SALT LAKE CITY — It's been nearly a decade since the protocol for medical examinations of sexual assault victims has been updated, though incidents of rape and other sexual violence are occurring with high frequency, and doctors' ability to detect and trace them has improved.
Citing medical and forensic advancements and improved practices, the U.S. Department of Justice on Wednesday announced a revised version of the National Protocol for Sexual Assault Medical Forensic Examinations — guidelines that intend to standardize the quality of care for sexual assault victims throughout the country.
The new protocol is intended to help end sexual violence in the country, which strikes a chord with local advocates.
"It's definitely a positive step forward for victims," said Holly Mullen, executive director at Salt Lake City's Rape Recovery Center. "The more support and compassion a victim receives at the front end of this process, the more likely they are to cooperate with authorities and come forward with reporting the crime."
Rape is one of the only violent crimes occurring in Utah that hasn't seen decline in recent years, Mullen said. A steady number of victims call the 24-hour statewide crisis hotline (888-421-1100) for help each year.
Fewer than 10 percent of victims who seek help from various crisis centers throughout the nation end up reporting the crime to authorities. Reporting sexual violence is up to the victim in most cases.
Mullen said rape is already an "awful experience," and resultant exams are often lengthy and meticulous, as is the legal process that can follow, which can dissuade many victims from pursuing justice.
"If we have a system that backs victims or at least provides them support and encourages them to come forward, ultimately we'll see more people coming forward and more rapists convicted," she said. "The more people who come forward and whose cases are taken seriously, that definitely leaves an impression in society that we will listen to you and do our best to make sure the case is handled fairly, adequately and that justice is served."
The 145-page Justice Department document released Wednesday points to more sensitive and supportive exams for all victims of rape and sexual assault, which Mullen said can go a long way in restoring lives and obtaining justice after the sometimes traumatic events.
The victim-centered approach is the greatest shift in focus for the still voluntary protocol, which updates the more prosecutorial guidelines found in a 2004 version of the document.
New efforts incorporate not only improved technologies and practices, but establish defined roles for responders, including victim advocates and those in health care and law enforcement.
The updated protocol also includes standards for involving culturally and linguistically appropriate care, as English is not a first language for many victims.
Mullen said that the one, full-time bilingual therapist at the local center almost always has to schedule clients six to eight weeks out on a waiting list. The center, however, contracts with a service that provides translation in 150 languages in order to help victims needing immediate attention.
The new nationwide protocol suggests standardized examination kits to improve evidence collection, which can help lead to more answers and allow authorities to reconstruct circumstances of the alleged rape or sexual violence more accurately in many cases.
Nationally, better evidence collection results in significantly higher prosecution rates, convictions and guilty pleas, and ultimately "strengthens criminal cases," according to Bea Hanson, acting director of the President's Office on Violence Against Women.
Hanson said the guidelines "ensure that victims will be cared for with compassion and respect when they turn to hospitals for help."
When a victim approaches an examination, trust is key, said Beth Fitzgerald-Weekley, director and nurse at Salt Lake Sexual Assault Nurse Examiners.
Fitzgerald-Weekley is one of about 20 nurses who are part of a mobile team that is called to Salt Lake Valley hospitals in the event that a victim arrives or is brought in by law enforcement or someone else. The agency, which is one of the longest standing in the country, averages about a case a day, but numbers increase each year.
"I like to think it is because more people are reporting these cases and not that it is happening more, but we don't know for sure," she said.
Emergency department staff at hospitals doesn't usually have the time to devote to a victim of sexual violence, as a proper examination can take up to six hours, depending on the severity of injuries incurred. Emergency rooms are already busy places and often patients with life-threatening conditions are a priority, Fitzgerald-Weekley said.
The evidence needed in these cases, she said, deteriorates over time and is best collected as soon as possible.
The specially certified nurses perform a thorough head-to-toe exam, taking evidence of DNA from both the victim and potential suspect wherever found, as well as documenting any injury medically and photographically.
"We end up serving as the expert witness for these cases, so the more thorough the better," Fitzgerald-Weekley said.
The process, she said, is long and arduous, but "it's amazing how many of them will sit through this." The hope is that answers obtained through the exam can lead a victim on a path to recovery.
Fitzgerald-Weekley said her team began working with law enforcement and hospital personnel to educate and dispel the common urge to judge victims long before Wednesday's updated protocol came out.
"The first interaction with the patient makes a big difference in where they ultimately end up," she said.
The new guidelines emphasize carefully delivered care and withholding judgment.
It is also recommended that rape victims be offered emergency contraception or information on how to get the medication, as well as other interventions to treat potential sexually transmitted infections.
"Cutting back on the number of hurdles that a victim has to jump can only be a good thing," Mullen said.