States may have victims’ rights laws, which provide protections and rights to crime victims. Some states require the patient be given the option of having a rape crisis advocate present during their examination. The hospital must inform the patient of this right and notify the advocate for the patient. In most jurisdictions, communication between the victim and advocate are privileged. Rape crisis center advocates understand the many ways sexual assault can impact a person and their family and are there to provide support and information so that the survivor may make informed, critical decisions. Advocates may also intervene or act on behalf of the survivor and assist with navigating the processes within the medical, law enforcement, and court systems.
Explore This IssueACEP Now: Vol 37 – No 11 – November 2018
Some states may have emergency contraception (EC) laws that require hospitals to provide emergency contraception to sexual assault survivors.5 If EC is not provided on site, such laws require the hospital have alternative plans for patients to obtain the medication. Some states require hospitals to register with the state and provide patient notification of the lack of provision of these resources.
Finally, and most important, federal laws play a role in sexual care. The Violence Against Women Act (VAWA) was passed in 1994 and has been reauthorized in 2000, 2005, and 2013.6,7 VAWA provides communities with tools and funding to improve response to victims of sexual assault, domestic violence, dating violence, stalking, and trafficking. The act includes access to examinations free of charge, regardless of victim cooperation with law enforcement. Every state receives VAWA funding to provide services to sexual assault survivors.
One of the enhancements to VAWA in 2005 required states, as a condition of funding, to allow victims to receive a medical forensic examination without having to report the crime to law enforcement.6–8 These kits have become known as Jane/John Doe kits or anonymous kits. This process allows victims to access medical care and allows time-sensitive evidence to be collected without forcing victims to immediately decide whether to report the rape to law enforcement. Victims can report the crime at any time to law enforcement within a prescribed time frame (which is state-dependent), and the collected evidence can then be analyzed. Giving victims time to decide about reporting is important for returning power to victims and giving them control over their participation with the criminal justice system. Failure to follow the VAWA statutes can cause a state to lose its VAWA funding.