BILLING FOR RAPE Victims billed for rape medical expenses

A New Orleans woman who wishes remain anonymous holds an itemized bill of medical expenses related to her treatment for the rape. In Louisiana, victims of sex crimes often are billed for forensic medical exams and related care even though state and federal guidelines require many of these services be provided at no cost. On Tuesday (Dec. 9, 2014), Gov. Bobby Jindal issued an executive order that will allow Louisiana hospitals to bill the state directly for costs associated with examining rape victims. The order provides some short-term solutions to a problem lawmakers say they'd like to resolve when the Legislature meets in April 2015.

(Kathleen Flynn, NOLA.com l The Times-Picayune)

Louisiana hospitals will soon be able to bill the state directly for costs associated with examining rape victims.

The move, made possible by a new executive order from Gov. Bobby Jindal, marks a significant change for the state's sexual assault victims, who sometimes receive thousands of dollars in burdensome bills after undergoing forensic medical exams following their attacks.

"Sexual assault is a horrendous crime that creates physical and emotional damage to victims, for which special measures must be taken by every public officer and agency in this state in order to bring the perpetrators to justice and assist victims in their recovery," reads the order, which Jindal issued early Tuesday (Dec. 9).

Effective immediately, the governor's order is the second such issued by his office since October, when three women shared their hospital bills with NOLA.com | The Times-Picayune showing charges of between $1,700 and $4,200 for services they or their loved one received while nurses and doctors checked their bodies for evidence of rape.

Jindal's latest order assigns tasks to three state agencies — the Louisiana Commission on Law Enforcement, the Department of Health and Hospitals and the Department of Public Safety — and aims to provide relief to sexual assault survivors between now and the start of Louisiana's next legislative session in April, when lawmakers hope to achieve a more permanent solution.

"We wanted to do whatever we could now, before the session," Stafford Palmieri, Jindal's assistant chief of staff, said Monday night. "It will be followed up by a bill or several bills."

Among the order's demands:

SPECIFY WHO PAYS AND HOW MUCH

The Louisiana Commission on Law Enforcement, which oversees the state's victim compensation fund, will create a list of eligible medical expenses for which hospitals may seek payment through the Crime Victims Reparations Fund on a sexual assault victim's behalf.

Currently, survivors must undergo a lengthy process to apply for reimbursement from the $2 million fund, which is designed to serve eligible victims of all violent crimes. Although there are 1,200 forcible rapes reported to law enforcement annually, only 33 sexual assault victims last year sought reparations — and fewer awarded.

Under the new scenario, patients could give permission to the hospital to seek the funds instead. Palmieri said the plan anticipates doing what many other states have done: setting fixed prices for medical services and/or setting an overall cap for what the state will pay to hospitals.

Unclear now is exactly how much this will cost and how the state would fund it. Palmieri said that for the short-term she believes the existing Crime Victims Reparations fund is large enough to meet the immediate victims' needs.

"Between now and the session we'll be fine," Palmieri said. "Moving forward, we will be looking at what the CVR comes up with and what the total cap will be."

She said the Louisiana Commission on Law Enforcement is working with parishes to improve collection of fines and fees levied on perpetrators — money that finances the reparations fund. In October, Louisiana Commission on Law Enforcement Executive Director Joey Watson told lawmakers that there are many parishes that aren't properly collecting those fees and sending them to his agency.

This issue of funding makes victims advocates nervous. They worry that if the state doesn't identify a reliable source of funding to pay for the exams and related expenses, leaders may divert federal Violence Against Women Act funds that are already devoted to helping victims.

"We don't want to take what little money we get for victims services," said Racheal Hebert, executive director of Sexual Trauma Awareness and Response, an advocacy group based in Baton Rouge.

Palmieri said such a move is "not something that is contemplated in this executive order. We're not interested in defunding anyone."

PROVIDE A LONGER WINDOW TO REPORT

Sexual assault survivors will have up to a year to report their attacks to law enforcement in order to be eligible for reparations.

Gov. Bobby Jindal

Currently, state law requires victims report to police within 72 hours in order to be eligible, even though federal law makes clear that reporting to police should not be a prerequisite for a victim to receive a forensic exam free of charge.

Palmieri said it will take a change in statute to completely eliminate the language requiring reporting to law enforcement. Studies indicate only one-third of sexual assault victims ever report to police.

The longer acceptable reporting period means that victims who were assaulted prior to the executive order being issued have more time to seek financial help.

DEFINE 'FORENSIC MEDICAL EXAM'

DHH and the Department of Public Safety should form a group that will define what a "forensic medical exam" should entail, the order says. The definition would include all related charges, "including, but not limited to emergency room charges, hospital stay charges and physician charges ... and that those expenses are not chargeable to the sexual assault victim," the order states.

Currently, the federal Violence Against Women Act states that forensic medical exams should include an examination of physical trauma, a determination of penetration or force, a patient interview and collection of evidence. By that definition, costs for procedures that are a regular part of the sexual assault screening – pregnancy tests and HIV tests, among them – are often considered extra.

CREATE REGIONAL RAPE CRISIS PLANS

The state's nine regional health services districts overseen by DHH will develop "detailed rape crisis response plans" by Feb. 1, 2015. These plans should clearly state who is responsible for paying for and storing rape kits — and clearly describe how payment of medical bills stemming from sexual assault examinations should be handled.

Right now, in Louisiana, there's little continuity in how rape victims are treated from parish to parish and hospital to hospital. And many victim advocates are calling for a statewide plan. But Palmieri said that the development the regional response plans doesn't rule out taking a statewide approach. She said she believes the process itself will help leaders identify whether there are enough commonalities to set the stage for a one-size plan of attack.

ESTABLISH RAPE KIT CONTINUITY

The contents of rape kits should be standardized, with DHH and the Department of Public Safety creating a series of minimum requirements for what should be included, the order states.

Hebert said that the Jindal administration's work to move the ball forward on these matters is encouraging.

"I feel like this is the first time, maybe ever, that there are this many people talking about this issue and coming together and trying to find solutions," she said.

A number of lawmakers, including Rep. Helena Moreno, Sen. J.D. Morrell and Sen. Karen Cater Peterson, all Democrats from New Orleans, as well as DHH Secretary Kathy Kliebert, have been outspoken about their interest in reforming the way Louisiana handles billing for sexual assault services. Moreno and Morrell said they would make it a legislative priority this spring.

In October, immediately following a legislative hearing on the issue, Jindal signed another executive order telling the Louisiana Commission on Law Enforcement to "immediately revise" its rules regarding the eligibility of sexual assault victims to receive compensation for the expenses they incur in the process of undergoing a forensic medical exam, including tests for pregnancy and HIV.

As it stood, the commission had the right to deny victims of sexual assault from compensation for a variety of reasons including how they were dressed, where they were prior to the assault, and whether they were under the influence of alcohol.

Asked Monday why the governor has shown such an interest in this issue, Palmieri said it's because victims deserve to have services and not be billed: "He's a father and a husband and it's the right thing to do."

Read the full order here: Executive Order Jindal Billing for Rape.pdf

Rebecca Catalanello can be reached at rcatalanello@nola.com or 504.717.7701.