STATE OF NEW HAMPSHIRE OFFICE OF THE ATTORNEY GENERAL SEXUAL ASSAULT: An Acute Care Protocol for Medical/Forensic Evaluation Ninth Edition, 2018 http://doj.nh.gov/criminal/victim-assistance/documents/acute-care- protocol.pdf HISTORY OF THE NEW HAMPSHIRE SEXUAL ASSAULT PROTOCOL PROJECT On April 26, l988, the New Hampshire Legislature passed RSA 21-M:8-c, which made the State responsible for the payment of forensic medical examinations of sexual assault victims when there is no insurance (See Appendix A). Under RSA 21-M:8-c the New Hampshire Department of Justice (Attorney General’s Office) is authorized to “implement rules establishing a standardized sexual assault protocol and kit to be used by all physicians or hospitals in this state when providing physical examinations of victims of alleged sexual offenses.” This Protocol is a statutory mandate for all hospitals and physicians in the state. In 1989, the New Hampshire Attorney General's Office formed the Sexual Assault Protocol Committee representing the medical, legal, law enforcement, victim advocacy and forensic science communities, to establish a New Hampshire protocol and kit. The Committee took great care to make recommendations based upon the physical and emotional needs of the sexual assault victim, reasonably balanced with the basic requirements of the legal system. The result was the publication of Sexual Assault: A Protocol for Medical and Forensic Examination, and a standardized evidence collection kit to be used in all of the hospitals in the state. This project was completed in June 1989. Recognizing that forensic science is a field in continual evolution, the Protocol is continually being revised in an effort to improve evidence collection outcomes for patients who have experienced sexual assault. The following is an up-to-date list of protocol revisions: Sexual Assault: A Protocol for Medical and Forensic Examination, First Edition, 1989 Sexual Assault: A Protocol for Medical and Forensic Examination, Second Edition, 1997 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Third Edition, 2002 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Fourth Edition, 2005 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Fifth Edition, 2008 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Sixth Edition, 2011 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Seventh Edition, 2014 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Eighth Edition, 2015 Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Ninth Edition, 2018 i THE NEW HAMPSHIRE SEXUAL ASSAULT AND NURSE EXAMINER ADVISORY BOARD Co-Chair: Lynda Ruel, Director Office of Victim/Witness Assistance NH Attorney General's Office Co-Chair: Janet Carroll, RN, CEN, SANE-A, SANE-P SANE Program Director New Hampshire Coalition Against Domestic and Sexual Violence Dartmouth Hitchcock Medical Center Co-Chair: Jen Pierce-Weeks, RN, SANE-A, SANE-P SANE Program Director New Hampshire Coalition Against Domestic and Sexual Violence International Association of Forensic Nurses Joy Barrett Kathleen Kimball Granite State Children’s Alliance Coordinator, NH SART Program NH Attorney General’s Office Jean Carroll Lisa Lamphere PREA Advocate Victim’s Compensation Program NH Department of Corrections NH Attorney General’s Office Megan Berman Jeffrey Maher UNH – Sexual Harassment and Rape Title IX Coordinator & Director of Campus Prevention Program (SHARPP) Safety Keene State College Detective Julie Curtin Concord Police Department Kevin McMahon, MS NH State Police Forensic Laboratory Jessica Eskeland David Rotman, JD NH Coalition Against Domestic and Sexual Merrimack County Attorney’s Office Violence Sergeant Sara Hennessey Trooper Catherine Shackford NH State Police NH State Police Meghan Jenks Joi Smith NH Coalition Against Domestic and Sexual Client Services Manager Violence HAVEN Dr. Elizabeth Karagosian, MD Tom Velardi, JD Southern New Hampshire Medical Center Strafford County Attorney ii OVERVIEW To maximize the continuity of care for patients who have experienced sexual assault, health care professionals, in concert with other professionals who assist victims of sexual assault in New Hampshire, have developed the following approach to support New Hampshire’s medical community in the care of patients reporting an acute sexual assault. INTRODUCTION According to the American College of Emergency Physicians, “appropriate management of the patient requires a standardized clinical evaluation, an effective interface with law enforcement for the handling of forensic evidence, and coordination of the continuum of care with a community plan. The clinician must address the medical and emotional needs of the patient while addressing the forensic requirements of the criminal justice system. Medical issues include treatment of acute injuries and evaluation for potential sexually transmitted diseases and pregnancy. Emotional needs include acute crisis intervention and referral for appropriate follow-up counseling. Forensic tasks include thorough documentation of pertinent historical and physical findings, proper collection and handling of evidence, and presentation of findings and conclusions in court.1” Despite the appearance of two separate and distinct issues, the medical and forensic components of the examination cannot be separated. This document seeks to assist the medical professional in accomplishing the above tasks and meet the standard of care requirements. 1 Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient, ACEP 2014 iii TABLE OF CONTENTS HISTORY OF THE NEW HAMPSHIRE SEXUAL ASSAULT PROTOCOL PROJECT ................................................................................................................... i THE NEW HAMPSHIRE SEXUAL ASSAULT AND NURSE EXAMINER ADVISORY BOARD ................................................................................................. ii OVERVIEW .............................................................................................................. iii INTRODUCTION ......................................................................................................................... iii TABLE OF CONTENTS ......................................................................................... iv THE PURPOSE OF THE NEW HAMPSHIRE SEXUAL ASSAULT AND NURSE EXAMINER ADVISORY BOARD ........................................................... 1 NEW HAMPSHIRE’S SEXUAL ASSAULT AND RELATED LAWS ................. 2 OTHER STATUTES ...................................................................................................................... 2 OTHER IMPORTANT LEGAL PRINCIPLES .............................................................................. 2 EMOTIONAL NEEDS OF THE PATIENT ............................................................ 4 CRISIS CENTER ADVOCACY .................................................................................................... 4 WORKING WITH VICTIMS ........................................................................................................ 4 RESPONDING TO VICTIMS ....................................................................................................... 5 PRESENTATION OF PATIENT .............................................................................. 8 EMERGENCY MEDICAL SYSTEM (EMS) RESPONSE ........................................................... 8 LAW ENFORCEMENT ACCOMPANIMENT ............................................................................. 8 EMERGENCY DEPARTMENT RESPONSE .............................................................................. 9 OUT-OF-STATE SEXUAL ASSAULT .................................................................. 11 SPECIAL PROGRAMS .......................................................................................... 12 THE SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM ..................................... 12 NEW HAMPSHIRE VICTIMS’ COMPENSATION PROGRAM .............................................. 12 PATIENT OPTIONS ............................................................................................... 14 CHILDREN/MINORS ................................................................................................................. 14 REPORTING TO LAW ENFORCEMENT AND OTHER STATE AGENCIES ....................... 15 CHILD ABUSE REPORTING LAW ........................................................................................... 15 PROCEDURES FOR REPORTING CHILD ABUSE ................................................................. 16 IMMUNITY ................................................................................................................................. 16 ABUSE OF ELDERLY AND VULNERABLE ADULTS REPORTING LAW ........................... 16 REPORTING ANONYMOUSLY ................................................................................................ 17 THE MEDICAL/FORENSIC EVALUATION ..................................................... 19 LOCATION .................................................................................................................................. 19 HIPAA .......................................................................................................................................... 19 iv USE OF BODY-WORN CAMERAS BY LAW ENFORCEMENT AND MAINTAINING HIPAA COMPLIANCE ..............................................................................................................