What to expect at the hospital.
When you arrive, you will speak to an admitting clerk. He or she will ask:
- 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.
You will also see a triage nurse. Please make sure the triage nurse knows you are there for a sexual assault, as that will allow him or her to start the procedures so that you are seen quickly. This nurse will also take your vital signs and obtain some basic information about what happened to determine if you have any serious or life threatening injuries. You will be placed in a private room as quickly as possible.
You will have three general options when coming to the Emergency Department:
- Everyone who comes to the emergency department can be seen for medical reasons. You will be examined by the emergency room staff and receive treatment as needed for injuries or other medical conditions. In addition, you can receive medications to prevent possible health problems, if indicated. For example, you may receive antibiotics to prevent some common sexually transmitted diseases, emergency contraception to prevent pregnancy, or other medications if they are indicated and you want them.
Under Virginia law, individuals under the age of 18 can receive treatment for reproductive health care needs, substance use and mental health needs without parental permission, so some health care may be available to you without parental permission. However, your parents may receive bills and insurance statements from the visit.
Information collected during the emergency department visit is not released to the University or to law enforcement (unless required by law) without your consent. The medical examination after a sexual assault is confidential in the same way that all medical visits are confidential.
- If you are at least 18 years old, you may also ask for a forensic exam and evidence collection WITHOUT notifying law enforcement. Emergency department staff may not contact law enforcement about a sexual assault without your permission, except in certain limited cases. These cases include when you have been seriously injured by a weapon such as a gun or knife. Forensic examinations, except for certain highly unusual cases, are limited to 72 hours after the assault.
If you do not choose to involve law enforcement, the forensic examination is conducted and a limited amount of evidence can be collected. Some forms of evidence, such as urine and blood for forensic toxicology, cannot be collected if there is not a law enforcement investigation. Additionally, the other evidence is not analyzed prior to a law enforcement investigation. The evidence collected is either given to the appropriate law enforcement agency identified only by a number (not your name) or it is mailed to the Consolidated Forensic Laboratory in Richmond, depending on where the assault occurred where it will be stored unopened. The findings from the examination are documented in your medical record.
- You may also decide to have a forensic examination and to notify law enforcement in the first 72 hours after the assault. In that case, the forensic examination is conducted and all evidence warranted by the situation is collected. The evidence collected is given to the appropriate law enforcement agency. The findings from the examination are documented in the medical record. Depending on the situation, an officer may take a statement from you in the emergency department or may make arrangements to speak to you at another time.
At the University of Virginia, forensic examinations after sexual assault are conducted by trained forensic nurses working with emergency department physicians. You will also be seen by an emergency department physician. They will ask questions to make sure you do not have any life-threatening or urgent medical needs. You do not have to provide all the details of the assault. You will be asked some basic questions about your health history and the general nature of the assault. (For example, if you received any serious blows to the head or abdomen, or if you are having significant pain or other serious symptoms).
Before the forensic exam, the forensic nurse will ask you details about the assault. Even though these questions may seem very personal and difficult to answer, the information you give is needed to provide you with optimal care and to ensure that the appropriate examination is conducted and evidence collected. You will be asked about your medical history, medications you now take, and your most recent voluntary sexual contact. If you are a woman, you will also be asked about the dates of your last period and your current contraception, if any. The nurse will ask you specific questions about the types of acts that happened during the assault and where the assault occurred. This information will all be documented in the medical record. After obtaining all of this information, the nurse will usually ask you to disrobe. Your physical privacy will be respected throughout this process.
The nurse will examine your entire body looking for injuries and areas of pain or discomfort. Any injuries will be documented and often photographed. (Photographs become part of the medical record). Your genitals and the area around your rectum will be examined, looking for injuries. Special techniques may be used to allow the nurse to visualize small injuries.
The forensic nurse will use the Commonwealth of Virginia’s Physical Evidence Recovery Kit to collect evidence. This evidence collected is guided by the information you provide about the assault. It may include clothing worn at the time of the assault, including underwear. (If your clothing is collected and you did not bring other clothes with you, you will be provided clothing such as sweatpants and a t-shirt). Swabs for possible DNA evidence will be taken from areas of the body indicated by the history. Often hair samples are obtained. A sample of your blood is taken.
It is important to remember that you can decide what the nurse does during the exam. You may always refuse some elements of the exam, even after you gave consent to the exam at the beginning. You may stop the exam completely or ask to take a break.
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 important.
Do I Have to Report This?
If you are age 18 or older, 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 stored for at least 60 days (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. They are required to make reports if they suspect child abuse or elder abuse, if they believe the patient is a threat to themselves or others, or if a patient has been injured by certain kinds of weapons including guns and knives.
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, the UVA Emergency Department always calls a SARA advocate for any patient reporting sexual assault. You do not have to speak to the advocate, but one will be available to you. You may 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 may receive follow-up care through Student Health Services or through their own care providers.
Who Pays for My Treatment?
The Commonwealth of Virginia will pay for all evidence collection after an assault, STI & HIV prevention medications, 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.
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 may be cut to help distinguish your own hair from that of the assailant.
Collection of DNA Evidence
In order to collect evidence, the clinician will swab your lips and the inside of your mouth.
Swabs moistened with sterile water are used to wipe your inner thighs and external genitalia. For women, a speculum is used to examine the vaginal walls and cervix for injuries, and additional swabs are obtained from these locations. For both men and women, swabs may be collected from the areas around and inside the rectum if there is possibility of anal assault. Special techniques may be used to visualize small injuries. Depending on the history of the assault, swabs may be collected from other areas where there was significant contact, such as places you were kissed or areas where there might be semen or other body fluids. Sometimes, special techniques are used to identify possible areas for evidence.
Vaginal/cervical swabs can be collected up to 72 hours after the assault. Evidence from other areas is usually gone within 24 hours. The nurses will follow the Commonwealth of Virginia evidence protocols and use their own judgment in determining what samples to collect based on the information you provide.
Blood is obtained to determine your DNA profile. The nurse may draw blood (if needed for other reasons) or do a finger stick. Women will usually be asked to provide a urine sample for a pregnancy test. Depending on the type of assault, you may be offered medications to prevent gonorrhea, chlamydia, HIV, hepatitis B, and/or tetanus. Most of those will be one-time doses provided at the time of the visit. If HIV prophylaxis (prevention medication) is needed, you will have to take medications for 28 days. Women will be offered emergency contraception if warranted. You will need to see a health care provider about 2 weeks after this examination for follow up care (up to 4-6 weeks in the case of HIV exposure). Follow up care is essential and can be done by your primary care physician or at Student Health.
If you or the person who accompanied you, (such as a family member, friend, or police officer), believe you may have been incapacitated by drugs or alcohol at the time of the assault (whether you ingested the substances yourself or someone else gave them to you), blood and/or urine may be collected for forensic toxicology analysis. That testing is performed at the state forensic laboratory, not at the University of Virginia.
If the clinicians assess that your medical condition warrants testing to provide you with optimal care, you may also be tested for drugs of abuse or alcohol levels. 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).
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 2-4 weeks after the emergency department 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. This is especially important if you started medications to prevent HIV.
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. The forensic nurse, SARA advocate, or hospital social worker can help you with this.