WASHINGTON – “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
“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, sexual assault nurse examiner for adolescents and
adults, 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
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
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 pubic 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 envelope, 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
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
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
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
Once the exam is over, the forensic
nurse might not see the victims again unless they opt for an unrestricted
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
Whether they choose
restricted or unrestricted, the victims will be offered follow-up care by
doctors, nurses, healthcare 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.
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.