Victims of rape are sometimes charged for medico-legal examinations. Why? : Coups

Six years ago, a new graduate from the Chicago School of Art Institute was taking up three part-time jobs and adapting to life as a non-student. She stopped for a drink one night at a restaurant in Bucktown, Chicago, where she had a conversation with a guy. The next thing she clearly remembers is the awakening at home the next morning, painful, covered in bruises, with a swollen lip.

She thought she had been raped and went to the local police station to file a report. The police sent her to the emergency room of a nearby hospital where, with her permission, a doctor conducted a forensic examination. She examined him for any injuries and was able to gather evidence of his body and clothing that could possibly be used in a lawsuit. The exam took hours and made it even more miserable.

The police never arrested them.

As time passed and the woman tried to override the assault, she regularly received unwelcome reminders: bills from the hospital and the group of emergency doctors who treated her.

The group of doctors finally sent their bill to a collection agency and she also started receiving harassing phone calls. Now 28 years old and living near Dallas, she still receives phone calls and letters several times a year ordering her to pay.

"When I get this call, it's still so raw, I'm shaking," said the woman, whose first name is Erin. (NPR agreed not to use Erin's last name to protect her privacy.)

For 25 years, the federal law on violence against women requires any state wishing to benefit from certain federal grants that it certifies that the state covers the cost of forensic examinations of sexually assaulted individuals.

Subsequent re-authorizations of the law have made it clear that these individuals also can not be required to participate in law enforcement to obtain a review; nor should they pay anything for this exam (even if they would be reimbursed later).

And yet, for some people who have been raped, bills continue to be introduced – despite this long-standing federal ban and other state laws that provide additional financial protections in many places.

"There is often a gap between the emergency room staff who take care of the person and the billing department that sends the bills," said Jennifer Pierce-Weeks, executive director of the company. 39; International Association of Forensic Nurses, composed of professionals specializing in the form of assessing and caring for victims of violent crime or abuse.

The way in which states fulfill their financial obligations in the fight against sexual assault varies considerably. examinations – sometimes called "rape kits" – that gather evidence of the crime. Many states use the funds they receive under the Federal Victims of Crime Act. Others use funds from the budgets of law enforcement, prosecutors or other designated options.

Services covered as part of the rape examination may also vary from one state to the other. Federal rules require that the patient be examined and examined for physical trauma, penetration or use of force, and that evidence be collected and evaluated.

But many states include additional services without charging victims, including screening and treatment for pregnancy or sexually transmitted diseases. Some may cover treatment for counseling, or for injuries that survivors experience during the attack.

Having financial protections in the books for people who have been raped, however, does not necessarily mean integrated services at no cost and in the field.

For example, New York requires that patients treated for sexual assault receive free services that go beyond federal requirements, including emergency contraception and STD treatment, said Christopher Bromson, executive director of Crime Victims. Treatment Center in New York.

Yet last November, the New York Attorney General's Office announced regulations with seven hospitals that illegally indicted more than 200 such people. patients for medico-legal examinations, with amounts ranging from $ 46 to $ 3,000. In some cases, hospitals have referred people to the bills of collection agents who have pampered them for payments.

Subsequently, the New York State Healthcare Association, a non-profit group advocating for better health services, teamed up with the State Department of Health and others to present four webinars to hospital staff to explain their legal responsibilities.

Karen Roach, senior director of regulatory affairs and rural health association, said that the billing problem in New York did not seem generalized.

"Some of these problems are due to greater automation of the billing process," said Roach. said. "Training is needed to report these cases, to set up systems that do not automatically generate an invoice."

Working with a lobby group, Erin finally asked the hospital to stop billing her. But the group of emergency doctors who treated him she no longer exists, and her $ 131.68 bill was bundled with other debts and resold to different collectors on several occasions, she said.

When Erin tells a collection officer that her bill deals with rape-related services: "They say," Oh, we'll fix the problem, "but they do not," she says. "They are reselling it again and that is just becoming the problem for someone else, but it is still my problem."

Despite federal and federal laws, many people who are raped end up paying for some medical services out of pocket, even if they have insurance. An analysis of the billing records of 1,355 female victims of rape revealed that in 2013, they had paid an average of US $ 948 for prescription drugs and hospital or outpatient hospital services in the first 30 days l & # 39; assault. The study found that this amount accounted for 14% of total costs.

"We just assumed that this was only a problem for women who were left behind," said Kit Simpson, professor in the Department of Leadership and Management of Health Care at the Medical University of South Carolina. from Charleston, who co-authored the study. . "But it was a systematic problem."

Some people who have been sexually assaulted In any case, they do not want to use their insurance because they fear for their privacy or their safety if their family members or others discover it, according to the lawyers.

The Violence Against Women Act, often referred to as VAWA, is due for re-authorization this year. We do not know if a new bill would solve these payment problems. If states do not certify that they bear the cost of the rape exams, funds can be frozen. (States must also certify that they are not asking these patients to participate in the criminal justice system.)

The Ministry of Justice has refused multiple requests for comment on whether and how these provisions of the VAWA Act are enforced.

Some advocates of sexually assaulted individuals would like to see the federal definition of what should be included in a free forensic examination to include services such as screening and therapeutic management of pregnancy and sexually transmitted infections, including the HIV. Such a move would standardize the rules of the game in the United States, they say.

Janine Zweig, assistant vice president of justice policy at the Urban Institute, who co-authored a study examining state payment practices for rape exams, said that a federal standard should be considered. "Do we really want it to be about the state in which you live?"

Kaiser Health News is a non-profit, editorial independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.