Discharge and Post-exam

General Instructions

  • If appropriate facilities are available, allow a patient who so desires to brush her/his teeth and to shower after all evidence has been collected.
  • If the patient’s clothing was collected as physical evidence, take necessary steps to ensure that the patient does not leave the facility in a hospital gown/slippers.
  • Whenever a sexual assault patient is discharged from the hospital or transferred to an inpatient department, the Discharge Instructions (see below and page 26) should be completed and a copy should be given to the patient.

Discharge Instructions

  • At the completion of the examination and treatment of a sexual assault patient, regardless of whether the Kit was completed, the Discharge Instructions (Pages 6 of the Medical Report) should be completed.
  • All information contained in the Discharge Instructions should be discussed with the patient, as well as written on the form.
  • The patient should be encouraged to ask any questions that s/he may have.
  • Ensure that the patient understands the information contained in the Discharge Instructions and the importance of follow-up care.
  • The discussion of follow-up care for medical and counseling purposes is an important treatment aspect for sexual assault patients.
  • Specific information should be provided regarding the following:
  • Follow-up exam and testing for STIs in two weeks;
  • Referral to a clinic which provides for anonymous, free or low cost HIV testing.
  • If the patient is undecided whether to report the assault to police, create a Control Number as indicated on the Discharge Instructions. (See page 19 for further information)
  • Complete the signature section of the Discharge Instructions as directed.
  • After all necessary information and signatures have been recorded on the Discharge Instructions, give the yellow carbonless duplicate copy of the Discharge Instructions to the patient or the patient’s representative. Reserve the white original copy for the patient’s medical record.

Booklet

  • Give the patient a copy of the, Information for Victims of Sexual Assault and Their Families Booklet, and indicate on the Discharge Instructions that it was given.

Additional Discharge Procedures

  • Whenever possible, avoid requiring a sexual assault patient to wait at another location in your facility for release forms and/or prescriptions. Any additional discharge procedures should be completed in a way that minimizes waiting and stress to the patient.
  • Assist sexual assault patients in making the necessary arrangements for transportation leaving the facility (e.g., calling family or friend or arranging for taxi cab service).

EVIDENCE TRANSFER

Preparation of Evidence Containers

  • All evidence containers, such as the CT100 Kit, CT400 Kit, and clothing bag(s), must be marked with identification information, properly sealed, and marked with chain of custody information. (Refer to REPACKAGING, LABELING AND SEALING EVIDENCE CONTAINERS page 51)
  • All stickers, such as the orange “BIOHAZARD” and if applicable, (if a moist specimen was collected in Step 13) the yellow “MOIST SPECIMEN” sticker must be placed on the upper left corner of the Kit. (Refer to REPACKAGING, LABELING AND SEALING EVIDENCE CONTAINERS page 51)
  • All evidence seals should be placed on the evidence containers. Two (2) seals should be placed on the Kit and two (2) seals should be placed around the ends of the folded opening on the large brown clothing bag. Initial all seals.
  • The yellow carbonless duplicate copy of page one (1) of the Medical Report must be sealed in the envelope on the bottom of the Kit.
  • The white copies of all Medical Report pages must be placed in the patient’s medical record.

Appropriate Transfer Personnel

  • Under no circumstances should sexual assault patients be allowed to handle evidence after it has been collected. (Exception- Pubic hairs specimens may be pulled by the patient if           s/he prefers. The patient should wear non-lubricated gloves if s/he completes this step). (Refer to step 9 KNOWN PUBIC HAIR PULLED PAGE 45).
  • Only a police officer should transfer physical evidence from health care facilities to the State of Connecticut Forensic Laboratory or the Toxicology/Controlled Substance Laboratory for storage and/or analysis.
  • If the patient is undecided about the notification of the police regarding the assault, the department or troop with jurisdiction where the assault occurred (if known) or where the health care facility is located (if unknown) should be contacted (See below regarding when to contact police).

Appropriate Contact Timing

If the patient consents to the notification of police regarding the assault:

  • Contact police as soon as possible to avoid delaying the sexual assault patient for longer than necessary.
  • If police are unable to arrive before the examination and treatment of the patient is completed, suggest that arrangements be made for the police interview to be conducted at another location at a later time, rather than require the victim to wait in the hospital.
  • Encourage police to arrive at the facility as soon as possible to conduct the interview with the victim and to transfer evidence to the State of Connecticut Forensic Laboratory.

If the patient is undecided about notifying police regarding the assault:

  • Use a Control Number instead of the patient’s name and medical record number on the Kit identification label. The patient’s identity should not be disclosed to the police without her/his consent.
  • Contact police after the patient has been discharged to avoid making the patient feel pressured by the officer’s presence.
  • Labeled, sealed evidence containers should be properly and securely stored until they are turned over to police. (See below-Temporary Storage of Evidence Container).

Temporary Storage of Evidence Containers

  • Completed Kits and filled clothing bags should be transferred to police custody as soon as practical for transport to the State of Connecticut Forensic Laboratory.
  • Evidence that is not immediately transferred to police for transport to the State of Connecticut Forensic Laboratory should be labeled, sealed, and temporarily stored in a secure area or kept under observation until turned over to police.
  • If temporary storage of the Kit and clothing bags is required prior to the transfer of custody to police, store as follows:
    • The completed, sealed Kit should be stored in a secure, refrigerated area.
    • The filled, sealed clothing bag(s) should be stored in a secure, dry area at room temperature.
    • If evidence is stored prior to being transferred to police, the person storing the evidence must document the storage as instructed on the Kit box. (See below).
    • Do not retain evidence at the hospital if the patient is undecided about reporting. To preserve the chain of evidence and evidence integrity, evidence should be stored at the Laboratory and not the health care facility. Evidence must be stored for sixty (60) days when a patient is undecided about whether to notify police of the assault and must be transferred to police for transport to and for storage at the State of Connecticut Forensic Laboratory or Toxicology/Controlled Substance Laboratory.

Transfer Documentation

The evidence transfer must be documented in the following places:

  • The evidence container labels (Kit and clothing bag(s)). (Refer to QUESTIONS REGARDING EVIDENCE COLLECTION page 31).
  • Page 4 of the Medical Report. (See SAMPLE FORM page 25).
  • Lines 13 and 14 of the Checklist. (See SAMPLE FORM page 27).

Evidence Containers

  • Be sure that “MEDICAL PERSONNEL” section of the Kits and clothing bag labels are completed.
  • If evidence is stored prior to being turned over to police, the person storing the evidence should complete the lower section of the “MEDICAL PERSONNEL” section on the Kit and clothing bag labels. (Note that if the patient is undecided about notifying police about the assault, a Control Number, and not the patient’s name or medical record number, should be used to identify evidence containers. See CONTROL NUMBER page 19).
  • The health care personnel who transfers the evidence to police should complete the first line of the “POLICE PERSONNEL” section of the Kit and clothing bag labels.
  • The police officer who received the evidence from the health care facility person should complete the second line of the “POLICE PERSONNEL” section of the Kit and clothing bag labels.
  • Police and the State of Connecticut Forensic Laboratory/Toxicology-Controlled Substance Laboratory personnel will document the continuing chain of custody.

Medical Report Forms

  • If evidence is stored prior to being turned over to police, the storing person must complete Section 9E on page four (4) of the Medical Report.
  • The health care personnel who transfers the evidence to police must complete section 9e on page four (4) of the Medical Report.
  • The police officer that takes custody of the evidence from the health care personnel must  complete Section 9E on page four (4) of the Medical Report.

Checklist

  • Line 13 of the Checklist should be appropriately marked by the examiner responsible for the examination of the sexual assault patient to indicate that evidence was transferred to police.
  • Line 14 of the Checklist should be appropriately marked by the examiner responsible for the examination of the sexual assault patient to indicate that arrangements were made for the transfer of evidence to the State of Connecticut Forensic Laboratory by police for sixty (60) day storage.

POLICE INTERVIEWS

General Information

  • If the patient consents to the notification of police regarding the sexual assault, police will need to conduct a preliminary interview of the sexual assault patient, in addition to transferring evidence from the health care facility to the State of Connecticut Forensic Science Laboratory or Toxicology-Controlled Substance Laboratory.

Location

  • Whenever possible, a quiet private area should be provided for police to interview a sexual assault patient.
  • If no suitable area is available, suggest that the interview be conducted later, at another location, such as a sexual assault crisis services office or a place selected by the patient.
  • It is important for a sexual assault patient to feel that s/he is moving forward during the difficult process that follows a sexual assault and to regain a sense of control. Leaving the examining room after the examination is completed will help the patient as well as allow the examining room to become available for other use.

Timing

  • Police should be contacted at such time, and in such a manner, that will enable the officer to coordinate her/his arrival with the completion of the patient examination.
  • If the officer arrives prior to the completion of the examination, s/he should be asked to wait in the waiting area until the examination is completed. There is no reason for the presence of a police officer (male or female) during the forensic examination. (Refer to ATTENDING PERSONNEL page 29).
  • See Child & Adolescent Victims section (Pages 52-54) when interviewing minors.

REFERRALS AND VICTIM ASSISTANCE

General Instructions

  • The support and advocacy of a trained sexual assault counselor can be very beneficial to a sexual assault patient during the patient’s visit to the health care facility and afterward.
  • The presence of a trained sexual assault counselor can also be very helpful for the examiner completing a sexual assault examination.

STATEWIDE SEXUAL ASSAULT
24-HOUR TOLL FREE HOTLINE

ENGLISH: (888) 999-5545 | SPANISH: (888) 568-8332

All calls will automatically be routed to the nearest center.

All calls are confidential. None of the centers subscribe to Caller ID.

Description of Services

  • Connecticut Sexual Assault Crisis Services, Inc. (CONNSACS) has 9 centers located throughout the state.
  • Each community-based center provides free, confidential services for past and present victims of sexual assault/abuse/harassment and their families, parents, friends and partners. Services include:
    • 24-hour hotline with immediate access to certified counselors.
    • Crisis intervention and short-term counseling for victims of sexual assault and their families and friends.
    • Support and advocacy for the victim’s additional counseling and other needs.
    • Support groups for rape, child sexual abuse and incest victims, and parents and partners.
    • Counselor/advocates trained to work with child victims.
    • TTY access available during office hours (M-F, 9:00 – 4:30). Bilingual staff and male counselors.
    • Centers may be able to provide clothing for patients whose own clothing has been collected as evidence so that patients don’t leave the facility after discharge in a hospital gown/slippers.