Current through Register Vol. 48, No. 12, March 22, 2024
a)
Every
hospital and approved pediatric health care facility providing medical forensic
services to sexual assault survivors shall comply with the federal
Emergency Medical Treatment and Active Labor Act and, as minimum
requirements for such services, provide, with the consent of the sexual assault
survivor, and as ordered by the attending physician, an APRN who
possesses clinical privileges recommended by the hospital or approved pediatric
health care facility medical staff and granted by the hospital or approved
pediatric health care facility, as authorized by the Nurse Practice Act,
or a physician assistant, the services set forth in Section 5(a-5) of
the Act and this Section. (Section 5(a) of the Act)
b) A qualified medical provider shall
provide the services set forth in Section 5(a-5) of the Act, and this
Section. (Section 5(a) of the Act)
c) Every hospital with a treatment
plan approved by the Department shall employ or contract with a qualified
medical provider to initiate medical forensic services to a sexual assault
survivor within 90 minutes after the patient presenting to the treatment
hospital or treatment hospital with approved pediatric transfer. The provision
of medical forensic services by a qualified medical provider shall not delay
the provision of life-saving medical care. (Section 5(a-7) of the
Act)
d)
A treatment
hospital, a treatment hospital with approved pediatric transfer or an approved
pediatric health care facility shall provide the following services in
accordance with Section 5(a) of the Act:
1)
Appropriate medical forensic
services without delay, in a private, age-appropriate or developmentally
appropriate space, required to ensure the health, safety, and welfare of a
sexual assault survivor and that may be used as evidence in a criminal
proceeding against a person accused of the sexual assault, in a proceeding
under the Juvenile Court Act of 1987, or in an investigation under the Abused
and Neglected Child Reporting Act. (Section 5(a-5) of the Act) Medical
forensic services shall include, but are not limited to:
A) A general physical examination;
B) Evaluation and treatment for sexually
transmitted infections in accordance with the guidelines of the Centers for
Disease Control and Prevention titled Sexually Transmitted Diseases Treatment
Guidelines, or the standards of the American College of Emergency Physicians
titled Management of the Patient with the Complaint of Sexual Assault (see
Section 545.25);
C) Evaluation and possible treatment for HIV
exposure in accordance with the guidelines of the Centers for Disease Control
and Prevention titled Sexually Transmitted Diseases Treatment Guidelines, or
the recommendations titled Antiretroviral Postexposure Prophylaxis After
Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV in the
United States, or the standards of the American College of Emergency Physicians
titled Management of the Patient with the Complaint of Sexual Assault. Testing
for HIV shall be conducted in accordance with the AIDS Confidentiality Act;
and
D) Pregnancy test for females
of childbearing age;
2)
An offer to complete the Sexual Assault Evidence Collection Kit for any
sexual assault survivor who presents within seven days after the
assault,
who has disclosed past sexual assault by a specific
individual and was in the care of that individual within the last seven
days, or who has a clinical indication for medical forensic services
beyond seven days. Nothing in the Act or this Part prevents a treatment
hospital or a treatment hospital with approved pediatric transfer from offering
to complete the Sexual Assault Evidence Collection Kit for any sexual assault
survivor who presents more than seven days after the assault;
A)
Appropriate oral and written
information concerning evidence-based guidelines for the appropriateness of
evidence collection, depending on the sexual development of the sexual assault
survivor, the type of sexual assault, and the timing of the sexual assault,
shall be provided to the sexual assault survivor. A qualified medical
provider shall educate and encourage prepubescent sexual assault
survivors who present to a hospital or approved pediatric health care facility
with a complaint of sexual assault within 96 hours after the sexual
assault to agree to evidence collection (however, the seven-day period
in subsection (d)(2) still applies);
B) The information required under
this subsection (d) shall be provided in person by the
qualified medical provider providing medical forensic services directly to the
sexual assault survivor (Section 5(a-5) of the
Act);
C)
The written information provided shall be the information created in
accordance with Section 10 of the Act (Section 5(a-5) of the
Act);
D)
Following the discussion regarding the evidence-based guidelines for
evidence collection in accordance with subsection (d)(2)(A),
evidence collection shall be completed at the sexual assault survivor's
request. A sexual assault nurse examiner conducting an examination using the
Sexual Assault Evidence Collection Kit may do so without the presence or
participation of a physician. (Section 5(a-5) of the Act)
3)
Appropriate oral and
written information concerning the possibility of infection, sexually
transmitted infection, including an evaluation of the sexual assault survivor's
risk of contracting human immunodeficiency virus (HIV) from sexual assault, and
pregnancy resulting from sexual assault (Section 5(a-5) of the
Act);
4)
Medically and
factually accurate written and oral information about emergency contraception;
the indications and contraindications and risks associated with the use of
emergency contraception; and a description of how and when sexual
assault survivors may be provided emergency contraception at no cost
upon the written order of a physician, a licensed APRN, or a licensed physician
assistant (Section
2.2(b) of the
Act);
5)
Appropriate oral
and written information concerning accepted medical procedures, laboratory
tests, medication, and possible contraindications of that medication available
for the prevention or treatment of infection or disease resulting from sexual
assault (Section 5(a-5) of the Act);
6)
After a medical forensic
or physical examination, access to a shower at no cost, unless
showering facilities are unavailable (Section 5(a-5) of the
Act);
7)
An amount of
medication, including HIV prophylaxis, for treatment at the hospital or
approved pediatric health care facility and after discharge as is deemed
appropriate by the attending physician, an APRN, or a physician assistant in
accordance with the Centers for Disease Control and Prevention
guidelines in Section
545.25(b)(1) and
(2), and consistent with the
hospital's or approved pediatric health care facility's current approved
protocol for sexual assault survivors. (Section 5(a-5) of the Act)
When HIV prophylaxis is deemed appropriate, an initial dose or doses of HIV
prophylaxis, along with written and oral instructions indicating the importance
of timely follow-up health care, shall be given to the survivor;
8)
Photo documentation of the sexual
assault survivor's injuries, anatomy involved in the assault, or other visible
evidence on the sexual assault survivor's body to supplement the medical
forensic history and written documentation of physical findings and evidence.
Photo documentation does not replace written documentation of the
injury. (Section 5(a-5) of the Act);
9)
Written and oral instructions
indicating the need for follow-up examinations and laboratory tests
one to two weeks after the sexual assault to determine the presence or
absence of sexually transmitted infection (Section 5(a-5) of the
Act);
10) Appropriate referral to a
physician. The survivor shall be referred for follow-up health care and
monitoring of medication given or prescribed at the time of the initial
hospital or approved pediatric health care facility medical forensic services
visit as may be deemed appropriate by the attending physician, APRN, or
physician assistant;
11)
Referral by hospital or approved pediatric health care facility
personnel for appropriate counseling. (Section 5(a-5) of the Act)
Initial referral should be to a community-based rape crisis center, if a center
is available, or referral to other counseling shall be provided;
12)
Medical advocacy services
provided by a rape crisis counselor whose communications are protected under
Section 8-802.1 of the Code of Civil Procedure, if there is a memorandum of
understanding between the hospital or approved pediatric health care facility
and a rape crisis center. With the consent of the sexual assault survivor, a
rape crisis counselor shall remain in the exam room during the medical forensic
examination (Section 5(a-5) of the Act);
13)
Written information regarding
services provided by a children's advocacy center and rape crisis center, if
applicable (Section 5(a-5) of the Act);
14) The brochure "After Sexual Assault",
published by the Illinois Coalition Against Sexual Assault and the Illinois
Department of Public Health, and the pamphlet "Crime Victim Compensation -
Frequently Asked Questions by Sexual Assault Victims", published by the
Illinois Office of the Attorney General;
15) Information on drug- or
alcohol-facilitated sexual assault testing, including an explanation of the
comprehensive scope of a drug test or blood alcohol test, and the limited time
frame within which evidence can be collected; and
16)
Written information regarding the
Illinois State Police sexual assault evidence tracking system, as
provided in Section 545.61. (Section 5(a-5) of the
Act)
e)
Records
of medical forensic services, including results of examinations and tests, the
Illinois State Police Medical Forensic Documentation Forms, the Illinois State
Police Patient Discharge Materials, and the Illinois State Police Patient
Consent: Collect and Test Evidence or Collect and Hold Evidence Form, shall be
maintained by the hospital or approved pediatric health care facility as part
of the patient's electronic medical record.
1)
Records of medical forensic
services for sexual assault survivors under the age of 18 shall be retained by
the hospital or approved pediatric health care facility for a
period of 60 years after the sexual assault survivor reaches the age of 18.
Records of medical forensic services of sexual assault survivors 18 years of
age or older shall be retained by the hospital for a period of 20 years after
the date the record was created.
2)
Records of medical forensic
services may only be disseminated in accordance with Section
6.5 of the Act, Section
545.61 of this Part, and
other State and federal law. (Section 5(a-5) of the Act)
f)
Any person who is a
sexual assault survivor who seeks medical forensic services or follow-up
healthcare under the Act shall be provided those services without the consent
of any parent, guardian, custodian, surrogate, or agent. If a sexual assault
survivor is unable to consent to medical forensic services, the services may be
provided under the Consent by Minors to Health Care Services Act, the Health
Care Surrogate Act, or other applicable State and federal laws.
(Section 5(b) of the Act)
g) The
hospital or approved pediatric health care facility shall develop a
uniform system for recording results of medical examinations and all
diagnostic tests performed in connection with the examination
to determine the condition and necessary treatment of sexual assault
survivors. The results shall be preserved in a confidential
manner as part of the hospital's or approved pediatric health care facility's
record of the sexual assault survivor. (Section
6.1 of the Act) The medical
record shall include the information required in this subsection (g):
1) The medical record shall indicate if the
sexual assault survivor changed clothes, bathed or douched, defecated,
urinated, ate, smoked, or performed oral hygiene between the time of the sexual
assault and the time of the examination.
2) The medical record shall indicate presence
of all indications of trauma, major or minor, that may be used in a criminal
proceeding (e.g., cuts, scratches, bruises, red marks, any minor signs of
trauma). Photographs of indications of trauma may be taken for evidentiary
purposes with the written consent of the sexual assault survivor or the
survivor's parent or guardian if the survivor is under 13 years of age. If the
survivor is under 13 years of age and the parent or guardian is not immediately
available, photographs may be taken and shall be released to law enforcement
personnel and state's attorney staff with written consent of a parent,
guardian, or law enforcement officer, or the Department of Children and Family
Services.
3) The medical record
shall not reflect any conclusions regarding whether a crime (e.g., criminal
sexual assault, criminal sexual abuse) occurred.
4) Medical history shall include brief,
general information concerning possible injury; drug allergies; and, for female
patients, a detailed gynecological history, including whether the patient knows
or believes that she is pregnant, history of prior gynecological surgery such
as hysterectomy or tubal ligation, history of contraceptive use, history of
cancer, and any prior genital injury or trauma.
5) The medical record shall indicate the
presence of any and all persons during the examination process. If a medical
advocate from a rape crisis center is present, the medical advocate may be
listed by first name only, so long as the full name of the rape crisis center
is listed in the record.
6) The
medical record shall document the compliance with each procedure required by
subsection (i).
7) The medical
record shall indicate whether a report was filed with the Department of
Children and Family Services, or whether the Department on Aging or the
Department of Public Health was contacted.
8) The medical record shall include a
completed emergency department record.
9) The medical record shall indicate whether
the Sexual Assault Evidence Collection Kit was completed.
h) All medical records for sexual assault
survivors shall be maintained through a filing system that allows for immediate
accessibility during Department surveys. This filing system may be maintained
electronically.
i) Procedures to
ensure the welfare and privacy of the survivor shall be followed and shall
include, but not be limited to, the following:
1) A member of the health care team shall
respond within minutes to move the survivor to a closed environment to ensure
privacy. Health care personnel shall refer to survivors by code to avoid
embarrassment.
2) If, for any
reason, the survivor is incapable of receiving oral and written information
required in subsection (a), the information shall be given to the
caregiver/guardian.
3) When a
survivor is in custody, or has been arrested for or convicted of a violent
crime or forcible felony and continues to be in custody when the survivor
presents for the medical forensic exam, then if the qualified medical provider
and the representative of the custodial agency, after consultation with the
rape crisis advocate, agree that it is a necessary safety precaution, the
representative of the custodial agency may remain in the room. In these
situations, hospital staff shall facilitate privacy for the survivor using
curtains and positioning.
4) The
hospital or approved pediatric health care facility shall call a sexual assault
crisis advocate, where available, and shall offer to call a friend or family
member to accompany the survivor.
j)
When a minor is the victim of a
predatory criminal sexual assault of a child, aggravated criminal sexual
assault, criminal sexual assault, aggravated criminal sexual abuse or criminal
sexual abuse, as provided in Sections 11-1.20 through 11-1.60 of the Criminal
Code of 2012, the consent of the minor's parent or legal guardian need not be
obtained to authorize a hospital, approved pediatric health care
facility, physician, chiropractic physician, optometrist, APRN,
physician assistant, or other medical personnel to furnish medical care or
counseling related to the diagnosis or treatment of any disease or injury
arising from the offense. The minor may consent to counseling, diagnosis or
treatment as if the minor had reached his or her age of majority. This consent
shall not be voidable, nor subject to later disaffirmance, because of
minority. (Section 3(b) of the Consent by Minors to Health Care
Services Act)
k) All hospitals or
approved pediatric health care facilities that provide emergency medical
services to sexual assault survivors shall comply with the Crime Victims
Compensation Act, the Consent by Minors to Health Care Services Act and any
local ordinances, municipal codes, rules, or regulations that may apply to the
treatment of sexual assault survivors.
l) All hospitals or approved pediatric health
care facilities shall comply with the reporting procedures for sexual assault
survivors required by Section
3.2 of the Criminal
Identification Act.
m)
Nothing in this Section creates a physician-patient relationship that
extends beyond discharge from the hospital or approved pediatric health care
facility. (Section 5(c) of the Act)
n) The hospital or approved pediatric health
care facility shall take all reasonable steps to secure the patient's informed
written decision to consent to or decline examination and treatment.
o) Nothing in the Act or this Part prohibits
a treatment hospital, a treatment hospital with approved pediatric transfer, or
an approved pediatric health care facility from treating a sexual assault
survivor who presents more than seven days following the assault.