Question re: rape

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Specializes in PACU, pre/postoperative, ortho.

Just found out a friend's 16 yr old daughter was raped within the past few days. She was taken to the ER at my facility (I'm on ortho). At the ER, it was decided she was just "active" & no rape kit was done. Her mother immediately took her to their own physician who confirmed that she was raped, several obvious lacerations etc. My question is - If someone states they have been raped is there not an obligation to do a rape kit, even if the ER provider has doubts? I would think that it would be better to do one & have it than not to. Plus, this was the 2nd rape in the same part of town within about 2-3 wks. (I'm in a rural area; while rape isn't unheard of, it's not terribly common either.) I just can't get over the fact that the ER dismissed this so completely.

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Did she refuse the exam and evidence collection without letting her mom know? Rape kits are for potential evidence collection and to make sure the patient is physically ok, they often don't immediately "prove" anything one way or another. That's a common misconception we deal with, parents wanting proof that something happened and what and often the exam is normal regardless of what happened.

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It's possible that there is more to this story than you know. It is not completely unheard of for parents to bring teenage daughters to the ED for a pelvic exam to find out if they are sexually active (yet another example of inappropriate use of the ED). If this is the case, the pelvic exam is completely inappropriate. The doctor can't confirm whether it was sexual assault, only that there was sexual activity. The sex could have been consensual. Rough sex or sex without enough lube can cause lacerations.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

That is a really difficult question to answer not having spoken to the victim. I would be surprised if they really blew it off and there was slightly more to the story than what the mother is revealing.

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Specializes in Emergency/Trauma/Critical Care Nursing.

I'm not sure if this is a state or national law, but when it comes to anything sexual/reproductive/STD etc, the patient is considered emancipated in regards to medical treatment at age 13. This means that if a 13y.o pt comes in and is found to have an STD for example, medical personnel are legally allowed to treat them without parental consent, nor are we allowed to give the patient's parents any information regarding the pt's complaint, testing/results, diagnosis, etc or it is considered a HIPPA violation. As far as I know this is the only exception to the NORMAL rules of treating minors and it could very well be that her mother was not in the exam room or maybe the doctor talked to the patient privately, which she had every right to do.

Also, it is my hospital's policy, and im sure many others use this, but when a rape victim comes in, they're C/O will be Code R so that orther hospital staff won't barge in and startle her etc. We evaluate patient in the ER, she NEVER gets placed into our pelvic rooms out of courtesy, and because in these cases, the doctor gives the pt prophylactic meds, make sure there are no major injuries elsewhere and then send the patient by cab to the S.A.N.E clinic (Sexual assault Nurse Examiner), who are connected to the county sherriffs office to ensure the chain of evidence was not tampered with.

Being that the patient is 16, she coud've possibly been examined without her mother in the room, which could've lead the doctor to get more of the story now that teh girl doesn't think her mom will get upset/critical etc.

Last question is Why did she take her to the ER if her own PCP was open and available to take her as a patient that day?

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Specializes in Emergency & Trauma/Adult ICU.

There is an "obligation" to collect evidence only if the patient agrees to the exam, and it is impossible for any of us to know exactly what the conversation was between the patient and the physician.

It would be rare to find a PCP skilled in sexual assault evidence collection.

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I agree that there's likely much more to the story than the OP is hearing, and there's no way that a family physician would be in a position to "confirm" by physical exam that someone was raped. That is a legal question, not a medical question.

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Specializes in PACU, pre/postoperative, ortho.

Thanks for the comments! Yeah, I agree that there could be a lot that was left out when I was told about this. Whether she was examined privately or not, I don't know, & the fact that she could have refused a rape kit didn't occur to me. I was just kind of dumbfounded that it was not an automatic thing. Nothing was mentioned about the private physician doing a kit, just an exam. I just have a lot of personal feelings/opinions based on knowing this girl since she was born & the type of person I know her to be; she's terribly awkward socially with just a few close friends (she's homeschooled) & doesn't really even date or go out much though I know appearances aren't everything - she IS a teenager. She had been riding her bike & someone stopped her along the way when this happened. This being the second reported rape in the same area in a short time also concerns me; I don't know if her description of the person matches the first victim's description or not. Hoping it doesn't happen again. Thanks again for the replies.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

My heart breaks for her and her family and the evil that may have befallen her.

My prayers for them all....:loveya:

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I am a SANE nurse and I would like to comment here.

In my state, the age of legal consent is 16. Meaning if a 16 year old comes to the ER, even with his/her parents and want to be checked for STD's/pregnancy test/rape kit, we do NOT have to give the parents any info. The patient has a right to REFUSE a rape kit if they want. We can not force a rape kit/SANE exam on anybody.

Also, if the patient does decide to get a SANE exam done, they do NOT have to report to the police.

The only thing I can think of is the patient in the OP either refused a SANE exam/rape kit, or possibly told the doctor another story. I don't know if your ER has a designated SANE nurse or not, but I do my own pelvic exams and order my own meds. The ony time I've called a doctor to the SANE room during an exam is when the patient had severe lacerations/tears to her genitals.

Maybe there is more to the story. And at my hospital, a doctor does not collect foresnic evidence (from genitals or anywhere else) in order to determine if a rape occured.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I am also a SAFE (sexual assault forensic examiner) at my hospital. Our facility will only do a forensic exam/evidence collection kit if the alleged assault/events took place within that last 120 hours, and our threshold actually used to be 96 hours. Not sure how far out this patient was from the event. As the others said ... probably more to the story.

Reporting requirements vary from state to state. In Virginia, a patient can have evidence collected without involving law enforcement. At our military facility in Georgia, only if our patient is active duty and has not told anyone outside of a victim advocate, sexual assault response coordinator, chaplain, or healthcare professional, he/she is entitled to a "restricted" case -- no law enforcement involved, kit held by the provost marshal's office for 5 years. If the patient is a family member or presents to an outside/civilian facility, they are required to notify law enforcement.

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Specializes in Emergency.

There is very good information in this thread. In addition, Did the parent then report the rape to the police? They do not need the hospital to do that for them.

But my initial thought is really that there is a lot more to the story than the mother knows. Children do amazing and unusual things that parents are entirely entirely unaware of.

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