Editor’s Question: Consent for Rape Kit in Unconscious Victim

During my blog tour for Proof I had an interesting question from fiction editor, Ramona Richards, in the comments section of the blog on this post that dealt with collecting a rape kit.

Ramona: If a sexual assault victim is stable but unconscious– will the medical team do a rape kit and if so– who do they get consent from?

Jordyn: This is an interesting question on many levels. As a nurse, I’m first an advocate for the patient but also as a nurse and woman– I want to see justice happen for this woman as a victim.

The central issue is that part of the rape kit is very invasive. Particularly the pulling of the hair from the head and groin area and well as the internal pelvic exam.

No one wants to put a victim through something more traumatizing– so generally– permission must be given by the victim in order for the exam to be done.

But say– the victim looks like she is not going to wake up to give that permission?

Part of the exam can be done. External evidence and swabs can be collected. An external exam of the vaginal area could also be done. Pictures can be taken.

Likely– we’ll wait to see if the patient wakes up. Nothing should be disturbing the internal presence of the evidence if the patient is hospitalized. Exams should be done within 72 hours and one nurse practitioner I work with said semen could be preserved on the cervix for 10 days.

But what if it looks like the victim is never going to wake up?

Then it becomes an issue for the courts. They would have to issue an order for the exam to be done. So either the victim has to give permission (and no– not next of kin)– or the court would order the exam to be done.

Forensic Issues: Collecting a Rape Kit (2/2)

Last post, I covered some generalizations about how a sexual assault victim is managed in the ED. Today, I’m going to get into specifics about how a rape kit or Sexual Assault Examination (SAE) kit is collected.

Herald Times Online

The sexual assault victim is a crime scene. Medical needs always come first. If the victim presents with life threatening injuries, these will be managed first above everything else. Collection of evidence will come at a point when the patient is stable.

In the kit are generally some large paper drapes. On the ground, we’ll lay out two large bed sheets with the towel on top. The patient (assuming she is wearing the same clothes at the time of the attack) is asked to undress in the middle of these sheets and then given a gown to wear.

Each piece of clothing is bagged in a different paper bag and labeled. I do a piece of clothing, time, date and my initials. Plastic bags are never used. Moist things in plastic will mold and disintegrate and this can damage valuable evidence.

Once the clothes are bagged, each of those sheets are bagged individually as well. This is done in hopes of collecting trace evidence that may have dropped off the patient as she unclothed.

Next, it is important to know the details of the assault as this will dictate what pieces of evidence are collected.

Mouth swabs are collected. They do need to dry before being placed in either an envelope or small cardboard box designed for these swabs.

Fingernail scrapings are collected and fingernails are also trimmed and collected as well.

The pubic hair is combed and any debris is collected in an envelope. The comb is placed there as well.

Probably one of the most humiliating parts of the exam for the victim is that known hair samples need to be collected from their head and pubic area. These must be pulled from the victim. The hair cannot be cut. The point of this is to get the hair shaft that contains DNA so this can be compared to other DNA samples that are combed off the victim.

Blood samples are collected.

A pelvic exam will be conducted by either the ED doctor, ED Nurse Practitioner or the SANE nurse. This would be outside the scope of practice for a bedside ER nurse to do but she is able to do all the other parts of the kit.

If residual fluids are left behind, these are swabbed as well. Any place where the victim may have been bitten will also be swabbed.

Remember, all swabs need to be air dried before they are placed in an envelope or cardboard container. This takes time.

Photographs are taken.

The patient will likely be prophylactically treated for sexually transmitted diseases and pregnancy (if they choose). Counseling will be done in these areas. Some STD’s require follow-up testing– like HIV and a follow-up medical plan will be provided for the patient as well.

For additional information on collection of a rape kit, check this source: http://www.enotes.com/forensic-science/rape-kit.