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Evaluation and Treatment of Patients Reporting Sexual Assault (1.2.17)

Evaluation and Treatment of Patients Reporting Sexual Assault (1.2.17) - Policies, Clinical, UW Health Clinical, Administrative, Legally Driven Care

1.2.17


UW HEALTH CLINICAL POLICY 1
Policy Title: Evaluation and Treatment of Patients Reporting Sexual Assault
Policy Number: 1.2.17
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: October 20, 2017

I. PURPOSE

To provide care to patients reporting sexual assault at UW Health.

II. DEFINITIONS

Forensic Nurse Examiner (FNE): An RN trained in collecting forensic evidence for alleged cases of abuse,
including sexual assault and domestic and/or elder abuse.

Victim advocate: An individual who is an employee or volunteer of an organization which provides
counseling, assistance, and support services free of charge to the victim.

III. POLICY ELEMENTS

Adult patients reporting a sexual assault will be evaluated and treated for physical and emotional trauma.
Evidence will be collected for legal purposes as needed. This treatment and evidence collection can be
provided by Forensic Nurse Examiners (FNE’s) from UnityPoint Health-Meriter (“UPH-Meriter”) Emergency
Department.

Pediatric patients under the age of 18 years old will be evaluated by the UW Child Protection program, and
treated for physical and emotional trauma. Evidence will be collected for legal purposes by the providers
from the Child Protection program.

Patients will be offered the services of a Victim Advocate at the time of presentation or when the sexual
assault is reported.

IV. PROCEDURE

A. University Hospital or The American Center (TAC) Emergency Department (ED):
i. Escort patient into a private exam room.
ii. Notify patient of opportunity to be accompanied by victim advocate following process outlined in
Section VI.
iii. Follow standard ED nursing assessment and screening protocol.
iv. The ED provider will perform a medical screening exam to ascertain medical needs and provide
appropriate treatment.
v. In accordance with Section V, if patient is an adult and police are not present, notify patient of
his/her option to report the sexual assault. If patient is a minor, follow Section V(B) regarding
mandatory reporting.
vi. If the patient is female, inform the patient of her right to receive emergency contraception and
provide the patient with accurate and unbiased written and oral information about emergency
contraception and its use and efficacy. Explain to the patient a pregnancy test may be required and
UW Health will facilitate such request which could take place at UPH-Meriter.
vii. Notify patient or guardian of the option of evidence collection in accordance with Section VI. As
further explained in Section VI, if patient has been medically cleared and FNE at UPH-Meriter is
available, patient should be directed to UPH-Meriter for evidence collection. If patient remains in
the UH or TAC ED for treatment of injuries or due to medical condition, FNE from UPH-Meriter
should be contacted to collect evidence at the UH or TAC ED in accordance with Section VII.
B. Ambulatory Setting
i. If patient presents with an emergency medical condition, follow clinic specific process.
ii. If patient reports a sexual assault and does not have any other emergency medical condition, UW
Health may facilitate contacting the UPH-Meriter SANE program at 608-417-6000. Details are
outlined in Section VII.
iii. In accordance with Section V, if patient is an adult and police are not present, notify patient of
his/her option to report the sexual assault. If patient is a minor, follow Section V(B) regarding



UW HEALTH CLINICAL POLICY 2
Policy Title: Evaluation and Treatment of Patients Reporting Sexual Assault
Policy Number: 1.2.17

mandatory reporting.
iv. Contact Meriter Forensic Nurse Examiner (FNE) by calling 608-417-6000.
C. Inpatient Setting
i. In accordance with Section V, if patient is an adult, notify patient of his/her option to report the
sexual assault. If patient is a minor, follow Section V(B) regarding mandatory reporting.
ii. If the patient is female, inform the patient of her right to receive emergency contraception and
provide the patient with accurate and unbiased written and oral information about emergency
contraception and its use and efficacy.
iii. Notify patient or guardian of the option of evidence collection in accordance with Section VI. Upon
patient’s request, contact Meriter Forensic Nurse Examiner (FNE) by calling 608-417-6000 to
collect evidence at the patient’s inpatient unit.

V. REPORTING

A. Adult Patients. If a patient is an adult and a police officer is not present, ask the patient if they wish to report
the assault to law enforcement. Adult patients are not required to report a sexual assault. If the adult patient
wishes not to report, let them know that evidence can still be collected. The evidence is submitted
anonymously to the State Crime Lab using a tracking number, and kept secured until needed. If patients
wish to report to law enforcement, the RN or Social Worker will contact the law enforcement service
appropriate to the location of the alleged crime.
B. Minor Patients. If the patient is a minor, it requires mandatory reporting. The following steps must be taken:
i. The UW Child Protection Program should be notified via paging. Ask for the Child Protection
Program Provider on call.
ii. Social Services from the county of residence must be notified.
iii. Law enforcement agency where the alleged incident occurred must be notified

VI. PATIENT’S RIGHT TO ACCOMPANIMENT BY VICTIM ADVOCATE

A. Notification.
i. The hospital must notify the patient (and, if the patient is a minor, the patient’s parent, guardian, or
legal custodian) that the patient has the right to have an advocate present during the examination
or consultation, except as provided below.
ii. In addition to explaining this information orally to the patient, patients reporting sexual assault may
be provided with a copy of DHS Form F-01805. Staff should document in the clinical record that the
form was provided to the patient.
B. Delay. The hospital need not delay examining or treating the victim pending arrival of a victim advocate if the
delay would endanger the health or safety of the victim or risk the loss of evidence
C. Exclusion of Victim Advocate at Patient Request. The patient may request exclusion of a victim advocate at
any time, and the victim advocate must comply with such a request.
D. Hospital Exclusion of Victim Advocate. The hospital may exclude a victim advocate from any examination or
consultation in the following situations (however, if excluding a victim advocate under this section, the
patient must be offered an opportunity to have a different victim advocate present):
i. The presence or continued presence of the victim advocate obstructs the provision of necessary
medical care to the victim;
ii. The victim advocate fails to comply with hospital policies governing the conduct of individuals
accompanying patients in the hospital; or
iii. The hospital has knowledge that the victim advocate, in his/her role as a victim advocate at any
hospital, has taken one of the following actions and is more likely than not to take that action again:
(a) failing to agree to or comply with confidentiality requirements relating to another individual at a
hospital; or (b) failing to comply with a request by a victim to exclude the victim advocate from the
examination or consultation.
E. Minor Patients.
i. At any age, a minor patient may request that a victim advocate accompany him/her without the
consent of the patient’s parent, guardian, or legal custodian.
ii. A minor’s parent, guardian, or legal custodian may request a victim advocate accompany the minor
patient.
iii. If the minor patient has not attained the age of ten (10), a treating medical professional may make a
request that the patient be accompanied by a victim advocate.
F. Request. Request Victim Advocate by calling Rape Crisis Center of Dane County at 608-251-7273.



UW HEALTH CLINICAL POLICY 3
Policy Title: Evaluation and Treatment of Patients Reporting Sexual Assault
Policy Number: 1.2.17

Advocates are available 24/7 and may be called to the ED, clinic, or inpatient unit. The Victim Advocate may
be called prior to the patient leaving for UPH-Meriter, if applicable.
G. Documentation. Documentation must be added to the clinical record indicating whether the patient declined
or accepted the offer to have a victim advocate present during the examination or consultation. If it is
determined that waiting for an advocate would cause a delay in treatment or examination, or if the advocate
is excluded from an examination or consultation by the hospital, the record should reflect this fact.

VII. EVIDENCE COLLECTION BY FORENSIC NURSE EXAMINER

A. Explain to the patient/parent/guardian:
i. A Forensic Nurse Examiner (FNE) is available 24/7 at UPH-Meriter Emergency Department to
provide evidence collection and information about the patient’s options.
ii. FNE’s are available for both adult and pediatric patients.
B. Contact UPH-Meriter Forensic Nurse Examiner (FNE) by calling 608-417-6000 and ask for the on call FNE.
Notify the FNE as to whether or not the advocate has been called, and expected time of arrival.
C. Explain to the patient/family/guardian that it may take some time to coordinate these specialty resources.
Reassure them that wait times will not interfere with the collection of evidence. (Note that for adults,
evidence can be collected up to 120 hours following the incident. For pediatrics, evidence can be collected
up to 72 hours after incident).
D. In the event that the patient needs to remain at UW Health for treatment of injuries and/or the patient’s
condition does not allow for the patient to be directed to UPH-Meriter, contact the UPH-Meriter FNE on call
to arrange evidence collection at UW Health.
E. In the event that UPH-Meriter does not have an FNE available, request from paging to speak to UPH-
Meriter’s Forensic Coordinator or Supervisor and they will assist with identifying another available program
in the region.
F. In the rare event that all options have been exhausted to locate a Forensic Nurse in the region, evidence
collection may need to be performed by a UW Health RN. If this is required, the nurse should:
i. Follow instructions in the State of Wisconsin Forensic Test Kit. Complete all forms in the kit and
have them scanned into Health Link. (In the ED, forms are scanned into Health Link by the ED
Coordinator). Document evidence collection in Health Link. Kits can be obtained from UW Health
Emergency Departments.
ii. Provide emergency contraception when indicated.
iii. Provide prophylactic treatment as appropriate for the prevention of sexually transmitted diseases.
iv. If patient is reporting the sexual assault to law enforcement, release information and evidence to
appropriate Law Enforcement Agency. If patient is not reporting, submit evidence to the State
Crime Lab using a tracking number.

VIII. RELEASE OF INFORMATION

A. Authorization for Release of Information and Evidence to Law Enforcement Agency form should be signed
by appropriate individuals. See UW Health administrative policy #4.13, Using and Disclosing (or Releasing)
Protected Health Information.
Patients reporting a sexual assault within 5 days of the crime or when a report could reasonably be made
should notify the State of Wisconsin Crime Victim Office, as they may be eligible for reimbursement for
medical, mental health bills or other losses directly related to the crime.
Wisconsin Department of Justice
Crime Victim Compensation
P.O Box 7951
Madison, WI 53707
Phone:
Toll-free: (800) 446-6564

IX. FOLLOW UP

A. An RN and/or provider will advise the patient to follow-up with his/her primary physician in 10-14 days.
Referral may also be made to University Health Service if the patient is a student at UW Madison.

X. REFERRAL SOURCES




UW HEALTH CLINICAL POLICY 4
Policy Title: Evaluation and Treatment of Patients Reporting Sexual Assault
Policy Number: 1.2.17

A. Patients should be discharged with referral numbers and should be informed that these can be used in the
future if the need arises:
i. Within Dane County: Rape Crisis Center, 2801 Coho Street, Madison, WI 53713. Phone 608-251-
7273. The Rape Crisis Center provides telephone and face to face counseling for sexual assault
victims and offers a support group for sexual assault survivors.
ii. Outside of Dane County: RAINN runs the National Sexual Assault Hotline, a 24/7 hotline staffed by
trained advocates providing support and referral services for survivors of sexual assault. The
RAINN website also has an anonymous chat function for the same support. http://www.rainn.org or
1-800-656-4673.
B. For additional resources (e.g., mental health, safe housing, transportation), contact Social Work (for ED and
inpatients) or Patient Resources (ambulatory patients).

XI. COORDINATION

Author: Director, Emergency Services
Senior Management Sponsor: VP, Chief Nursing Officer - Inpatient
Reviewers: Nurse Manager, Emergency Services; CNS, Emergency Services, RN Case Manager,
Emergency Services; Pediatric Nurse Coordinator, Emergency Services
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: September 18, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

XII. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

XIII. REFERENCES

Guidelines for Victim Advocate Accompaniment during Hospital Exams and Consultations, State of
Wisconsin Department of Health Services
UW Health clinical policy #1.2.4, Suspected Child Abuse and Neglect
UW Health administrative policy #4.13, Using and Disclosing (or Releasing) Protected Health Information

XIV. REVIEW DETAILS

Version: Revision
Last Full Review: October 20, 2017
Next Revision Due: October 2020
Formerly Known as: UWHC policy #4.44, UWMF policy114.008, Suspected Sexual Assault Victims