Model Protocol Letter

January 18, 2006

Governor Dirk Kempthorne HAND DELIVERED
Attorney General Lawrence Wasden
700 W. Jefferson St.
P.O. Box 83720
Boise, ID 83720

Re: Adoption of the National Protocol for Sexual Assault Medical Forensic Examinations of the Department of Justice for Adult and Adolescent Clients

Dear Governor Kempthorne and Attorney General Wasden:

As organizations concerned with the welfare of sexual assault victims, we are writing to urge you to take immediate action on behalf of the sexual assault victims of Idaho. In December 2004, the Department of Justice issued its first ever National Protocol for Sexual Assault Medical Forensic Examinations for adult and adolescent clients, a guideline for treating victims of sexual assault (available at www.ncjrs.org/pdffiles1/ovw/206554.pdf). The protocol includes important recommendations for states regarding forensic examinations done by medical professionals with the education and experience in working with sexual assault victims.[1] We urge you to consider this national protocol and support the development of a specific protocol for the state of Idaho.

Of particular concern, the national protocol omits any discussion of emergency contraception, a safe and effective method to prevent pregnancy. In particular, we ask that you ensure that the state protocol for Idaho include the recommendation that rape victims are offered emergency contraception, and that you advocate for increased funding for health care professionals that specialize in the response to individuals reporting sexual assault, particularly sexual assault nurse examiners.

Idaho Sexual Assault Protocol Should Recommend that Rape Patients Receive Emergency Contraception
at their Initial Exam

Although comprehensive in many respects, the national protocol lacks critical information about pregnancy prevention, a pressing concern for women who have been sexually assaulted. Thus, in implementing our state protocol, we urge you to act where the federal government has failed to, making certain that our protocol recommends victims of sexual assault be offered emergency contraception on-site in their initial exam. Because emergency contraception could greatly reduce the number of pregnancies occurring from sexual assault in Idaho, leading medical organizations, including the American College of Obstetricians and Gynecologists endorse the offering of emergency contraception to rape victims.[2] Each year 25,000 pregnancies occur in this country as a result of sexual assault, and EC could prevent up to 22,000 of these pregnancies.[3]

Experts agree that emergency contraceptives must be taken within days of unprotected intercourse to be most effective, so timely response in the case of sexual assault is critical. Given this, the Idaho protocol should explicitly state that sexual assault victims must be offered emergency contraception on-site when they receive their initial exam. Failure to provide EC on-site in an emergency care facility can dangerously delay care and prevent women from obtaining EC at all. A woman who has just survived a sexual assault is already in crisis. She should not have to face the added burden – and in some cases the impossibility – of finding a doctor to prescribe and a pharmacy to fill a prescription for EC.

Idaho Should Fund Specialized Staff Education for Effective Response To Sexual Assault Victims

Although the national protocol omits crucial information about pregnancy prevention, it does have other important recommendations, including that all communities strive to provide response by examiners with specific knowledge and skills for effective intervention for victims of sexual assault. In particular, Sexual Assault Response Teams (SARTs) inclusive of Sexual Assault Nurse Examiners (SANEs) have been found to increase reporting, increase prosecution of offenders, and improve outcomes of victims who experience sexual assault in the communities where these have been implemented. We ask that you make this guideline a reality in our state by providing increased funding and education opportunities that support the development and implementation of SART programs.

If treated by a SANE professional, (also referred to as Sexual Assault Forensic Examiner, or SAFE) the benefits for the assault victim are wide ranging. For instance, research shows that victims treated by a SANE in their initial exam cope more effectively with the trauma and evidence improved health outcomes.[4] SANE professionals are skilled forensic examiners and can collect detailed forensic evidence to be used by law enforcement, prosecutors and the courts to increase conviction rates. [5]

We urge you to implement a protocol in Idaho in light of the development of federal standards, including the critical addition that sexual assault patients receive emergency contraception on-site where they receive their initial exam. Along with this, we encourage you to evaluate whether the current funding for SANE training and implementation is adequate in our state to ensure individuals are provided timely, thorough, effective, and compassionate care.

If you would like assistance in developing a model EC protocol or expanding the SANE programs, please do not hesitate to contact the Idaho Coalition Against Sexual and Domestic Violence at (208) 384-0419 or the Idaho Council on Domestic Violence and Victim Assistance at (208) 334-6512.

Thank you in advance for your attention to this matter. We hope that you will do your utmost to improve the quality of care for victims of sexual assault in Idaho.

Sincerely,

Marty Durand, Legislative Counsel
American Civil Liberties Union of Idaho

Rev. Elizabeth Beck, Co-Chair
The Interfaith Alliance of Idaho

Dixie Chapman, Executive Director
Bingham Crisis Center

Sue Chew, President
Idaho State National Organization for Women

Jane Crosby, President
Idaho Women’s Network

Sue Fellen, Executive Director
Idaho Coalition Against Sexual and Domestic Violence

Susan Fenger, Executive Director
Family Safety Network

Cj Gribble, President/CEO
Planned Parenthood of the Inland Northwest (Serving nine counties of northern Idaho)

Rev. Ed Keener, Co-Chair
The Interfaith Alliance of Idaho

Yolanda Matos, Director
Valley Crisis Center

Dr. Judith Murray, Executive Director
Idaho Nurses Association

Rebecca Poedy, President/CEO
Planned Parenthood of Idaho

Jeanette Ross, President
Church Women United of Southern Idaho

Saundra Schmidt, President,
Ada County Church Women United

Tricia Swartling, Executive Director
Advocates for Survivors of Domestic
Violence and Sexual Assault

J.R. Seaman, President
Delmar Stone, Lobbyist
Dr. Linda Vermette, Executive Director
National Association of Social Workers, Idaho Chapter

[1] U.S. Department of Justice, Office on Violence Against Women, A National Protocol for Sexual Assault Medical Forensic Examinations 53 (2004) (“All communities should strive to ensure that victims of a recent sexual assault have access to specially educated and clinically prepared examiners to perform the medical forensic exam. . . . It is useful for examiners to have specific knowledge and skills that can guide them as they perform these exams.”)
[2] Am. Coll. Obstet. Gynecol., Violence Against Women: Acute Care of Sexual Assault Victims (2004), at http://www.acog.org/from_home/departments/dept_notice.cfm?recno=17&bulle....
[3] Felicia H. Stewart and James Trussel, Prevention of Pregnancy Resulting from Rape: A Neglected Preventive Health Measure, 19 Am. J. Preventive Med. 228, 229 (2000).
[4] See Rebecca Campbell, The Effectiveness of Sexual Assault Nurse Examiner Programs, VAWnet Applied Research Forum 3 (2004)
[5]A survey conducted in New Mexico found in cases where the victim was treated by a SANE/SAFE, the conviction rates were significantly higher and resulted in longer average sentences. See Campbell, The Effectiveness of Sexual Assault Nurse Examiner Programs, at 5.