Referral of Sexual assault victims (rape/sex abuse) Accident & Emergency deptt GTB hospital

2 SEXUAL OFFENCES SEXUAL OFFENCES Natural offences: Rape; Incest Natural offences: Rape; Incest Unnatural offences: Sodomy; Tribadism; Bestiality; Buccal coitus Unnatural offences: Sodomy; Tribadism; Bestiality; Buccal coitus Sexual abuse of children Sexual abuse of children

All patients male or female are received in main casualty All patients male or female are received in main casualty Female patients are refd to deptt. of Gynecology and Obs. for further management. Female patients are refd to deptt. of Gynecology and Obs. for further management. Male victims – are taken care of in main casualty. Male victims – are taken care of in main casualty.

1. Consent 2. Confidentiality 3. Maintenance Of Records 4. Collection And Preservation Of Samples DUTIES OF REGISTERED MEDICAL PRACTITIONER TOWARDS STATE

5 STEPS IN SPECIFIC CASES IN RAPE CASE IN RAPE CASE Inform the police Inform the police After taking consent, medicolegal examination and treatment given After taking consent, medicolegal examination and treatment given Samples for examination of blood, stains, semen, swabs, sweat, hair, nails etc preserved, sealed, labeled and sent to police under proper receipt Samples for examination of blood, stains, semen, swabs, sweat, hair, nails etc preserved, sealed, labeled and sent to police under proper receipt Issue medicolegal certificate and send report as early as possible Issue medicolegal certificate and send report as early as possible

EXAMINATION OF PERSON ACCUSED OF SEXUAL ASSAULT Section 53A CrPC Brought by police written and signed request Details of examination findings Sample preservation –Clothing/Blood/Semen sample/Pubic hairs for DNA profiling Opinion Age determination Consent not required

7 STEPS IN SPECIFIC CASES IN RAPE CASE IN RAPE CASE THE CrPC 2005 AMENDMENT: Some mandatory points for examination: examined within 24 hrs after taking proper consent examined within 24 hrs after taking proper consent Always examined in presence of female Always examined in presence of female Note the time of start and the time of end Note the time of start and the time of end Always state reasons for all conclusions Always state reasons for all conclusions It is necessary to keep samples for examination of blood, stains, semen, swabs, sweat, hair, nails, DNA etc as required It is necessary to keep samples for examination of blood, stains, semen, swabs, sweat, hair, nails, DNA etc as required

Guidelines laid down by hon’ble court Guidelines laid down by hon’ble court A detailed description of assault/abuse history is mentioned A detailed description of assault/abuse history is mentioned In case of girl victim medical examination preferably by a female doctor In case of girl victim medical examination preferably by a female doctor As far as practical –psychiatrist help made available to victim As far as practical –psychiatrist help made available to victim Report prepared as early as possible Report prepared as early as possible Parents/ guardian whom child trust allowed to be present Parents/ guardian whom child trust allowed to be present In case of results of examination are likely to be delayed the same mentioned In case of results of examination are likely to be delayed the same mentioned Emergency medical treatment/prophylaxis against STD provided when necessary/HIV testing after window period Emergency medical treatment/prophylaxis against STD provided when necessary/HIV testing after window period After examination child permitted to wash up and provide fresh clothing if clothing is taken as evidence After examination child permitted to wash up and provide fresh clothing if clothing is taken as evidence Samples Preserved according to guidelines –SAFE [Sexual abuse Forensic Evidence] Kit provided in Govt. hospitals Samples Preserved according to guidelines –SAFE [Sexual abuse Forensic Evidence] Kit provided in Govt. hospitals CHILD ABUSE/ SUSPECTED VICTIMS OF SEXUAL ASSAULT/ABANDONED CHILDREN

MEDICAL EXAMINATION OF VICTIMS OF SEXUAL ASSAULT Section 164A of CrPC Examination only by female registered medical practitioner in case of female victims Without delay Consent -documented Note down particulars Complete history Examination – Genital examination and injuries: Standard protocols and guidelines Preserve samples-DNA profiling Emergency Contraception if required Treatment /prophylaxis as required Opinion

Where? Specified area is defined for all such cases Specified area is defined for all such cases Emergency Department is the area where males victims MLC is prepared Emergency Department is the area where males victims MLC is prepared but but sometimes may be in wards after detection of new findings sometimes may be in wards after detection of new findings

Clothes in assault/injury/fire-arm/burn cases Clothes in assault/injury/fire-arm/burn cases Nail clippings in assault/rape cases Nail clippings in assault/rape cases Vaginal swabs/public hair in rape cases Vaginal swabs/public hair in rape cases Swabs in un-natural sexual offence cases Swabs in un-natural sexual offence cases COLLECTION AND PRESERVATION OF SAMPLES Gastric lavage/ vomitus in poisoning cases Blood in alcoholic/poisoning cases/drug abuse or for DNA test

12 PREPARATION OF MEDICOLEGAL REPORT Medicolegal report (MLR) prepared immediately after the examination of a medicolegal case is done Medicolegal report (MLR) prepared immediately after the examination of a medicolegal case is done It is prepared in duplicate, preferably with a ball- point-pen, in a clear and legible handwriting It is prepared in duplicate, preferably with a ball- point-pen, in a clear and legible handwriting Cutting/ overwriting etc avoided as much as possible and all corrections properly initialed Cutting/ overwriting etc avoided as much as possible and all corrections properly initialed Abbreviations of any sort avoided Abbreviations of any sort avoided

Consent in Medico legal cases Consent in Medico legal cases CONSENT FOR MEDICOLEGAL EXAMINATION TO BE TAKEN IN WRITTEN IN ALL CASES CONSENT FOR MEDICOLEGAL EXAMINATION TO BE TAKEN IN WRITTEN IN ALL CASES Exception : Cases brought by police being arrested on charge of committing an offence Exception : Cases brought by police being arrested on charge of committing an offence Person below 12 years/unsound mind- consent of guardian is to be taken. Person below 12 years/unsound mind- consent of guardian is to be taken.

Information is given only to I.O. or any Information is given only to I.O. or any person designated by I.O. person designated by I.O. If the I.O. gives requisition for any clarification regarding certain points mentioned in the report given, answer is given in writing. If the I.O. gives requisition for any clarification regarding certain points mentioned in the report given, answer is given in writing. DOCTORS MAINTAIN CONFIDENTIALITY IN ALL MLC CASES DOCTORS MAINTAIN CONFIDENTIALITY IN ALL MLC CASES

Important issues Psycho- social support to the victims Psycho- social support to the victims Need to adjust them in families Need to adjust them in families Foster families /care homes Foster families /care homes Police protection to the victims/ family members Police protection to the victims/ family members

Issues of Abused Boys Stigma of homosexuality Stigma of homosexuality Loss of freedom Loss of freedom Expected male role Expected male role deal with problems alone deal with problems alone don’t be so sensitive don’t be so sensitive be strong be strong allegiance allegiance