Sexual abuse no doubt is traumatic for the victim. The processes involved following the incident may get even more confusing and stressful. Having to recount what happened to investigators and medical professionals and subjecting victims to almost similar invasive stimuli can be distressing for the victim and the loved ones providing them with support.
To better understand sexual abuse examinations, Kim Basinger and Roger Blevins take turns to explain the acute and non-acute sexual assault exams that victims must go through following sexual assault/abuse. Kim is a certified Sexual Assault Nurse Examiner (SANE) for adults and children, a registered nurse, and a Master Certified Peace Officer with experience in different aspects of law enforcement. Meanwhile, Roger is a pediatric nurse practitioner and clinical nurse specialist focusing in child maltreatment/abuse.
Specifics they delved into in this session include:
- What Sexual Assault Nurse Examiners (SANE) are – their scope of work and responsibilities.
- Defining nursing and the exceptions afforded to nurses in terms of federal and state hearsay rules.
- The purpose of sexual assault examination which primarily centers on providing the victim with the necessary care and secondarily to collect evidence.
- A brief discussion on the four major parts of a sexual assault exam.
- The acute sexual assault exam which must be conducted within 120 hours from the incident.
- The distinct characteristic of an acute sexual assault exam which is time-bound, lengthy, invasive, and may involve multiple medical professionals.
- What is done in an acute sexual assault exam and how it addresses the victim’s trauma, potential disease processes and pregnancy, and identifies link cases as trafficking and strangulation.
- A breakdown of the sexual assault evidence collection kit, the processes involved to preserve evidence, and the medication that may be provided.
- The important post-exam resources of advocacy and follow-up care to provide to the victims.
- The non-acute/delayed medical evaluation conducted exclusively for diagnosis and treatment.
- A step-by-step look into the delayed medical evaluation process including the relational aspect of establishing rapport, obtaining consent, and allowing comfort persons.
- The distinct characteristics of a delayed medical evaluation that isn’t invasive, is not considered an emergency and done largely for the physical and emotional health of the victim.
- Disclaimers and limitations with delayed medical evaluations and its findings that must be explained in court.
- The value in conducting these exams despite the usually normal results in addressing undetected health issues and risks, and reassuring and reducing the victims’ anxiety from the incident.
- Pointers on how to write an unbiased diagnosis for delayed medical evaluations.
- Supporting medical literature surrounding sexual abuse, the importance of the examinations, and the findings of which.
Questions from the audience were about:
- Reference for the national protocol on sexual abuse examinations.
- Deciding whether to conduct the acute sexual assault exam or the delayed medical evaluation.
- Techniques to build rapport with the patients.
- The time it takes to conduct the examinations.
- ER doctors conducting the acute sexual assault exam when a SANE isn’t available.
- Processing the kits and the potential backlog.
- Collecting blood and/or urine for the exams.
- Acquiring consent from victims who are minors and workaround to conduct an exam due to medical necessity despite having an objecting patient.
- The concept of two positions and positive findings.
This is part of a 3-part series:
- Part 1: Medical Aspects of Child Neglect
- Part 2: The Prosecution of Child Neglect Cases
- Part 3: Understanding Sexual Abuse Examinations in Investigation and Prosecution Efforts (this webinar)
Resources and Handouts
- Academic References Used During the Webinar
- A National Protocol for Sexual Abuse Medical Forensic Examinations (Pediatric) 2016
- Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient (American College of Emergency Physicians)
- A National Protocol for Sexual Assault Medical Forensic Examinations (Adults/Adolescents)
- Management of the Patient with the Complaint of Sexual Assault
- Previous Webinar: The Investigation and Prosecution of Strangulation Cases
- Previous Webinar: Traumatic Brain Injury: It’s Not Just About Football
- Previous Webinar: Investigating and Prosecuting Sex Trafficking Cases in Tribal Communities
- Visit our Domestic Violence and Sexual Assault Feature page for more webinars in this topic.
- “Since I am new to my unit, it was nice to hear an overall approach to the topic.” –Adam
- “Very helpful information – now have clarity on acute and nonacute exams. And better understand difference between forensic and medical exams (especially the fine line of a medical exam sliding into the forensic exam realm). Great concrete examples of practice as well. Thank you all.” — Amber
- “Speakers presented with knowledge and comfort. The Q&A session did not appear rushed. Thank you!” — Tony
- “I am an advocate and I was under the assumption that forensic nurses are mainly forensic evidence collectors. I had also never heard the term “nursing diagnosis”. — DeAnna
- “As someone that isn’t from the medical community, I found all of it helpful.” — Evelyn
- “The presenters’ ability to share the wealth of knowledge that they have with such ease. This is my first time attending a course through JCH and I look forward to reviewing the topics that you have at hand already and possibly share with my fellow officers. Thank you.” — Jose
- “Most of this information was valuable, simply to hear it from the perspective of the examiner. I learned quite a bit.” — Joshua