Outline and Summary

Indiana Recommended Protocol

for the

Forensic and Medical Examination

of the Sexual Assault Victims

Developed by:

Indiana Coalition Against Sexual Assault

Indiana State Police

Indiana Criminal Justice Institute-Violent Crime Compensation

Governor Orr’s Task Force for the Indiana

Examination Protocol

Ft Wayne Sexual Assault Treatment Center

Introduction
Reports of sexual assaults against adults have continued to increase throughout the past decade, although no one knows how many actual assaults take place each year. Some victims choose not to report the assault because of embarrassment, fear and trauma. Others lack faith in the follow-up treatment and the investigative and prosecutorial systems. Additionally, there is a wide, jurisdictional variance in legal definitions of what constitutes sexual assault. For example, many communities only submit statistics cases of forced penetration of a female by a male—the traditional but very narrow definition of ‘rape’. Others report all types of deviate sexual behavior, including the use of foreign objects and anal or oral copulation.

Reports of child sexual abuse also have increased dramatically in the past few years, although these reports remain even more difficult to document than adult reports. This is due largely to deficiencies in the collection of child sexual abuse data and submission of that data to one central location. The lack of available data is compounded by the low rate of reporting of the abuse by either the victim or a third party.

The reasons for these problems are extremely complex. Many children are too young to understand that certain kinds of physical contact by adults or older children are inappropriate. Others may realize that something is wrong but are unable to articulate their feelings or are dependent upon the abuser for care. When children do report the abuse to a third party, their story may be dismissed as fantasy or even as a lie. Further complicating the situation is the fact that threats, however subtle, may be made, which discourages reporting by children. Children can be led to believe that something terrible will happen to them or to their family if anyone finds out, or that they are responsible for the abuse.

Traditionally, the successful prosecution of adult and child assault cases has been difficult. Since the victim often is the only witness to the crime, the collection of physical evidence as well as the documentation of medical trauma may be necessary either to substantiate an allegation or to help strengthen a case for court. Evidence from the offender and the crime scene often may be found on the body and clothing of the victim. When immediate medical attention is received, the chances increase that some type of physical evidence will be found. Conversely, the chances of finding physical evidence decrease in direct proportion to the length of time, which elapses between the assault and the examination. The job of collecting physical evidence in sexual assault cases has fallen to physicians and nurses in hospital emergency rooms, sexual assault treatment centers, and pediatric units. The role of medical personnel in this process often can be the key to successful prosecution and can help to promote early victim recovery.

The primary purpose of this document is to assist treatment facilities to:

• Minimize the physical and psychological trauma to the victim of a sex crime;
• Maximize the probability of collecting and preserving the physical evidence for potential use in the legal system; and,
• Address important issues surrounding the collection of medical and physical evidence.

Although a few states and several individual communities in the country already have standardized protocols, many do not. Some communities lack the resources to formulate a protocol or to update their current procedures to reflect changes that have taken place in the fields of scientific evidence and support services.

Under Governor Orr, a Task Force for the Indiana Sex Crime Victim Examination Protocol was formed to address the evidentiary, medical and emotional needs of victims of sexual assault/abuse. The Governor’s Task Force based much of its work on a protocol developed by a National Advisory Committee.

In 1990, the Governor’s Task Force disbanded. Four years later, the Indiana Coalition Against Sexual Assault and the Violent Crime Compensation Fund assembled a new task force, similar in composition to the original task force, in order to update and complete the protocol developed by the Governor’s Task Force. The members of the new task force represented the medical, legal, law enforcement, victim advocacy and forensic science professions, and had extensive experience and expertise in working with sexually assaulted adults and children. Recommendations were based upon the physical and emotional needs of the sexual assault victim, reasonably balanced with the basic requirements of the legal system.

Although evidence collection is the primary focus of the document, basic medical, psychological, and support issues also have been included as much as possible throughout the protocol. However, for more detailed information on the medical, psychological, investigative and legal aspects surrounding sexual assault treatment, topic-specific literature should be consulted.

For the purpose of this protocol, the term ‘sexual assault’ will be used to refer to all sex crimes perpetrated against adults, and the term ‘sexual abuse’ will refer to all sex crimes perpetrated against children, both terms being defined in a broad context as follows: any act of sexual contact or intimacy performed upon one person by another without mutual consent, or with an inability of the victim to give consent due to age, mental or physical incapacity.

Topics included in the Protocol Manual

GENERAL INFORMATION

SENSITIVITY TO VICTIM NEEDS

The Female Victim
The Elderly Victim
The Male Victim
The Child Victim
The Deceased Victim

INITIAL LAW ENFORCEMENT RESPONSE

ADULT PROTOCOL

TREATMENT PLAN

Facility
Transfer
Support Personnel

THE EVIDENTIARY (FORENSIC) AND MEDICAL EXAMINATION

Attending Personnel
Collection Procedures
Collection Procedures
Hair Evidence
Whole Blood Standard Collection Procedures
Saliva Standard Collection Procedures
Fingernail Scraping Collection Procedures

MEDICAL/FORENSIC EXAMINATION AND DOCUMENTATION

Examination Documentation Guide
Use of Medical/Forensic Form and Benefits Application Form
Documentation of Other Medical Information
Sexually Transmitted Diseases
Toxicology Blood/Urine Screen
Analysis of Specimens
Distribution of Specimens
Post-Examination Information

PRIOR TO THE MEDICAL EXAMINATION

Additional Text

Sexual Assault Survivor Form
Forensic Examination Form – Sexual Assault Form
Adult/Child Sexual Assault Evidence Collection Kit Instructions
After-Care Information
Urine for Forensic Toxicology Sample Protocol
Forensic Odontology
HIV/STD Resource Guide
Sex Crime Victim Services Fund Summary
Indiana Criminal Statutes Related to Sexual Assault
Sexual Assault Resources
Bibliography
Child Sexual Assault Protocol