It's tough enough for rape victims to come forward. Now there's another reason for them to think twice about reporting the crime: They may get stuck with a hefty bill for the rape kit used to collect evidence against their attacker.
Talk about adding insult to injury. In a story last week in the Raleigh News & Observer, reporter Mandy Locke described the situation in North Carolina, where "the vast majority of the 3,000 or so emergency room patients examined for sexual assaults each year shoulder some of the cost of a rape kit test." A state victims compensation fund intended to help cover the bills is woefully underfunded and had capped payouts for the $1,600 test at $1,000. Since Locke's story ran, "The cap has been lifted," says North Carolina Department of Crime Control and Public Safety spokesperson Patty McQuillan, though she noted that the legislature would still have to provide the additional funds.
Chalk one up for the power of the press to shine a bright light into dark corners and encourage change. But the News & Observer story made me wonder—just how big and dark is this particular corner? Is this a national phenomenon or is the practice limited to one state?
Turns out experts on sexual assault are all too familiar with the issue. "It's been a problem for a long time," says Ilse Knecht, deputy director of public policy at the National Center for Victims of Crime. "We've heard so many stories of victims paying for their exams, or not being able to and then creditors coming after them." In order to qualify for federal grants under the Violence Against Women Act, states have to assume the full out-of-pocket costs for forensic medical exams, as the rape kits are called. But according to a 2004 bulletin published by the NCVC, "[F]eedback from the field indicates that sexual assault victims are still being billed." Knecht says she's recently heard from caseworkers in Illinois, Georgia, and Arkansas reporting that rape victims continue to be charged for their forensic exams.
The rape kit itself generally contains bags to collect clothing, test tubes for collecting blood, swabs for fluid, and a comb to collect pubic hair. Small-change stuff. But exams also involve administering tests for pregnancy, HIV, gonorrhea, and syphilis, and that's where the costs add up, says Randall Brown, medical director for the Baton Rouge Rape Crisis Center in Louisiana.
How forensic exam costs are handled varies. In some locations, hospitals bill patients' insurance and absorb whatever the insurers don't pay or bill patients for the balance. Some states have special funds to cover a portion of the costs. Others require convicted offenders to pay into a fund to reimburse the costs of the exams.
No one I spoke with tried to defend the practice of billing rape victims for their exams. Predictably, people cited a host of problems—from bureaucratic inefficiency to chronic underfunding of victim compensation funds—that partially explain but don't excuse it. Ironically, the nature of rape may actually make it more likely that victims will be billed for the evidence-gathering exam. Unlike a break-in, where police gather forensic evidence at the victim's home and send it directly to the crime lab, in rape the victim's body is the scene of the crime. In these cases, "there's a crossover between medical care and forensic care," says Brown.
Fair enough. Processing the evidence of a rape is complicated. But unless we can do a better job ensuring that rape victims don't have to pay for that evidentiary exam, we're victimizing them all over again.