Office of the Illinois Attorney General Lisa Madigan
Illinois Hospital Association

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Discuss the SASETA mandates for transfer hospitals
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Discuss how best to meet the immediate needs of the sexual assault patient
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Discuss the best practice for preserving evidence
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Discuss the role of law enforcement in the transfer process
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Discuss special considerations for Critical Access
Hospitals

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Scope of sexual assault is staggering
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1 in 7 women in Illinois = 670,000 women
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5,620 rapes reported to Illinois law enforcement in
2008
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The Illinois Coalition Against Sexual Assault Centers helped 9,991 survivors of sexual assault in FY 2009
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Served an additional 8,442 anonymously on 24-hour rape crisis hotlines

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Sexual Assault Survivors Emergency Treatment Act
(SASETA)
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Passed in 1975 (called the Rape Victims Emergency
Treatment Act)
Mandates emergency and forensic services to sexual assault survivors of ALL ages – overseen by the Illinois Department of Health (IDPH)
Establishes the statewide evidence collection program – overseen by the Illinois State Police (ISP)
Provides for reimbursement of costs for emergency and forensic services and follow-up care – overseen by the
Illinois Department of Healthcare and Family Services (HFS)

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SASETA administrative rules through IDPH
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Requires hospitals to submit a transfer or treatment plan every 3 years
Transfer services
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Defined as “the appropriate medical screening examination and necessary stabilizing treatment prior to the transfer of a sexual assault survivor to a hospital that provides hospital emergency services and forensic services to sexual assault survivors pursuant to a sexual assault treatment plan or area-wide sexual assault treatment plan” 410 ILCS 70/1a
~24 transfer hospitals in Illinois per IDPH website

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All transfers must comply with the federal
Emergency Medical Treatment and Active Labor Act
(EMTALA)
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Medical screening examination needed
 All unauthorized personnel (including law enforcement) shall remain outside the examination room
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Must be stable prior to transfer
 Use your trauma patient protocol as a guide
First attempt to transfer to designated treatment hospital

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Sexual assault patient shall be given an appropriate explanation concerning the reason for the transfer to another hospital for treatment
Emergency department staff of the transfer hospital shall notify the receiving hospital of the transfer of a sexual assault patient
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Patient must consent to transfer
Transfer hospital shall offer to call a friend, family member or rape crisis advocate to accompany the patient

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Receiving hospital shall
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Have available space and staff for the treatment of a sexual assault patient
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Agree to accept the transfer and to provide the appropriate treatment of a sexual assault patient
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Must respond within minutes to ensure the privacy, shall refer to the patient by code to avoid embarrassment, and shall offer a private room

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Transfer hospital shall send a copy of the ED record
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Shall not reflect any conclusions regarding whether a crime occurred
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Records shall include
 Complete ED admission form
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Clinical findings
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Nurses’ notes
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Any person present during the MSE
 Any treatment provided
 Test results

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Transfer hospital shall maintain chain-of-custody
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Handle the sexual assault patient and her/his clothing minimally
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If removal of clothing is necessary, attempt to remove without cutting, tearing or shaking garments
Shall not attempt to obtain any evidence specimens
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Nothing that would be collected with the SA evidence kit (hair combings, swabs, blood)
If any clothing or other loose possessions must be collected as evidence
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Left to dry if possible
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Placed in separate paper bags – can be placed in a larger bag for convenience after properly sealed/labeled
Bag(s) shall be transported with the patient

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If the patient does not have any life-threatening conditions, may be transported to receiving hospital by police or friend/family member
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Consent of patient needed
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If not medically stable, must be transferred by ambulance, in accordance with EMTATLA requirements

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Anytime a patient states that (s)he has been sexually assaulted within 7 days and consents to a medicalforensic examination
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SASETA rules mandate evidence collection up to 7 days following sexual assault
It is not the healthcare professional’s role to determine if the report of sexual assault is “valid” or to investigate
If after 7 days
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Refer for medical examination
Do not need to transfer unless a medical emergency exists or injury is noted

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Triage patient
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Perform a medical screening examination
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Do not need entire patient history of the sexual assault
 Need general information only – enough to facilitate transfer
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Who, what, when, where
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Do not conduct a genital examination unless medically necessary
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Do not collect evidence unless necessary
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Do not provide medication unless necessary

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Call receiving hospital for transfer acceptance
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Provide physician and nurse report to receiving hospital
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Provide patient with a copy of ED record and transfer paperwork
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Written patient consent needed
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If medically stable, allow patient to be transported by law enforcement or friend/family member
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Must follow all mandated reporting requirements

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Shall not include any conclusions
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Discourage the use of “Alleged Sexual Assault”
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Use these as possible diagnosis
 Sexual Assault
 Sexual Assault Examination
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Sexual Assault by History
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Evaluation of Sexual Assault
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Patient states…

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Assume that rape occurred
Use open ended questions
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Poor question: “So, you think you were raped?”
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Good question: “Please, tell me what happened.”
Avoid leading questions or questions that could indicate blame
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Do not start a question with “Why?”
If clarification needed, reflect patient’s own words back to them
Allow time for answer

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You are safe here
I’m sorry this happened to you
You did not deserve to be hurt
You did not ask to be hurt
The person who did this is the only one responsible
You did everything right
You are very brave
Thank you for coming to see me
I’m glad I got to meet you
We are going to get you to the right place for the best treatment

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Provide an explanation of why transfer is necessary
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Provide an explanation of the transfer process
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Provide an explanation for what to expect at the receiving hospital
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Medical advocate
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SANE

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Six main steps of the SANE exam:
1.
Obtain consent
2. History
3. Head – to – toe assessment
4.
Detailed genital assessment
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Only exception would be if no genital contact reported by patient for adolescent/adult population
5.
Evidence collection
6. Medication administration and discharge instructions

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Do not collect evidence unless necessary
What about allowing the patient to urinate or have a drink?
What if clothing must be collected?
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How to properly seal
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Evidence bags sealed with clear tape
Examiner labels with date and initials – on and off the tape
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Label outside of bag with patient name, date, time of collection, examiner name and contents of bag
Can place individually sealed bags in one large bag
Give to patient or law enforcement

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Mandated reporting requirements
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Respond to transfer hospital
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Facilitate transfer and provide transportation

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Staffing – Would it make sense for a Critical Access
Transfer Hospital to have a SANE on staff, as a resource for the MDs and other nurses? How could the SANE keep up skills?
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Weather – If weather is bad and transferring the patient may be dangerous, what should the CAH do?
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Other concerns?

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Illinois Department of Healthcare and Family Services (HFS) oversees billing
Patients with private insurance – transfer hospital must bill private insurance
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Any monies normally covered by patient – bill the Illinois Sexual
Assault Program (co-pay, deductible, co-insurance, etc.)
Patients with Medicaid/Medicare – bill Medicaid/Medicare
Others patients – transfer hospital can utilize the Illinois
Sexual Assault Program for payment
For billing questions

Kathy Prunty at kathleen.prunty@illinois.gov
or 217-782-3303

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SASETA (Act)
 http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1531
&ChapAct=410%26nbsp%3BILCS%26nbsp%3B70%2F&C hapterID=35&ChapterName=PUBLIC+HEALTH&ActName=
Sexual+Assault+Survivors+Emergency+Treatment+Act%2E
SASETA (Administrative Rules)
 http://www.ilga.gov/commission/jcar/admincode/077/07
700545sections.html
To view a listing of treatment/transfer hospitals
 http://www.idph.state.il.us/healthcarefacilities/SASETA/ind ex.htm

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Shannon Liew, RN, BSN, SANE-A
SANE Coordinator
Office of the Illinois Attorney General
100 West Randolph Street, 13 th Floor
Chicago, IL 60601
312-814-6267 sliew@atg.state.il.us
Barbara E. Haller
Illinois Hospital Association
Director, Health Policy & Regulation
1151 E. Warrenville Road
Naperville, IL 60566
630.276.5474
bhaller@ihastaff.org
Karen Senger, RN, BSN
Supervisor of Central Office Operations
Division of Health Care Facilities and Programs
525 West Jefferson Street, 4th Floor
Springfield, IL 62761
217-782-0381 karen.senger@illinois.gov