SOP 208.06-att-5: Procedure for SANE Evaluation/Forensic Collection

SOP 208.06
Attachment 5
Revised: 06-23-2022

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# Procedure for SANE Evaluation/Forensic Collection

A. Initial Report of Sexual Abuse or Assault
a. Initial notification or reporting of sexual abuse or assault will be handled in

accordance with GDC SOPs 507.04.91, 208.06 and 508.22.

i. Medical staff shall conduct an initial assessment of the offender to

determine if there is evidence of any physical trauma requiring immediate
medical intervention in accordance with good clinical judgment.
ii. Medical staff shall immediately initiate all necessary urgent/emergent

treatment for bleeding, wounds, and other traumas.

b. Nursing staff shall complete the Nursing Protocol Assessment form for alleged

Sexual Assault. This shall be filed in the nurse’s notes section of the medical
record.

c. Facility clinicians (MD/NP/PA) shall document the physical examination in the

progress notes.

d. When medically indicated, medical staff shall initiate arrangements to transfer

the offender accompanied by a qualified staff member to the designated
emergency facility for continued treatment and collection of forensic evidence.
The Urgent/Emergent and Medical PREA Log will be completed.

e. Upon return from hospital SOP 507.04.91 and 508.22 shall be followed.

B. Collection of evidence by SANE Nurse on-site
a. The following facilities have SANE Nurses assigned:

i. Small facilities shall use their assigned medical catchment State Prison for

SANE Nurse services.

b. Notification of SANE Nurse

i. Offenders must consent to a SANE examination, prior to contacting

SANE in accordance with _SOP 507.04.85 Informed Consent._
ii. If the alleged assault occurred within 72 hours of the reported incident,

and the offender does not require transport to the ER, the designated
facility SANE Nurse shall be immediately notified, and an appointment
scheduled for the collection of forensic evidence. This will occur only if
there has been penetration reported by the patient. For females and males,
this also includes oral penetration. Otherwise, no rape kit will be collected.

SOP 208.06
Attachment 5
Revised: 06-23-2022

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NOTE: The 72 hours begins at the time the alleged assault occurred.
iii. If the sexual assault occurred more than 72 hours previously, the decision

on whether the evaluation is done by a local hospital, by the SANE Nurse,
or facility staff will be made on a case-by-case basis. The decision shall be
made by the Health Authority in consultation with the Facility Investigator
in accordance with GDC PREA Policy.
iv. For sites without a designated or available SANE Nurse, a designated

catchment facility, or the SANE is not available within a reasonable time
frame, the Appointing Authority, in consultation with the Regional SAC,
shall coordinate with the Office of Health Services (OHS) to arrange for
the offender to be transported to a hospital for collection of the forensic
evidence.

c. A list of the SANE Nurse call schedule shall be posted in the medical unit along

with the physician on-call schedule and, for sites without 24-hour nursing,
designated security locations. The SANE Nurse Call Roster shall include the
SANE Nurses approved to enter the facility.

d. Once the SANE Nurse is notified, the Warden or designee shall be notified of the

date and time for the scheduled forensic assessment and collection. Date and time
of SANE Nurse notification shall be placed on the log.

e. The offender will remain in a designated area until the forensic exam is

completed. The Consent for Treatment Form will be completed consenting to the
exam by the SANE Nurse prior to scheduling the visit. *See Refusal of
Treatment. During this time the process should be explained to the offender with
confirmation they understand what to expect.

C. SANE Assessment/Forensic Collection
a. Patient Preparation

i. An exam room must be ready at the time the SANE exam is scheduled and

the SANE Nurse arrives.
ii. The patient is allowed to eat and drink if no oral penetration has occurred.
iii. If oral penetration occurred, the patient should be nil per os NPO, if

possible, until the exam is completed. If the exam does not occur within 8
hours, the patient can eat or drink as necessary. However, if the patient
cannot tolerate the NPO status, limited food and drink can be consumed
after 4 hours. This will not preclude the exam from being done. Patients
with medical conditions will be assessed for nutritional and fluid needs on
a case-by-case basis, i.e. diabetics.

SOP 208.06
Attachment 5
Revised: 06-23-2022

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iv. The patient should not change clothes or underwear, and should not

shower or brush teeth until the exam is done. The patient should be
counseled as to the reason due to the importance of not destroying
evidence.
v. If at all possible, clothes should not be removed until the SANE Nurse is

present. If clothes are removed, they should be removed with victim
standing on exam paper and all clothes must be placed in PAPER bags.
Each article of clothing must be placed in separate PAPER bags. The bags
must be sealed. The bag must also be labeled with the inmate’s name, date
and time.
vi. If no signs or symptoms of bleeding or severe trauma are present or

witnessed by medical staff, which would have required immediate first aid
intervention, no medical exam should occur until the SANE Nurse
completes the forensic exam.
vii. Medical staff should wear exam gloves at all times when
interfacing/assisting/assessing the patient until the SANE exam has been
completed.

b. Equipment

i. The SANE Nurse shall arrive with an approved SANE Kit which will

include the following:

a. Camera
b. Forensic Ruler
c. Toludine Swabs
d. 10% Acetic Acid or KY Jelly
e. Red Top Tube (Lab)
f. Pipette
g. Sterile Water Syringes (2)
h. SANE Forms
i. Goggles
_NOTE: This is subject to change_
ii. The exam room must have the following available and ready at the

scheduled time of the SANE exam:

a. All routine exam supplies, i.e. gloves, gauze pads, etc.
b. Woods Lamp/Ultraviolet light
c. Sterile Water
d. Rape Kit (make sure it is not expired)
e. Index Cards

SOP 208.06
Attachment 5
Revised: 06-23-2022

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f. Blood Tube, or similar product will be available and a rack
to hold blood tubes and for drying the swabs After the
evidence is collected.
g. Table Exam Paper
h. Paper Bags (small and large (grocery size))
i. Supplies for collection of required labs

c. Procedures

i. Lab- The following labs will be drawn:

a. Perpetrator
i. Confirm HIV status
ii. Hepatitis profile
iii. Rapid Plasma Reagin (RPR)

b. Victim
iv. HIV

v. Hepatitis profile
vi. RPR
_NOTE: All changes in HIV status will be entered into SCRIBE._

ii. Treatment: When a SANE exam is completed on site, the facility provider

or designee (i.e. On-Call provider) shall be responsible for ordering
prophylactic treatment for STIs, as well as pregnancy prophylactics if
applicable. This includes follow-up of all labs collected.

a. All necessary clinical treatment must be initiated by a clinical
practitioner; Recommendations include:

i. Female Patients

NOTE: Patients should have a pregnancy test with results
before administering medication.
ii. Coverage for GC, BV, Chlamydia and Trichomonas

_Recommended Regimens_
Ceftriaxone 250 mg IM in a single dose

PLUS
Metronidazole 2 g orally in a single dose
PLUS
Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days
iii. Patients Penicillin Allergic

Azithromycin 2 g PO
PLUS
Metronidazole 2 gms orally in a single dose

iv. MALE PATIENTS

SOP 208.06
Attachment 5
Revised: 06-23-2022

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_Recommended Regimens_
Ceftriaxone 250 mg IM in a single dose
PLUS
Metronidazole 2 g orally in a single dose
PLUS
Azithromycin 1 g orally in a single dose

iii. There shall be a follow-up visit by a clinician 3 working days following

exam.

d. Documentation Forms

i. SANE Nurses shall bring a copy of their assessment forms which they will

complete on site.
ii. Once completed, the SANE Nurse shall leave a copy of their nurses notes

which shall be filed in the medical record with the Nursing Protocol Form
for Sexual Assault.
iii. The SANE Nurse shall also leave a copy of their Forensic Exam

documentation which shall be filed in a designated locked filing cabinet in
medical administration, along with copies of the complete GDC Facility
Chain of Custody Form.
iv. These shall be retained in accordance with the medical retention schedule.

e. Chain of Custody

i. Once the rape kit is collected, required legal chain of custody shall be

followed until it is sent to the GBI lab. Until it leaves the facility it must
remain locked up.
ii. The Chain of Custody shall be from SANE Nurse to Security Shift

Supervisor or at a level above.
iii. The Security individual collecting the kit shall sign the Medical PREA

Log. All other Chain of Custody policies shall be followed including
completion of the GDC Facility Chain of Custody form. A copy of this
form shall be given to medical and attached to the completed SANE Exam
documentation left by the SANE Nurse.

f. Refusal of Treatment

i. Individuals refusing to be evaluated following a report of sexual abuse

shall be counseled regarding the medical and legal implication of
foregoing the evaluation. This shall be thoroughly documented in the
medical record and on a refusal of treatment form.

SOP 208.06
Attachment 5
Revised: 06-23-2022

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D. Referrals for MH Evaluation and Counseling
a. Referrals for MH evaluation and counseling will be done in accordance with SOP

507.04.91 and 508.22.

E. Medical PREA Log and SANE Invoice

a. The reported incident shall be entered on the PREA Medical Log. The log shall

be completed in its entirety to include the home of the victim for which forensic
evidence is being collected.

b. The Health Services Administrator (HSA) or Director of Nursing (DON) shall

forward the log electronically in a confidential manner to the Administrative
Assistant to the Director of Patient Care Services, by the 5 [th] calendar day of the
month for the previous month. The log shall be reviewed for completeness
before sending.

c. The HSA shall review all invoices for the forensic exam upon receipt. Once

verified, invoices will be forwarded to the contract vendor for processing in
accordance with current budgetary practices.