Section 545.60  Treatment of Alleged Sexual Assault Survivors

a)         Every hospital providing appropriate emergency hospital services to an alleged sexual assault survivor shall conform to the requirements of the federal Emergency Medical Treatment and Active Labor Act (42 USC 1395dd) and, as minimum requirements for such services, provide, with the consent of the alleged sexual assault survivor, and as ordered by the attending physician, the following:

1)         Appropriate medical examinations and laboratory tests required to ensure the health, safety, and welfare of an alleged sexual assault survivor or which may be used as evidence in a criminal proceeding against a person accused of the sexual assault, or both.  Records of the results of such examinations and tests shall be maintained by the hospital and made available to law enforcement officials upon the request of the alleged sexual assault survivor.  (Section 5(a) of the Act) Examinations and tests shall include, but not be limited to:

A)        General physical examination;

B)        Evaluation and/or treatment for sexually transmitted infections in accordance with the guidelines of the Centers for Disease Control and Prevention titled Guidelines for Treatment of Sexually Transmitted Diseases, or the standards of the American College of Emergency Physicians titled Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient (see Section 545.25);

C)        Evaluation and possible treatment for HIV exposure in accordance with the guidelines of the Centers for Disease Control and Prevention titled Sexually Transmitted Diseases Treatment Guidelines, or the standards of the American College of Emergency Physicians titled Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient; and

D)        Pregnancy test for all females of childbearing age;

2)         Appropriate oral and written information concerning the possibility of infection, sexually transmitted disease and pregnancy resulting from sexual assault (Section 5(a) of the Act);

3)         Medically and factually accurate written and oral information about emergency contraception; the indications and counter-indications and risks associated with the use of emergency contraception; and a description of how and when victims may be provided emergency contraception upon the written order of a physician   (Section 2.2(b) of the Act);

4)         Appropriate oral and written information concerning accepted medical procedures, medication, and possible contraindications of such medication available for the prevention or treatment of infection or disease resulting from sexual assault (Section 5(a) of the Act);

5)         Such medication, dispensed at the time of service, including, but not limited to, HIV and STD prophylaxis, as deemed appropriate by the attending physician, for treatment at the hospital and after discharge (Section 5(a) of the Act);  

6)         Written and oral instructions indicating the need for a follow-up appointment two weeks after the sexual assault (Section 5(a) of the Act);

7)         Appropriate referral to a physician licensed to practice medicine in all of its branches as provided in the Medical Practice Act of 1987;

8)         Appropriate counseling that provides:

A)        Emotional support;

B)        Confidentiality;

C)        Explanations of treatment and related questioning to ensure that the patient understands that such procedures are necessary for  his/her health, safety and welfare and for the collection of forensic evidence;

D)        Distribution of the brochure "After Sexual Assault" (1982, updated 1989 and 1998), published by the Illinois Coalition Against Sexual Assault and the Illinois Department of Public Health, and the pamphlet "Financial Aid for Crime Victims", published by the Illinois Office of the Attorney General; and

E)         Referrals, which may include rape crisis or other counseling services;

9)         Information on date rape drug testing, including an explanation of the comprehensive scope of a drug screen and the limited time frame within which such evidence can be collected; and

10)         Information regarding evidence collection, and the process and use of evidence in criminal investigation/cases.

b)         The hospital shall develop a uniform system for recording results of medical examinations and all diagnostic tests performed in connection with the examination to determine the condition and necessary treatment of alleged sexual assault survivors. Such results shall be preserved in a confidential manner as part of the hospital record of the patient.  (Section 6.1 of the Act) A medical record shall include, but not be limited to, the following information:

1)         The medical record shall show if the patient changed clothes, bathed or douched, defecated, urinated, ate, smoked, or performed oral hygiene between the time of the alleged assault and the time of the examination.

2)         The medical record shall indicate presence of all trauma, major or minor, that may be used in a criminal proceeding (i.e., cuts, scratches, bruises, red marks, any minor signs of trauma).  Photographs of incidence of trauma may be taken for evidentiary purposes with the written consent of the patient or the patient's parent or guardian if the patient is under 13 years of age.  If the patient is under 13 years of age and the parent or guardian is not immediately available, photographs may be taken and shall be released to law enforcement personnel and State's Attorney staff with written consent of parent, guardian, law enforcement officer or Department of Children and Family Services.

3)         The medical record shall not reflect any conclusions regarding whether a crime (e.g., criminal sexual assault, criminal sexual abuse) occurred.

4)         Medical history shall include brief, general information concerning possible injury and drug allergies, and for female patients a detailed gynecological history must be obtained including:  Menstrual history (last menstrual period), whether the patient knows or believes that she is pregnant, history of prior gynecological surgery such as hysterectomy or tubal ligation, history of contraceptive use, history of cancer and any prior genital injury or trauma.

5)         The medical record shall indicate the presence of any and all persons during the examination process.

6)         The medical record shall document the compliance with each procedure required by subsection (d) of this Section..

7)         The medical record shall indicate whether a report was filed with the Department of Children and Family Services, or whether the Department on Aging or the Department of Public Health was contacted.

8)         The medical record shall include a completed emergency department record.

9)         The medical record shall indicate whether an evidence collection kit was completed.

10)         All medical records for alleged sexual assault survivors shall be maintained through a filing system that allows for immediate accessibility during Department surveys.

c)         The appropriate evidence collection kit shall be used, in the manner prescribed by the information contained in the kit.

1)         With the survivor's consent, the kit shall be completed if the survivor presents himself/herself within seven days after the sexual assault.

2)         If the evidence collection kit is not collected by law enforcement promptly after completion, hospital staff shall store it in a safe location for at least two weeks.

d)         Procedures to ensure the welfare and privacy of the patient shall be followed and shall include, but not be limited to, the following:

1)         A member of the health care team shall respond within minutes to move the patient to a closed environment to ensure privacy and shall refer to such patients by code to avoid embarrassment.

2          If, for any reason, the patient is incapable of receiving oral and written information required in subsection (a) of this Section, the information shall be given to the caregiver/guardian.

3)         All unauthorized personnel, including law enforcement personnel, shall remain outside the examination room during the medical examination.  If a patient who is in the custody of law enforcement officers exhibits behavior that may cause physical harm to herself/himself or hospital staff, the staff shall request that law enforcement officers be posted outside the treatment room door.

4)         The hospital shall offer to call a friend, family member, or rape crisis advocate to accompany the survivor.

e)         Where a minor is the victim of a predatory criminal sexual assault of a child, aggravated criminal sexual assault, criminal sexual assault, aggravated criminal sexual abuse or criminal sexual abuse, as provided in Sections 12-13 through 12-16 of the Criminal Code of 1961 [720 ILCS 5/12-13 to 12-16], the consent of the minor's  parent or legal guardian need not be obtained to authorize  a hospital, physician or other medical personnel to furnish medical care or counseling related to the diagnosis or treatment of any disease or injury arising from such offense.  The minor may consent to such counseling, diagnosis or treatment as if the minor had reached his or her age of majority.  Such consent shall not be voidable, nor subject to later disaffirmance, because of minority. (Section 3 of the Consent by Minors to Medical Procedures Act [410 ILCS 210/3])

f)          A sexual assault evidence collection kit may not be released by a hospital without the written consent of the sexual assault survivor.  In the case of a survivor who is a minor 13 years of age or older, evidence and information concerning the alleged sexual assault may be released at the written request of the minor.  If the survivor is a minor who is under 13 years of age, evidence and information concerning the alleged sexual assault may be released at the written request of the parent, guardian, investigating law enforcement officer, or Department of Children and Family Services.  Any health care professional, including any physician or nurse, and any health care institution, including any hospital, who provides evidence or information to a law enforcement officer pursuant to a written request as specified in this subsection (f) is immune from any civil or professional liability that might arise from those actions, with the exception of willful or wanton misconduct.  The immunity provision applies only if all the requirements of this Section are met. (Section 6.4 of the Act)

g)         All hospitals that provide emergency medical services to alleged sexual assault survivors shall comply with the Crime Victims Compensation Act [740 ILCS 85], the Consent by Minors to Medical Procedures Act [410 ILCS 210] and any local ordinances, municipal codes, rules, or regulations that may apply to the health of sexual assault survivors.

h)         All hospitals shall comply with the reporting procedures for sexual assault survivors as required by Section 3.2 of the Criminal Identification Act [20 ILCS 2630].

i)          All treatment hospitals are strongly encouraged to enter into a networking agreement with a community-based rape crisis center, to assist the victim in receiving ongoing support, information, counseling and advocacy.

j)          The hospital shall take all reasonable steps to secure the patient's written informed consent to or refusal of such examination and treatment.  

(Source:  Amended at 27 Ill. Reg. 1567, effective January 15, 2003)