Publicly Released: September 11, 2023
Objective
The objective of this audit was to determine whether DoD medical treatment facilities triaged sexual assault victims with priority treatment as emergency cases, offered to perform Sexual Assault Forensic Examinations (SAFE), and notified support services, in accordance with Federal and DoD policies. In March 2021, the Acting Assistant Secretary of Defense (Health Affairs) (ASD[HA]) suggested that we review this topic.
Background
DoD guidance requires emergency department (ED) providers to:
• provide sexual assault victims with priority treatment as emergency cases;
• offer a SAFE to sexual assault victims; and
• immediately notify a Sexual Assault Response Coordinator (SARC), Sexual Assault Prevention and Response Victim Advocate (SAPR VA), or Family Advocacy Program (FAP) clinical provider when a victim discloses a sexual assault.
Findings
ED providers did not assign consistent triage levels for sexual assault victims who received care during FY 2021. Specifically, the DoD did not assign consistent triage levels for 43 out of the 209 sexual assault victims we reviewed. We project that the DoD did not assign consistent triage levels for 124 (20 percent) of the 630 sexual assault victims. See the Appendix for more details on the projections. The DoD did not assign consistent triage levels because DoD guidance does not prescribe a specific or minimum triage level for sexual assault victims. The assignment of inconsistent triage levels could result in sexual assault victims not receiving timely medical care and critical support services at DoD medical treatment facilities, which could prolong the physical and emotional harm experienced by those victims.
Also, ED providers did not consistently document triage levels, SAFE offers, or notification information for sexual assault victims who received emergency care at medical treatment facilities during FY 2021. Specifically, ED providers did not document triage levels for 25 victims; SAFE offers for 32 victims; and notification of SARC, SAPR VA, or FAP clinical providers for 34 out of 209 victims. We project that the DoD did not document triage levels for 82 victims (13 percent); SAFE offers for 96 victims (15 percent); and notification of SARC, SAPR VA, or FAP clinical providers for 108 victims (17 percent) of the 630 sexual assault victims.
The ED providers did not document care because the ASD(HA) did not require it. As a result, neither the ASD(HA) nor the SAPR Office can verify whether ED providers gave sexual assault victims access to needed care and services.
Recommendations
We recommend that the ASD(HA) conduct a study concerning triage levels for sexual assault victims, including a review of industry standards, and revise DoD guidance to prescribe a specific triage level for sexual assault victims or a minimum level that meets the requirements for priority and uniformity. We also recommend that the ASD(HA) revise guidance to require ED providers to document the triage level, SAFE offers, and notification information for sexual assault victims in the victim’s medical record. The ASD(HA) should develop a process to review and ensure that ED providers implement and consistently apply the new guidance on assigning triage levels and documentation requirements for sexual assault victims.
Management Comments and Our Response
The ASD(HA) agreed or partially agreed with the recommendations and described actions planned to resolve two of the five recommendations; therefore, two recommendations are open and resolved, and three recommendations remain unresolved.
We request that the ASD(HA) provide additional comments within 30 days in response to the final report.
This report is a result of Project No. D2022-D000AW-0031.000.