Palin and Rape Kits: More Complex Than First Impression

[Update 9/17/08: Although charging for rape kits may not be unheard of, Wasilla was the only town in Alaska to do it - which prompted the state legislature to ban the practice, over the objection of Palin's police chief. (Via M. LeBlanc at Bitch Ph.D.)]

This is via email from a very knowledgable source, Prof. Rose Corrigan, Assistant Professor of Politics and Director of Women's Studies at Drexel University. (I hesitated to post it, because it negates a powerful, clear-cut line of attack on Palin [see update below], but since I am not a Republican, in the end I don't lie to win a political contest.)

As someone who studies rape, including how rape kits get handled, I feel a need to weigh in about some of the stuff I've been reading about Sarah Palin and the city of Wasilla's refusal to pay for rape kits.

Some writers have held up Wasilla's practice of charging rape victims for their kits as unusual and barbaric, while others have linked the lack of funding for rape kits to her opposition to abortion and emergency contraception. Here is a broad sketch of these issues in a national context, along with a few exhortations to action.

Continued after the jump.

First: funding for rape kits. Decisions about funding for rape kits are largely at the local level and depend on the interactions of medical & law enforcement systems. Generally rape kits are forensic evidence and as such are paid for by local or state police, or by crime victim compensation boards. Some hospitals bill the funding agency directly, while others bill the victim, who then has to seek reimbursement, typically through a state victim compensation board. Some hospitals are willing to cover a good part of the cost for the rape kit (which is mostly the cost for the medical staff time + any medication), while others absolutely do not. Whenever possible the rape kit is usually charged to a victim's own medical insurance.

In the past, in many states, a victim without medical insurance would in fact be billed by the hospital for cost of completing the rape kit. Very recently (regulations went into effect July 1, 2008), the federal Violence Against Women Act (sponsored, of course, by Senator Biden) has required that hospitals offer and states pay for "Jane Doe" rape kits, which permits victims to have evidence collected without making an official police report. Thus a victim who wanted medical care could get evidence collected and decide later if she wanted to make a report to the police and possible press charges. But again, every state and each city handles these issues differently, and I encourage you to look into your own local practices.

My understanding is that the Wasilla chief of police appointed by Mayor Palin decreased, then eliminated, funding to pay for the rape kits at the local level. So certainly she bears some responsibility for his appointment, and for approving the budget in which funding was eliminated. Unfortunately, however, she is not alone in believing that sexual assault victims should bear the cost of their own post-rape medical care. I strongly encourage you to find out what is happening in your own community, and to use this to ensure that rape victims in your state are treated fairly and with respect.

Second: rape kits and emergency contraception. Rape kits are different from emergency contraception (EC). One can have a rape kit done without getting EC, and can get EC without completing a rape kit. EC is one of the medications which MAY be offered as part of a post-rape exam, but it is NOT part of the collection of forensic evidence related to the assault.

If they are lucky and decently funded, some local communities have post-rape exams done by specially trained forensic nurses called SANEs: sexual assault nurse examiners. These SANEs are trained to understand both the physical and emotional trauma that accompany rape. Among SANE training programs, standard practices include at least prescribing EC as part of the standard post-rape protocol, along with medications to prevent or treat sexually transmitted infections.

But the decision about whether EC is actually prescribed or dispensed at a particular hospital is usually up to that hospital. While some states have passed laws requiring that EC be discussed with or offered to rape victims (not the same thing!), the actual practices vary primarily based on the hospital. Even good SANE programs sometimes refuse to provide EC to rape victims, even when that may violate a state law. In areas without SANEs or other specially-trained medical personnel, decisions about providing EC are often made on an individual basis by whatever random medical person happens to get called in to perform the exam. In states without EC laws, control is almost totally in the hands of the hospitals. So the EC issue is really separate from the rape kit issue; it is unlikely that Governor Palin had anything to do with the decisions about whether EC was offered and thus unlikely that she was refusing to pay for rape kits because of some opposition to abortion. As governor she could have vetoed legislation requiring EC in the ER, but as mayor or governor she likely would have very little to do with decisions about EC at the local level.

Regardless of funding issues, I can assure you with almost 100% certainty that your local rape crisis center needs assistance to ensure that survivors of sexual violence in your community get compassionate, high quality medical care. This is especially true if you live outside a large metropolitan area. So in addition to continuing to write and blog about this issue, please consider taking time to for some other really useful actions.

Contact your local rape crisis center and make a donation of your time, skills, and money. They desperately need you. Demand that your state provide adequate funding for all services for rape victims. Many centers operate on the brink of solvency; staff are routinely on call for months at a time, for salaries that are barely enough to survive on. Write to your state legislator requesting that ALL rape kits are paid for by the state, and are processed in a timely fashion and don't sit on shelves for years, as is common across the country. Let your local hospital know that you support *dispensing* emergency contraception to rape victims when they are being treated, and write to your governor and state legislature to ensure that emergency contraception is easily available, on demand, in every pharmacy in your state.

Under a McCain-Palin administration these issues would be almost incidental, since their commitment to overturning Roe v. Wade and further federal regulation of abortion and contraception would likely make it increasingly difficult for ALL women to access reproductive health care. Rape victims would bear the force of these policies in a uniquely painful way, but all women's rights are at stake. This is, sadly, just the tip of the iceberg.

So, my summary: (1) Lots of places charge victims for rape kits, (2) it's unlikely Palin approved the policy due to anti-abortion concerns about emergency contraception (as I thought) because EC probably wasn't even being offered, (3) even in states that require that emergency room workers discuss or offer EC to rape victims, individual hospitals and hospital workers routinely ignore the law on "conscience" grounds, and (4) your local rape crisis center is probably teetering on the edge of bankruptcy and its workers grossly overworked and underpaid, so give your money and time, although if McCain wins it won't matter anyway. Very depressing.

Update 9/18/08: I no longer think this negates an attack on Palin, just broadens it.  Responding to Digby's post, I came up with three points that I think we should pursue:

1. It is unconscionable that any rape victim anywhere is required to pay for the collection of evidence. No municipality should have such a policy, and Sarah Palin was wrong to approve it in Wasilla.
2. No rape victim should have to risk becoming pregnant from her attacker. Emergency contraception prevents pregnancy, it doesn't end one, as some people wrongly believe. EC should be made available for rape victims in emergency rooms, for free if insurance doesn't cover it 100%.
3. Rape crisis centers all over the country are underfunded and overburdened, and Congress should take action to ensure adequate funding for trained Sexual Assault Nurse Examiners. This is the minimum we can do to give rape victims the medical care they need and law enforcement the evidence required to catch their attackers.