**# Sexual Assault

The Lafourche Parish Coroner's Office is also responsible for Sexual Assault Exams and coordinates with local law enforcement and the Lafourche Parish District Attorney's Office.

Anyone needing the Sexual Assault services must contact 911 as the Lafourche Coroner's Office deals directly with law enforcement agencies on criminal complaints.

There are programs being developed at this time to assist victims. Lafourche Parish Coroner's Office is applying for several programs.

PREFACE In the 2015 Louisiana Regular Legislative Session, the Legislature passed ACT No: 229, which addresses the treatment and billing of victims of a sexually-oriented crime offense. The legislation was enacted to ensure victims have access to a forensic medical examination in every parish and to ensure no hospital or healthcare provider bill a victim for any healthcare services rendered in conducting a forensic medical examination as provided for in R.S. 15:662. All coroners, licensed hospitals, and healthcare providers in Louisiana must adhere to the mandates in the statute in the event that a person, male or female, presents himself or herself or is presented for treatment as a victim of a sexually-oriented criminal offense. The provisions of this Act apply to any victim of a sexually-oriented criminal offense that occurred on or after January 13, 2015, in accordance with emergency rules promulgated by the Crime Victims Reparations Board and pursuant to Executive Order BJ 14-17, which provides relative to the administrative rules, policies, and practices for medical expenses and examinations related to victims of a sexually-oriented criminal offense.

The Governor of Louisiana’s EXECUTIVE ORDER NO. BJ 2014-7 (signed and issued on December 9, 2014) authorized the Department of Health and Hospitals and the Department of Public Safety to jointly review and formulate the minimum standards and requirements for the contents of a sexual assault examination kit, including the accompanying paperwork to be included therein, with the intent of creating a kit that is shelf stable and has no expiration date. Per ACT No. 229, all sexual assault collection kits used by the coroners, or designee and all physicians or hospitals in Louisiana when providing forensic medical examinations of victims of alleged sexual offenses must meet the standards developed by the Department of Health and Hospitals and the Department of Public Safety and Corrections. In accordance with ACT No. 229, the Department of Health and Hospitals, in collaboration with the OPH Region 3 Medical Director, coordinated the first annual sexual assault response plan for the OPH Region 3 in 2015. Input was solicited from such regional partners as law enforcement, coroners, hospitals, first responders, higher education institutions, school board/school systems, district attorneys, crime labs, sexual assault advocacy organizations, and child advocacy centers. The OPH Region 3, Act 229 Compliance Document was approved by the secretary and implemented February 1, 2016. ACT No. 229 mandates each of the DHH medical directors to coordinate an annual sexual assault response plan for their respective regions. In October 2016, input was solicited from District Attorneys, and their staff designated to respond to sexual assaults, to evaluate and update the 2016 OPH Region 3 efforts to build SANE Capacity for the region. Attached is the Regional Sexual Assault Response Plan for the 7 parishes of OPH Region 3 for submission to the secretary (no later than November first of each year) and approval for implementation by February 1, 2017 (effective February first of the following year). Recognizing that ACT No. 229 mandates each OPH regional plan to incorporate a sexual assault response team protocol to the extent possible, the following OPH Region 3 2017 Regional SAR Plan meets the minimum statutory mandates.

The 2017 OPH Region 3 Sexual Assault Response Plan, builds upon the year 1 Compliance Template and developed from the recommendations of regional partners in 2015 is intended for victims of sexually-oriented crimes aged 18 years and older. Taking into consideration the partners’ current resources (monetary, human, social) limitations to meet –the ACT 229 mandates by February 1, 2017, the following updated consensus response plan ensures that victims of sexual assaults have immediate access to coordinated care that is victim-centered, respectful, as well as culturally and age appropriate. OPH Region 3 will continue to update the regional sexual assault response plan in an effort to improve medical treatment and evidence collection outcomes and to maximize continuity of care for victims of a sexually-oriented criminal offense.

The following sections address the minimum statutory mandates of ACT No. 229.

The Lafourche Parish Coroner’s Office Region 3 Sexual Assault Response Team consists of key responders who will ensure that victims have access to medical, law enforcement, advocacy, and prosecutorial services.

Coroner Dr. John C. King

District Attorney Honorable Camille A. Morvant

Emergency Medical Services Acadian Ambulance Service Lafourche Ambulance District

Hospital Emergency Room (ER) Services Designated Hospital ER are for patients 18 and older as follows: Patients that reside in Lafourche Parish from Leeville to Cut Off are designated to have a FME (Forensic Medical Examination) at Our Lady of Sea ER in Cut Off, LA. Patients that are under the age of 17 will be transported to Children’s Hospital in New Orleans by law enforcement if medically cleared. Patients that reside in Larose to Raceland are designated to have a FME (Forensic Medical Examination) at Ochsner St. Anne’s ER in Raceland, LA. Patients that are under the age of 18 will be transported to Children’s Hospital in New Orleans by law enforcement if medically cleared. Patients that reside in Thibodaux are designated to have a FME (Forensic Medical Examination) at Thibodaux Regional Medical Center ER in Thibodaux, LA. Patients that are under the age of 18 will be transported to Children’s Hospital in New Orleans by law enforcement if medically cleared.

Sexual Assault/Rape Crisis and Advocacy Centers/Programs The Haven 2101 Duet Street Houma, LA (985) 872-0757 o Crime Lab: Louisiana State Police Crime Lab

Law Enforcement Sheriff Craig Webre Lafourche Parish Sheriff’s Office (985) 446-2255 Chief Craig Jaccuzzo Nicholls State University Police(985) 448-4746 Chief David Harrelson Lockport Police Department (985) 532-9799 Chief Reggie Pitre Golden Meadow Police Department (985)475-5213 Chief Bryan Zeringue Thibodaux Police Department (985) 446-5021

  1. Contents of the SA Collection Kits In OPH Region 3, all sexual assault collection kits used by the coroners, or designee, and all physicians or hospitals in Louisiana when providing forensic medical examinations of victims of alleged sexual offenses will meet the standards and requirements developed by the Department of Health and Hospitals (DHH) and the Department of Public Safety and Corrections (DPSC), per ACT No. 229, with the intent of creating a kit that is shelf stable and has no expiration date. See APPENDIX A for the minimum standards and requirements developed by DHH-DPSC for the contents of a sexual assault examination kit, including the accompanying paperwork to be included therein.

  2. Purchase and Storage of the SA Collection Kits

In Lafourche Parish OPH Region 3, all emergency rooms (ERs) in the 3 designated full service hospitals and the stand-alone ER (see chart below) will be responsible for the purchase of the sexual assault collection kits and the storage of the kits prior to use, effective February 1, 2016. Vendor selection, SA collection kit selection/ordering, and inventory management of the unused kits are the responsibility of each designated entity by parish. See APPENDIX B for a price quotation of SA kits from TRITECHFORENSICS (state recommended vendor). Designated Region 3 Hospitals/ERs Location Parish Ochsner St. Anne Hospital Raceland, LA Lafourche Parish Lady of the Sea General Hospital Cut Off, LA Lafourche Parish Thibodaux Regional Medical Center Thibodaux, LA Lafourche Parish

This section clearly outlines the standards and procedures for a victim to receive a forensic medical examination, as defined in R.S. 15:622, to ensure access to such an examination in every parish in OPH Region 3.

  1. DESIGNATED LEAD MEDICAL ENTITIES/FACILITIES AND PROVIDERS

In OPH Region 3, there is no one exclusively regional nor parish designated health facility for all sexual assault victims to receive medical services. Region 3 coroner’s report they have designated all hospitals and Emergency Departments as providers to serve as lead entities to perform the forensic medical exams, as required by R.S. 40:1300.41 since the region does not have a SANE Program nor is there a regional SART with a SANE/SAFE available to perform FMEs in each of the ERs.

FOR ADULTS (aged 18 years and older)

OPH Region 3 Designated Lead Medical Entity/Facility for Medical Screenings and FMEs: All emergency rooms (ERs) in the 10 full service hospitals and the stand-alone ER (see chart below) are designated.

Designated Region 3 Hospitals/ERs Location Parish Ochsner St. Anne Hospital Raceland, LA Lafourche Parish Lady of the Sea General Hospital Cut Off, LA Lafourche Parish Thibodaux Regional Medical Center Thibodaux, LA Lafourche Parish

OPH Region 3 Designated Lead Healthcare Provider(s) for Medical Screenings: All physicians who work in the ERs are designated. A physician on duty in the ER when a sexual assault victim presents to the ER will perform the medical screening.

OPH Region 3 Designated Lead Healthcare Provider(s) for FMEs: All physicians who work in the ERs of designated facilities will serve as the sexual assault forensic examiner (SAFE). A physician on duty in the ER when a sexual assault victim presents to the ER will perform the FME, with the assistance of a nurse working in the ER. NOTE: A sexual assault victim’s advocate should be present for all FMEs. A SANE or SAFE nurse may perform a FME, upon designation by the coroner(s). (See pg. 16 for definitions)

FOR CHILDREN (under age 18 years):

OPH Region 3 Designated Lead Medical Entity/Facility for Medical Screenings: All emergency rooms (ERs) in the 10 full service hospitals and the stand-alone ER are designated.

Designated Region 3 Hospitals/ERs Location Parish

Ochsner St. Anne Hospital Raceland, LA Lafourche Parish Lady of the Sea General Hospital Cut Off, LA Lafourche Parish Thibodaux Regional Medical Center Thibodaux, LA Lafourche Parish

OPH Region 3 Designated Lead Medical Entity/Facility for ACUTE Pediatric FMEs:

Parish Designated Lead Medical Entity/Facility for ACUTE Pediatric FMEs Lafourche

Children’s Hospital – New Orleans, LA Our Lady of the Lake - Baton Rouge, LA OPH Region 3 Designated Entities for SUB-/ NON-ACUTE FMEs: Parish Lead Medical Entity/Facility for Sub-Acute FMEs Lafourche

Children’s Hospital – New Orleans, LA Our Lady of the Lake - Baton Rouge, LA

  1. TRANSPORTATION OF SEXUAL ASSAULT VICTIMS

An emergency medical unit and/or law enforcement unit will be dispatched per 911 dispatch protocols for adult and pediatric sexual assault/injuries. EMS First Responders:
For Adults/Older Adolescents: In Lafourche Parish/OPH Region 3, sexual assault victims should be transported to the nearest medical facility where medical screening and forensic sexual assault evidence exams can be performed, unless injury severity dictates otherwise or the victim chooses a different facility in the region. A primary caregiver, family member or friend, who is not the suspected perpetrator, should be allowed to accompany the SA victim in the emergency medical unit. For Children: In Lafourche Parish/OPH Region 3, all pediatric victims of sexual assault should be transported by EMS to the nearest lead medical facility for a medical screening, unless injury severity dictates otherwise or the victim’s parent/caregiver chooses a different facility (in the region). Once cleared by the physician, the pediatric victim is to be transported by EMS or law enforcement to the designated lead medical facility for an acute FME. EMS transportation arrangements are the responsibility of the transferring ER. A parent or primary caregiver, who is not the suspected perpetrator, should be allowed to accompany the child in the emergency medical unit. Law Enforcement: In Lafourche Parish/OPH Region 3, if law enforcement must provide transportation of a medically stable SA victim to or from a medical facility, then an unmarked vehicle should be used, especially when transporting a child. A parent or primary caregiver, who is not the suspected perpetrator, should be allowed to accompany the child SA victim in the vehicle, and a family member or friend should be allowed to accompany an adult SA victim. NOTE: EMS first responders provide transportation to designated medical facilities. When a patient is ready to leave the hospital, transportation may be provided by a family member, friend, victim advocate who was called to the hospital for support, and, in some cases, by the local police/sheriff’s department.

  1. THE FORENSIC MEDICAL EXAM AND EVIDENCE COLLECTION

A. For the purposes of this section, the following applies (from ACT No.229): "Sexually-oriented criminal offense" shall have the same meaning as sex offense as defined in R.S. 15:541(24). “Forensic medical examination (FME) means an examination provided to the victim of a sexually-oriented criminal offense by a health care provider for the purpose of gathering and preserving evidence of a sexual assault for use in a court of law. A forensic medical examination shall include the following: (a) Examination of physical trauma. (b) Patient interview, including medical history, triage, and consultation. (c) Collection and evaluation of evidence, including but not limited to the following: (i) Photographic documentation. (ii) Preservation and maintenance of chain of custody. (iii) Medical specimen collection. (iv) When determined necessary by the healthcare provider, an alcohol- and drug- facilitated sexual assault assessment and toxicology screening. "Healthcare provider" means either of the following: (a) A physician or other healthcare practitioner licensed, certified, registered, or otherwise authorized to perform specified healthcare services consistent with state law. (b) A facility or institution providing healthcare services, including but not limited to a hospital or other licensed inpatient center, ambulatory surgical or treatment center, skilled nursing facility, inpatient hospice facility, residential treatment center, diagnostic, laboratory, or imaging center, or rehabilitation or other therapeutic health setting. "Healthcare services" means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease ancillary to a sexually-oriented criminal offense.

NOTE: Medical Screening Exam is a thorough medical assessment to determine if the patient is seriously injured or impaired.

B. Healthcare Services for Victims of Sexually-oriented Criminal Offenses In Lafourche Parish/OPH Region 3, all licensed hospitals and healthcare providers agree to adhere to the following procedures in the event that a person, male or female, presents himself or herself or is presented for treatment as a victim of a sexually-oriented criminal offense: Sexual assault patients should be viewed as “priority emergency cases” and given priority for room assignment in a private area, and should never be left alone. A sign language or foreign language interpreter should be made available, upon request, to be present during medical and advocacy services in the emergency room. A language line, though not ideal, is an acceptable alternative to a language interpreter being present in the ER. A SA/Rape Crisis Advocate should be contacted upon arrival of the victim to the emergency room. Advocates do not provide health care, collect, or handle forensic evidence. Reporting: The victim shall make the decision of whether or not the incident will be reported to law enforcement officials. No hospital or healthcare provider shall require the person to report the incident in order to receive medical attention. EXCEPTION: In Region 3, the appropriate law enforcement official shall be immediately notified if the victim is 17 years of age or younger (§14:403 Criminal; Art. 609 & 603 Children’s Code) and/or if the victim is physically or mentally incapable of making the decision to report (ACT 229). If the victim wishes to report the incident to law enforcement officials, the hospital staff or healthcare provider shall notify the appropriate law enforcement agency before the victim is examined and treated, per ACT No.229. The hospital or healthcare provider staff member who notifies the appropriate law enforcement official shall document the date, time, and method of notification and the name of the official who received the notification, per ACT No. 229. Any member of the hospital staff or a healthcare provider who in good faith notifies the appropriate law enforcement official shall have immunity from any civil liability that otherwise might be incurred or imposed because of the notification. The immunity shall extend to participation in any judicial proceeding resulting from the report, per ACT No. 229. Forensic Medical Examinations: Hospitals and healthcare providers shall follow the procedures outlined in ACT No. 229 for performing a FME for a victim who does not wish to report the incident to law enforcement officials; for a victim who does wish to report the incident to law enforcement; for a child victim under age 17 years; and for a victim who is physically or mentally incapable of making the decision to report. Collection and Packaging Evidence: Designated healthcare providers shall follow the envelope steps (See APPENDIX C) provided in the approved SA evidence collection kit. Medical/FME findings will be documented on the Louisiana Forensic Medical Report form. (See APPENDIX D) Assignment of a Code Number: Per ACT No. 229, if the victim does not wish to report the incident to law enforcement authorities, then any evidence collected shall be assigned a code number and the hospital or healthcare provider shall maintain code records for a period of at least one year from the date the victim is presented for treatment. The hospital or healthcare provider shall assign the code number by affixing to the evidence container a code to be used in lieu of the victim's identifying information to maintain confidentiality. The code number is to be used for identification should the victim later choose to report the incident.

In Lafourche Parish/OPH Region 3, a unique alpha-numeric identification code will be assigned and affixed to the collected evidence kit of unreported cases, according to each hospital’s plans/ procedures.

Notification of Law Enforcement: In Lafourche Parish/OPH Region 3, each law enforcement agency provides each hospital located in its respective jurisdiction with the name of the responsible contact person along with the responsible person's contact. If the victim wishes to report the incident to law enforcement officials, then the hospital staff or healthcare provider shall immediately notify the appropriate law enforcement agency before the victim is examined and treated, per ACT No.229. If the victim does not wish to report the incident, then the hospital staff or healthcare provider shall immediately notify the appropriate law enforcement agency once a code number has been assigned to the evidence. Evidence transferred shall bear only the assigned code number assigned by the hospital or healthcare provider In Lafourche Parish/OPH Region 3, the hospital or healthcare provider shall immediately notify the local law enforcement agency having jurisdiction in the parish in which the hospital or healthcare provider is located and shall coordinate the transfer of the evidence with the law enforcement agency in a manner designed to protect its evidentiary integrity. (See pg.17 for Chain of Custody of Evidence)

Post-Examination, Medical Discharge, and Follow-up Care of the Patient Forensic medical examiners are responsible for documenting the details of the medical forensic exam and treatment provided in the medical record, as well as documenting required data for the evidence collection kit. All forms should be checked for completeness of information and signatures. Assist the patient with coordination of aftercare, including follow-up medical appointments, counseling/mental health appointments, and transportation home or to a safe location. Sexual Assault/Rape Crisis and Child Advocacy Centers should be notified because they can provide advocacy, intervention, and support services to patients, families, hospitals/healthcare providers, and law enforcement. Lafourche Parish/OPH Region 3 is served by 1 accredited Sexual Assault/Rape Crisis Providers and Child Advocacy Centers. Name Service Area Services The Haven Lafourche

24-Hour Crisis Hotline Louisiana Crime Victims Reparations application process assistance Counseling Services Provide information about the legal process and monitors case progress through court system

  1. FME TRAINING FOR DESIGNATED HEALTHCARE PROVIDERS

All training should include, but is not limited to, the following: victims’ informed rights to privacy, medical and reporting options, medical care and a FME, advocates, interpretive services, and Crime Victims’ Reparation Fund; the Federal Emergency Treatment and Active Labor Act (EMTALA); and available counseling/support services for SA victims. Training requirements apply to staff in designated medical facilities who are newly hired, contracted, full-time and part-time and should take place upon hiring and then annually.

Designated medical facilities should ensure staff trainings on their respective current policies and procedures for the provision of timely, private, comprehensive, coordinated, victim-centered medical services, referrals, and follow-up care to adult, adolescent, and child victims of sexual assault and for the appropriate billing of applicable medical services/FMEs so that SA victims are never billed.

Designated healthcare providers from any discipline providing sexual assault FMEs should be trained on conducting a SA interview/history and FME, and on the collection, documentation, preservation, and chain of custody of physical evidence. Training should also include use of all equipment and supplies required during the exam (including the SA evidence collection kit contents), medical lab diagnostics and drug testing, medication prophylaxis treatment, and unique identification coding of completed evidence collection kits for unreported or anonymously reported cases.

Sexual Assault Forensic Examiner (SAFE) Nurses is a registered nurse who has successfully completed the minimum classroom and clinical training requirements, a 40-hour SANE training program plus 60 additional hours of SANE clinical training, as outlined in the International Association of Forensic Nurses’ (IAFN) Sexual Assault Nurse Examiner Education Guidelines, which enable him/her to provides victim-centered medical forensic care and collect sexual assault forensic medical evidence within the scope and standards of forensic nursing practice outlined by the Louisiana State Board of Nursing and the National Protocol for Sexual Assault Medical Forensic Examinations Adults/Adolescents (2nd edition). At least 12 contact hours of relevant continuing education must be obtained per year.

Sexual Assault Nurse Examiners (SANE) —Adult and Adolescent (SANE-A)- is a registered nurse who is certified through the International Association of Forensic Nurses to provide victim-centered medical forensic care and collect sexual assault forensic medical evidence. He/she has successfully completed a 40-hour SANE training program plus 60 additional hours of SANE clinical training as outlined in the most current edition of the International Association of Forensic Nurses’ (IAFN) Sexual Assault Nurse Examiner Education Guidelines plus practiced as a SAFE nurse for a minimum of 300 hours (required to take the certification exam). At least 12 contact hours of relevant continuing education must be obtained per year.

Sexual Assault Victims’ Advocates should be trained to provide victims with confidential, non-judgmental, calm emotional support; to provide crisis intervention when victims arrive for treatment; to assist victims in understanding the medical and evidence collection procedures, as well as medical and legal options; to provide support to family members and friends; to provide accompaniment through the legal system; and to provide relevant information and community resources. Also, they should be trained in the policies and procedures of the local hospitals to which they respond.

In Lafourche Parish/OPH Region 3: Hospitals and healthcare providers will coordinate the transfer of the evidence with the law enforcement agency in a manner designed to protect its evidentiary integrity. The healthcare provider who performed the FME must complete and sign the forensic chain of custody form. The form must include the signatures of everyone who has had position of the evidence, and both signatures (one from the person releasing the evidence and the second from the person receiving it) are required for any transfer. The completed SA collection kit and completed collection forms should be handed over to law enforcement when they arrive. Upon arrival of law enforcement to the ER, custody of the evidence shall be transferred from the healthcare provider to local law enforcement agency having jurisdiction in the parish in which the hospital or healthcare provider is located (who will then be responsible for maintaining/transferring the evidence to the local law enforcement agency having jurisdiction in the parish in which the crime occurred).
NOTE: City police respond within city limits and sheriffs respond in unincorporated areas.

The law enforcement agency should retrieve from the hospital or healthcare provider the evidence immediately, ideally no later than one (1) hour, after receiving notification from the hospital or healthcare provider that evidence collection is completed (reported case) and that a code number has been assigned to the evidence (unreported case). If law enforcement is unable to pick up the evidence within the stated timeframe, then the healthcare provider who performed the FME must place the evidence in a locked storage area in the ER, preferably accessible to only the key holder. When law enforcement arrives, the healthcare provider with the key to the locked storage area should sign for and retrieve the evidence and personally hands it to law enforcement (ideally).

Submission of SA Collection Kits to a Forensic Laboratory (per ACT No. 229) Within thirty days of receiving a sexual assault collection kit for a reported case involving an unknown suspect, the criminal justice agency shall submit the sexual assault collection kit to a forensic laboratory for testing. If a prosecuting agency makes an official request for analysis of a sexual assault collection kit, the criminal justice agency shall submit the sexual assault collection kit to a forensic laboratory within thirty days of receiving the request from the prosecuting agency.

  1. MEDICAL BILLING All designated hospitals and healthcare providers will develop and implement their respective policies and procedures for the handling and payment of medical bills related to the forensic medical examination to ensure compliance with ACT No. 229 and will include the following: Regarding Explanation of Billing Process (per ACT No. 229) The Department (DHH/DPSC) shall make available to every hospital and healthcare provider licensed under the laws of this state a pamphlet containing an explanation of the billing process for services rendered pursuant ACT No. 229 Every hospital and healthcare provider shall provide a copy of the pamphlet to any person presented for treatment as a victim of a sexually-oriented criminal offense.

Regarding Medical Billing (per ACT No. 229) No hospital or healthcare provider shall directly bill a victim of a sexually-oriented criminal offense for any healthcare services rendered in conducting a forensic medical examination as provided for in R.S. 15:622. The expenses shall include the following: (a) Forensic examiner and hospital or healthcare facility services directly related to the exam, including integral forensic supplies.

(b) Scope procedures directly related to the forensic exam including but not limited to anoscopy and colposcopy

(c) Laboratory testing directly related to the forensic examination, including drug screening, urinalysis, pregnancy screening, syphilis screening, chlamydia culture, gonorrhea coverage culture, blood test for HIV screening, hepatitis B and C, herpes culture, and any other sexually transmitted disease testing directly related to the forensic examination.

(d) Any medication provided during the forensic medical examination.

Except for those services specifically set forth in the provision of this Section, no other services shall be subject to the reimbursement or billing provisions of this Section and shall continue to be reimbursable under the ordinary billing procedures of the hospital or healthcare provider. In addition, a victim of a sexually-oriented offense may seek reimbursement for these services through the Crime Victims Reparations Board.

Regarding Payment Claims Submission to Victim’s Health Insurance Issuer (per ACT No. 229) A healthcare provider may submit a claim for payment of healthcare services rendered in conducting a forensic medical exam for a victim of a sexually-oriented offense to any of the following: (a) With the consent of the victim, to the victim's health insurance issuer.

(b) The Louisiana Medicaid, Medicare, or Tricare programs, if the victim is enrolled as beneficiary of any of these programs

Regarding Payment Claims Submission to Crime Victims Reparations Board (per ACT No. 229) The healthcare provider may submit a claim to the Crime Victims Reparations Fund For satisfaction of any non-covered services (by the victim’s health insurance), not to exceed one thousand dollars. If the victim does not consent to the healthcare provider submitting a claim to his or her health insurance issuer or the victim is not otherwise insured. The Crime Victims Reparations Board shall reimburse at the rate as promulgated by the board for healthcare services rendered but in no case shall reimburse in any amount greater than one thousand dollars. A victim of a sexually-oriented offense may seek reimbursement for (billable) services under the ordinary billing procedures of the hospital or healthcare provider.

Regarding a Health Insurance Issuer Receiving a Claim (per ACT No. 229) Notwithstanding any provision to the contrary, a health insurance issuer receiving a claim for covered healthcare services rendered in conducting a forensic medical exam shall waive any applicable deductible, co-insurance, and co-pay In addition, the health insurance issuer shall allow the victim to designate any address to be used for purposes of transmitting an explanation of benefits or allow the victim to designate that no explanation of benefits be generated or transmitted.

  1. CRIME VICTIMS REPARATIONS BOARD

Filing an Application

A victim of a sexually-oriented criminal offense shall not be required to report a sexually-oriented criminal offense to any law enforcement officer for purposes of a claimant filing a valid application for reparations. A claimant must follow the application process for the Crime Victims Reparation Boards, as outlined in ACT No. 229.

Notification to Potential Applicants by Hospitals and Healthcare Providers

Every hospital licensed under the laws of this state shall display prominently in its emergency room posters giving notification of the existence of the crime victims’ reparations program. The board shall set standards for the location of the display and shall provide posters and general information regarding this Chapter to each hospital. Every hospital and healthcare provider licensed under the laws of this state shall make available to hospitals and healthcare providers a pamphlet containing an explanation of the billing process for services rendered pursuant to the provisions of R.S. 40:1300.41.

Many thanks go out to the regional and state stakeholders who contributed their skills and expertise to the development of the annual Sexual Assault Response Plan (SAR) for OPH Region 3. Their participation in various meetings and providing feedback and guidance throughout the drafting process is greatly appreciated. This coordinated annual plan meets the minimum statutory mandates of ACT No. 229; however, OPH Region 3 will continue to seek sustainable funding mechanisms toward the development of a more comprehensive regional sexual assault response capability. Regional partners are in agreement that this would improve medical treatment and evidence collection outcomes and maximize continuity of care for victims of a sexually-oriented criminal offenses. Per ACT No. 229, “when developing the annual response plan, each district shall incorporate a sexual assault response team protocol to the extent possible…” OPH Region 3 does not currently have a regional SANE (sexual assault nurse examiner) program nor a regional SART (sexual assault response team) to provide FMEs to SA victims in the designated hospital ERs in the region. However, several hospitals have identified previously trained SANE’s already on their staff and attempt to use them when possible for the maintenance of plans and performance of FMEs. Two agencies one governmental and one non-governmental have agreed to serve as a future program home if funding can be identified to establish a SANE/SART capability for the region.
To ensure compliance with ACT No. 229 (and continued compliance with other legislative mandates applicable to their agency), stakeholders will evaluate their respective internal policies/procedures/protocols and formal/informal collaborative partnerships and align them with the mandates of this ACT. Highlighted below are a few new goals for stakeholders that require special attention during 2017. By January 1, 2017 On or before January first of each year each law enforcement agency shall provide each hospital located in its respective jurisdiction with the name of the responsible contact person along with the responsible person's contact information.

Plan staff trainings in all designated medical facilities on their respective current policies and procedures for the delivery of medical care and a FME to victims of sexual assaults.

Plan training of designated healthcare providers on conducting a SA interview/history and FME, and on the collection, documentation, preservation, and chain of custody of physical evidence.

Plan training of sexual assault hospital/medical advocates to ensure victims’ access to such services in all designated medical facilities in Region 3.

Review protocols for chain of custody of FME, especially for unreported cases, to ensure that custody of the evidence shall be transferred from the healthcare provider to local law enforcement agency having jurisdiction in the parish in which the hospital or healthcare provider is located (who will then be responsible for maintaining/transferring the evidence to the local law enforcement agency having jurisdiction in the parish in which the crime occurred).

APPENDIX A: SEXUAL ASSAULT KIT CONTENTS Adult Kit
Louisiana Physical Evidence Recovery Kit Vendor - To Be Determined Patient Information and Chain of Custody Information on Outside of Box (4 entries) Collection Directions on Envelopes numbered in order of collection (include place to mark Used and Not Used) Unique Kit #, labeled env with Kit #, labeled paperwork with Kit # - 4 extra labels with kit # Foreign Material and Drape --48x48 or 48x36 Outer Clothing Bag (2) (One large bag) Undergarments Bag (2) Oral Evidence Swabs Reference Buccal Swabs/Patient's Reference DNA Additional Swabs (4) (Such as Breast, bitemarks, neck swabs) Debris Collection - Debris; Dried Secretions, Fingernail Swabbings Known Blood Sample Card (Hospital to provide collection supplies) - blood applied to card Necessary only when Reference Buccal Swab not collected Additional Swabs (thigh, Alternate Light Source, Penile) Clipped Matted Pubic Hair and bindle Pubic Hair Combings (with comb and paper) Reference Cut Pubic Hair (if applicable)

Vaginal, Vulva, Cervical Swabs Vaginal Washings Syringe with catheter Conical Tube Anorectal Swabs Envelope with: Victim Advocacy Info and Phone Numbers Consent Standardized Victim and Case paperwork Drug Faciliated Sexual Assault Alert Sheet Self- Stick Evidence Tape (8) FDA Insert Small ruler - ABFO Local Area Supplemental Info

Additional Suggestions: Storage protocol on exterior of kit Biohazard Sticker on Outside Plastic stick cotton swabs Two vials of sterile water - This will expire - may provide separately Glass Slides (Majority of cases processed statewide do not use this item) - Needs cost evaluation performed - May have individual regions add to kit   Direct ship standardized kit to collectors   Collection facilities must notify Law Enforcement within 24 hours - Law Enforcement must retrieve kit from collection site within 7 business days of collection and notification Unused Kit stored room temperature Dissecant in Kit Storage - Reported Cases - store collected kit refrigerated until transported to Crime Lab or 1 year then room temp thereafter Storage - Unreported Cases - store collected kit refrigerated one month then room temp thereafter for one year

APPENDIX B: UPDATES MADE TO REGION 3 2016 SAR PLAN Overall, the key responders to sexually-oriented criminal offenses in Region 3 did follow the 2016 Template of Compliance to the extent possible, therefore meeting the minimum statutory mandates of ACT No. 229. This year, Region 3 abandoned the “Template of Compliance” and adopted this “SAR PLAN” format used by OPH Region 9 for its annual report. The following chart outlines the specific changes made to sections of the OPH Region 3 2016 SAR Plan reflected in the 2017 SAR Plan. NOTE: The Louisiana Department of Health and Hospitals (DHH) has been renamed to the Louisiana Department of Health (LDH). However, in some locations, the name was not changed from DHH to LDH in this 2017 Region 3 SAR Plan to remain consistent with ACT 229’s use of DHH.

Credit and reference to: W.S. Riggins Jr., MD, MPH, FAAFP, FACPM Regional Administrator/Medical Director OPH Region III Louisiana Department of Health

Nicole Soudelier RN, BSN Regional Maternal and Child Heatlh Coordinator OPH Region III Louisiana Department of Health

Submitted to Director of Emergency Department of Thibodaux Regional Medical Center Ochsner St Anne Hospital Lady of the Sea Hospital Submitted to: W.S. Riggins Jr., MD, MPH,FAAFP,FACPM Nicole Soudelier RN, BSN
Regional Maternal and Child Heatlh Coordinator OPH Region III Louisiana Department of Health

Dr. John C. King, Coroner of Lafourche Parish

Mark A. Goldman FI, D-ABMDI Chief Investigator/Administrator

William C. Credo III, Attorney

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