When I was in residency, sexual assault exams were part of our training. We spent a lot of time learning how to ask the right questions, how to be gentle and empathetic, how to gather evidence appropriately and thoroughly.
While many hospitals now have SANE programs (Sexual Assault Nurse Examiner), I have never enjoyed the privilege of working with one of them. I have, for two decades, performed sexual assault exams on my own.
In 21 years of practice, I have been in court (as far as I can recall) no more than three times to testify in a sexual assault case. That suggests to me that one of two things may have happened in the cases which involved me. First, the case was never prosecuted for any number of reasons (the alleged victim recanted, law enforcement felt the case was too weak, the story was good but the evidence was inadequate, procedural problems, etc.). Second, the case was prosecuted and the evidence was so damning that my testimony (separate from the evidence gathered) was irrelevant. Third, the case indeed went to court but the story and evidence were so poor that no prosecution resulted and it was deemed unnecessary to involve me. I am not of a particularly legal mind, so excuse me if I have missed other reasons.
I was recently thinking back to a patient I saw some years ago, who alleged that she had been sexually assaulted. And then I thought back to residency. And I remembered something that always troubled me. In residency, I recall being told not to comment, in my chart, on whether or not the alleged victim had been using alcohol or drugs. I seem to recall (and I may be wrong on this point) being discouraged from obtaining blood alcohol levels or urine drug screens. (In like manner I was told to note in the chart whether I saw live sperm in samples, but not to remark on their absence.)
Back to the case at hand: the patient I saw had been drinking copious amounts of alcohol and was clearly very intoxicated. While I saw her, and law enforcement officers spoke to her, her story changed wildly from assault by multiple men to assault by no men.
Now, I ask you wide and gentle reader, was her alcohol use relevant to the situation? When asked ‘who assaulted you and describe what happened’ would her recollections be trustworthy? Would they be sufficiently lucid to possibly put a man, or several men, or a woman for that matter, in prison for years for what could have been consensual sex? And before you accuse me of sexism, remember that in an era of equality, both men and women are capable of sexual adventure as well as being capable of deceit and vindictiveness.
I believe that an alcohol level and drug screen was relevant. Not in order to punish someone for substance use, not to ‘slut shame,’ but because like sexual assault, arrest and prison are serious, life altering things. And because one’s ability to recollect what happens clearly can be influenced by drugs.
If I were intoxicated and said that I had seen young man commit a crime, and if my story varied wildly with each telling, it would be evident to all that my impairment was an issue in terms of the validity of my testimony. I don’t see how it can be any less in sexual assault.
Sexual assault is a problem. False accusations of sexual assault are also a very real problem. But covering up reality to attain a particular end, however gilded our intentions, is never the right thing to do.
Whoa, oh oh oh oh there buddy! Your pathetic drivel reveals how hopelessly ignorant, white-privileged, male-privileged, Christian-privileged, et cetera, et cetera, that you are!!! No man could ever be qualified to comment on such a topic! Even if a woman is a voluntarily coked-out, meth-tweaking, Xanaxed, pissed-drunk, peyote-gobbling half-comatose zombie with an (irrelevant) sexual history of 100s of prior partners just this year, if she even *thinks* she may have been raped, or even maybe has kinda hurt feelings about what happened, then RAPE HAPPENED and A MAN MUST PAY (it doesn’t really matter which one, as you are all… Read more »
A truly awesome parody of an irrational response! Well done! I figure 1) if it is a parody, I don’t need to say anything. 2) If it isn’t, nothing I say will matter. But I’m leaving it up for others to see and comment! Thanks for writing!
P.S. Even the CA law that only “Yes means Yes” goes nowhere near far enough. Even if a man were to somehow deceive a woman into saying “yes” either on tape or signing a contract consenting to sexual activity, if the woman were to come forward later that the subsequent events were RAPE!, then those statements and contracts would necessarily be declared NULL and VOID REMNANTS of a DYING PATRIARCHAL SOCIETY!
Alcohol and or drugs are often used to impede the consciousness of an individual for the purpose of rape. This undermines weather they are a contributing factor or on fact was it part of crime.
Hi Dr. Leap, Thanks for writing this article. My first reaction was, “No way!” I know I’ve heard stories of immune assays being administered to test for “date rape drugs” when people (both men and women) come into the ED and reporting a sexual assault. But, as I thought about it more, I couldn’t remember a specific conversation in detail, so I contacted an expert. Hopefully this input will be of some consolation that there are protocols in place for situations like this in order to objectively gather as much information as possible – for the benefit of both the… Read more »
I disagree with Ryan. The medical eval. has no practical impact on the forensics and prosecution because our info does not address consent. In the context of sexual prosecution. The clinician is a neutral bystander with little to offer, as your experience has shown. It is the prosecutor and/or jury with the difficult task. In residency , you were taught to bias the male guilty ; the female a victim. These cases ultimately are questions of consent. Unless you were present at the scene, you have nothing to add. Adding to femazi list: young female cadet spends weekend off campus… Read more »
“I promise not to be hateful, cruel or demeaning to anyone, because that would violate my allegiance to Christ.” This post is all the above to victims of sexual assault.
OK, how? I wasn’t hateful. I was doing my best to help. I offered several times to perform a sexual assault exam and she changed her mind repeatedly. I can’t exactly force a pelvic exam; that’s an assault in itself. I was never demeaning, I spoke over and over to the police to try and find the best solution. I certainly wasn’t cruel or unkind. Explain, if you’re going to throw stones. And tell me what you do for a living, please. If you’re a physician or nurse, I want your professional perspective.