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.
One key tenet of sexual assault care is that patients must be able to provide consent for the medical forensic examination; patients have the right to refuse any or all parts of the examination.9,10 Also, they have the right to decide what happens with the evidence collected.
Patients who are intoxicated may be not be capable of providing informed consent or actively participating in the exam process due to their level of intoxication. In these cases, patients should be observed and allowed time for detoxification. After clinical sobriety, options regarding reporting and the medical forensic examination can be re-reviewed with patients. Some patients who are unconsciousness, head-injured, or have other serious traumatic or medical conditions may remain unable to consent for a much longer period. During this prolonged period, evidence may be lost or degraded. Therefore, emergency departments should have protocols for handling consent and examination in these unconscious/nonconsentable patients.