This project was supported by Grant No. 2010-RASC-00116 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication are those of the author(s) and do not necessarily represent the views of the Department of Justice, Office on Violence Against Women.
"Forensic Compliance" is the term we use to discuss whether rules about the medical forensic exam are being followed.
What is the medical forensic exam?
The medical forensic exam is the physical examination offered to victims following a sexual assault. The exam has two main purposes: to evaluate and treat any injury and collect any evidence of the assault that may be on the victim's body or clothing.
What kind of rules are there about the medical forensic exam?
While there are numerous regulations and best practices about the exam, MNCASA is primarily concerned with two main rules at this time. The federal Violence Against Women Act (VAWA) requires states to:
1) offer the medical forensic exam to victims regardless of the victim's willingness to cooperate with the police or make a police report. In the past, some states required victims to report the assault to law enforcement before receiving the exam; and
2) ensure that victims are not burdened with the cost of the exam.
By requiring these two things, VAWA recognizes that while victims are not always ready to make a police report immediately after an assault, they should not be deterred from seeking critical health care and time-sensitive evidence collection.
As of January 5, 2009, all states must be in compliance with these mandates in order to continue to receive VAWA funding.
Is Minnesota following these rules?
Yes. Minnesota has its own law in place to ensure these rules are followed, Minn. Stat. §609.35 (2003). Although Minnesota is technically in compliance through this statute, many details remain unsettled. For example, because the Minnesota statute requires counties in which the assault occurred to pay for the exam, there is great variation in practice among Minnesota’s 87 counties. There is also confusion about which agency within the county is responsible for payment, or how much the county must pay for the exam.
In addition, there is also confusion across counties and even within counties about where evidentiary kits from non-reporting victims are stored, and how long such kits will be stored. Questions also arise regarding emergency contraception, mandatory reporting, or a minor or vulnerable adult’s ability to consent to the exam.
These variations result in an unpredictable system for victims and professionals alike to navigate.
How will SVJI @ MNCASA address these challenges?
SVJI started its Forensic Compliance Project in August of 2009 to address these challenges. The Project has an Advisory Board, consisting of victim advocates, law enforcement personnel, crime lab technicians, sexual assault nurse examiners, prosecutors and representatives from the Minnesota Hospital Association.
The Project has three main goals:
1. Address exam payment challenges.
2. Develop and publish model policies for forensic compliance. These model policies will be informed by the successes and challenges articulated by our member programs, a state-wide advisory board and our national counterparts.
3. Enhance the competence and confidence of medical professionals to treat and collect evidence from patients who have been sexually assaulted. MNCASA will enhance access to continuing education and support for forensic examiners by organizing and hosting a state-wide conference, establishing a listserv, and holding web-based training and networking opportunities.
At the conclusion of this project, victims of sexual violence will benefit from a system that offers consistent information, quality medical care and forensic evidence collection and a more victim-centered response. To find out how this project could help your jurisdiction, please contact us (651) 209-9993 or firstname.lastname@example.org.
What is SVJI @ MNCASA doing about the challenges associated with exam payment?
On September 21, 2010, SVJI @ MNCASA hosted an exploration of the following question: What are the implications of MN using a state fund to pay for sexual assault medical-forensic exams beginning on January 1, 2013? Around 45 people came together to explore this question with us—a multidisciplinary group that included advocates, law enforcement, sexual assault nurse examiners, crime victim reparation fund managers (from inside MN and from two other states), a representative of the Minnesota Hospital Association, a county payor, a policy staffer, etc. We used a process called the Implications Wheel™ offered by the Institute for Strategic Exploration. The event was made possible with support from the Minnesota Department of Public Safety, Office of Justice Programs.
Our group worked hard and generated over 300 implications that we will be sharing with the Forensic Compliance Advisory Board and others in the coming months. While there is no current plan underway to start a statewide fund, many states do use this approach. Thus, MNCASA is beginning to explore the potential implications of such an approach here in Minnesota.
Here’s what you should know about the exploration we’ve initiated:
1) There is no existing plan to start a statewide fund; it is an idea we are exploring. Through our Forensic Compliance project we are funded to improve compliance with the letter and spirit of the VAWA requirement that victims have access to forensic exams without being required to report to law enforcement and without being required to pay for the exam. There are a number of challenges with the current payment system and we are exploring a variety of options that might improve this. One option might be the move to a statewide payment system. Many states use this approach, and MNCASA is taking a lead in exploring the potential implications of Minnesota adopting such an approach.
2) In order to explore the implications of a statewide fund in the way we did, we needed to make certain assumptions about what such a fund would entail. Developing those assumptions has itself been educational, improved the questions we are asking, and will help guide further exploration of this topic. For example, we had to assume what the fund might cover and how much the fund might pay before any meaningful implications could be generated. This may lead some to misunderstand that MNCASA has made some more permanent determination with regard to these details. This is simply not true. None of the assumptions we developed can automatically be taken as a given ingredient of a plan moving forward. This goes for both those assumptions to which some might attach a perceived value of ‘good’ from their point-of-view or those that they may see as ‘bad’ for them. It is simply too early to know if any of these details will fit the solutions that may emerge out of the full exploration.
3) There will be more time and opportunity to provide input and work with what we learned. While we recognize that it is not common for groups to hold large ‘What if?” sessions early in a process, that’s precisely what we did. And, we intentionally invited people we knew might generally agree or disagree with the question as it was presented. This was done to counteract the effects of ‘tunnel vision’ from which experts on any side of an issue can suffer. We are pleased that doing this exploration now allows us time to actually work with the ideas generated to formulate better questions, to research information we now know we want, and to have more focused conversations with a variety of stakeholders. Our goal is to work with the Forensic Compliance Advisory Board and MNCASA membership to make recommendations to the Office of Justice Programs for how payment should be handled in the future in order to be in compliance with VAWA and get to the best solution for victims.
As more information becomes available, we will post it here. If you are interested in more information about our work on this topic or other aspects of the Forensic Compliance project, please contact us at email@example.com.
Minnesota Coalition Against Sexual Assault
161 St. Anthony Avenue
St. Paul, MN 55103