WASHINGTON (Army News Service, December 30, 2013) – “It’s important for victims of sexual assault to know that they are safe with the medical forensic nurses,” said a nurse who’s a sexual assault medical forensic examiner.
“We will take care of their emotional, safety, medical and forensic care,” with the understanding that victims have been through a traumatic event and are still emotionally distraught, said Kelly Taylor, a sexual assault nurse examiner for adolescents and adults at Womack Army Medical Center, Fort Bragg, N.C.
Taylor said recent changes in Army medicine have made the process smoother for victims than before. Previously, they might have to re-tell their story four to six times to different health care providers, law enforcement and victim advocates.
“It’s very re-victimizing and traumatizing to have to relive that experience over and over,” she said, explaining that now, she and the 28 forensic doctors and nurses she supervises provide continuity of care to every victim so that they only need to tell their story once and the navigation through law enforcement and medical is helped along for them.
She described this process as “patient-centered care.”
HOW IT WORKS
Victims will usually be seen by victim advocates, who often accompany them to the emergency triage unit where a medical screening takes place. Only after needed medical care is provided will victims be offered the choice of having a forensic exam, the details of which are fully explained to them, she said.
The exams are held in a room specifically dedicated only to forensic exams, she said.
The forensic exam can take four to six hours, sometimes even longer, she said, and, the exam itself can often be traumatic because victims are reliving the assault as they provide all of the details of what happened in a 14-page document, known as the DD-2911.
The details include very personal questions about drinking, drug ingestion, threats made and so on, she said.
The document then goes into a box which also contains all of the tools for the exam. The box comes sealed and isn’t opened until the forensic nurse and the patient are in the forensic exam room, she explained.
Separate consents are required for each level of the exam — photography, drawing blood, swabs, fluorescence imaging for fluids, fingernail cuttings and scrapings, collection of underwear and other clothing, full genital exam and photography, she said, adding that some of the procedures can be a bit painful, such as pulling a sample of head or public hair.
“I always tell patients ‘I’m doing the kit but you’re in control of it,'” she said.
Each piece of evidence collected has a separate envelop, all of which are placed in the box. Once the exam is completed, the box is resealed to protect the “chain-of-custody” of the evidence, she said.
Patients who receive forensic exams include not only victims but also the accused. And, these patients can include men, women and children. And, she added, all must consent to the exam and all can opt out of any part of the exam at any time, even after signing the consent form.
Victims and the accused are seen in different sections of the medical treatment facility and they are seen by different forensic nurses, she said.
Victims as well as the accused “receive the same level of care,” she said. “We’re not an arm of law enforcement or of the courts. We’re forensic providers who are neutral and unbiased.”
Although taking the forensic exam is strictly voluntary and can be long and somewhat painful, Taylor said most of the victims as well as those accused opt to consent to undergo the entire exam.
Once the forensic exam is completed, victims are treated with prophylactic antibiotics for any possible sexually transmitted diseases and are offered Plan B, the morning after pill, if they so choose, she said. Also, patients are offered HIV prophylactic if they meet the Centers for Disease Control guidelines and recommendations per a risk assessment form.
Part of being honest with the patients, Taylor added, is not giving them false hope.
“We’re never going to look at a victim and say definitively, ‘you were assaulted or you were not assaulted,'” she said. “What I can do is say, ‘there are findings consistent with sexual assault.'”
She compared the process to putting together a puzzle with different pieces of the puzzle being the victim’s account, evidence collected, witness statements and so on.
Ideally, to get more definitive evidence, “what I’m hoping to gain from the forensic evidence is blood or body fluid from the alleged suspect that may be found on the victim that indicates unwanted sexual contact has occurred,” she said. “I’m also looking for injuries.”
Once the exam is over, the forensic nurse might not see the victims again unless they opt for an unrestrictive report, meaning involving the courts and law enforcement. Should they choose that route, the same forensic nurse who examined them will testify in court, she said.
Whether they choose restrictive or unrestrictive, the victims will be offered follow-up care by doctors, nurses, health-care providers and victim advocates, she said.
Taylor said that while coming in for the forensic exam sooner is better than later, victims should not hesitate to come in, even days later and even if they bathed or showered, although doing the latter isn’t recommended.
The science and technology for extracting DNA are improving all the time and a lot of evidence can still be gleaned internally days later so “we definitely encourage patients to come in.”
TEAM OF PROFESSIONALS
Taylor’s team of 28 forensic examiners are on call “24/7, 365 days a year,” she said, so someone will always be there for the victim.
All have volunteered to do forensic exams and all have received forensic exam training that includes counseling skills, she said, adding that it’s a collateral duty with most working as emergency room doctors and nurses.
“They often dedicate extra hours after they’ve done their normal shift to provide forensic care,” she said.
As to why anyone would want to do extra hours in work that can only be described as arduous, she said “they’re doing this for all the right reasons. They really want to help people and make the process as smooth and as painless as possible for them. They’re an amazing group.”
Taylor is helping to ensure the same level of care and training is provided elsewhere around the Army and she provides forensic exam training for other installations twice a year, along with post-training follow-ups.