What to expect at the hospital.
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 (triage) nurse will talk with you. Additional information necessary for registration includes:
- your name
- date of birth
- reason for coming to the Emergency Department
- occupation and employer (if applicable)
- next of kin or emergency contact
- insurance information
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.
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 assault occurred, such as in a car, on grass or carpet, etc., and to describe what happened. All of this information is needed in order to provide you with the best and most accurate medical care and treatment. It is not part of a police or investigative report.
If you believe that you may have been the victim of a drug-assisted assault, inform the nurse immediately so that testing for such drugs can occur in a timely manner. Many of these drugs are only detectable in blood or urine samples and only after a short period of time, so drawing timely samples is quite important.
Do I Have to Report This?
The decision to report the assault to law enforcement authorities is solely up to you. 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 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. If you don’t want to report the crime, the hospital isn’t required to notify the police when a sexual assault has occurred although it 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 SARA 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?
The Commonwealth of Virginia will pay for all evidence collection after an assault, STI prevention, and emergency contraception. Additional medical services, if needed, should be covered by private insurance. If you submit claims through your parent's insurance, they may learn about your visit to the emergency room through the insurance company. 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 that you need.
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.
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. Other expenses, such as follow-up medical care, psychological counseling, or lost wages due to the assault, may only be covered if you report the assault to the police.
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. 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.
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 emergency department prior to leaving if you would like.
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.
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. However, if you voluntarily consume alcohol or a club drug, such as GHB or Ecstasy, this could be important 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.
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, as a U.Va. 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) or if you are a male survivor, General Medicine (982-3915 ), as soon as possible to make a follow-up appointment.
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.