Medical News

Treating a patient who has experienced sexual assault

In light of recent media coverage of the Belfast rape trial, IMN reached out to the Dublin Rape Crisis Centre (DRCC) and to Dr Maeve Eogan, Consultant Obstetrician and Gynaecologist, Rotunda Hospital, asking for insight for doctors who might find themselves treating a patient who has been a victim of rape or sexual assault.

Noeline Blackwell, CEO of the DRCC, spoke to IMN about the challenges that victims of sexual assault currently face. She expressed concern regarding the impact of the Belfast trial, commenting: “We do worry about the level of detail that we heard about how the complainant was dealt with in court because of how it may impact others who have to make a decision about reporting to the police and then proceeding to court.

“This is something that we already had concerns about. At the beginning of February, we submitted our submission to the Law Reform Commission (the government’s think tank on law reform) suggesting that for their next programme of work, they include the journey of the victim through the justice system”.

The DRCC’s submission delineated the wariness of victims of rape and indecent/sexual assault to report the crimes committed against them.

The last comprehensive study in this area, the Sexual Abuse and Violence in Ireland (SAVI) Report (2002) found that 42 per cent of women had experienced some form of sexual abuse in their lifetime and that only 10 per cent of sexual offences were reported.

A 2014 survey undertaken by the European Union Agency for Fundamental Rights (FRA) revealed that violence, particularly against women and girls, is pervasive across the EU, including Ireland. Eight per cent of Irish women who responded to the survey said that they had experienced sexual violence since the age of 15, slightly lower than the European average of 11 per cent.

“Reporting rape or other sexual offences is a difficult option that many victims will not take”

The most recently published census figures found that there were 2,407,437 women in Ireland who had experienced abuse of this nature and, using those figures and the FRA findings for Ireland, the RCC estimate that approximately 192,500 women are likely to have been victims of sexual violence, prompting the RCC to describe it as, “one of the most endemic crimes in Ireland, albeit one which is largely hidden and under-discussed”.

In 2016, the CSO figures recorded the highest number of sexual offences for 10 years: 2,549, a significantly smaller number than the RCC’s estimation.

The RCC commented: “These figures bear out what we know from those who contact our services: Reporting rape or other sexual offences is a difficult option that many victims will not take”.

According to the 2009 EU Daphne II project, which aimed to track attrition in reported rape cases across Europe, the reporting of rape increased in Ireland by over 500 per cent between 1977 and 2007 but the conviction rate had fallen.

Between 1998 and 2000 the conviction rate was 16 per cent, but at the time of the report in 2009 that figure had dropped to 8 per cent.

In their submission, the DRCC claimed that this under-reporting of sexual crime undermines efforts to combat and prevent these crimes, which also leads to difficulty in trying to establish the true incidence rates of sexual violence in Ireland.

The submission concluded: “Victims who go through the criminal justice system are often delayed in their own healing from the trauma of the offence and the investigation and trial process often causes further serious harm through re-traumatisation”.

Dr Maeve Eogan spoke about the role that Ireland’s Sexual Assault Treatment Units (SATU) could have in a scenario where a GP is approached by a victim of sexual assault or rape: “Care is provided by forensic examiners who may be doctors or specially trained nurses or midwives. This care is provided in forensically clean environments, not used for other clinical services.

“There are six SATUs around the country, as well as an additional out of hours service in Limerick. The aim is that no person in this country is more than 3 hours from their nearest SATU so that this care can be accessed by all who need it.

“The particular care that is provided depends on the patients specific needs, as well as forensic examination and collection of relevant forensic samples, this also includes psychological support (provided by our colleagues from Rape Crisis Centres), provision of emergency contraception and infectious disease preventative treatment”, she added.

Dr Eogan explained that these SATUs are involved in multiagency education and that universities include this education in undergraduate medical education and some nursing and midwifery modules.

However, for those seeking to refresh their procedural knowledge, Dr Eogan highlighted the importance of the interagency national guidelines that outline best practice and key performance indicators in this arena, particularly as they delineate care both within and without a SATU.

“most SATUs (Dublin, Mullingar, Waterford, Cork, Letterkenny and Galway) are always on the look out for additional medical staff who wish to be involved in this care”

Entitled ‘National guidelines on referral and forensic clinical examination in Ireland (2014)’, the purpose of this document, which is available on the HSE website, is to facilitate all aspects of a responsive service for women and men over the age of 14 years who have been raped or sexually assaulted.

This includes guidance for general practitioners (GPs) in cases when an adult patient makes a disclosure of recent sexual violence.

The report advises that the medical stability of the patient should take priority over the collection of evidence and that emergency medical treatment should be considered. If so, immediate care at an Emergency Department may
be appropriate and, provided the patient gives their informed consent, it might be pertinent to contact a SATU in such
cases, as it may
be possible for a Forensic Clinical Examiner to carry out a Forensic Clinical Examination at the Emergency Department.

The guidelines emphasise the importance of establishing the time frame of the incident because forensic evidence, including both physical injuries and “trace” evidence, decays rapidly with time and generally forensic samples are not taken if more than seven days have elapsed since the incident.

There are many different manners of response for those who have experienced sexual abuse and GPs must be prepared to anticipate unexpected complications and to adapt their own procedure to best suit their patient’s need. For instance, should the patient not want to report the incident to An Garda Síochána, it is advised that it is usually possible for the patient to attend a SATU without Garda involvement.

Where a patient is undecided as to whether or not to report the incident to An Garda Síochána, it may be possible for forensic evidence to be obtained and stored for use in later criminal investigations.

If the patient is not willing to attend a SATU, the GP must address the forensic and health needs of the patient in so far as possible and carefully document the history of sexual violence that has been disclosed.

In addition to organising follow-up Sexually Transmitted Infection (STI) screening, it is recommended that the GP ensures that adequate psychological support is in place, either by providing the contact details of a preferred RCC and considering the need to offer a GP follow-up consultation for psychological support, or by making a Social Services referral, if appropriate.

Dr Eogan appealed: “Recruitment & training of nurses and midwives to the role of forensic examiner is done via national HSE competitions, but most SATUs (Dublin, Mullingar, Waterford, Cork, Letterkenny and Galway) are always on the look out for additional medical staff who wish to be involved in this care”.

She concluded by urging any IMN readers who are interested in working for a SATU to contact their local SATU, where relevant training will be provided.

The six SATUs in the Republic of Ireland are located in the counties of: Waterford (University Hospital Waterford), Mullingar (Midland Regional Hospital), Galway (Hazelwood House), Dublin (Rotunda Hospital), Donegal (Letterkenny General Hospital), Cork (South Infirmary, Victoria University Hospital).

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