Christina Cauterucci, America Has a Critical Shortage of Medical Sexual-Assault Examiners, Slate

The U.S. is facing a shortage of forensic examiners for sexual assault survivors, according to a recent Government Accountability Office report. Most states don’t even keep any data on their sexual assault examiners, who perform rape kit exams in medical settings, and though states can get federal grants to underwrite training and salaries for examiners, the few examiners that do exist are often given inadequate or inconsistent training.

Rural areas of the U.S. are most likely to suffer a lack of examiners, the report states. In Wisconsin, for example, almost half of the state’s counties don’t have a single one. All six states GAO studied— Colorado, Florida, Massachusetts, Nebraska, Oregon, and Wisconsin—reported that their ranks of their examiners were not sufficient to meet their needs for sexual-assault exams. This poses more than just an inconvenience for victims and their medical providers: If examiners can’t meet a rape survivor at a hospital in a timely manner, the state’s case against the perpetrator could suffer.

Between 2005 and 2010, 80 percent of female survivors of rape or sexual assault sought care in a medical setting. There, a trained examiner is supposed to conduct a forensic exam, which could involve collecting samples of hair, blood, saliva, and semen; scraping under the victim’s fingernails; recording any abrasions or bruises; and swabbing parts of the body. Examiners must log the evidence and keep a proper chain of custody in case it’s used in a civil or criminal case against the perpetrator. If the survivor does go to the police, the examiner might testify in court.

That’s why good examiners are trained in courtroom testimony in addition to preserving evidence integrity, providing testing and treatment for STIs, and being sensitive to the needs of a child or adult victim of recent trauma. But GAO found a complete lack of federal standards in examiner training or examiner availability in medical facilities, besides those in military, correctional, and Indian Health Services institutions. Most states don’t have their own guidelines for examiner training, either.

The GAO report highlights a troublingly high turnover rate as one of the biggest barriers to an effective, robust lineup of examiners. Since there are so few of them, they’re often on call for long, unpredictable shifts of emotionally draining work. Over two years in Wisconsin, GAO found, the state trained 540 examiners. At the end of the two years, just 42 of them were still active.

Though the Violence Against Women Act authorizes federal funding from three Department of Justice grant programs to be used to train and pay sexual assault examiners, five of the six states GAO studied reported trouble “obtaining support from stakeholders,” often because hospitals did not want to pay for examiners’ training or salaries.

On Thursday, Sens. Patty Murray, Michael Bennet, and Al Franken sent a letter to U.S. Attorney General Loretta Lynch and Department of Health and Human Services Secretary Sylvia Burwell. In it, they recommend establishing a task force to determine national standards of care for examiners, instituting best practices in evidence collection and preservation, and surveying states and hospitals that receive federal grants to identify challenges in providing examiner training, pay, and retention.

“Studies have shown that when exams are performed by medical providers trained to collect and preserve evidence, victims have better physical and mental health outcomes, higher quality evidence is collected, and prosecution rates are higher,” the senators wrote. “It is critical to survivors’ recovery and their efforts to seek justice that the Department of Justice work closely in coordination with the Department of Health and Human Services to better meet survivors’ needs.”


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