Denise Picard-Stencer says she hopes more sexual assault victims will come forward once the Hawkesbury General Hospital’s new Sexual Assault and Partner Abuse Care program is up and running.

“Now they’ll have a venue to get help,” says Picard-Stencer, vice-president of patient care and chief nursing executive.

Last September HGH announced it received an initial $221,000 for 2016-2017, with a subsequent $330,000 annually beginning this year for the new program and would implement it in early 2017.

However, the program hasn’t yet started. Picard-Stencer says that’s mostly because construction of the new emergency department isn’t finished.

The program will have a designated room away from the hustle of the emergency department to help keep the person in a calm environment.

“Once we get some more confirmed dates, if it’s too far in the year, we will look at an alternative in our existing space,” she adds. “We’re very anxious to provide those services to our patients and as soon as we can, we will.”

In the meantime, Picard-Stencer says they’ve recruited a social worker and nurse practitioner, which form the core team for the program.

“The two members of the team have been meeting with external partners,” says Picard-Stencer. “The idea is not to duplicate, resources are limited, we want to complement each other, collaborate with each other and ensure the patient’s needs are being met by the right agency, the right person at the right time.”

Program overview

A large part of the new program is introducing Sexual Assault Evidence Kits, which collect forensic evidence that can be used in an investigation. They can be used up to 72 hours after the assault took place.

Currently, sexual assault victims who come forward need to be brought to either Cornwall or Ottawa for this type of examination.

The kits allow healthcare professionals to collect DNA to try and link the assault to the perpetrator. They can also take photos to record bruising, abrasions or other physical indicators.

Picard-Stencer says the program is dedicated to more than collecting evidence.

“It’s comprehensive, holistic care that we’ll be providing,” she says. The social worker will be working closely with community partners to ensure care after the patient has left the hospital.

While Picard-Stencer says there are very few sexual assault victims currently walking through the hospital doors, she suspects that’s because the program isn’t there yet.

When asked if she expects there to be a significant increase in the number of sexual assault victims going to the hospital, she says, “from what I’m being told by the crown attorney, yes, unfortunately.”

Another large part of setting up the program is all the training involved. Picard-Stencer says emergency nurses were trained over three weeks between January and February on using the kit and the “trauma aspect of the care.”

When medicine and the law overlap

The intersection of law and medicine brings with it many grey areas. Picard-Stencer says some of the training still has to address these areas; for example, staff could be called on to testify in court.

And here’s another grey area: A patient suspected of having been sexually assaulted is brought in, but they’re unconscious and cannot consent to having the kit done. What happens?

When The Review spoke with Picard-Stencer, she said policies around the program are still in the works and didn’t want to comment on specifics.

“Certainly what we would do is follow the standards, and follow the patient’s rights, and best practices,” she says.

The Ontario Network of Sexual Assault/Domestic Violence Treatment Centres waded into the uncertainty the above scenario poses.

“The moral and ethical dilemma is trying to determine what the person would want if she/he had the capacity to make her/his own decision,” it wrote in its Guidelines for the Collection of Forensic Evidence From the Person Who is Unable to Provide Consent.

The document outlines questions like, what is the harm in telling the victim the assailant is not identifiable because no evidence was collected at the time? Would they feel violated if forensic evidence was collected and that was not what was wanted?

The guidelines explain under the Health Care Consent Act, medical staff can treat a patient unable to consent if there is an emergency that causes severe suffering and if a “substitute decision-maker” is unavailable or if they are “refusing consent in violating (sic) of the best interest decision-making rules contained in the legislation.”

However, there are no similar rules when it comes to the legal role of medically-collected evidence. And the Sexual Assault Evidence Kit isn’t considered treatment, therefore isn’t covered by the Health Care Consent Act.

To be clear, having the kit done does not automatically lead to a police investigation. Once the person regains capacity, they can decide whether or not to go forward with an investigation.

The guidelines highlight other factors as well, including the estimated time frame the person may regain the ability to consent (are they impeded by alcohol, trauma VS having a long-term mental disability); are there reasonable grounds to conclude there was a sexual assault (Are police involved? Are there any witnesses?); the wishes of family and/or substitute decision-makers.

“All must be balanced in determining whether or not evidence should be collected,” conclude the guidelines.