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FACTSHEET:
Child Victims and the Law

The law has traditionally treated children differently than other victims. State criminal codes define many crimes against children separately from the same offenses committed against adults.

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Newsletter: Summer 2004: Every Victim

By Harriet Lessel, CSW

Public attention was drawn to the development of Sexual Assault Examiner Programs in 1994 when Anna Quindlen described the Tulsa, Oklahoma Sexual Assault Nurse Examiner program in a New York Times editorial (October 19, 1994). Quindlen lauded the program’s ability to counteract the kind of negative experience reported by a rape survivor in a Brooklyn hospital. She was writing about a problem with which rape crisis advocates had long been struggling: the glaring weaknesses of the healthcare response to rape.

Ten years later, Sexual Assault Forensic Examiner (SAFE) programs, as they are known in NY, have come to national prominence as one way to accomplish the collaboration between victim advocacy, healthcare and the criminal justice system promoted by the Violence Against Women Act. But top quality medical care and forensic evidence collection do not routinely occur in hospital Emergency Departments. As the standard of care for rape victims is raised exponentially, it becomes imperative to develop ways to ensure that every rape victim in New York City has access to this new standard. Here are some critical issues that must be included in the dialogue on this pressing concern.

Model 1: Every Hospital
The Alliance’s Comprehensive Sexual Assault Treatment Program model combines the services of a forensic examiner with a rape crisis counselor program and a system of follow-up care. One way to ensure that every rape victim gets this highest level of care is to have every hospital develop this level of service. However, this is not a simple task for the following reasons:

Culture – A hospital needs to develop a culture that allows for the development of this specialty. Is hospital leadership from various key departments on board, including the Emergency Department, nursing, social work, ambulatory care, Infectious Disease, OB-GYN, Risk Management, Legal, Ambulatory Care, etc.?
System – Is the hospital able to develop a system that will become everyday policy and practice rather than relying on outstanding, self-motivated individuals?
Resources – Does the hospital have the resources to develop such a program? Is there adequate funding available from the city, state and federal level for hospitals that want to improve care? Who will provide the overall vision and coordination and ensure quality improvement?
Community support – Is there support from the local community for this program?

Model 2: Specialized Centers
If every hospital is not able to develop the highest level of care, then the city needs to have a system of specialized centers throughout the city where rape victims can be routed. In an informal poll conducted several years ago in one Brooklyn hospital, it was found that approximately half of the rape victims were transported by ambulance. The other half came in on their own. With this in mind, the following questions must be answered:

Can a system be developed with EMS and the NYPD to route rape victims to specialized centers?
How will this affect current EMS policies and procedures such as the 10-minute rule?
How does a city make sure that people know about the specialized centers? What kind of public awareness projects are necessary?
How do hospitals adhere to current laws that require them to treat any patient who enters their Emergency Department?
How do you respond to a victim who wants to go to her local hospital despite being informed about specialized care elsewhere?

Model 3: Dispatch Model
The dispatch SAFE model is currently practiced by two healthcare systems, St. Luke’s-Roosevelt Hospital and NYC Health and Hospital Corporation in the Bronx. It involves dispatching a SAFE examiner and rape crisis counselor to an Emergency Department in response to the arrival of a victim. This model may be utilized to increase the number of Emergency Departments with specialized care. However, the credentialing of practitioners to enable the team medical provider to practice in different Emergency Departments will have to be addressed.

Until all of these questions are answered, we will continue to see a disparity in the care provided to rape victims in New York City. Those that are raped in areas with a Sexual Assault Comprehensive Treatment Program or somehow find out about a program, will receive the best medical and forensic care. Those victims will less likely be revictimized by the healthcare system and will receive the kind of care that sets the tone for a positive recovery and follow-through with the criminal justice system. The other victims, simply, will not.

The answer is dependent upon leadership and commitment from the top echelons of our city, state and federal government. It may include city and state policy and legislation. The city will have to integrate and coordinate its activities with existing resources, and develop others. Because ultimately, if we know how to give excellent care, how can we not provide it to everyone? The Alliance challenges all parties that can help provide an answer to come together and do so soon. Nothing less is acceptable.

Ms. Lessel is Executive Director of The New York City Alliance Against Sexual Assault. [more]

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