I am a SANE and work with several other nurses. We have recently started to look at the situation where a patient is unconscious and the request has been made for a rape kit to be completed.
We are trying to set a protocol for this and I am wondering what other programs are doing regarding this.
There has been alot of dicussion regarding this. Some feel it is ok as long as they have gotten permission from the appropiate family member to proceed.Others feel the would rather wait until the person wakes up or collect the kit , then hold it till the person regains consciousness.
Either way it appears to be more of an ethical dilema. I am looking for any input you can provide. We will be discussing this in the next week.
Thanks so much.
Jul 20, '08
I have been in this situation twice. On both occasions the kit was completed on the premise of implied consent, as was the hospital course. Unfortunately evidence collection is a time sensitive issue. If your patient is unconscious your evidence has probably already been compromised to a degree with life saving and treatment measures. (ie-betadine and lube for the foley, hygienic care.)
Once the patients condition either stabilizes or deteriorates to an end course patient, family and police can decide in concert how far the case proceeds. If you are concerned that implied consent won't work you can always seek a court order for collection with the assistance of your police department. If your patient/potential victim was actually sexually assaulted you must attempt to obtain evidence before it is lost. And if the patient decides not to move forward in the legal arena once they regain consciousness, the kit can be destroyed. Yet if they regain consciousness a week or two later and want to move forward you are pretty much out of luck.
Just my $.02. Anxious to hear how you all resolve this issue.
Jul 20, '08
Thanks for your quick response. Getting consent is not the issue. It seems like the issue is boiling down now to whether or not we should even do the kit. The most recent case was a female with a gunshot to the head, on life support. Essentially they were waiting for her respirations to cease, and expected this with in 24 hrs. We were aware that the evidence may have already been compromised.
I am also aware that our Coroner has collected post mortum kits with sucess as the body temp decreases etc, and evidence can still be obtained.
So the issue became : Do we do the kit now or wait and let the Coroner complete it? I did do the kit but now I am having second thoughts. Would it have been better to wait and let the Coroner do it?
I base this primarily on how difficult it is to position the person in order to view the cervix ( if possible) and gather evidence. In a way I feel more damage can be done. I have also done another case where the patient woke up after 2 weeks and was able to identify the perpetrator.
As a team we are now trying to set up protocol regarding completion of a kit on an unconsious patient when they are on life support. I would appreciate anyone's feed back regarding their policy on this.
Jul 21, '08
Playing Devils advocate here. What if that pt who's respirations are expected to cease in 24 hours holds on for weeks or months? Or the family does not want to withdraw care and a persistent vegetative state is maintained for years?
Our medical examiners can definately look for anything we missed in the post, knowing that the exam was technically difficult to accomplish. But I strongly believe in erring on the side of evidence collection.
As an asside, the Intubated-sedated-paralyzed pt I did last needed additional care that the ICU docs hadn't thought of. Prophylactic antx that they just aren't familiar with, and as a SANE I was able to advocate for this.
Good Luck on this slippery slope.
Jul 21, '08
I think the kit should be collected but then wait until the unconscious patient wakes up to see how they want to proceed. Unless it's obvious they have been raped then I think a family member should approve it.
Jul 23, '08
Number one - check your state regs on this. I'd ask your local DA to be sure you are in compliance with these. Maybe they can consult on your policy as you develop it. That's what we did.
Number two - implied consent as stated above, covers this.
Number three - I would collect it no matter what as evidence is time sensitive. You might not know how long they've already been down, etc. Our docs are also good about holding off on foley, etc. if medically possible until I can get my swabs at least.