporting options from a person knowledgeable of the Department of Defense policy that defines reporting choices to ensure the patient’s rights are not violated.
  14. Policies should be in place regarding the process for obtaining photographs; the method used to identify the patient in the photographs; and documentation that the photographs exist in the permanent medical record for each patient.
  15. All patients are entitled to a medical forensic examination (Texas Code of Criminal Procedure §56).
  16. Adult patients who do not meet mandatory reporting criteria, may choose to have sexual assault evidence collected without reporting to law enforcement (Texas Health and Safety Code §323). A sexual assault evidence collection kit should be used only when indicated, as described in Subchapter F (Texas Code of Criminal Procedure §42).

References