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Turning Away Rape Victims

September 28, 1987

Your article on hospital emergency rooms turning away rape victims (Part I, Sept. 19) correctly identifies problems for the victims exacerbated by the new state protocols. However, the article places undue emphasis on financial concerns as a hospital's reason for not performing rape evidentiary exams. And it did not mention problems caused for other patients waiting to be seen in an emergency department when a rape victim is present.

I work in a large urban medical center whose administration wants to perform this service. However, it is opposed nearly unanimously by the emergency physicians.

We see a volume of 120 patients per day with a staffing of 38 physician hours. Caring for an average of three new patients per hour, we are extremely busy.

To evaluate and treat a rape victim for medical problems takes about 20 minutes. This can and should be done by physicians in every hospital emergency room. It is, however, the evidentiary aspect of further examination which causes problems. Here the physician and staff are asked to spend several hours, no longer for medical evaluation and treatment, but in forensic collection for the district attorney.

What do I say to the other patients who come in with acute medical problems like chest pains, difficulty in breathing, fractures or lacerations while I am tied up collecting evidence? How do I get caught up?

The inevitable consequence of doing one complete rape exam is keeping a dozen sick people waiting for emergency care, and having some of those people give up and leave untreated. Or, I can see the acutely ill patients, and keep the rape victim waiting an unconscionable period of time. It is a no-win situation.

The answer to the problem lies in mobilizing resources other than the traditional hospital emergency room personnel to perform the evidentiary examination.

A team of nurse practitioners trained as specialists to do rape examinations, employed on a regional basis, is an excellent solution.

If the state would spend the money to fund rape examination teams of nurse practitioners, it would get better evidence, and would lessen the trauma on the victims and on the health care facilities which care for them.

RICHARD GELLER, M.D.

Fresno

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