How EM Physicians Should Manage Their Legal and Medical Duties

A 16-year-old female presents to the emergency department (ED) after being sexually assaulted by two males at a party at her friend’s house. She denies any complaints or injuries. She is asking for an exam, as well as medications to avoid pregnancy and diseases. She refuses to allow her parents or the police to be notified. What do you do?

The answer to that question varies with your practice location. Federal and state laws dictate what actions you will take in this scenario. The key to answering this question, no matter where you are, is to engage your hospital attorney or risk manager. They are very familiar with the laws in play in these scenarios and can easily work with you throughout the process.

First, the federal Violence Against Women Act (VAWA), 42 USC.A § 3796gg-4(d)(1) (2005), allows for sexual assault survivors to undergo medical forensic examination without reporting to law enforcement and at no cost to them. VAWA specifies which components must be included in the exam for free. Failure to follow these forensic compliance provisions of VAWA can result in loss of funding for your state. Sexual assault nurse examiners (SANE nurses) are very familiar with the options available to patients regarding reporting to law enforcement and evidence collection. They should be consulted to assist in the discussion with the patient.

The first decision is whether your state requires you to report sexual violence to law enforcement. Some states mandate that certain crimes, including rape and sexual assault, must be reported to law enforcement regardless of the wishes of the patient. If you must report, you can tell the patient that, “by law I must report to law enforcement that you are here because of a sexual assault, however, you are under no obligation to talk to them and can tell them you do not wish to speak to them.”1

The next consideration is the age of consent in your state. If the patient is under the age of consent, you may be a mandated reporter. Therefore, you may be obligated to report the assault both to law enforcement and to child protective services. Even if the patient is above the age of consent, as a mandated reporter you may need to still notify authorities in cases where the perpetrator is a parent, guardian, family member, coach, teacher, or someone who may have regular contact with the patient. Once again, you should inform the patient of your duty, under the law, to report the assault to law enforcement and child protective services.