New Instruction on How DoD Providers Should Care for Sexual-Assault Victims

by U.S. Medicine

June 8, 2013

By Sandra Basu

WASHINGTON — DoD has released updated procedures to improve response to sexual-assault and care for victims.

The new DoD instruction includes an enclosure that provides guidance on medical management of victims of sexual assault to “ensure standardized, timely, accessible and comprehensive healthcare for victims of sexual assault, to include the ability to elect a SAFE [sexual-assault forensic exam] Kit.”

DoD said the policy is applicable to all MHS personnel who provide or coordinate medical care for victims of sexual assault as covered in the instruction.

Surgeons general of the services are given the responsibility of ensuring that “care provided to sexual-assault victims shall be gender-responsive, culturally competent and recovery-oriented,” according to the instruction.

“Healthcare providers giving medical care to sexual-assault victims shall recognize the high prevalence of pre-existing trauma (prior to present sexual-assault incident) and the concept of trauma-informed care,” it states.

Marine commanders and sergeants major receive Sexual Assault Prevention and Response training at Camp Pendleton earlier this year. The program encourages commanders to create a climate of trust among their Marines and sailors, enabling victims of sexual assault to come forward and receive the treatment and support they need to recover. U.S. Marine Corps photo by Sgt. Jacob H. Harrer

Among other guidance, the instruction states that the surgeons general also must “require that healthcare personnel maintain the confidentiality of a Restricted Report to include communications with the victim, the SAFE and the contents of the SAFE Kit, unless an exception to restricted reporting applies.”

The directive adds, “Healthcare personnel who make an unauthorized disclosure of a confidential communication are subject to disciplinary action and that unauthorized disclosure has no impact on the status of the Restricted Report; all Restricted Reporting information remains confidential and protected. Improper disclosure of confidential communications under Restricted Reporting, improper release of medical information, and other violations of this guidance are prohibited and may result in discipline pursuant to the [United Code of Military Justice] or state statute, loss of privileges, or other adverse personnel or administrative actions.”

It also says the surgeons general “must implement processes or procedures giving victims of sexual assault priority as emergency cases.”

GAO Review

The new guidance was released a few months after a GAO report suggested that military healthcare providers do not have a consistent understanding of their responsibilities in caring for sexual-assault victims.

Overall, that report credited DoD with taking positive steps toward addressing unique healthcare needs of deployed servicewomen. Most women interviewed by investigators said they “felt the medical and mental health needs of women were generally being met during deployments,” according to the report.

The report said, however, care providers lack clear guidance, particularly when it comes to DoD’s restricted reporting option, which allows sexual-assault victims to confidentially disclose crimes without triggering an official investigation.

“We met with senior medical personnel from the command who confirmed that provisions in their medical policy conflicted with other command policy and had created confusion for healthcare providers regarding the extent of their responsibility to maintain the confidentiality of victims who choose to make a restricted report of sexual assault,” the recent GAO report stated. “These inconsistencies can put DoD’s restricted reporting option at risk, undermine DoD’s efforts to address sexual-assault issues and erode servicemembers’ confidence.”

GAO investigators also stated that DoD requires first responders to sexual-assault incidents receive initial and annual refresher training on topics that include information about available medical- and mental-health treatments. First responders meeting with GAO investigators, however, said they were still unsure of the healthcare services available to sexual-assault victims at their locations.

“For example, we regularly found that Sexual Assault Response Coordinators, Victim Advocates, and health care personnel differed in their understanding as to where to take a sexual-assault victim for a forensic examination — a potentially problematic issue, given that the quality of forensic evidence diminishes the later it is collected following a sexual assault,” the report stated.

The new DoD instruction was published after the GAO’s review but will be examined by the GAO “to determine whether it meets the intent” of recommendations to strengthen the program.


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