Requirements for Transfer Hospitals

Office of the Illinois Attorney General Lisa Madigan
Illinois Hospital Association
Discuss the SASETA mandates for transfer hospitals
Discuss how best to meet the immediate needs of
the sexual assault patient
Discuss the best practice for preserving evidence
Discuss the role of law enforcement in the transfer
Discuss special considerations for Critical Access
Scope of Sexual Assault
Scope of sexual assault is staggering
in 7 women in Illinois = 670,000 women
 5,620 rapes reported to Illinois law enforcement in
 The Illinois Coalition Against Sexual Assault Centers
helped 9,991 survivors of sexual assault in FY 2009
 Served
an additional 8,442 anonymously on 24-hour rape
crisis hotlines
Sexual Assault Survivors Emergency Treatment Act
Passed in 1975 (called the Rape Victims Emergency
Treatment Act)
 Mandates emergency and forensic services to sexual assault
survivors of ALL ages – overseen by the Illinois Department
of Health (IDPH)
 Establishes the statewide evidence collection program –
overseen by the Illinois State Police (ISP)
 Provides for reimbursement of costs for emergency and
forensic services and follow-up care – overseen by the
Illinois Department of Healthcare and Family Services (HFS)
SASETA Designation
SASETA administrative rules through IDPH
Requires hospitals to submit a transfer or treatment plan
every 3 years
Transfer services
Defined as “the appropriate medical screening examination
and necessary stabilizing treatment prior to the transfer of
a sexual assault survivor to a hospital that provides hospital
emergency services and forensic services to sexual assault
survivors pursuant to a sexual assault treatment plan or
area-wide sexual assault treatment plan” 410 ILCS 70/1a
 ~24 transfer hospitals in Illinois per IDPH website
SASETA Requirements
All transfers must comply with the federal
Emergency Medical Treatment and Active Labor Act
 Medical
screening examination needed
 All
unauthorized personnel (including law enforcement) shall
remain outside the examination room
 Must
be stable prior to transfer
 Use
your trauma patient protocol as a guide
First attempt to transfer to designated treatment
SASETA Requirements
Sexual assault patient shall be given an
appropriate explanation concerning the reason for
the transfer to another hospital for treatment
Emergency department staff of the transfer hospital
shall notify the receiving hospital of the transfer of
a sexual assault patient
 Patient
must consent to transfer
Transfer hospital shall offer to call a friend, family
member or rape crisis advocate to accompany the
SASETA Requirements
Receiving hospital shall
 Have
available space and staff for the treatment of a
sexual assault patient
 Agree to accept the transfer and to provide the
appropriate treatment of a sexual assault patient
 Must respond within minutes to ensure the privacy, shall
refer to the patient by code to avoid embarrassment,
and shall offer a private room
SASETA Requirements
Transfer hospital shall send a copy of the ED record
 Shall
not reflect any conclusions regarding whether a
crime occurred
 Records shall include
 Complete
ED admission form
 Clinical findings
 Nurses’ notes
 Any person present during the MSE
 Any treatment provided
 Test results
SASETA Requirements
Transfer hospital shall maintain chain-of-custody
Handle the sexual assault patient and her/his clothing
Shall not attempt to obtain any evidence specimens
If removal of clothing is necessary, attempt to remove without
cutting, tearing or shaking garments
Nothing that would be collected with the SA evidence kit (hair
combings, swabs, blood)
If any clothing or other loose possessions must be collected
as evidence
Left to dry if possible
 Placed in separate paper bags – can be placed in a larger bag
for convenience after properly sealed/labeled
 Bag(s) shall be transported with the patient
SASETA Requirements
If the patient does not have any life-threatening
conditions, may be transported to receiving hospital
by police or friend/family member
 Consent
of patient needed
If not medically stable, must be transferred by
ambulance, in accordance with EMTATLA
When to Transfer
Anytime a patient states that (s)he has been sexually
assaulted within 7 days and consents to a medicalforensic examination
SASETA rules mandate evidence collection up to 7 days
following sexual assault
It is not the healthcare professional’s role to determine
if the report of sexual assault is “valid” or to investigate
If after 7 days
Refer for medical examination
 Do not need to transfer unless a medical emergency exists
or injury is noted
How to Transfer
Triage patient
Perform a medical screening examination
 Do
not need entire patient history of the sexual assault
 Need
general information only – enough to facilitate
 Do
Who, what, when, where
not conduct a genital examination unless medically
 Do not collect evidence unless necessary
 Do not provide medication unless necessary
How to Transfer
Call receiving hospital for transfer acceptance
 Provide
Provide patient with a copy of ED record and
transfer paperwork
 Written
physician and nurse report to receiving hospital
patient consent needed
If medically stable, allow patient to be transported
by law enforcement or friend/family member
Must follow all mandated reporting requirements
Emergency Department Record
Shall not include any conclusions
Discourage the use of “Alleged Sexual Assault”
 Use
these as possible diagnosis
 Sexual
 Sexual Assault Examination
 Sexual Assault by History
 Evaluation of Sexual Assault
 Patient states…
How to Communicate
Assume that rape occurred
Use open ended questions
 Poor question: “So, you think you were raped?”
 Good question: “Please, tell me what happened.”
Avoid leading questions or questions that could indicate blame
 Do not start a question with “Why?”
If clarification needed, reflect patient’s own words back to
Allow time for answer
You are safe here
I’m sorry this happened to you
You did not deserve to be hurt
You did not ask to be hurt
The person who did this is the only one responsible
You did everything right
You are very brave
Thank you for coming to see me
I’m glad I got to meet you
We are going to get you to the right place for the best
Explain Process
Provide an explanation of why transfer is necessary
Provide an explanation of the transfer process
Provide an explanation for what to expect at the
receiving hospital
 Medical
Explain the Medical-Forensic
Six main steps of the SANE exam:
1. Obtain consent
2. History
3. Head – to – toe assessment
4. Detailed genital assessment
Only exception would be if no genital contact reported by patient
for adolescent/adult population
Evidence collection
Medication administration and discharge instructions
Evidence Preservation
Do not collect evidence unless necessary
What about allowing the patient to urinate or have a
What if clothing must be collected?
How to properly seal
Evidence bags sealed with clear tape
 Examiner labels with date and initials – on and off the tape
 Label outside of bag with patient name, date, time of collection,
examiner name and contents of bag
 Can place individually sealed bags in one large bag
Give to patient or law enforcement
Role of Law Enforcement
Mandated reporting requirements
Respond to transfer hospital
Facilitate transfer and provide transportation
Critical Access Hospitals
Staffing – Would it make sense for a Critical Access
Transfer Hospital to have a SANE on staff, as a
resource for the MDs and other nurses? How could
the SANE keep up skills?
Weather – If weather is bad and transferring the
patient may be dangerous, what should the CAH
Other concerns?
Illinois Department of Healthcare and Family Services (HFS)
oversees billing
Patients with private insurance – transfer hospital must bill
private insurance
Any monies normally covered by patient – bill the Illinois Sexual
Assault Program (co-pay, deductible, co-insurance, etc.)
Patients with Medicaid/Medicare – bill Medicaid/Medicare
Others patients – transfer hospital can utilize the Illinois
Sexual Assault Program for payment
For billing questions
Kathy Prunty at [email protected] or 217-782-3303
SASETA (Administrative Rules)
To view a listing of treatment/transfer hospitals
Shannon Liew, RN, BSN, SANE-A
SANE Coordinator
Office of the Illinois Attorney General
100 West Randolph Street, 13th Floor
Chicago, IL 60601
[email protected]
Barbara E. Haller
Illinois Hospital Association
Director, Health Policy & Regulation
1151 E. Warrenville Road
Naperville, IL 60566
[email protected]
Karen Senger, RN, BSN
Supervisor of Central Office Operations
Division of Health Care Facilities and Programs
525 West Jefferson Street, 4th Floor
Springfield, IL 62761
[email protected]

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