Improving the Justice System Response to Sexual Offences: Report (html)

16. Forensic medical examinations

Overview

• Forensic medical examinations can play a part in improving evidence in the criminal justice system.

• There is an urgent need to invest in more access to forensic medical examinations, especially in rural and regional areas and for children and young people.

• This should be a priority for the Sexual Assault Strategy.

• Nurses should be used to conduct examinations more than they are now, to expand access to forensic medical examinations.

• People should be able to request the gender of the forensic medical officer.

• There should be more access to ‘just in case’ forensic medical examinations, which do not require reporting to police, as is common elsewhere in Australia and across the world.

Forensic medical examinations are an important part of sexual offence cases

16.1 The private nature of most sexual offending means there is often not much physical evidence. However, in cases of recent sexual assault, there may be evidence from the body or clothing of the person assaulted (for example, body fluids, fibres, and physical injuries).[1]

16.2 A forensic medical examination can be used to collect this evidence. Examinations have two purposes: providing appropriate medical care (for example, to deal with injuries) and collecting forensic medical evidence.[2]

16.3 In some cases, an early evidence kit can be used instead, followed by an examination. This is a kit that a victim survivor can use themselves to capture samples so that they can do things such as showering or drinking before a full examination, but it is not an alternative to a full examination.[3]

16.4 The experience of an examination can be distressing. However, it can also play a therapeutic role by, for example, enabling people to feel that they have done something to get justice, or that they are believed, and their decisions respected.[4] Some research indicates that people believe undergoing such examinations will make it easier to get justice, although it is unclear how much this influences their decision making.[5]

16.5 Getting a forensic medical examination does not always mean that someone will get the justice they deserve. It is not a choice that everyone can or will make. Yet, for too many people, it is a choice that they cannot make, because these examinations are not accessible to everyone who may benefit. Even for those who can make that choice, the experience of an examination can sometimes be traumatic rather than therapeutic.

How do forensic medical examinations work?

16.6 In Victoria, forensic medical examinations of adults are conducted by the Clinical Forensic Medicine team within the Victorian Institute of Forensic Medicine (VIFM). The VIFM is an independent authority,[6] and its examinations are conducted under an agreement for services with Victoria Police.[7] (We discuss its governance in Chapters 4 and 5.)

16.7 The Clinical Forensic Medicine team includes doctors (Forensic Medical Officers) and nurses (Forensic Nurse Examiners). The VIFM also has specialists to provide specialist clinical advice. In 2018–19, 69 per cent of forensic medical examinations were conducted by female staff.[8]

16.8 Seventeen per cent of forensic medical examinations were conducted by registered nurses (mostly in regional areas). The VIFM told us that it was ‘actively reviewing’ how to increase the use of forensic nurses in sexual assault examination services.[9] Sexual assault nurse examiners have been used in the United States for three decades, and have long been used in New South Wales.[10] They have been a key focus for improving access in other countries by expanding the pool of people who can conduct examinations, especially in regional areas.[11]

16.9 Under the agreement between the VIFM and Victoria Police, set out in the Code of Practice, Victoria Police typically requests an examination in cases of recent sexual assaults (within 72 hours of the assault).[12]

16.10 The VIFM practitioners are also involved in medical investigations of sexual assaults that result in death. It provides services in relation to alleged offenders who are children. The VIFM provides opinion reports to police, including on how to interpret injuries, and may give expert evidence in trials.[13]

16.11 Forensic medical examinations of adults take place at 20 examination sites across Victoria, including crisis care units (CCUs) and multi-disciplinary centres (MDCs, discussed in Chapter 5). CCUs are located at hospitals, while MDCs are specialist centres for sexual assault that also include police and sexual assault counsellors.

Table 16 lists the places where examinations took place in 2018–19.[14]

16.12 During coronavirus (COVID-19) restrictions, the VIFM changed the availability of its services. Forensic medical examinations were limited to three metropolitan locations from 8am to 10pm. Some people were required to travel across Melbourne for examinations. ‘Just in case’ examinations ceased.[15]

16.13 The Victorian Forensic Paediatric Medical Service is responsible for forensic medical examinations of children and adolescents.[16] The service is managed by the Royal Children’s Hospital. Examinations of children are not conducted at MDCs.[17] In Melbourne, they are conducted in the Royal Children’s or Monash Children’s Hospital.

Table 16: Forensic medical examinations in Victoria, 2018–19[18]

Place

Location

Number

% of total

Melbourne

Five CCUs (Monash Medical Centre, Royal Women’s Hospital, Sunshine Hospital, Austin Hospital, Maroondah Hospital)

422

65.9%

Emergency department of hospital

12

1.9%

Dandenong MDC

23

3.6%

Other sites (VIFM, police station, prison, private residence or residential care facility)

28

4.4%

Total Melbourne

485

75.8%

Regional

Regional CCUs

98

15.3%

MDCs (Morwell, Bendigo and Mildura)

57

8.9%

Total Vic

640

100%

16.14 In regional and rural areas, children may be examined in a hospital by a trained paediatrician. However, if there is no suitably qualified doctor, children must travel to hospitals in Melbourne.[19]

What are ‘just in case’ examinations?

16.15 The VIFM practitioners conduct examinations without a police report (‘just in case’ examinations) on a trial basis at the Monash Medical Centre.[20]

16.16 These examinations give people the option of deferring a decision on whether to report the sexual offence to the police. Sexual Assault Services Victoria told us:

there is so much pressure and trauma on the day someone has been harmed … we need to give victim survivors as many options as possible. ‘Just in case’ examinations are so crucial in terms of offering victim survivors options at a really overwhelming time. When someone is in crisis and overwhelmed – they don’t want to make a decision.[21]

16.17 ‘Just in case’ examinations are offered in every state or territory in Australia (see Table 17). They are commonly offered in other countries without requiring a police report, such as England,[22] Ireland[23] and New Zealand.[24]

Table 17: State and territory forensic medical examinations without report to police

State

Description

Australian Capital Territory

Offers forensic medical examinations with evidence stored for a minimum of 3 months.[25]

New South Wales

State guidelines provide that health services should respect the wishes of an adult or young person who is not at risk of significant harm as to whether they proceed with a formal police report, or choose an alternative reporting option. Evidence is stored for a minimum of 3 months, after which contact is made to assess the wishes of the patient.[26]

Northern Territory

Offers forensic medical examinations without a police report. Evidence is stored for 6 months.[27]

Queensland

All hospitals and health services are now required under a directive to provide forensic medical examinations regardless of whether victims decide to report the matter to the police or defer a decision. Evidence is stored for 12 months.[28] This reform was implemented in 2019, with a $1.3 million commitment to increase access.[29]

South Australia

Offered at Yarrow Place in Adelaide and at some general hospitals in regional areas. Evidence is stored for 12 months.[30] However, accessing services outside Adelaide remains challenging.[31]

Tasmania

Forensic medical examinations are offered without requiring a report to the police.[32]

Western Australia

Offers forensic medical examinations without a report to the police. Evidence is stored for a minimum of 6 months, after which the patient is contacted about their wishes.[33]

16.18 Queensland most recently expanded access to forensic medical examinations, including ‘just in case’ examinations. This included investing $1.39 million in specialised training for nurses and doctors.[34]

16.19 Scotland recently expanded access to forensic medical examinations. Health boards are now required by law to provide examinations without requiring a person to report to police. The law regulates how the health board is to destroy evidence or transfer evidence to the police as needed.[35]

16.20 This followed a period of reform. A taskforce transferred the responsibility for forensic medical examinations from police to the health system. Significantly more money has been invested in examination facilities across Scotland.[36]

16.21 In Ireland, an analysis of forensic medical examinations found that about 10 per cent of those attending the Dublin centre did so without reporting to police. Of these, 20 per cent subsequently reported the incident to police. Most of those who subsequently reported (60 per cent) did so within seven days, and 80 per cent within a month. This is similar to the rates in other jurisdictions.[37]

How are forensic medical examinations used in the criminal justice system?

16.22 Forensic medical examinations can:

• help identify the person who committed the crime

• support the account of the victim survivor

• determine that there was recent sexual activity

• establish if force was used or if someone resisted.[38]

16.23 Research suggests that forensic medical evidence can influence the decisions of police and prosecutors.[39]

16.24 However, a review of empirical research found no clear association between the use of forensic medical evidence and the outcomes in criminal cases. It suggests that there is a ‘disjunction between the expectations of forensic medical evidence … and what is required to prove adult sexual offences’. For example, DNA evidence cannot reveal anything about the key issue of consent.[40]

16.25 There is a risk that forensic evidence can compound misconceptions about sexual violence. For example, its focus on physical penetration can undermine efforts to broaden our understanding of sexual assault beyond rape. If a person has recently had sex with other people, this forensic evidence can be used to undermine the character and credibility of victim survivors. Its absence may undermine the accounts of those who do not have forensic evidence.[41]

16.26 There remains very little research on how forensic evidence is used in court, or how it influences the progress of cases.[42] Forensic officers receive little feedback about the use of forensic evidence (see Chapter 5).[43]

People told us about their experiences of forensic medical examinations

There is limited access and availability

16.27 The experience of having a forensic medical examination is often extremely difficult. For too many people, this experience was made more distressing by the lack of timely access to examinations (see box).

What people told us about forensic medical examinations

One woman spoke of how she had been turned away by one hospital because they said, incorrectly, that they did not deal with sexual assault. She then had to wait for six hours in the middle of the night at the next hospital in a public waiting room while she was bleeding.

The hospital staff kept ‘insulting’ her by asking publicly whether she was sure that she didn’t have her period. She was forced to sit in her ‘blood- soaked clothes’ for hours, and even after that she ended up having to leave without seeing a doctor.

Twelve hours later, she received a call telling her she could see a specialised forensic doctor. In the meantime, she was unable to shower and ‘had to sleep covered in my own blood’. She also wasn’t informed about the need to keep her clothing in a paper bag for evidence.[44]

Another person said she waited for eight hours after a traumatic trip for a visit from a forensic medical doctor. By that time, they said it was too late to know if she had been drugged.[45]

Another person said they were at the hospital ‘for 3.5 hours and most of it was waiting.’ The person reported that the doctor was ‘amazing but so overworked’ and had to leave to assist someone else.[46]

A parent reported her daughter had to wait 20 hours during the coronavirus (COVID-19) pandemic without washing herself because of the limited number of forensic medical officers available.[47]

One person had a simple and specific suggestion: When they took my underwear as evidence, the underwear they gave me were both too small and … well, they were black and lacey. It felt very inappropriate but I laugh about it now, in a dark humour sort of way. I think speaking frankly about what victims tangibly need after going through a kit or reporting would be more helpful, so people don’t donate weirdly sexy underwear to a rape crisis centre.[48]

16.28 Sexual Assault Services Victoria told us that there was a need for an ‘urgent review’ of the availability of examinations. It told us that the number of doctors available was ‘patently inadequate’. Waiting for a forensic medical officer for more than 10 hours could be re-traumatising and make people not want to continue with a report.[49]

16.29 Children in rural or regional areas faced the extra stress of travelling to Melbourne hospitals.[50] Associate Professor John Gall recommended:

• more effort in recruiting, training and retaining forensic services for children in rural and regional areas

• training nurses to work under the supervision of trained paediatricians or physicians in regional centres.[51]

16.30 We heard that in rural and regional areas forensic examinations were not accessible, and people were transported in police vehicles to examinations without support.[52]

16.31 Victoria Police highlighted the importance of increasing access to forensic medical officers, which would better support successful criminal prosecutions.[53]

The gender of a forensic medical examiner matters

16.32 We heard concerns about having a choice about the gender of forensic medical examiners. Sexual Assault Services Victoria told us:

Other recent changes to VIFM services have involved the increased recruitment of male FMOs. Given the strongly gendered nature of sexual assault, our members report that clients are being adversely impacted by this practice.[54]

What people told us about the gender of a forensic medical officer

Alison told us that her daughter had to wait ‘20 hours, with sperm on her face and chest, to be examined’ because the only person available earlier was a 65-year-old man. She said that her ‘daughter’s first sexual experience had just happened and now she was going to have to get naked in front of a male stranger. I told them that that was not ok.’

They were told that if they wanted a woman, they would have to wait until the next morning, and they were not offered other options.[55]

Another person told us that a ‘relative ended up showering after 2 days without being examined by a forensic female doctor (because only males were available) and this meant she could not get the evidence needed to prosecute her rapist (who was a stranger)’.[56]

16.33 The VIFM told us that in 2018–19, 69 per cent of examinations were conducted by female practitioners, and that appropriate chaperones (such as a doctor or nurse) were also used.[57] It also recruited for diversity.

16.34 The VIFM told us that its practice was to try to meet any requests for a specific gender or propose alternatives, such as arranging a different time or location for the examination. However, it would be ‘very difficult’ to always meet these requests.[58]

We heard concerns about the security and quality of facilities

16.35 The forensic examination facilities in some MDCs are not used often. Victoria Police told us that increased access to forensic medical practitioners would reduce the need for victim survivors to travel to hospitals, and ‘would be consistent with the spirit in which MDCs were intended’.[59] The VIFM told us it is necessary to conduct examinations of victims of sexual assault at hospitals, which have the appropriate specialist medical services to support the health and welfare of the victims. It believed these services could not be provided at MDCs. Associate Professor John Gall pointed to the medical risks of providing acute medical care within MDCs and recommended that these services should be provided at hospitals.[60]

16.36 We also heard concerns about the safety and quality of the hospital facilities:

• waiting rooms were not secure or private[61]

• hygiene—one client reported that she was unable to go through with the examination because the waiting room was dirtier than the place where she had been sexually assaulted[62]

• hospitals were unsafe for people with disability, including those whose immunity was compromised.[63]

We heard about the need for ‘just in case’ medical examinations

16.37 Sexual Assault Services Victoria recommended that everyone who experiences sexual assault should be offered an examination ‘as a matter of course’ and not require a police referral.[64] In its view, this would ‘change the experience for victim survivors enormously’.[65] Offering them in only one site, forcing some people to travel for hours, was not a real choice.[66]

A friend of mine called West CASA for me the day after I was raped. They told her I would need to go to Sunshine Hospital [in Melbourne’s west]. I decided to go to Monash Medical Centre [in the east] on my own the next day instead, for a just in case forensic examination.[67]

16.38 The VIFM did not support the expansion of the current model of ‘just in case’ forensic medical examinations. It expressed concern that this model could ‘reduce a victim’s future justice options’ because:

Failure to interact with police in the early stages after an assault might limit additional evidence collection … When issues at court revolve around consent, it is often these other pieces of evidence that become significant. On this basis, the [‘just in case’] process can actually impede positive justice outcomes for victims as other evidentiary options are not activated at the time of the report.[68]

16.39 The VIFM said it would be beneficial if a person was told that they could report to police with the understanding that they could decide not to proceed later. This would mean the victim receives the ‘necessary medical attention and has a forensic medical examination, and enables the preliminary collection of other evidence by police’.[69]

16.40 Since the VIFM commenced the trial of ‘just in case’ examinations in 2014, there have only been 61 ‘just in case’ examinations, and only four of these cases went on to report to police.[70]

16.41 Victoria Police explained that it would prefer evidence to be obtained rather than lost. However, it noted problems with ‘just in case’ examinations, including issues of where the evidence was stored and who had access to it, which could ultimately impact the success of a case.[71]

Access to and the experience of forensic examinations need to be improved

Access to forensic medical examinations should be expanded

16.42 A forensic medical examination may be the first or one of the first encounters a person has with the criminal justice system. This comes at a traumatic time, when someone may be overwhelmed by what has just happened to them.

16.43 It is therefore critical that the examination is timely, safe and supported. The main concern, in Victoria as elsewhere in Australia, is enabling fair access to examinations across the state. We are especially concerned about the lack of access for children and adolescents in rural and regional areas.

16.44 Other places, such as Queensland and Ireland, can show us the way. In Chapter 4, we recommend a review of the governance of the VIFM. There are advantages to a health-based model, as is common elsewhere in Australia and overseas. This could help expand access through the health system.

16.45 We support the VIFM’s efforts to expand access through increased use of nurses. This would be useful in addressing shortages in rural and regional areas. It may also help in increasing choices about the gender of the forensic medical officer in areas with shortages.

Access to choice should be expanded

16.46 We recognise that the VIFM is already trying to meet requests for the gender of a forensic medical officer or to propose alternatives. As with the similar issue of the gender of a police officer (see Chapter 17), the policy already supports choice and control. The challenge is a practical one of having enough female examiners.

16.47 What we have heard is that the gender of the examiner remains an important barrier for people. As the examples show, it can make the experience traumatic rather than therapeutic.

16.48 In Chapter 4, we recommend extending or enhancing the rights in the Victim Charter’s Act 2006 (Vic) to set clear expectations about the treatment of people experiencing sexual violence, and to ensure that partners within the sexual assault system are held accountable for that treatment. We recommend in that chapter that one of these rights should be the right to specify the gender of a forensic medical examiner.

16.49 This right is set out in similar legislation in Scotland.[72] It is different to the similar right to specify the gender of the police officer in an interview, which does require someone to grant the request unless, for example, it is not reasonably practical to comply.[73] Instead, the legislation requires the police officer to inform the medical examiner of the request, but does not require that this request is fulfilled.

16.50 This would not work if, as we recommend below, there is no police officer involved. We note that around 70 per cent of examinations are already conducted by female examiners and, without further evidence, do not see any reason why a forensic service could not be required to grant the request, unless it is not reasonably practical to comply.

The Sexual Assault Strategy should make this work a priority

16.51 More investment and effort are needed to enable everyone to have access to timely and safe forensic medical examinations. It will also need multi-agency leadership, as there is clearly a difference of view between key partners as to where examinations can take place, and the balance between access and ensuring specialisation.

16.52 As Associate Professor John Gall noted, the challenges here are not unique to forensic medical examinations but common challenges in our health system. These are mainly challenges of recruitment, training and retention.

16.53 We therefore recommend that this is an issue that is dealt with as part of the Sexual Assault Strategy. Key partners involved in developing measures should support a shared aim of increasing access to examinations.

Access to just in case examinations should be expanded

16.54 The Victorian Government should extend the availability of ‘just in case’ forensic medical examinations. This would help meet the goal of giving victim survivors choices and control.

16.55 We acknowledge the VIFM’s concerns about the risk that a late decision to report may affect the collection of other evidence. This is recognised in the Irish model, which notes that involving police ‘from the outset provides the greatest potential for gathering the best possible evidence’ for a prosecution.[74]

16.56 However, the guide explains that, despite this, the traumatic nature of such incidents means that people may need time to consider what to do. They should have the option of not reporting.[75]

16.57 We consider that these concerns should be addressed in a similar way to the Irish model, so that during the procedure for consent, people are advised that prompt reporting is encouraged so that an investigation can begin, and that reporting to police presents the best opportunity for detecting sexual crime and potentially prosecuting it. Those who went on to report to police in the Irish model did so within the first month.[76] This also reduces the risks of delay to a police investigation.

16.58 Offering examinations without requiring a police report is common practice elsewhere in Australia and overseas. In our view, this indicates that such a model is workable and may even increase reporting rates a little. We are not convinced the low uptake of the current trial indicates low demand, because the model was only available at one site and was not widely promoted.

16.59 It is unclear that the success of the model should be judged only by the number of people who report to police later. It is possible that, for some people, making the choice can be therapeutic and provide them with a sense of choice and control, even if they end up not reporting.

16.60 Implementing this option fully will take time, especially outside Melbourne. However, it should be developed as part of the Sexual Assault Strategy, together with broader measures to enhance access to forensic medical examinations.

 

Recommendation

62 The Victorian Government should, as part of the Sexual Assault Strategy, develop measures:

a. to extend access to forensic medical examinations across Victoria, including by the increased use of forensic nurses

b. to give victim survivors the option of a forensic medical examination, without requiring a report to the police.


  1. Antonia Quadara, Bianca Fileborn and Debra Parkinson, The Role of Forensic Medical Evidence in the Prosecution of Adult Sexual Assault (ACSSA Issues No 15, Australian Institute of Family Studies (Cth), 2013) 3–4 <http://www.aifs.gov.au/acssa/pubs/issue/i15/index.html>.

  2. Submission 61 (Victorian Institute of Forensic Medicine).

  3. Victoria Police, Code of Practice for the Investigation of Sexual Crime (Policy, 2016) 23 <https://content.police.vic.gov.au/sites/default/files/2019-01/Code-of-Practice-for-the-Investigation-of-Sexual-Crime-%282016%29.pdf>.

  4. Rebecca Campbell et al, ‘A Participatory Evaluation Project to Measure SANE Nursing Practice and Adult Sexual Assault Patients’ Psychological Well-Being’ (2008) 4(1) Journal of Forensic Nursing 19; see, eg, Janice Du Mont, Deborah White and Margaret J McGregor, ‘Investigating the Medical Forensic Examination from the Perspectives of Sexually Assaulted Women’ (2009) 68(4) Social Science & Medicine 774.

  5. Antonia Quadara, Bianca Fileborn and Debra Parkinson, The Role of Forensic Medical Evidence in the Prosecution of Adult Sexual Assault (ACSSA Issues No 15, Australian Institute of Family Studies, 2013) 15–16 <http://www.aifs.gov.au/acssa/pubs/issue/i15/index.html>.

  6. It is established by the Victorian Institute of Forensic Medicine Act 1985 (Vic).

  7. Submission 61 (Victorian Institute of Forensic Medicine).

  8. Ibid.

  9. Ibid.

  10. ‘Nurses to Train as Sex Assault Experts’, The Sydney Morning Herald (online, 12 December 2004) <https://www.smh.com.au/national/nurses-to-train-as-sex-assault-experts-20041212-gdkas6.html.

  11. See, eg, Thaddeus Schmitt, Theodore P Cross and Megan Alderden, ‘Qualitative Analysis of Prosecutors’ Perspectives on Sexual Assault Nurse Examiners and the Criminal Justice Response to Sexual Assault’ (2017) 13(2) Journal of Forensic Nursing 62; Clare Toon and Kurinchi Gurusamy, ‘Forensic Nurse Examiners versus Doctors for the Forensic Examination of Rape and Sexual Assault Complainants: A Systematic Review’ (2014) 10(5) Campbell Systematic Reviews <https://www.proquest.com/docview/1773941880/abstract/C38F4AD67384239PQ/50>.

  12. Victoria Police, Code of Practice for the Investigation of Sexual Crime (Policy, 2016) 13 <https://content.police.vic.gov.au/sites/default/files/2019-01/Code-of-Practice-for-the-Investigation-of-Sexual-Crime-%282016%29.pdf>.

  13. Submission 61 (Victorian Institute of Forensic Medicine).

  14. This was provided as an example of a more ‘standard’ year than 2019–20, which was affected by the COVID-19 pandemic.

  15. Submissions 11 (Associate Professor John AM Gall), 17 (Sexual Assault Services Victoria).

  16. ‘Victorian Forensic Paediatric Medical Service’, The Royal Children’s Hospital Melbourne (Web Page) <https://www.rch.org.au/vfpms/>.

  17. There are no forensic paediatricians at MDCs: Submission 14 (Gatehouse Centre, Royal Children’s Hospital).

  18. Submission 61 (Victorian Institute of Forensic Medicine). Table 16 lists the percentages of the total for Victoria, while the submission provides some figures for the percentage of the total in Melbourne.

  19. Submissions 11 (Associate Professor John AM Gall), 17 (Sexual Assault Services Victoria).

  20. Submissions 17 (Sexual Assault Services Victoria), 61 (Victorian Institute of Forensic Medicine).

  21. Submission 17 (Sexual Assault Services Victoria).

  22. NHS England, Commissioning Framework for Adult and Paediatric Sexual Assault Referral Centres (SARC) Services (Report, 10 August 2015) <https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/05/SARCs-service-spec-contract-template-and-paed-framework.pdf>.

  23. National SART Guidelines Development Group (Ireland), National Guidelines on Referral and Forensic Clinical Examination Following Rape and Sexual Assault (Ireland) (Guidelines, 4th ed, Sexual Assault Response Team, 2018) <https://www.hse.ie/eng/services/publications/healthprotection/sexual-assault-response-team-national-guidelines.pdf>.

  24. Nikki Macdonald, ‘Hundreds of Rape Evidence Kits Never Get Tested—Should We Be Alarmed?’, Stuff.co.nz (online, 14 August 2018) <https://www.stuff.co.nz/national/crime/105933366/hundreds-of-rape-evidence-kits-never-get-tested–should-we-be-alarmed>.

  25. Canberra Rape Crisis Centre, Sexual Assault Does Happen: A Booklet for People Who Have Experienced Sexual Assault and Their Supporters (Booklet, 2013) 12 <https://health.act.gov.au/sites/default/files/2018-09/CRCC_SexualAssaultHappens.pdf>.

  26. NSW Government, Responding to Sexual Assault (Adult and Child) Policy and Procedures (Policy Directive No PD2020_006, 7 February 2020) 39–40, 140.

  27. Debra Parkinson, Supporting Victims through the Legal Process: The Role of Sexual Assault Service Providers (ACSSA Wrap No 8, Australian Institute of Family Studies (Cth), 2010) 9 <http://www.aifs.gov.au/acssa/pubs/wrap/wrap8/index.html>.

  28. Queensland Government, Caring for People Disclosing Sexual Assault (Health Service Directive QH-HSD-051, Health Support Queensland, 22 July 2019) <https://www.health.qld.gov.au/sexualassault>.

  29. Daniele Bird, Delivering Forensic Services (Report No 21 2018–19, Queensland Audit Office, 27 June 2019) 25.

  30. ‘Forensic Medical Examination After a Sexual Assault’, Women’s and Children’s Health Network (Web Page) <https://www.wchn.sa.gov.au/our-network/yarrow-place/rape-and-sexual-assault-topics/forensic-medical-examination-after-a-sexual-assault>.

  31. Samantha Jonscher, ‘Sexual Assault Survivors Suffering Long Trips to Distant Hospitals for Examinations’, ABC News (online, 26 March 2019) <https://www.abc.net.au/news/2019-03-27/sexual-assault-exams-not-always-available-in-the-regions/10781756>.

  32. Sexual Assault Support Service (Tas), ‘It’s Happened to Me’—Information for Adults Who Have Been Sexually Assaulted (Fact Sheet, 2016) <https://www.sass.org.au/sites/default/files/resources/its-happened-me-information-adults-who-have-been-sexually-assaulted_version-current-april-2020.pdf>.

  33. ‘Have You Been Sexually Assaulted or Sexually Abused?’ Government of Western Australia (Web Page) <https://wnhs.health.wa.gov.au/our-services/service-directory/sarc/sexual-assault-abuse>.

  34. Caldwell, Felicity and Lydia Lynch, ‘Victims to Be Offered Rape Kits before Deciding on Police Complaint’, Brisbane Times (online, 11 February 2019) <https://www.brisbanetimes.com.au/politics/queensland/kit-20190211-p50x2k.html>.

  35. Forensic Medical Services (Victims of Sexual Offences) (Scotland) Act 2021 (Scot).

  36. Her Majesty’s Inspectorate of Constabulary in Scotland, Strategic Overview of Provision of Forensic Medical Services to Victims of Sexual Crime (Report, March 2017) <https://www.hmics.scot/sites/default/files/publications/HMICS%20Strategic%20Overview%20of%20Provision%20of%20Forensic%20Medical%20Services%20to%20Victims%20of%20Sexual%20Crime.pdf>; Scottish Government, ‘Forensic Medical Services Bill Passes Unanimously’ (Media Release, 10 December 2020) <https://www.gov.scot/news/forensic-medical-services-bill-passes-unanimously/>; Scottish Government, Equally Safe Consultation: Analysis of Responses (Report, 29 August 2019) <https://www.gov.scot/publications/analysis-responses-equally-safe-consultation-legislation-improve-forensic-medical-services-victims-rape-sexual-assault/pages/2/>; ‘Taskforce for the Improvement of Services for Adults and Children Who Have Experienced Rape and Sexual Assault’, Scottish Government (Web Page, 2021) <https://www.gov.scot/groups/taskforce-to-improve-services-for-rape-and-sexual-assault-victims/>.

  37. Daniel Kane et al, ‘Collection and Storage of Forensic Evidence to Enable Subsequent Reporting of a Sexual Crime to the Police “Option 3”—an Irish Experience’ [2021] Irish Journal of Medical Science 33439414:1–6 <http://dx.doi.org/10.1007/s11845-020-02491-1>.

  38. Antonia Quadara, Bianca Fileborn and Debra Parkinson, The Role of Forensic Medical Evidence in the Prosecution of Adult Sexual Assault (ACSSA Issues No 15, Australian Institute of Family Studies (Cth), 2013) 9 <http://www.aifs.gov.au/acssa/pubs/issue/i15/index.html>.

  39. Ibid 16–19.

  40. Ibid 3.

  41. Ibid 26–7.

  42. Ibid 22–3.

  43. Sally F Kelty, Roberta D Julian and Alastair Ross, ‘Dismantling the Justice Silos: Avoiding the Pitfalls and Reaping the Benefits of Information-Sharing between Forensic Science, Medicine and Law’ (2013) 230(1–3) Forensic Science International 8.

  44. Victorian Law Reform Commission, Improving the Response of the Justice System to Sexual Offences: Summary of Responses to Online Feedback Form from People with Experience of Sexual Assault (Report, April 2021).

  45. Ibid.

  46. Consultation 63 (A victim survivor of sexual assault, name withheld).

  47. Victorian Law Reform Commission, Improving the Response of the Justice System to Sexual Offences: Summary of Responses to Online Feedback Form from People with Experience of Sexual Assault (Report, April 2021).

  48. Ibid.

  49. Submission 17 (Sexual Assault Services Victoria). Its concerns about the need for a more collaborative process of decision making are discussed in ch 4.

  50. Ibid.

  51. Submission 11 (Associate Professor John AM Gall).

  52. Consultation 20 (Members of Barwon South West RAJAC and Barwon South West Dhelk Dja Action Group).

  53. Consultation 70 (Victoria Police (No 1)).

  54. Submission 17 (Sexual Assault Services Victoria).

  55. Consultation 99 (Alison, the mother of a rape survivor).

  56. Consultation 32 (Anonymous member, Victim Survivors’ Advisory Council).

  57. Submission 61 (Victorian Institute of Forensic Medicine).

  58. Email from Victorian Institute of Forensic Medicine to Victorian Law Reform Commission, 21 May 2021.

  59. Submission 68 (Victoria Police).

  60. Submission 11 (Associate Professor John AM Gall).

  61. Consultation 32 (Anonymous member, Victim Survivors’ Advisory Council).

  62. Consultation 53 (Elizabeth Morgan House and a victim survivor of sexual assault).

  63. Consultation 32 (Anonymous member, Victim Survivors’ Advisory Council).

  64. Submission 17 (Sexual Assault Services Victoria).

  65. Consultation 14 (Sexual Assault Services Victoria).

  66. Ibid.

  67. Consultation 63 (A victim survivor of sexual assault, name withheld).

  68. Email from Victorian Institute of Forensic Medicine to Victorian Law Reform Commission, 21 May 2021.

  69. Ibid.

  70. Ibid.

  71. Consultation 70 (Victoria Police (No 1)); email from Victorian Institute of Forensic Medicine to Victorian Law Reform Commission, 21 May 2021.

  72. Victims and Witnesses (Scotland) Act 2014 (Scot) s 9. However, this provision has not yet come into operation because it is not yet feasible to implement it. Given the percentage of examinations already conducted by female examiners, this appears not to be a constraint in Victoria.

  73. Ibid s 8. The police are required to grant the request unless it would be likely to prejudice a criminal investigation or it is not reasonably practical to comply.

  74. National SART Guidelines Development Group (Ireland), National Guidelines on Referral and Forensic Clinical Examination Following Rape and Sexual Assault (Ireland) (Guidelines, 4th ed, Sexual Assault Response Team, 2018) 104 <https://www.hse.ie/eng/services/publications/healthprotection/sexual-assault-response-team-national-guidelines.pdf>.

  75. Ibid.

  76. Daniel Kane et al, ‘Collection and Storage of Forensic Evidence to Enable Subsequent Reporting of a Sexual Crime to the Police “Option 3”—an Irish Experience’ [2021] Irish Journal of Medical Science 33439414:1–6, 4 <http://dx.doi.org/10.1007/s11845-020-02491-1>.