|
THE
EVIDENTIARY (FORENSIC) AND MEDICAL EXAMINATION |
| A
medical examination should be performed in all cases of
sexual assault, regardless of the length of time that may
elapse between the time of the assault and the
examination. It is recommended that a forensic exam using
the Sexual Assault Evidence Collection Kit be conducted if
the assault occurred within 72 hours prior to the time of
the examination. However, this determination should be
made on a case-by-case basis through the consultation of
medical personnel, law enforcement and crisis center
advocate or support personnel. |
|
If the sexual assault took place more than 72 hours prior
to the examination, it is unlikely that trace evidence
would still be present on the victim. However, evidence
may still be gathered by documenting any findings obtained
during the medical examination (such as bruises or
lacerations), photographs and bite mark impressions (if
appropriate), and statements about the assault made by the
victim. Some victims may ignore symptoms that would
ordinarily indicate serious physical trauma, such as
internal injuries sustained by blunt trauma or foreign
objects inserted into body orifices. Also, there may be
areas of tenderness that will later develop into bruises. |
|
Becoming infected with an STI or pregnant can be major
concerns for sexual assault victims. Therefore, these
issues must be addressed at the initial exam. |
|
All supplies needed for a standard evidentiary examination
are contained within the Sexual Assault Evidence
Collection Kit. The Kit contains instructions. Follow the
instructions to ensure a complete evidentiary examination.
All potential forensic evidence should be collected.
Supplies for additional evidence collection may be
obtained from medical treatment facility stock or from a
second Evidence Collection Kit. |
|
Attending Personnel |
|
The attending medical personnel and, with the consent of
the victim, a trained support person or advocate are the
only persons who should be with the victim in the
examining room. Although every effort should be made to
limit the number of people in attendance during the
examination, there may be instances when a victim requests
the presence of a close friend or family member. If at all
possible, these requests should be honored. |
|
The least traumatic and least time consuming method of
collecting physical evidence from sexual assault victims
is to integrate the collection procedures into the medical
examination. |
|
There is no medical or legal reason for a law enforcement
representative, male or female, to observe the medical
examination and evidence collection process. By virtue of
the examination, the rectum and genitalia of the victim
must be revealed for proper medical assessment and
evidence collection. Subjecting victims to the observation
of law enforcement personnel during these procedures, as
well as having the law enforcement representative privy to
the private communications between the victim and the
examining medical personnel/support team, is unnecessary.
Medical and law enforcement personnel communication should
be reciprocal. Maintaining the chain of custody during the
examination is the sole function of the attending medical
personnel and requires no outside assistance. |
|
The victim should be allowed to wash and dress before the
in-depth investigative interview with the law enforcement
officer. |
|
Medical Report for Sexual Assault Examination
|
|
Throughout the evaluation and medical examination, the
attending medical personnel should explain to the victim
why questions are being asked, why certain medical and
evidentiary tests may need to be performed and what
treatment, if any, may be necessary. |
 |
Vital signs
and other initial information, such as the date and time
of both the examination and the assault, should be
recorded. |
|
|
A brief
description of the medical details of the assault should
be recorded. This description should include any oral,
rectal, or vaginal penetration, whether the assailant
penetrated the victim with finger(s) or foreign object(s),
whether any oral contact occurred, and whether ejaculation
occurred (if known). |
|
|
The victim’s
account of what happened should be recorded accurately,
briefly, and in the victim’s own words as much as
possible. |
|
|
Information
regarding the physical location of the assault should be
recorded (car, rug, grass, pavement). This information
will assist the attending medical personnel with an
indication of where to look for evidence and what evidence
to collect such as hair, fibers, and other trace material.
|
|
|
Significant
medical history of the victim should be recorded. Include
any allergies, current medication, acute or chronic
illness, surgery and any post-assault symptoms such as
bleeding, pain, loss of consciousness, nausea, vomiting or
diarrhea. |
|
|
Gynecological
history information including menstrual history (last
menstrual period, date and duration, menstrual cycle),
pregnancy history (including evaluation of possible
current pregnancy), and contraceptive history should be
evaluated and recorded. |
|
|
If a victim
is at risk of pregnancy, a urine pregnancy test should be
done to establish a baseline for possible preexisting
pregnancy. |
|
|
During the
general physical examination, record all details of
trauma, such as bruises, abrasions, lacerations, bite
marks, blood or other secretions, with particular
attention to the genital and rectal areas of both male and
female victims. |
|
|
Common sites
and types of injury include the breasts, the upper portion
of the inner thighs, arms, wrists or legs, and injuries or
soreness to the scalp area, back or buttocks as a result
of being thrown against an object or onto the ground, and
grab or retraining marks on the arms.
If penicillin is to be given as prophylaxis, it should not
be delayed until the very end of the victim’s hospital
examination. A victim may be allergic to penicillin but
unaware of the allergy. It is recommended that this
treatment be administered in time to allow for at least 30
minutes of victim observation. |
|
Evidence Collection and
Handling |
|
If the assault has occurred
within the recommended 72 hours or as determined on a
case-by-case basis, use a Sexual Assault Evidence
Collection Kit paying close attention to the following
procedures. If a Kit is not available, the procedures
described below should nevertheless be accomplished if
considered appropriate by medical and law enforcement
personnel. |
|
Packaging and Refrigeration
|
|
In order to prevent the
degradation of biological fluid stains and the loss of
hair, fibers, or other trace evidence, clothing and other
evidence specimens must be air dried and then sealed in
paper or cardboard containers. Do not seal in plastic. If
the containers are plastic, moisture remaining in the
evidence items will be sealed in, making it possible for
bacteria to quickly destroy biological evidence. Unlike
plastic, paper “breathes” and allows moisture to escape.
There are paper containers in the Kit. The paper and
cardboard containers should be sealed with tape. Do not
seal with staples as this will result in a biohazard to
lab personnel. |
|
See Appendix A-1. |
|
The Kit must be refrigerated
(do not freeze) at all times after the evidence has been
collected. The hospital or law enforcement must maintain
this refrigeration until delivery to the crime laboratory.
Standard transportation regulations should be followed to
prevent freezing during winter months or heating during
summer months. |
|
Evidence Integrity (Sealing
and Labeling) |
|
The custody of the Kit and the
specimens it contains must be accounted for from the
moment of collection until the moment it is introduced in
court as evidence. This is necessary in order to maintain
the legally necessary “chain of evidence,” sometimes
called “chain of custody,” or “chain of possession.” Its
importance cannot be overemphasized because without being
able to establish the “chain of custody,” evidence cannot
be introduced in court. |
|
It is also important that the
names of those involved in the medical examination and
collection and handling of evidence be legible on the
evidence specimen and that enough information is recorded
to locate them in the event their testimony is needed.
|
|
Proper handling and
information recording are important. There must be a
consideration for the chain of custody if the specimens
collected are to be of later evidentiary value. “Chain of
custody” need not be a concern if these simple practices
are implemented: |
|
|
Properly
label, preserve and store evidence specimens. |
|
|
Package,
seal, and label evidence specimens, specifying the date,
the time, the identity of the victim, the name of the
attending medical personnel, and the area of the body from
which specimen was taken. |
|
|
Minimize the
number of persons handling the evidence specimens and have
each person doing so initial the specimens. |
|
|
Note how and
when samples are transferred from medical personnel to law
enforcement and have law enforcement initial the external
labels.
|
|
Spermatozoa and Semen |
|
In order to understand the
importance of both spermatozoa and semen and the role they
can play in the forensic analysis of sexual assault
evidence, the following brief explanation is offered for
review: |
|
Semen is composed of cells and
fluid, known as spermatozoa and seminal plasma,
respectively. |
|
The finding of spermatozoa is
useful for two reasons: |
|
|
When present,
it is positive indication that ejaculation occurred and
that semen is present. |
|
|
When
spermatozoa are motile (alive), it can be an indicator of
the length of time since ejaculation. |
|
The survival time of
spermatozoa in the vaginal, oral and rectal orifices
following ejaculation varies considerably in scientific
studies. However, there is fairly wide consensus that they
may survive for up to 72 hours or longer in the vagina
(persisting longer in the cervical mucosa), and up to
several hours or more in the rectal cavity, particularly
if the victim has not defecated since the assault.
|
|
Seminal plasma is also
useful for two purposes: |
|
|
In the
absence of spermatozoa, seminal plasma components (p30 and
acid phosphatase) can be used to identify semen. p30 is a
prostatic antigen known to exist in the semen of humans
and its presence is regarded as a conclusive indication of
semen. Acid phosphatase is present in high levels in
seminal samples but is considered only a presumptive test
for the presence of semen because it also appears in
samples that are not seminal in origin, such as vaginal
fluid. |
|
|
Most of the
genetic markers detected in semen and which are used to
identify the possible donor, are located in seminal
plasma.
Inasmuch as seminal plasma is produced in the ejaculates
of all males, vasectomized or not, the forensic examiner
is especially interested in the presence of seminal
plasma. It is primarily the seminal plasma, not the
spermatozoa, that gives evidence of the ABO blood type of
secretors and the genetic markers of the donor of the
specimen.
|
|
There has been a dramatic
increase in the number of vasectomies. Many sexual assault
offenders are sexually dysfunctional and do not ejaculate
during the assault. Additionally, offenders may use a
condom, have a low sperm count (frequent with heavy drug
or alcohol use), ejaculate somewhere other than in an
orifice or on the victim’s clothes or body, or fail to
ejaculate if the assault is interrupted. Therefore, a lack
of spermatozoa is not conclusive evidence that no assault
occurred. It only means that spermatozoa may have been
destroyed after being deposited or that it may never have
been deposited at all. |
|
Furthermore, the absence of
semen means only that either no ejaculation occurred, for
the reasons described above, or that various other factors
contributed to the absence of detectable amounts of semen
in the specimen. For example, there could have been a
significant time delay between the assault and the
collection of specimen, penetration of the victim could
have been made by an object other than the penis, the
victim could have inadvertently cleaned or washed away the
semen, or the specimen could have been collected
improperly. |
|
Although the finding of semen,
with or without the presence of spermatozoa, may
corroborate the fact that a sexual act did take place and
make a stronger case for the prosecution, its presence is
not an absolute necessity for the successful prosecution
of a sexual assault case. |
|
NOTE: When collecting the
vaginal specimen, it is important not to aspirate the
vaginal orifice or to dilute the secretions in any way. Do
not use lubricants or speculum aperatici.
|
|
Presence of Sperm and Sperm
Motility – Wet Mount and Permanent Smears |
|
Wet mount slides are generally
made immediately after specimens are collected, by
combining a drop of the specimen from a swab with a drop
of nutrient medium on the slide. The appropriate medical
professional then examines the slide immediately to
determine whether sperm is present, and if so, whether
motile, non-motile or both. Motile sperm indicates a very
recent ejaculation. It may be present for as short a time
as 30 minutes and seldom beyond 6 to 8 hours. Several
factors affect motility and/or presence of sperm. These
factors include body temperature, amount of ejaculation,
vaginal pH, presence of contraceptives, post-assault
hygiene and whether the offender has had a vasectomy.
|
|
Permanent smears (dry mount
slides) should be made from the samples obtained. These
can be stained to help visualize sperm, kept indefinitely
and examined by both medical and forensic personnel.
Non-motile sperm may be seen on these slides where no
sperm were seen on the wet mount. Nonmotile sperm may be
seen in vaginal or rectal secretions up to 12 to 20 hours
following ejaculation – rarely might be found 48 to 72
hours later. |
|
Wet mounts do not need to be
retained. Permanent smears must be labeled and retained as
evidence and placed in the Kit before sealing.
|
|
Analysis of Specimen –
Specimen Collection |
|
Unlike the clinical
laboratories in most hospitals, forensic laboratories
generally have more sophisticated equipment, specialized
training and ultra-sensitive techniques that enable them
to detect even minute traces of semen and spermatozoa.
They are also able to conduct a genetic marker analysis of
semen that the majority of hospital technicians are not
equipped to perform. This information is entered into the
CODIS with the Federal Bureau of Investigation. CODIS
(Combined DNA Index System) is an electronic database of
DNA profiles that can identify suspects. |
|
Certain tests must be run
immediately after evidence collection at the medical
facility. The results of these hospital-run tests should
be shared with forensic personnel. |
|
It is not uncommon for the
tests run at the forensic laboratory to contradict those
run at the medical facility. For instance, because of the
enhanced detection ability of the forensic laboratory
traces of semen may be found despite negative test results
from the hospital. Forensic personnel must then testify in
court to explain the contradiction. |
|
To minimize the chance of
contradictions occurring, all medical and forensic
specimens collected during the sexual assault examination
must be kept separate both in terms of collection and
processing. Those required only for medical purposes
should be kept and processed at the Examining Hospital,
and those required strictly for forensic analysis should
be transferred with the Sexual Assault Evidence Collection
Kit to the Forensic Laboratory for interpretation.
|
|
Use of Wood’s Lamp
|
|
A Wood’s Lamp is a long wave
ultraviolet light that can be used to scan clothing or the
body for evidence of dried or moist secretions, stains or
injury. Semen usually exhibits a green or blue
fluorescence under this light but may not when fresh.
Clothing made of fluorescent synthetic material or washed
in light optical density detergent may show seminal
stained areas as absent or diminished fluorescence. If
observations such as these have been made, diagrams should
be used to record the location and extent of stains and/or
injury. |
|
If secretions are found on the
hair, the matted hair can be cut and placed in a paper
bindle. But be sure to relate to the victim what you are
about to do and get consent from the victim before cutting
hair. Thinner stains can be collected with the use of
swabs moistened in distilled water that are then air dried
and packaged in an envelope or tube. Secretions that are
still moist can be collected with dry swabs to avoid
dilution, air dried and packaged in the same way.
|
|
Use of Colposcope/Medscope
|
|
Genital trauma is a good
indication of recent forced sexual contact. To obtain
photographic evidence of injuries, the use of a colposcope
is necessary. Recent research indicates that injury to the
posterior forichette, the point of greatest stress in
forced penetration, is characterized by an acute mounting
injury. This injury is indicative of sexual assault. Other
trauma sites may include labia minora, hymen, or fossa
naviularis. |
|
The colposcope can have video
or camera equipment easily attached and these test results
can be used as forensic documentation. The non-invasive
nature of this procedure makes it valuable for use with
all victims, especially children and the elderly.
|
|
Pregnancy Concerns and
Sexually Transmitted Infections |
|
A major fear for sexual
assault victims is becoming pregnant. The attending
medical personnel should discuss this with the victim and
explain her options for pregnancy prevention. Most medical
treatment facilities offer pregnancy prevention or the
“morning-after” pill. This is for women who are at risk to
becoming pregnant within the first 72 hours after the
assault and who have had a negative pregnancy test. This
option should be offered to the victim along with
information regarding the risk of pregnancy and
effectiveness and side effects of treatment. |
|
During the medical
examination, attending medical personnel should be mindful
of the possibility that the sexual assault may lead the
victim to contract an STI. |
|
Most clinicians recommend
prophylactic treatment of STI’s rather than performing
cultures for the following reasons: performing cultures at
the initial exam has not proven helpful to the prosecution
of the perpetrator; positive cultures at the initial exam
have been used against the victim in court to indicate
sexual promiscuity; STI cultures are expensive and time
consuming; and victims often do not return for follow-up
testing and treatment. |
|
Court-ordered Testing for
Sexually Transmitted Infections |
|
A court may order testing of
any defendant charged with a sex offense (and any juvenile
offender who is alleged to have committed certain crimes)
to determine whether the defendant or alleged juvenile
offender has any sexually transmitted disease. See
Appendix I. |
|
The court may order this
testing only if the court receives a petition from the
victim or from the prosecuting attorney with a written
request from the victim. The suggested petition for use in
North Dakota is attached as Appendix H. |
