1. The Forensic Medical Exam and Other Victim/Survivor Rights:

2. *This course (including all power points, lectures, and assignments) is the instructor’s intellectual property. The materials may not be copied or redistributed without her prior consent. Additionally, the information on the following slides is intended for educational purposes only. It does not constitute legal advice.

3. Warning: The following slides contain information about sexual assault.
Should you or anyone you know require assistance with a sexual assault-related matter, contact the National Sexual Assault Hotline HOPE (for information, safety planning, and resources) or 911 in the event of an emergency.
Specific legal questions should be directed to the appropriate police agency or prosecuting attorney’s office. Confidential help is also available through the SHSU Counseling Center:

4. A note about language: The terms “victim” and “survivor” are used interchangeably throughout this presentation to both acknowledge sexual assault as a crime and to respect the strength and dignity of those affected.

5. “You are a 50-year-old woman living alone
“You are a 50-year-old woman living alone. You are asleep one night when suddenly you awaken to find a man standing over you with a knife at your throat. As you start to scream, he beats and cuts you. He then rapes you. While you watch helplessly, he searches the house, taking your jewelry, other valuables, and money. He smashes furniture and windows in a display of senseless violence. His rampage ended, he rips out the telephone line, threatens you again, and disappears into the night. At least, you have survived. Terrified, you rush to the first lighted house on the block. While you wait for the police, you pray that your attacker was bluffing when he said he'd return if you called them. Finally, what you expect to be help arrives.
The police ask questions, take notes, dust for finger-prints, make photographs. When you tell them you were raped, they take you to the hospital. Bleeding from cuts, your front teeth knocked out, bruised and in pain, you are told that your wounds are superficial, that rape itself is not considered an injury. Awaiting treatment, you sit alone for hours, suffering the stares of curious passersby. You feel dirty, bruised, disheveled, and abandoned. When your turn comes for examination, the intern seems irritated because he has been called out to treat you. While he treats you, he says that he hates to get involved in rape cases because he doesn't like going to court. He asks if you ‘knew the man you had sex with’” (pp ).
[Excerpt from the 1982 President’s Task Force on Victims of Crime Final Report]

6. “The nurse says she wouldn't be out alone at this time of night
“The nurse says she wouldn't be out alone at this time of night. It seems pointless to explain that the attacker broke into your house and had a knife. An officer says you must go through this process, then the hospital sends you a bill for the examination that the investigators insisted upon. They give you a box filled with test tubes and swabs and envelopes and tell you to hold onto it. They'll run some tests if they ever catch your rapist.
Finally, you get home somehow, in a cab you paid for and wearing a hospital gown because they took your clothes as evidence. Everything that the attacker touched seems soiled. You're afraid to be in your house alone. The one place where you were always safe, at home, is sanctuary no longer. You are afraid to remain, yet terrified to leave your home unprotected” (p.12).
[Excerpt from the 1982 President’s Task Force on Victims of Crime Final Report]

7. “You didn't realize when you gave the police your name and address that it would be given to the press and to the defendant through the police reports. Your friends call to say they saw this information in the paper, your picture on television. You haven't yet absorbed what's happened to you when you get calls from insurance companies and firms that sell security devices. But these calls pale in comparison to the threats that come from the defendant and his friends. You're astonished to discover that your attacker has been arrested, yet while in custody he has free and unmonitored access to a phone. He can threaten you from jail. The judge orders him not to annoy you, but when the phone calls are brought to his attention, the judge does nothing.
At least you can be assured that the man who attacked you is in custody, or so you think. No one tells you when he is released on his promise to come to court. No one ever asks you if you've been threatened. The judge is never told that the defendant said he'd kill you if you told or that he'd get even if he went to jail. Horrified, you ask how he got out after what he did. You're told the judge can't consider whether he'll be dangerous, only whether he'll come back to court. He's been accused and convicted before, but he always come to court; so he must be released…”(p. 12).
[Excerpt from the 1982 President’s Task Force on Victims of Crime Final Report]

8. The information on the aforementioned slides represents a composite of victim testimony before the 1982 President’s Task Force on Victims of Crime.
At that time, victims had few rights and compensation programs were “less than optimal.”
Since then, the federal government and all 50 states have passed victim rights legislation.
Additionally, more than 30 states have passed constitutional amendments formally acknowledging crime victims’ rights.

9. In 1985, Texas passed a law affording crime victims limited rights.
Four years later, Texas voters approved a constitutional amendment, creating a Victim Bill of Rights.
Today, victim rights are outlined in both the State Constitution and the TX Code of Criminal Procedure:
Victims are required to assert their rights in order for them to be applied. System advocates are responsible for informing them of their rights.

10. 10 Basic Categories of Rights:
1.) to be treated with dignity & respect 2.) to be heard 3.) to notification 4.) information and referral 5.) to be present 6.) to reasonable protection from intimidation & harm 7.) to restitution 8.) to apply for compensation (violent crimes) 9.) to speedy proceedings 10.) to “special” rights & protections (as applicable)

11. Special Rights for Sexual Assault Survivors:

12. The following rights apply specifically to victims of sexual assault in Texas:
(Upon request) the right to be accompanied by a trained advocate during the forensic examination and to be provided crisis counseling, support, and information on crime victims’ rights.
(Upon request) the right to counseling regarding HIV/AIDS.
(Upon request) the right to information about payment arrangements for the forensic examination and to receive referrals to social service agencies.
[Source: Texas Association Against Sexual Assault. (nd.) Sexual assault legal advocacy
manual. Retrieved from:

13. The Forensic Exam:
“In a sexual assault case, the body is the crime scene.”
Victim Advocate, Montgomery County, TX
Unlike any other crime, evidence collection in sexual assault cases requires the victim to undergo a forensic examination.

14. In the state of Texas, a victim may request a forensic exam within 96 hours of the assault.
The local police department is responsible for paying for the exam when the victim files a report. (The department is reimbursed by the Office of the Texas Attorney General).
Other hospital-related charges (ex. the ER visit, etc.) that the victim incurs may be covered by Crime Victims’ Compensation.
[Previously, in order to file for CVC, the victim had to file a police report. However, recent changes to the law now allow victims to seek compensation for the hospital visit.]
[Source: Texas Association Against Sexual Assault. (nd.) Sexual assault legal advocacy manual. Retrieved from: .]

15. Non-Reporting Option:
As of July 2009, sexual assault victims in the state of Texas may obtain a forensic examination without making a police report. (The ‘rape kit’ evidence is stored by the Texas Department of Public Safety). This is an option for victims who are undecided about filing a criminal complaint. Given the limited window for a forensic exam, it gives them the option of preserving the evidence and filing a complaint at a later date.
[Sources: Busch-Armendariz, N.B. and Heffron, L.C. (2011). Non-report sexual assault evidence program: Forging new victim-centered practices in texas. Retrieved from: and Department of Public Safety. (nd.) Non-reported sexual assault evidence program. Retrieved from: .]

16. Who is Eligible for the Non-Reporting Option in the State of Texas?
A victim who.. “is at least 18 years old, arrives at the medical facility within 96 hours (4 days) of the assault, and consents to the exam.”
“If a child (anyone younger than 18) has been sexually assaulted, that must be reported to law enforcement under Texas’ mandatory reporting laws.”
[Source: Texas Association Against Sexual Assault (nd.). Sexual assault examinations without police involvement. Retrieved from: .]

17. In Addition to Hospital Costs, What Other Expenses Might CVC Cover?
The following award categories apply SOLELY to sexual assault victims pursuing criminal charges:
Medical (ex. follow-up medical appointments and psychological counseling, etc.)
Relocation and Rental Assistance (for sexual assaults occurring on rental property)
Crime Scene Clean-Up
Items Rendered Unusable (ex. a sexual assault victim’s clothing, etc.)
Travel (ex. to court, etc.)
Childcare
Lost Earnings (ex. missed work due to medical appointments, court dates, etc.)
Lost Support
In Texas, CVC does not cover property loss or damage.
[Source: Texas Office of the Attorney General. (nd.) Texas Crime Victims’ Compensation Program Application. Retrieved from:

18. All CVC awards must relate directly to the victimization (ex
All CVC awards must relate directly to the victimization (ex. one’s need for childcare or dental assistance, etc. must be new).
Additionally, if the victim is engaged in illegal activity at the time of the offense, this may result in the denial or reduction of an award.
[Source: Texas Office of the Attorney General. (nd.) Texas Crime Victims’ Compensation Program Application. Retrieved from:

19. Texas Awards:
Up to $50,000
AND up to $75,000 for victims sustaining catastrophic injury. [Catastrophic refers to an injury resulting in permanent disability (ex. vision or mobility impairment, etc.)].
The fund reimburses victims of crime for out-of-pocket expenses.
Funding is not guaranteed. The OAG is responsible for reviewing applications and determining awards.
The fund is a PAYER OF LAST RESORT. This means that the victim is required to exhaust collateral sources of payment first (ex. insurance, worker’s compensation, settlements, etc.). Victims are required to notify the OAG of any crime-related lawsuits and will be responsible for repaying CVC funds if they collect damages.
[Source: Texas Office of the Attorney General. (nd.) Texas Crime Victims’ Compensation Program Application. Retrieved from:

20. Pseudonyms:
In the state of Texas, victims may use a pseudonym when filing a report. This name will be used on all public records associated with the offense.
[Source: Texas Association Against Sexual Assault. (nd.) Sexual assault legal advocacy manual. Retrieved from: .]

21. Sexual Assault Protective Orders:
Survivors may apply for protective orders regardless of their relationship to their offenders.
A protective order does not require a police report.

22. In Certain Cases, Sexual Assault Victims Are Permitted to Break their Leases Without Penalty:
To qualify, one must...
• be either a victim of sexual assault or the parent of a victim;
• provide one’s landlord with 30 days’ notice prior to vacating the rental property;
• provide documentation that the offense occurred on the rental property.
Such documentation may include: a protective order, hospital discharge paperwork, or verification that the client is receiving services from a rape crisis center.
[Source: Texas Association Against Sexual Assault (nd). Breaking your lease without paying a penalty: A guide to the new Texas law. Retrieved from: .]

23. The Right to Have an Advocate Present During the Forensic Exam:
Texas is one of a limited number of states to afford sexual assault victims the right to be accompanied by a trained advocate during the forensic examination.
(Only seven other states afford victims similar rights).

24. What Do Sexual Assault Advocates Do?
Sexual assault advocates provide:
Crisis intervention;
Supportive listening;
Safety planning;
Information (ex. on crime victim rights, etc.);
Referrals (ex. for shelter, counseling, and medical care, etc.);
Advocacy; and
Follow-up services.

25. In Texas, sexual assault advocates are bound by client confidentiality (with the exception of mandatory reporting obligations and responses to properly issued court orders, etc.).
(Mandatory reporting applies to child and elder abuse cases and the maltreatment of persons with disabilities.)
Sexual assault advocates are also required to complete a 40-hour OAG-approved training.
They are community-based advocates, employed by a rape crisis organization. They are NOT affiliated with the legal system unlike their counterparts working in police agencies or prosecuting attorneys’ offices.
NOTE: The advocate is NEITHER a healthcare provider nor a legal professional and should refrain from providing either medical or legal advice.

26. Where are Forensic Examinations Performed?
As of September 2013, a victim in Texas may have a forensic exam performed at any hospital emergency room. However, not all ERs are staffed with forensic, or SANE (Sexual Assault Nurse Examiner) nurses.
A SANE is a registered nurse who is specially trained to treat survivors in the aftermath of victimization and to collect forensic evidence.
Under SB 1191, if a victim arrives at a hospital emergency room not staffed with a SANE nurse, the hospital must offer to transport the victim to the nearest facility with a SANE program. If the victim is opposed to being transported elsewhere, the exam may be completed instead by the ER nurse and doctor.
[Source: Luthra, S. and Lai, R.K.K. (2013). More hospitals to collect sexual assault evidence. The Texas Tribune. Retrieved: .]

27. SANE Nurse Training:
“An RN must complete both classroom and clinical components before applying for certification (through the Office of the Texas Attorney General). Information is provided on Adult, Pediatric and Courtroom components and covers the following:
Advocacy
Survivor Symptomology
Documentation
History-taking Skills
Collection of Forensic Evidence
Use of a Sexual Assault Evidence Collection Kit
Courtroom Testimony” (

28. Components of the Exam:
Stabilization and treatment for injuries (performed by ER doctor and nurses—not SANE nurse);
Detailed medical history;
Evidence collection;
Evaluation and (prophylactic) treatment for sexually transmitted infections;
Evaluation and treatment for pregnancy; and
“Crisis intervention and referrals”
[Source: [Source: National Center for Women and Policing (n.d.) “Successfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement.”]  

29. Overview of the Evidence Collection Process:
“Once consent is obtained from the patient, a medical history is taken by the SANE to determine injuries and appropriate medical treatment for the patient. The next step is a head-to-toe examination, including the genital area, in order for the SANE to document trauma to any part of the body. Last, a collection of forensic evidence is done, and a sexual assault evidence collection kit (often referred to as a ‘rape kit’) is sometimes used.” (

30. Activity—View Clip on the Evidence Collection Process as Explained by a SANE Nurse:

31. “(The kit is) a container that includes a checklist, materials, and instructions, along with envelopes and containers to package any specimens collected during the exam. A rape kit may also be referred to as a Sexual Assault Evidence Kit (SAEK). The contents of the kit vary by state and jurisdiction and may include:
Bags and paper sheets for evidence collection
Comb
Documentation forms
Envelopes
Instructions
Materials for blood samples
Swabs” (

32. According to the Rape Abuse and Incest National Network, the following “outlines the general process for the (forensic exam. A survivor) may stop, pause, or skip a step at any time.
Immediate care. If (the survivor has) injuries (requiring) immediate attention, those will be taken care of first.
History. (The survivor) will be asked about (his or her) current medications, pre-existing conditions, and other questions pertaining to (his or her health history. Some of the questions, such as those about recent consensual sexual activity, may seem very personal, but these questions are designed to ensure that DNA and other evidence collected from the exam can be connected to the perpetrator. (The survivor) will also be asked about the details of what…happened…to help identify all potential areas of injury as well as places on (his or her) body or clothes where evidence may be located.
Head-to-toe examination. This part of the exam may be based on (the survivor’s) specific experience, which is why it is important to give an accurate history. It may include a full body examination, including internal examinations of the mouth, vagina, and/or anus. It may also include taking samples of blood, urine, swabs of body surface areas, and sometimes hair samples. The trained professional performing the exam may take pictures of (the survivor’s) body to document injuries and the examination. With(the survivor’s) permission, they may also collect items of clothing, including undergarments. Any other forms of physical evidence that are identified during the examination may be collected and packaged for analysis, such as a torn piece of the perpetrator’s clothing, a stray hair, or debris.
Possible mandatory reporting. If (the survivor is) a minor, the person performing the exam may be obligated to report it to law enforcement…
Follow up care. (The survivor) may be offered prevention treatment for STIs and other forms of medical care that require a follow up appointment with a medical professional. Depending on the circumstances and where (the survivor lives), the exam site may schedule a follow up appointment, or (the survivor) can ask about resources in (his or her) community that offer follow up care for survivors of sexual assault..,” (

33. Note for advocates: If possible, to best preserve evidence, survivors should avoid bathing, brushing their hair and teeth, using the restroom, and changing their clothes.
If they happen to change clothes, they should be advised to bring them to the hospital in a paper bag. (They should not use a plastic bag as this could compromise the evidence).
[Source:

34. What a Forensic Exam CAN & CANNOT Do:
What CAN be Established:
What CANNOT be Established:
Recent sexual contact/penetration or trauma;
Consistency between the physical evidence and the victim’s account.
The “truthfulness” of the allegation;
A sexual assault “diagnosis;”
Either the “degree of force or the presence or absence of consent.”
[Source: [Source: National Center for Women and Policing (n.d.) “Successfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement.”]  

35. View Clip--Inside the Lab—How a Rape Kit is Processed as Explained by a Forensic Scientist:

36. Justice Denied--The “Rape Kit” Backlog:
While necessary, the evidence collection process can be revictimizing for survivors. When they consent to the forensic exam, they do so with the understanding that the evidence will be used to assist in the criminal justice process. Yet, this isn’t always the case.
In recent years, “troves” of untested rape kits have been discovered in police evidence rooms. This phenomenon is referred to as the “rape kit backlog” (
[Source: to-address-the-countrys-backlog-of-untested-rape-kits.]

37. According to at least one source, “It started really in the late 90s and early 2000s as we saw advancements in the science itself around DNA technology and as people started to literally open up the evidence rooms and warehouses across the country and discover these troves of kits in different jurisdictions…. Unfortunately, we don't have an overarching number so that's why we still talk in estimates and that maintains the problem. But if you look at states like Texas, where they were one of the pioneers in auditing and inventory in their kits, they had 20,000 kits. We had thousands in cities alone and the numbers were to say the least disturbing. In Illinois, 4,000 kits. Michigan, 11,000 in Detroit alone. In Ohio, 4,000 kits found in Cleveland and then 10,000 kits across the state.” (
[Source: to-address-the-countrys-backlog-of-untested-rape-kits.]

38. On average, it costs between $400 and $1,200 to process a single kit (www.npr.org).
In addition to cost considerations, the following have been identified by researchers as reasons why SAKs were not processed by law enforcement:
1.) officers did not know the identity of the perpetrator (see Strom and Hickman, 2010);
2.) officers believed that the kit lacked forensic value because the survivor either bathed, used the restroom, or brushed his or her teeth, etc. following the assault (see Burgess et al., 2005; and Strom and Hickman, 2010;
3.) officers believed that transporting the kit from the hospital to the crime lab would be too time- consuming [ex. in rural areas with limited law enforcement resources (see Strom and Hickman, 2010).]
As Patterson and Campbell (2012) note, #1 is particularly “perplexing” considering that a DNA match (and suspect identity) could be revealed by processing the kit and entering the information into the CODIS database. Interestingly, one factor said to INCREASE the likelihood that SAKs would be processed was a positive working relationship between local law enforcement and the community rape crisis center.
[Sources: and Patterson, D. and Campbell, R. (2012). The problem of untested sexual assault kits: Why are some kits never submitted to a crime laboratory? Journal of Interpersonal Violence, 27(11): 2259 –2275.]

39. Activity—View Clip on the Rape Kit Backlog: