TEXAS EVIDENCE COLLECTION PROTOCOL

The Texas Evidence Collection Protocol (TECP), updated in 2022, guides healthcare providers who are conducting forensic medical assessments for patients who report sexual assault and addresses the roles of the multidisciplinary team to provide a trauma-informed, patient-centered response. The protocol is an excellent reference and is available online (see “Resources” at the end of this course).

Key Points of the TECP

Following are key points from the protocol:

1. Sexual assault is a trauma, regardless of the presence of physical injuries. Healthcare providers can help reduce the neurobiological response to trauma by providing trauma-informed care that restores safety, security, and control to patients.
2. Treat emergent medical conditions before, or concurrently to, addressing forensic issues such as evidence collection.
3. Nonfatal strangulation is a life-threatening event that requires specialized assessment and close patient monitoring.
4. Patients guide the assessment process and have the right to decline any part, or all, of the examination and evidence collection.
5. Use open-ended questions that allow patients to provide their narrative of what occurred.
6. In all patient interactions, it is important to maintain confidentiality of forensic medical information and documentation. The Health Insurance Portability and Accountability Act (HIPAA) applies to this patient population.
7. Offering access to a sexual assault advocate during the forensic medical assessment is mandated by Texas law. This advocate is distinct and separate from healthcare, law enforcement, and judicial personnel.
8. Mandatory reporting is required for suspected abuse of children, older adults, or a person with a disability, regardless of the wishes of the patients, their families, or friends.
9. Two types of patients—children and suspected perpetrators—should always be seen by a forensic expert (sexual assault nurse examiner, forensic nurse examiner, child abuse pediatrician, or specially trained medical forensic professional). Children should also be seen in a child advocacy center.
10. Suspected perpetrators should always be seen by a forensic expert and care must be taken to keep suspected perpetrators separated from survivors for psychological and physical safety reasons.
11. During the examination and evidence collection process, avoid contamination of potential evidentiary items. After all the evidence and clothing have been collected by the healthcare provider, labeled, and sealed appropriately, evidence should be opened only by crime laboratory personnel.
12. All patients should receive person-first, culturally responsive, trauma-informed, quality, and unbiased healthcare.
13. It is critical that adult military-affiliated survivors receive information about their reporting options from a person knowledgeable of the Department of Defense policy that defines reporting.
14. Policies should be in place regarding the process for obtaining photographs; the method used to identify the patient in the photographs; and documentation that the photographs exist in the permanent medical record for each patient.
15. All patients are entitled to a medical forensic examination (Texas Code of Criminal Procedure §56).
16. Adult patients who do not meet mandatory reporting criteria may choose to have sexual assault evidence collected without reporting to law enforcement (Texas Health and Safety Code §323).
17. A sexual assault evidence collection kit should be used only when indicated, as described in Subchapter F (Texas Code of Criminal Procedure §42).
    (Texas A&M, 2022)

Types of Sexual Assault Forensic Exams

The TECP describes the following types of sexual assault forensic exams:

• Adults (18 years and older). Evidence may be collected up to 120 hours after an assault. Adult patients have the option of requesting that evidence be collected with or without law enforcement involvement. The option for an exam without law enforcement involvement is referred to as a nonreport exam.
• Military adults. The military offers a “restricted” nonreporting exam option. Military survivors have legal options that are exclusive to the military system. In order to preserve the patient’s privacy rights within the military justice system, it is best to ask the patient to talk to an advocacy representative from the Department of Justice.
• Adolescents. Adolescents are defined as children under the age of 18 who have reached puberty. Mandatory reporting requirements apply to this group, and an adolescent may consent to the exam without a parent or guardian’s permission. A minor who is at least 16 years of age may decline any part or all of an exam.
• Children (under the age of 18). Exams of these patients should be conducted by a skilled and certified sexual assault examiner. Pediatric exams to collect evidence are done within 120 hours of an event, but another type of exam may be done for children who report abuse beyond 120 hours. Mandatory reporting requirements apply to this group. A child of any age may withhold their assent for a procedure.
• Elders (age 65 and over) and adults with disabilities should be examined by a certified sexual assault examiner. They may consent to an exam without a conservator’s permission (if applicable). Mandatory reporting applies to these groups.
• Suspect exams. Exams of suspected perpetrators of sexual assault should be conducted by someone who has specialized training.