A forensic exam is performed by a specially-trained forensic nurse, called a Sexual Assault Nurse Examiner (or “SANE Nurse”). SANE Nurses work with physicians in the Emergency Department.
The purpose of a forensic exam is to (1) assess the patient for injuries that need treatment, (2) provide medical care (including medications to prevent infections and pregnancy), and (3) document and collect evidence of sexual contact or physical trauma (including injuries on the body and genitals), trace evidence, and identifiable DNA from the perpetrator of a sexual assault.
When there is suspicion or concern that a victim may have been incapacitated by alcohol or other drugs during a sexual assault, the forensic exam may include the collection of urine and/or blood samples for toxicology testing.
Evidence recovered from a forensic exam can be used to support a subsequent University or criminal complaint; however, having a forensic exam performed does not mean you must report the incident to police or to Western.
A forensic exam should be completed within 5 days of an assault in most cases. The exam is conducted in a confidential health care setting. You may elect to have the exam performed and decide later whether you want to report the assault to the police and/or to Western. That decision is entirely yours to make.
- If possible, do not brush your teeth, bathe/shower, change your clothes, or use the bathroom. This is to ensure any/all available forensic evidence is preserved for collection.
- If you have already done some/all of these things, it is still worth obtaining a forensic exam.
- Forensic evidence may still be present for collection; regardless, it is also important to seek health care treatment (described below).
- You may wish to bring a change of clothes with you to the Emergency Department.
First, you will be seen by a physician in the Emergency Department; the physician will assess whether you have any life-threatening or urgent medical needs. The physician will ask you basic questions about your health history, the general nature of the assault, and any current pain or other symptoms to help understand what care you need. You do not have to share details of the assault with the physician.
Next, you will be seen by the SANE (Sexual Assault Nurse Examiner) Nurse. The SANE Nurse will ask you about:
- your medical history,
- any current medications you are taking,
- your most recent consensual sexual contact,
- the dates of your last menstrual period (if applicable), and
- any current contraceptive methods.
The SANE Nurse will also ask you details about the assault to help determine how best to perform the forensic exam. In order to determine where to look for forensic evidence, the SANE Nurse will ask about the types of conduct that occurred and where (in or on the body) sexual contact was made. This information will be documented in the medical record. After obtaining all this information, the SANE Nurse will usually ask you to disrobe so the forensic exam may be performed. Your physical privacy will be respected throughout the forensic exam. The evidence that is collected is guided by the information you provided about the assault. The evidence may include:
- Clothing worn at the time of the assault, including underwear. If your clothing is collected and you did not bring other clothing with you, you will be provided clothing (such as sweatpants and a t-shirt) to wear home.
- Swabs for possible DNA evidence taken from areas of the body where you reported sexual contact occurred.
- Hair samples
- Blood and/or urine samples (particularly if there is concern of drug facilitated assault).
- Any external injuries or areas of pain and discomfort. Any injuries will be documented and often photographed. (Photographs become part of the medical record)
- Injuries to the genital and rectal areas.
You control the scope and duration of the forensic exam. You may refuse any part of the forensic exam, even after giving full consent at the start. You may elect to stop the forensic exam before it is completed or you may ask to take a break. The medical staff needs your signed consent to administer the forensic exam and/or to provide any forensic evident that is collected to Police. All forensic exam procedures should be explained so that you understand why and how they are done; if you have any questions, you can ask the SANE Nurse or the doctor to explain what they are doing.
The Emergency Department will call an advocate from Domestic Violence and Sexual Assault Services (DVSAS) for anyone reporting sexual assault. You do not have to speak to the DVSAS advocate, but one will be available to you. You may also contact DVSAS yourself by calling (360) 715-1563) before arriving. Your interaction with DVSAS advocates will be kept confidential. No reports or actions will be taken without your permission.
A DVSAS advocate can help you in many ways including:
- Provide emotional support during the forensic exam and any related report-taking,
- Help explain medical procedures and the process of evidence collection,
- Talk to friends or family members who may be at the hospital with you,
- Assist you with follow-up medical appointments and may provide support throughout any subsequent criminal process.
- You may also have your own support person (e.g., a friend) present with you before, during and after the forensic exam. You may request to see or speak with a hospital chaplain, other clergy, or your own private therapist (if you are currently seeing one)
- You may decide whether you wish to report the sexual assault to police and/or to Western.
- You do not have to make a report to the police, to Western, or to any other agency if you choose to have forensic evidence collected.
- If you decide not to report to police at the time the forensic exam is performed, the evidence will typically be stored for at least 120 days.
- An officer will make a brief anonymous report without your name explaining why they are holding the evidence. They will then wait for your decision.
- If you are under the age of 18, state law may require hospital employees to report the assault to Child Protective Services. Such reports are made when there is evidence of child abuse.
- Hospital employees are also required to report information when they:
- note that a patient has been injured by certain weapons, such as guns or knives, and/or
- believe that a patient is a threat to themselves or others
The Violence Against Women Act states that if you have experienced sexual assault, you must be provided with access to a medical forensic examination free of charge, and without requiring you to cooperate with law enforcement or participate in the criminal justice system.
- You do not have to make a report to receive the exam at no cost–it just has to be performed with the intent of collecting evidence for prosecution in case you decide to report in the future.
- In order to comply with this, Washington State has provided these exams through payment from the Crime Victims Compensation Program.
- The exam should not be billed to you directly or indirectly through a primary insurance plan.
- Additional medical services, if needed, are typically covered by private insurance. If you are a dependent on your parents’ or family health insurance plan, they may learn about your visit to the emergency room through the insurance company.
- Forensic evidence collected at the hospital may be released to police only with your written consent or if an authorized third party provides consent on your behalf.
- This forensic evidence may be used to support any subsequent criminal and/or University disciplinary complaint (when applicable).
- The hospital will only release information at the individual's written request or with their written permission.