What is a forensic exam?
While there is no standard protocol for how these are conducted in Washington State, Harborview Medical Center provides some recommendations and guidelines for both adult and adolescent forensic exams (see Additional Online Resources below). However, it is important to recognize that different counties and even different hospitals within counties may have difference procedures.
A forensic exam following a sexual assault will most likely consist of:
- Interview: To ascertain medical history, identify gynecological history, and gather assault details. The examiner and police will do interviews. Sometimes victims get concerned because they just went through this. Let them know that each person is asking questions for different reasons.
- Physical: To identify and document external injuries, conduct a pelvic exam, collect pubic hair, scrape fingernails, and collect other evidence relevant to the assault.
- Other tests: To collect a blood sample, photograph injuries, collect clothing, photograph any bite marks, etc.
- Drug-facilitated rape: If drugs or alcohol were used to facilitate a rape, it is important that the victim give a urine sample immediately since most of these drugs leave the system within 12-15 hours. However, it is also important to let the victim know that should they give a urine sample, any drugs or alcohol that they took voluntarily will also show up in the results. The police are not likely to prosecute but some have. The victim needs to be aware of this and consent to the procedure.
Due to the possibility of physical injuries sustained during the assault, the physician or SAFE/SANE may:
- Pay particular attention to the areas of the body likely to have been injured as indicated by the history;
- Inspect the back, buttocks, and inner thighs for signs of trauma;
- Examine the external genitalia for signs of trauma such as lacerations, redness, or swelling;
- Conduct a speculum examination of the cervix and vagina;
- Perform a bimanual (two fingers) examination for signs of swelling or tenderness in the area of the fallopian tubes and ovaries;
- Inspect the mouth and/or anal orifice;
- Take cultures of the mouth/throat, cervix, and rectum;
- Conduct the evidence-gathering procedures;
- Fill out the necessary paperwork; and/or
- Provide follow-up care instructions.
Many hospitals use a prepackaged medical evidence-gathering kit. All specimens should contain the patient's name, the date and time the evidence was gathered, the person collecting the specimen, and the type of evidence. A chain of custody must be maintained in order to protect the integrity of the evidence. This means that a record should be collected of all persons who handle the evidence, that is, the physician, nurse, and police officer (if a report was made). The evidence should not be left lying around where other people will have access to it and should never be handled by an advocate.
Advocates should NEVER insert themselves into the investigation. Ways to avoid being inserted into the chain of custody includes:
- Never provide translation.
- Don't take notes or prompt the victim to say something.
- Never sign things as a witness.
- Don't ever be alone with the forensic evidence and never touch it.
Cost of Services
There are provisions in state and federal law ensuring sexual assault survivors have access to a medical forensic exam free of charge, without reporting to law enforcement. For more about these as well as to review billing guidance from the Crime Victim's Compensation Program: http://www.wcsap.org/guidelines-ensure-survivors-have-free-access-sane-e...
Additional Online Resources