Exams Overcoming the Challenges CDR Michelle A French NC USN Navy Medicine West SAMFE Training Officer Navy Medicine West SAPR Officer and SAMFE Program Manager Interim Objectives ID: 776151
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Slide1
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Sexual Assault Forensic ExamsOvercoming the Challenges
CDR
Michelle A. French, NC,
USN
Navy Medicine West SAMFE Training Officer
Navy Medicine West SAPR Officer and SAMFE Program
Manager
(Interim)
Slide2Objectives
1)
Define SAMFE
2) Describe
components of a SAFE
3) Explore why SAFE cases are challenging
4
) Review priorities for sexual assault patients
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) Highlight recommendations for shipboard medical providers
Slide3SAMFE
A sexual assault medical forensic examiner (SAMFE) is a healthcare provider (privileged or non-privileged) trained to conduct a sexual assault forensic examination (SAFE) on adult patients.
Providers functioning in this role require specialized education and clinical experience in the treatment of sexual assault patients (victims and suspects) and the collection of forensic evidence.
80 hour SAMFE Course required following NDAA-15
Follow-on annual clinical training and competency validation
Slide4SAMFE
Roles and Responsibilities
Provide medical care for victims and suspects
Collect samples from victims and suspects for SAFE kit when requested
Ensure maintenance of chain of custody
Provide expert and fact witness testimony
Collaborate with SARC/VA to develop safety and discharge planning
Slide5Basic Principles
Patient may
initially present
to medical, SARC or
SAPR victim advocate,
law enforcement, chaplain, chain of
command
Service members and adult military dependent victims of sexual assault shall receive timely access to comprehensive medical and psychological treatment
Sexual assault victims shall be treated as emergency cases
Slide6SAFE
Exam is
optional
– patient elects to have evidence collected
Must be clinically competent to consent to evidence collection
Can decline any portion of the exam
Exam performed up to
7 days
following a sexual assault
For both medical and forensic reasons, the earliest possible time is recommended
Exam can take approximately 2-4 hours
Multiple variables can change the timeframe
Slide7Documentation
Standardized form DD2911 is utilized in documenting the forensic exam
Consent
Focused medical
h
istory
Assault history
Physical exam
Summary of evidence collected
Chain of custody
Slide8WHY ARE THESE CASES SO CHALLENGING?
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Slide9SEXUAL ASSAULT
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Slide10Slide11Drunk Sex
Alleged sexual assault
Wrongfully accused
Delayed reporting
Didn’t fight back
Lack of physical findings
You know you wanted it
No signs of trauma
Underage drinking
Victim rights
Blacked out
Sexual predator
Consensual sex
Credibility
Retaliation
Inconsistent story
Choice
misunderstanding
RAPE or REGRET?
Slide12Consider the
priorities immediately following a sexual assault
Medical
Psychosocial/ Advocacy
Forensic/ Criminal Justice
Legal
Slide13Priorities
Emergent/Urgent medical care
E
vidence preservation
Safety- victim/suspect considerations, medical staff considerations
Support of DOD policy
Restricted/unrestricted reporting options
Slide14Challenges with drug facilitated sexual assault
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Unique barriers to reporting – shame, guilt
No memory = poor historian, questionable suspect, no eyewitness or eyewitnesses not credible
Unconscious victim – competing medical priorities
Lack of physical/biological/toxicological evidence
Photographic evidence may paint a picture that appears inconsistent with a crime
Societal view on drugs and sex -Did a crime actually occur?
Slide15Steps following patient presentation
Medically screen and stabilize
Victim advocate notification
Maintain privacy, dignity and safety
Law enforcement notification if unrestricted
Transfer to location capable of performing a SAFE if patient elects this option (reports within 7 days of assault)
Slide16SAFE Components
Medical
Provide medical evaluation and care
Sexually transmitted
infection
screening/treatment
Pregnancy prevention and counseling
Safety Assessment
Provide referrals as needed
Forensic
History of sexual assault
Collect evidence
Document
injuries
Written and photographic
Release documentation & evidence to:
NICS or Local Law Enforcement (Unrestricted)
Mail to NCIS Repository (Restricted)
Slide17If a SAFE is to be performed
Recommend against the following:BathingWashing handsBrushing teethEating, drinking or smokingUrinating or defecatingRemoving a tampon, diaphragm or NuvaRingChanging clothing
-
The above are relative recommendations with consideration given to transport time to a SAFE capable facility.
-If all of the above were performed, there is still potential to obtain evidence
Slide18SAFE Kit
Slide19Forensic Exam
PURPOSE
Obtain a
history of the events
To document any injuries patient may
have
Written and photographic
Collect DNA and/or trace
evidence
Collect toxicology if indicated
To
compare
evidence
that may corroborate
the
patient’s history
Slide20Takeaways
Develop a process for timely medical and forensic care for sexual assault patients
Notify victim advocates early
Safety is paramount
Victim, suspect, medical provider and shipmate considerations
Walk through the process in your spaces
Privacy, safety, medical capabilities, transport considerations
Consider timing of patient presentation and coordination with SAFE capable facility in coordinating medical care
STI and pregnancy prophylaxis,
b
ehavioral health referral etc.
Slide21Consider…
“A small percentage of our patients will ever see the inside of the courtroom, but 100% of them have the potential to develop healthcare sequelae from the violence they’ve experienced (research is clear on this, from child abuse to elder abuse; trafficking, sexual violence, domestic violence – you name it). If you’re only focused on the forensic part of the job, you are doing a disservice to the majority of your
patients…
Slide22Continued
…Take
the potential legal implications of the patient encounter seriously, and perform the sample collection meticulously so that patients have all of the criminal justice options available to them if that’s the route they choose. But do not put patients in a position where they are receiving a lesser standard of healthcare than if they just wandered into any ED in the US because the focus is on the kit or the photography.”
–
Jenifer
Markowitz
Forensic Healthcare Online
Slide23Navy Medicine West Sexual Assault Medical Forensic Contact
CDR Michelle French – SAMFE Training Officer
SAPR
Officer/SAMFE Program
Manager
619-767-6017
Michelle.a.french4.mil@mail.mil