Throughout the nation, survivors of sexual assault can have their injuries treated and evidence collected as part of a Sexual Assault Forensic Evaluation (SAFE).  These exams, often performed by an expert Forensic Nurse Examiner, benefit those who initially report the assault to law enforcement or those who want to hold open the possibility of reporting  later.  Recognizing the confidential nature of this treatment and not wanting to burden a survivor with associated costs, states must offer these services at no cost to the patient.  In fact, it is illegal to bill a survivor’s insurance for SAFE exams.

Surprisingly, outside of sexual assault, there is no comparable provision for forensic services for intimate partner violence (IPV) survivors in Maryland.

This disparity creates many challenges for victims.  Many survivors of IPV assaults will not seek medical care or documentation because of cost barriers. There are even barriers for those who are insured. Survivors of IPV are much more likely to be on the same health insurance plan as their abuser, and seeking treatment often presents a confidentiality and safety risk if the information is not properly shielded, not to mention the cost of co-pays.  Other disincentives exist for survivors. For example, undocumented immigrants or those with conditional residency status may fear, rightly or wrongly, that their report or treatment could have unintended consequences.  A multitude of other deterrents to confidential care and documentation exist because these forensic services are not covered by the state.

To complicate matters further, law enforcement and others who know that SAFE exams are covered for sexual assault, mistakenly inform IPV survivors that their forensic exam will be free.  In cases of serious assaults, as commonly happens when strangulation is involved, SAFE Programs throughout Maryland offer IPV exams.  However, even those programs that have grant support to cover forensic services have no choice but to bill for the physician, facility, and other medical costs.  Survivors are regularly told post-assault that their trip to the hospital will be without cost only to face hefty hospital bills.

Intimate partner assaults, including strangulation, may stand alone as the only crime in which the cost for documenting evidence falls on the victim.  The Maryland Health Care Coalition Against Domestic Violence (HealthandDV.org) firmly believes that Maryland needs a fund to support forensic exams and associated costs on a par with what SAFE services offer. The option of a covered exam should be available for those who need it because of financial or safety reasons, perhaps with an option to cover co-pays and deductibles for survivors who want to bill their insurance.  Doing so will increase access to justice for survivors of IPV and, most importantly, promote critical medical care for IPV survivors who have been assaulted.

Written by:

Colleen Moore
Manager, Violence Response Team – Grace Medical Center, Lifebridge Health Center for Hope &
Past President, Maryland Health Care Coalition Against Domestic Violence