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Referral of Sexual assault victims (rape/sex abuse)

Referral of Sexual assault victims (rape/sex abuse). Accident & Emergency deptt GTB hospital. SEXUAL OFFENCES Natural offences: Rape; Incest Unnatural offences: Sodomy; Tribadism; Bestiality; Buccal coitus Sexual abuse of children. 2.

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Referral of Sexual assault victims (rape/sex abuse)

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  1. Referral of Sexual assault victims(rape/sex abuse) Accident & Emergency deptt GTB hospital

  2. SEXUAL OFFENCES Natural offences: Rape; Incest Unnatural offences: Sodomy; Tribadism; Bestiality; Buccal coitus Sexual abuse of children 2

  3. All patients male or female are received in main casualty • Female patients are refd to deptt. of Gynecology and Obs. for further management. • Male victims – are taken care of in main casualty.

  4. DUTIES OF REGISTERED MEDICAL PRACTITIONER TOWARDS STATE Consent Confidentiality Maintenance Of Records Collection And Preservation Of Samples

  5. STEPS IN SPECIFIC CASES IN RAPE CASE Inform the police After taking consent, medicolegal examination and treatment given Samples for examination of blood, stains, semen, swabs, sweat, hair, nails etc preserved, sealed, labeled and sent to police under proper receipt Issue medicolegal certificate and send report as early as possible 5

  6. EXAMINATION OF PERSON ACCUSED OF SEXUAL ASSAULT Section 53A CrPC • Brought by police written and signed request • Details of examination findings • Sample preservation –Clothing/Blood/Semen sample/Pubic hairs • for DNA profiling • Opinion • Age determination Consent not required

  7. STEPS IN SPECIFIC CASES IN RAPE CASE THE CrPC 2005 AMENDMENT: Some mandatory points for examination: examined within 24 hrs after taking proper consent Always examined in presence of female Note the time of start and the time of end Always state reasons for all conclusions It is necessary to keep samples for examination of blood, stains, semen, swabs, sweat, hair, nails, DNA etc as required 7

  8. Guidelines laid down by hon’ble court A detailed description of assault/abuse history is mentioned In case of girl victim medical examination preferably by a female doctor As far as practical –psychiatrist help made available to victim Report prepared as early as possible Parents/ guardian whom child trust allowed to be present In case of results of examination are likely to be delayed the same mentioned Emergency medical treatment/prophylaxis against STD provided when necessary/HIV testing after window period After examination child permitted to wash up and provide fresh clothing if clothing is taken as evidence Samples Preserved according to guidelines –SAFE [Sexual abuse Forensic Evidence] Kit provided in Govt. hospitals CHILD ABUSE/ SUSPECTED VICTIMS OF SEXUAL ASSAULT/ABANDONED CHILDREN

  9. MEDICAL EXAMINATION OF VICTIMS OF SEXUAL ASSAULT Section 164A of CrPC • Examination only by female registered medical practitioner in case of female victims • Without delay • Consent -documented • Note down particulars • Complete history • Examination – Genital examination and injuries: • Standard protocols and guidelines • Preserve samples-DNA profiling • Emergency Contraception if required • Treatment /prophylaxis as required • Opinion

  10. Where? Specified area is defined for all such cases Emergency Department is the area where males victims MLC is prepared but sometimes may be in wards after detection of new findings

  11. COLLECTION AND PRESERVATION OF SAMPLES Gastric lavage/ vomitus in poisoning cases Blood in alcoholic/poisoning cases/drug abuse or for DNA test • Clothes in assault/injury/fire-arm/burn cases • Nail clippings in assault/rape cases • Vaginal swabs/public hair in rape cases • Swabs in un-natural sexual offence cases

  12. PREPARATION OFMEDICOLEGAL REPORT Medicolegal report (MLR) prepared immediately after the examination of a medicolegal case is done It is prepared in duplicate, preferably with a ball-point-pen, in a clear and legible handwriting Cutting/ overwriting etc avoided as much as possible and all corrections properly initialed Abbreviations of any sort avoided 12

  13. Consent in Medico legal cases CONSENT FOR MEDICOLEGAL EXAMINATION TO BE TAKEN IN WRITTEN IN ALL CASES Exception : Cases brought by police being arrested on charge of committing an offence Person below 12 years/unsound mind- consent of guardian is to be taken.

  14. Information is given only to I.O. or any person designated by I.O. If the I.O. gives requisition for any clarification regarding certain points mentioned in the report given, answer is given in writing. DOCTORS MAINTAIN CONFIDENTIALITY IN ALL MLC CASES

  15. Important issues • Psycho- social support to the victims • Need to adjust them in families • Foster families /care homes • Police protection to the victims/ family members

  16. Issues of Abused Boys • Stigma of homosexuality • Loss of freedom • Expected male role • deal with problems alone • don’t be so sensitive • be strong • allegiance

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