University of Virginia
Medical Attention: Why Should I Go to the Emergency Room?

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From: Handbook for Survivors: A Guide for Survivors of Sexual Assault ©2004 UVA Women's Center/Sexual and Domestic Violence Services

Why Should I Seek Medical Care?

IN TIMES OF EMOTIONAL STRESS, people tend to minimize their own feelings out of self-protection, or out of consideration for the feelings of people they love. Although you may feel fine physically, your body may be numbed by a state of shock, so it's important to seek medical care as soon as possible. Your need for treatment is, and should be considered, an emergency even if there are no visible signs of physical injury. Taking care of your health at this time is an important step in your healing process. If you choose to have evidence collected, the sooner this is done, the more reliable and potentially useful it will be. It is important to seek medical care in order to:

It's important that you receive treatment at a facility where the staff is specially trained to provide care for sexual assault survivors and to use the correct methods for evidence collection.

Where should I go?

In the Charlottesville/Albemarle County area, the University of Virginia Medical Center and Martha Jefferson Hospital are able to examine and treat you after an assault, whether or not you choose to report the assault to the police. The University of Virginia has specially-trained nurses (SANE, or Sexual Assault Nurse Examiners) to provide evidence collection, which is vital to prosecution.

What if I Need Transportation?

If a friend or family member isn't available, you may call "911" for police or rescue squad transportation to the hospital, or a SARA counselor may be able to arrange transportation for you. You may ask for them to come in an unmarked vehicle. If you have any questions before or after medical treatment, call the Sexual Assault Resource Agency (SARA) office at 295-7273 during business hours, or the 24-hour hotline: 977-7273.

Before You Arrive at the Hospital

Whether or not you decide to have evidence collected, it is important not to change clothes, shower or bathe, douche, drink, eat, smoke, brush your teeth, or use the bathroom unless absolutely necessary before the medical exam in order to keep your legal options open as long as possible. These activities can destroy vital evidence. Bring a change of clothes with you. If you've changed your clothes since the assault, place the clothes you wore at the time of the attack in a paper bag (not plastic). Bring them with you to the emergency room. Let your nurse or doctor know you have them, and tell them if you have done anything else (washed, etc.) before you arrived. This will assist them in making their report.

If you arrive by way of rescue squad, you will be taken to a patient-care room, and a nurse or admitting clerk will ask you initial questions. If you arrive on your own or with a police officer through the emergency room main entrance, you will then be taken to a private area where the screening (ÒtriageÓ) nurse will talk with you. Additional information necessary for registration include:

Any information that you are asked to provide in the emergency room is confidential and necessary for registration, as well as for medical recordkeeping. If you are under the age of 18, your parent or legal guardian should give consent for an examination. However, if consent can't be obtained and you need care right away, hospitals and law enforcement offices have procedures for this situation.

Do I Have to Report This?

The decision to report the assault to law enforcement authorities is solely up to you. If you aren't sure whether or not you want to report the assault, you can talk with a police officer about having evidence collected and held while you make a decision. You don't have to follow through with prosecution or report to any other agency even if you choose to have evidence collected. Having evidence collected does give you a wider range of options later if you decide you do want to press charges against the assailant(s). The evidence will be kept by the police until you do decide to file charges (although how long they will hold onto it varies case-by-case), which requires an officer to make a brief report without your name explaining why they are holding evidence. They will then wait for your decision. It is important for you to know that if you don't want to report the crime, the hospital isn't required to notify the police when a sexual assault has occurred. The hospital is required to report suspected child abuse or elder abuse to the Department of Social Services.

May I Have a Support Person With Me?

Hospital personnel will allow you to have someone with you during all examination procedures. In addition to having a friend with you, both the UVa Medical Center and Martha Jefferson Hospital will call SARA to send an advocate for you if you request this. You can also contact SARA yourself before you go to the hospital. Your interaction with SARA counselors will be kept confidential.

A well-trained advocate can provide emotional support during the examination and report-taking. Your advocate can help to explain medical procedures and the process of evidence collection. This person may also counsel friends or family members who may be at the hospital. An advocate may assist you with follow-up medical and counseling appointments and provide support throughout the criminal justice process.

The University of Virginia hospital has in-house staff trained to provide crisis intervention and follow-up counseling for sexual assault survivors. You may also request to see a hospital chaplain, other clergy, or your own private therapist (if you are currently seeing one). UVa students receive follow-up care through Student Health Services.

Who Pays for My Treatment?

If you have a private insurance policy, it may pay for your medical services, and possibly some psychological counseling. The Commonwealth of Virginia will pay for all evidence collection after an assault. However, you must cooperate in the investigation with the police department in order for the Commonwealth to authorize payment for evidence collection.

The Virginia Crime Victims Act established the Crime Victims' Compensation Fund to pay for some physical and emotional injuries as a result of a crime. This fund can compensate you for out-of-pocket medical expenses, psychological counseling, or lost wages that are a result of the assault. It is coordinated through the Victim & Witness Assistance Program. The Victim & Witness Program Coordinator can explain the fund to you and help you complete the application.6

If you are a UVa student, you are required by the University to carry health insurance. Most insurance covers at least part of the cost of emergency treatment. If you submit claims through your parent's insurance, you need to know that they may learn about your visit to the emergency room through the insurance company. After your emergency room visit, it is important for you to seek follow-up care at Student Health. There is no charge for an office visit with a clinician, but there are charges for any laboratory tests that are needed. You may discuss your payment options with the hospital accounting department. The Department of Student Health recognizes that there can be financial barriers to obtaining appropriate care and will assist you in obtaining the care you need.

Will I Have Any Control in Making Decisions Regarding My Care And Treatment?

The medical staff cannot examine you or collect physical evidence without your permission. They need your signed consent for the examination and to give the evidence kit to the police. Remember, you have the right to refuse any part of the examination or treatment and to ask any questions you may have about any aspect of your care. All procedures should be explained so that you understand why and how they are done; if not, it's OK to ask the nurse or doctor to explain what they are doing. This may help you maintain some feeling of control during the medical procedures.

What is The Physical Evidence Recovery Kit (PERK)?

The PERK is designed to assist the examining clinician in the collection of evidence (specimens) for analysis by the Virginia Division of Forensic Science. If the assault took place within 72 hours of the medical exam, this kit can be used. If it occurred more than 72 hours ago, some evidence may still be collected.

Before the medical exam, you will be asked details about the assault. Even though these questions may seem very personal and difficult to answer, the information you give may be helpful in identifying the assailant, in providing you with optimal care, and in documenting the assault. They will also ask about your medical history regarding past and present health conditions, including date of your last period, contraceptive history and the date of your most recent voluntary sexual contact. Information is needed regarding the type of assault or penetration, such as oral, vaginal, or anal. The staff will ask you where the the assault occurred, such as in a car, on grass or carpet, etc., and to describe what happened.

Clothing Evidence

If you're wearing the same clothes you wore during or after the assault these items must be taken as evidence. Sometimes even shoes are gathered. Tampons or sanitary pads may also be kept for evidence if you are wearing them. You'll be given clean clothes and new underwear to wear home if you didn't bring any with you. You may also shower in the E.D. prior to leaving if you would like.

Hair Samples

The clinician will collect hair combings from your head and pubic region. Twenty-five full-length hairs from different parts of your scalp and 25 from your pubic area must be pulled out to help distinguish your own hair from that of the assailant. If you'd rather pull out the hair samples yourself, the clinician should allow you to do so. Semen found on your pubic hair will be cut or clipped out.

If There Was Oral Contact

In order to collect evidence, the clinician will swab your lips and the inside of your mouth and then collect a mouth rinse.

Vaginal Assault and/or Anal Contact

Swabs moistened with sterile water are used to wipe your inner thighs and external genitalia. Female survivors have a pelvic exam to collect other samples of evidence and to test for sexually transmitted diseases. For both females and males who were assaulted anally, additional swabs are used to collect evidence of sexual assault in the anal area. In addition to swabs, a specialized microscope called a colposcope will be used to detect and document microscopic injuries.

Blood/Urine Screen

After the physical exam, the nurse will draw a blood sample from your arm to determine your DNA type and screen for sexually transmitted diseases. A urine screen and pregnancy test will also be done. All screening tests done immediately after an assault are to document your state of health before the assault or for preexisting conditions. HIV and Hepatitis B screening will also be done after a sexual assault. If a significant exposure has occurred, medication and follow-up care will be initiated. This is why follow-up medical appointments are necessary for retesting 4-6 weeks after the assault. Follow up care is essential and can be done by your primary care physician, at Student Health, or the Infectious Disease Clinic.

The follow-up tests will indicate if pregnancy or sexually transmitted diseases resulted from your assault. HIV antibody tests may not give reliable results until 3 to 6 months after the assault. It's best to have an HIV test done where follow-up counseling is available. Free and anonymous HIV antibody tests are available through the Health Department. Student Health offers confidential (not anonymous) HIV testing. Again, your consent is needed before any of these tests are performed.

If you or the person who accompanied you, (such as a family member, friend, or police officer), state that you were drugged by the assailant, screening tests may be done, including testing for alcohol. This is also the case if your clinician feels your medical condition appears to warrant screening to provide you with optimal care. You have the right to refuse this, as with all procedures. Its important for you to know that even if you voluntarily consume alcohol or a club drug, such as GHB or Ecstasy, this could be evidence in a sexual assault case, because the assailant may have taken advantage of your incapacitation. That is why it is so important to tell your clinician if you took a drug yourself (illegal or not). Any drug (over-the-counter, prescription, or street drug), can also influence your medical needs/care, and any criminal case that may be prosecuted.

Release of Evidence

This information is also relevant if the perpetrator is a University of Virginia student, and you elect to have your case heard before the Sexual Assault Board. Evidence collected in a hospital may be released to a law enforcement officer only with your written consent or if an authorized third party does so on your behalf. If you are unsure about prosecuting, the police can send collected evidence to the state lab to be held for up to one year (although this time may vary, depending on your case).

Follow-Up Care

It is important to have follow-up tests and an exam within 4-6 weeks after the emergency room visit. You may be seen by your private clinician or the UVa Gynecology Clinic in Student Health to check for possible pregnancy or sexually transmitted diseases and to talk about counseling.

After the Examination

In addition to this book, the hospital staff will give you a card with the names of the staff who treated you, the police officer who took your report (if you did report), contact names at SARA or the Victim/Witness Program, and phone numbers of the clinic to call for your follow-up appointment. Notify them as to the purpose of your visit - they need to know this so that you receive the proper medical care.

If you are a UVa student, follow-up care can be provided at Student Health. Professional services are covered by your prepaid Student Health Fee. There are additional charges for lab tests and medications, if needed. It's best if you call Student Health Gynecology (924-2773)Ñor if you are a male survivor, General Medicine (982-3915 )Ñas soon as possible to make a follow-up appointment. If you wish to shower before leaving, the emergency department nurse will provide you with soap and shampoo, towels and fresh clothing if needed.

Transportation

If you don't have a ride and if you don't need to accompany a law enforcement officer for further questioning, transportation home or to a safe place may be arranged with a family member, friend, victim advocate, or by the local law enforcement agency.