Changing the perception of sex assault victims and survivors aids kit production and prosecution
BY CHRISTIE PASCHAKIS
ACUMEN SENIOR EDITOR
Even as rates of sexual assault and violence continue to rise, challenges faced in collecting evidence of the crimes in order to prosecute perpetrators, mimic those of 100 years ago.
Imagine this scenario: It’s the 1970s. You’re the victim of a violent sexual assault. You call the police who take you to the ER in the back of their squad car. You barely hold it together while you are subjected to tests and swabs, all while answering questions about what you were wearing and how much you'd drunk that night. You are given two cloth gowns to wear home as all your clothing has been bagged as evidence. And as you sit, again, in the back of the police car that is taking you home, you believe that the traumatizing process you just went through will be worth it in the end. That the evidence gathered will help catch and prosecute the person who did this to you.
But now you’re horrified to learn that the evidence has been declared unusable. And while you are justifiably angry, you can’t really blame the hospital staff, not after you learned there are no established protocols for this type of crime. They weren’t aware that each item had to be clearly labeled and sealed. They weren’t advised to take fingernail scrapings. Or that they should have taken photographs and measurements of the marks left on your body, or that their written documentation needed to be submitted alongside the evidence. They weren't aware because there isn't a clear, standardized practice on how to collect and preserve evidence from a crime scene when that crime scene is a living, breathing, human being…
While working for a small family foundation in 1972, Martha “Marty” Goddard made a connection with the National Runaway Switchboard Metro Hub in Chicago, Ill., an organization whose board she would join for the next eight years. In that time, Marty became increasingly aware of the high number of disclosures of sexual abuse that were occurring to children and youth as well as to women.
She founded the Citizens Committee for Victim Assistance in Chicago in 1974 to tackle the haphazard collection of trace evidence in sexual assault cases, and to combat the rape stigmas and myths that were deeply embedded into 1970s rape law, and enforced by police departments.
In researching the trace evidence needed to bring predators to justice, Goddard found that when a rape exam in the 1970s was conducted at a hospital, generally after satisfying that the assault aligned with the legal definition of “rape” (i.e. the assailant was an unknown man that apprehended and brutally assaulted the victim) the exam was more about determining the victim’s virtue and credibility than acquiring any physical evidence that may have been left behind. After all, if the survivor did not have physical signs that she attempted to fight her assailant off and did not show signs of being in a hysterical state, the chances of her undergoing a medical exam were rare.
And in those rare instances where a medical exam was conducted to collect trace evidence, the collection was haphazard at best. In the 2003 oral history interview of the Crime Victim Assistance Field, Goddard spoke on the conversations she had with forensic lab technicians. She stated that due to a combination of a lack of proper training of medical personnel in evidence collection, and having never been asked for input on what they needed, the crime labs would often receive kits with contaminated evidence:
“Marty, we don’t get evidence. Sometimes people try and they take two slides with swabs from say the vagina or the mouth and or the rectum. They put it on the slides. They make the slides. They rubber band ’em together and they’re face to face. So there goes that. It’s worthless.” she noted. “It’s just absolutely worthless. We don’t get hair. We don’t get fingernail scrapings. We don’t— nothing’s marked to tell you what’s vagina and what is the rectum. We don’t get decent clothing evidence.”
By speaking with the people who would utilize and need them—law enforcement, medical professionals, forensic scientists, and survivors—Goddard designed a prototype for the first standardized rape kit in 1976, complete with the required items like swabs, slides, envelopes, combs, bags, and a detailed checklist for medical personnel to follow.
Martha Goddard presented her design concept to Louis Vitullo, a police sergeant and chief microanalyst in the Chicago crime lab, who allegedly rejected the idea initially. However, he ended up building the prototype of the kit that would be named after him.
While the Vitullo® Evidence Collection Kit for Sexual Assault Examination would become the first standardized rape kit for collecting trace evidence, it still required funding to both produce the kits themselves and distribute them to hospitals in Chicago to pilot.
“We had to put together the first ten thousand to test them around the state before we did anything else. So first, the city of Chicago and then Cook County and then the rest of the state, county by county, there are a hundred and two counties,” she said.
As the majority of funding for women’s initiatives were invested in the Girl Scouts and the YWCA, Goddard and the Citizens Committee for Victim Assistance had to look elsewhere for funding. As luck would have it, they were approached by executive director Margaret Standish, who ran the Playboy Foundation in the late 1970s.
Despite the backlash she received from the women’s movement for partnering with a magazine that objectified women, Goddard and her team accepted the $10, 000 funding grant from the Playboy Foundation, which allowed them to acquire the components necessary for the rape kits. Playboy’s graphics designers also created the packaging and put a call out for senior volunteers to help assemble the first 10, 000 kits.
Once the kits were assembled, Goddard and her team traveled hospital to hospital to distribute the kits, and to train the hospital personnel in how to properly use them.
By 1980, the Vitullo® rape kits were being commended as a vital element in prosecuting sexual assault cases, including from one of Goddard’s contacts in the Chicago Police Department, Sgt. Rudy Nimocks, whom Goddard had worked closely with and befriended, while he was an officer handling incest cases, and whom she credited as being her foot in the door with the Chicago police.
Nimocks, who was then the Commander of the Homicide/Sex Crimes unit, spoke highly of the kits to the Chicago Tribune in 1980, stating that roughly 25% more usable evidence for rape cases came from hospitals that had the kits.
"Our experience has been very positive," he said, "…in addition to the kits being very practical, we find that it impresses the jurors when you have a uniform set of criteria in the collection of evidence.”
The inclusion of carefully collected evidence brought before a court was not a new concept, nor was the standard that the burden of proof lay on the prosecution. They had to prove, based on the evidence they presented, that not only did the crime occur, but that it was beyond a reasonable doubt that it was the defendant who attempted or successfully completed the crime.
However, unlike other crimes, when it came to rape cases prior to the 1980s, there were several corroboration and special evidentiary laws put in place in order to discredit the victim's account as untrustworthy and unreliable before the case even got to court. And for those that did make it to trial, judges would then give formal, on the record, warnings to the jury about a woman's propensity to lie about being raped.
The rape kit's entry into the criminal justice world and specifically into the trial process became that of a 'corroborative' witness of sorts, a technoscientific witness, in that it objectively provided knowledge of the assault.
By 1987, the trademark for the Vitullo® kit had expired and by the following year, nearly a dozen manufacturers had created their own standardized rape kits, with multiple states and jurisdictions adopting rape kits into their use.
While the exact number is unknown, there are a number of manufacturers producing rape kits, as well as standardized protocols and practices for rape exam and evidence collection within designated hospitals and/or specialized sexual assault referral centers around the world, in the present day.
“Courts love forensic evidence," says Dave Broughton, President of Latent Forensics in Burlington, ON Canada, because, unlike testimony from a complainant, witness or defendant which may be undependable in its certainty or even its truthfulness, "forensic evidence always tells the truth."
A forensic investigator for twenty of his thirty-seven years as a police officer, Broughton started Latent Forensics in 2015 and recently began manufacturing Sexual Assault Evidence Kits (SAEKs, as they are more commonly referred to in Canada). Even though he admittedly had experience as an officer in taking victims of sexual violence to a hospital so they could get a kit done, “the police don't participate in any part of the Sexual Assault Evidence Kit,” he said, “they don't gather any of the evidence. That's all done by the SANE [Sexual Assault Nurse Examiner]."
In order to ensure that his SAEKs would meet the needs of those utilizing the kits, he relied heavily on the feedback provided from SANEs when designing and creating his SAEK, providing him and his team with an insight into the rape exam process. Because of this, Latent Forensics' SAEKs look different from the others on the market in that his kit is divided into three separate packages.
Why three? The feedback some SANEs provided to him included that the standard kits that are on the market often result in unused items. Many survivors will begin the process of the rape exam, only to find themselves overwhelmed and unwilling to continue following the removal of their clothing and/or after the initial photographs have been taken. The way most kits are manufactured, all necessary components are in the same package and once opened, nothing in the package can be removed or repurposed.
As a survivor is able to stop the exam at any point, in the cases where only the bags and drop sheets were utilized, the rest of the items within the kit becomes unusable. Only using approximately $9-$12 of an $80-$130 (CAD) SAEK, which can be a 'drawback' for hospitals in a time where every decision is tied to budgetary restraints.
Broughton combatted this by structuring his SAEK to have the bags and drop sheets packaged in one smaller package, and the toxicology items (which also may not be utilized during the exam) separate from the rest of the swabs, comb, and other collection items. That way, if a hospital ends up ordering 50 full kits, and uses more of the packages containing the bags and drop sheet, they can simply reorder those in order to replenish their stock.
The SAEK packaging kit consists of an extra large bag, one large bag, two medium bags, two drop sheets, an evidence seal, and labels.
The Sexual Assault Toxicology Kit contains 2 blood collection tubes, 1 urine collection cup, gauze, 1 specimen collection bag, an antiseptic wipe, & an evidence seal.
The Sexual Assault Evidence Kit consists of: Consent forms, investigative reporting forms, traumagrams, & blood & urinalysis documentation, Labels, KISS Wound Photo Guide & markers, Two jars for small debris collection, Sterilized tweezers, Eight envelopes with swabs (each detailed for specific areas of the body), Two envelopes for fingernail scrapings (one for each hand), One envelope with a comb; and One envelope with extra drop sheets.
Based on feedback from SANEs, each of the envelopes in the SAEK have step-by-step instructions in both English and French. This would ensure a more efficient process as opposed to having to refer to a booklet or manual, particularly for those SANEs who are either new to the role, or for those who aren’t dealing with a large volume of SAEKs on a daily basis.
“In places like Toronto, Ontario, a SANE might be completing a SAEK per day, so it becomes routine to them and they may rarely need to double check the instructions,” Broughton explained, “but in a more remote town in say Northern Ontario, a SANE may complete one a week or one a month.”
The clear instructions, according to Broughton, also make it plausible for any non-SANE nurse or doctor to be able to complete the SAEK if needed. This would allow kits to be available at every hospital and would avoid staff having to turn a victim away or send them to another location should there be no kits, or SANEs on site—a situation that sadly become more frequent in Canada, the United Kingdom, and the United States.
“Once again, a victim is re-victimized,” Broughton says, “And that is happening in so many different ways. I know, from personal experience, that people have been sent, gone to one place [hospital], and then been told, ‘we don't have anything here, go to Brampton, Ontario.’ And they drive to Brampton, and there's nothing there. So, then they're directed to, you know, Mississauga, Ontario. That's three places! After this person has been sexually assaulted, we've sent them to three hospitals saying ‘sorry, we can't help you here!’ Yeah, it’s horrible.”
Having limited sites where a survivor can access a rape kit is not unique to Canada. In London, England, there are three sites—called The Havens—where sexual assault forensic exams are conducted.
The three Havens locations would be sufficient to manage the current demand for rape exams, explains Charmaine Laurencin, Detective Superintendent, Public Protection, London Metropolitan Police Service, as long as they are fully staffed which, at the present time, they are not. But when it comes to dealing with victims of sexual violence and capturing forensic evidence, ideally, “it's about making sure that you've got something in place that gives you that 24/7 coverage.”
And that ‘something’ that the London Metropolitan Police Service currently has in place to assist them with the 24/7 coverage? Early Evidence Kits (EEKs) that all first responding officers are mandated to have in their police vehicles as well as in police stations.
Following the release of the Independent Review into the Investigation and Prosecution of Rape in London by Dame Elish Angiolini DBE QC in April 2015, a recommendation was put forward in order to better ensure that early forensic evidence was properly obtained from first responding officers responding to reported rape offenses:
Recommendation 9. A new mandatory training regime relating to evidential and forensic retrieval should be created to ensure that all first responders can provide a consistent level of service to those who report rape offenses. This should also apply to dealings with suspects. A mandatory system should be put in place to ensure all police vehicles carry Early Evidence Kits and seat covers. Their use should be audited. (Angiolini, 2015)
The recommendation was adopted and put into place, along with a full training policy for first responding officers, on not only how to administer and use the EEKs, but step-by-step policies surrounding how to approach the victim, secure the scene, handle the media (if any) and how to transfer the victim to The Havens (with the victim’s consent) and more.
“So EEKS are administered by the police officers who go out and deal with survivors of sexual violence,” explains Joe, Acting Detective Inspector (DI), London Metropolitan Police Service, “So there are some parts of that kit which the survivor will carry out themselves, I.e. urine tests, and then the officer will help them with the other bits and pieces that can be done away from the hospital setting. And that's our early capture of that evidence.”
The EEKs that are used are referred to as non-intimate kits as they do not include swabs for the vagina or rectum or require the victim to remove any clothing.
The purpose of the kit is to recover trace evidence that may otherwise be impacted or lost with the lapse of time. It is designed to be complementary to the traditional full forensic examination, where a standardized rape kit is utilized, and not as a substitute, though the survivor can choose to only have an EEK done.
When comparing how the rape kit has modernized since the first standardized kit was designed by Martha Goddard in the 1970s, it would be fair to say that the vast majority of kits being produced today are geared toward the medical and law enforcement professions. Whether the kit used is the one with three individual packages or the non-intimate complementary kit, they are all designed to be used by either a medical professional such as a SANE, or by first responding police officers. And while these enhancements improve efficiency for those utilizing them, there are still a number of survivors whom they will not reach.
Though sexual assault reporting is on the rise, data from non-police organizations show that the vast majority of sexual violence cases still go unreported. Fewer victims will get a kit done for a variety of reasons, ranging from uncertainty around the rape exam and the kit, unwillingness to undergo a further invasive procedure following an intimately violating assault, they’re discouraged after being turned away from a hospital that doesn’t have kits or SANEs on site, or because their closest hospital to get an exam done is too difficult for them to get to.
With the shortage of nurses in hospitals, and even fewer SANE-trained nurses on staff, coupled with the impact COVID had on the healthcare industry since 2020, wait times at emergency rooms have increased, and victims attending hospitals that are listed as having a sexual assault center and staff on-site to conduct a rape exam are being turned away and told to come back anywhere from 12 to 24 hours later, and advised to avoid using the washroom, removing any clothing, or showering, due to not having a SANE available in the hospital or on-call.
The Leda Health team, (from left to right) Ilana Turko, Shweta Shrivastava, Liesel Vaidya, and Madison Campbel during a November 2022 interview with The Acumen Group’s Christie Paschakis. / Photo SY Sherman for Acumen
And for those survivors who do not want to go the traditional route of a rape kit, particularly after hearing about the backlog of completed kits sitting untested in storage facilities across the country, and who may just want the autonomy to self-collect their own evidence, in their own time, in their own home, even fewer options were available.
At least they were until Leda Health, a company based out of New York City, decided to challenge the barriers surrounding self-collection for sexual assault survivors.
“Self-collected evidence, in and of itself is not novel, right? Survivors have been doing it for a long time,” explains Madison Campbel, Chief Executive Officer & Founder of Leda Health, “whether they kept the clothes in bags at the back of their closet, or kept text messages or video recordings, this notion of self-collection is not a new concept.”
While in her junior year at college, Campbel was sexually assaulted. “I didn't report, nor did I get medical care or therapeutic care,” she says, but once she began opening up about her experience, just after the #MeToo movement took hold of media attention, she realized just how widespread the issues surrounding sexual assault were.
“I think the #MeToo movement did a really great job of kind of bringing it to the surface,” says Campbel, “but it's this unspoken thing around, primarily women, in that we go to college and, because consent is not taught at a high school level or even younger, we’re kind of disenfranchised to even know what to do and often times get put in positions that we don't want to get put into.”
The mission of Leda Health—founded by Madison Campbel and Liesel Vaidya (who also serves as the company’s Chief Technology Officer)—is to combat the larger issues surrounding sexual assault which includes navigating through the forensic collection process.
“I think in a good co-founder relationship, in general, it's one person who sees the big macro issue, and then a really good team behind them that can say, here are all the micro things that we can do to fix this macro problem and that’s what Leda is to me,” explains Campbel, “it's this massive awareness of a problem. But we're going to approach the problem by using technology.”
One of these areas is the forensic collection process for survivors, offering an alternative to the often-problematic option of either submitting to a rape exam or not.
“There's literally no other way of doing anything else,” says Shweta Shrivastava, Leda’s software engineer, “which is where we come in here saying, you don't want to do that? There is another option. But the fact that they feel they have to do something, by itself, is so overwhelming.”
This can be a relief to a survivor, who often feels that, despite being told that, to get justice, they need to get to a hospital right away and get a kit done, instead often feels like doing just the opposite.
Leda’s option for survivors? An Early Evidence Kit was created for survivors, by survivors— with the help of nurses, advocates, and lawyers—and combined it with a virtual or telehealth component.
“Early evidence kits have been used in Australia and in the UK primarily by the police,” says Campbel, “so it was us kind of looking at the for-profit, telehealth sector… and everything is telehealth now because of COVID, and actually build something that can help survivors.”
“I mean, as Madison said, this is not rocket science,” says Vaidya, “In my personal opinion, some of the gaps that arise in existing systems come because no one has really innovated upon what they initially built, to adapt and really meet the needs of different communities. And our goal is essentially to hopefully be a complementary support system…so that we can help survivors feel or get justice in whatever way that means for them.”
The Leda Health EEK is designed to meet a survivor where they are and provide them with the autonomy to make their own decisions for their healing journey. Whether that be accessing justice or not.
Inside the kit are swabs, garment bags, an evidence seal, an instruction manual, and intake forms. There is a unique barcode on each kit which the survivor can scan into the Leda Health app. Once online, the survivor can access instructions, provide the intake forms digitally through the app, and chat with a member of the care team which includes SANEs to assist with guiding them through the collection process.
Once the kit is complete, survivors have a choice to either keep the kit or send it to Leda Health’s partner lab for testing. As they are a private company, kits submitted to the lab do not become part of the backlog. All kits are tested within a 2-to 6-week timeframe.
However, being a private company, they do not have access to the Combined DNA Index System (CODIS) database, which contains DNA profiles of convicted offenders and arrestees of certain crimes. DNA from rape kits that are reported to law enforcement are uploaded into CODIS.
Leda Health has been very clear in their messaging that they cannot guarantee that their services are not a replacement to either medical care, or law enforcement procedures and encourages survivors to report the assault to the authorities and/or visit a medical center for a full examination. They also have been clear that information collected in the kit is not guaranteed to be admissible in court.
That doesn’t mean, however, that the Leda Health team haven’t taken necessary measures to ensure chain of custody throughout the use of the EEK.
“Obviously that is the main question that most interested parties have for us or those who come with a legal background. And so many steps have been baked into our process to protect the chain of custody to galvanize chain of custody,” explains Ilana Turko, Leda’s Chief Strategy Officer, “And right now the rationale behind not requiring a video recording or video call with a SANE is that we are survivor-centered. We’re about serving survivors, meeting them where they're at, and providing something that is responsive to what they want and what they're ready for.”
While rape laws and rape kit collection has modernized and adapted since Martha Goddard’s first standardized rape kit prototype, including the induction of early evidence kits by law enforcement in countries like Australia and the United Kingdom, rape myths and stigmas remain buried throughout the criminal justice system, medical field, and society as a whole. Despite progressive moves and rape reform—as Marty Goddard stated, “It’s called the criminal justice system, not the victim justice system,”—there still remains a multitude of barriers for survivors to surpass in order to access justice.
Barriers will be explored further in this series.
But, like Goddard before them, the team at Leda Health open up a world of possibilities for victims and survivors of sexual violence, by not just drawing awareness to the problem, but by designing and innovating new ways to solve the problem for generations to come.
“Just because we didn't have these options, doesn’t mean we can’t get these options to the new generation,” says Campbel, “Because it's not about me, it's not about my survivorship, but it's about the next generation, my kids’ generation, and their kids’ generation… it's not just about me, and how I would like the system to appear or adapt now. It's for the future generations.”
The Acumen Group supports each individual preference on how they are identified. While some may identify as a victim of sexual violence, others may prefer the term survivor, therefore, throughout the course of this article, the terms ‘victim’ and ‘survivor’ will be used interchangeably to refer to anyone who has been sexually assaulted.