38,947 rape cases were registered in India in 2016 (data from National Crime Records Bureau). That translates into 106 rape cases every-day or about 4-5 rapes every hour. The data also shows that incidence of rapes is on rise. On the other hand, the conviction rate in rape cases is just 25.5%, as of 2016, which is a reduction from 29.4% of the previous years. With such low conviction rate, the heinous crime of rape is difficult to be contained. One of the biggest reason for low conviction rate is the insufficiency of evidence due to poor quality of medical examination of rape victim. Many doctors and hospitals are not updated and prepared for proper examination of rape victim. Doctors and hospitals can play a big role in increasing the conviction rate in rape cases, thus reducing the number of rape cases occurring in our country. This post is intended to make hospitals aware about how to properly handle the medical examination of rape victims. The detailed protocol of medical examination, as issued by Government of India can be accessed here.
Purpose of examining a rape victim at hospital
The purpose of examining a rape victim are following1. Collecting evidences from the victim’s body and belonging
2. Forming an opinion on
a. Whether a sexual act has been attempted or completed
b. Whether such sexual act is recent
c. Whether any harm has been caused to survivor’s body
3. Verifying the age of survivor, in case he/she is adolescent
4. Recording the findings
5. Providing necessary medical support and emergency care to the victim
The purpose is not to opine whether ‘rape’ happened or not. ‘Rape’ is a legal term and can be decided only by a court of law. As far as the medical examination is concerned they just have to give the findings and opinion related to the sexual act.
When is medical examination initiated
The rape survivors’ examination shall be initiated· When asked by a law enforcing agency such as police, or
· When requested by the rape survivor herself.
The medical examination can be started irrespective of whether FIR has been filed or not. FIR can be filed by the victim, after medical examination.
In case where the doctor suspects an incident of rape on his/her patient, the doctor can suggest her for getting a medical examination do an FIR. However, if the patient doesn’t agree to the same, no MLC can be filed and no medical examination shall be done. Agreement of survivor is necessary for initiating medical examination even when asked by police.
Who should perform the examination and who can be allowed to be present
As per guidelines of MoHFW· Examination of a rape survivor can be done by any registered medical practitioner. It is preferable to have a Gynaecologist for examining such cases but not mandatory.
· It is also preferable that such examination be done by a female doctor. However, in absence of any female doctor the examination can be done by a male doctor, in the presence of a female attendant.
· In case of a minor or person with disability, his/her parent/guardian or any other person with whom the survivor is comfortable may be present during examination.
· In case of a transgender, the survivor’s choice regarding gender of doctor should be taken.
· If the survivor request, her relative may be present while the examination is done
· Police personnel must not be allowed in the examination room during the examination process
Arrangements and preparation to be done by hospital
· Designate doctors who can conduct medical examination. Such doctors shall be preferably female Gynaecologist, however, not mandatory· Designate staff nurses who will assist the doctor during examination
· Identify the room where such examination can be conducted. The room shall be separate and accord full privacy during the examination. There shall be adequate waiting space for relatives accompanying the survivor.
· Spare clothes shall be available in hospital and shall be given to the survivor if her clothes are taken as an evidence
· A Psychologist shall be available or arranged whenever required for providing counselling or psychological support to survivor
· Staff involved in examination shall be oriented or trained on behavioural aspects
· Availability of the complete medical examination kit, as given below.
o Informed consent form
o Paper Envelopes (15-20 per kit)
o Sterile swabs and swab guards
o Bags for storing clothes
o Catchment Papers
o Comb
o Nail Cutter
o EDTA vacutainer
o Plain vacutainer
o Sodium fluoride vacutainer
o Syringe and needle
o Distilled water
o Disposable Gloves
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o Torch
o Microscope
o Colposcope
o Disposable Speculum
o 2% 30 gm tube of sterile lignocaine jelly
o Cytofix spray
o Surgilube
o Spirit Lamp
o Toluidine Blue
o Polaroid camera
o UPT Kit
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Steps for conducting medical examination:
The detailed procedure for conducting medical examination can be learnt through this video. The steps involved in medical examination are1. Counselling and psychological support to the survivor – This can be done by trained staff nurse or by a counsellor
2. Taking informed consent – It is mandatory to obtain consent from survivor. She should be explained about the procedure and why is it necessary to get medical examination done. In case she refuses, medical examination shall not be conducted and refusal shall be documented. In case the survivor is less than 12 years or not mentally stable, consent shall be taken from parent/guardian.
3. Obtaining general information (name, age, sex, contact, FIR etc. )
4. Obtaining of medical history
5. Obtaining of sexual assault history
6. Collection of forensic evidence from body parts, clothing etc.
7. General examination of the survivor
8. Genital examination
9. Age determination, in case the survivor is a minor
10. Sending swabs collected for lab tests
11. Forming an opinion
12. Completing documentation, signature and seal and handing over a copy to legal authorities
Other care that shall be taken
1. If required survivor shall be given first aid or emergency treatment before examinthe ation2. As a health service, survivthe or shall also be assessed for any sexually transmitted disease, such as Gonorrhoea and also and treatment shall be recommended
3. The recording of examination shall be meticulously done and a copy of record the shall be carefully stored in hospital
4. All evidences collected shall either be stored safely or handed over to police on request
5. All materials handing over to police shall be recorded and an acknowlgement of the same shall be taken
6. For hospitals where such examination happens frequently a rev,iew of the process shall be done for improvement
