Q 1. The process that the victim has to follow: the patient’s first point of contact in the hospital and handling of paper work ( Who is supposed to fill, where and with whom) :

First point of contact of victim is Casualty Medical Officer (CMO) or Nodal officer.
Basic paper work is done by CMO and remaining is done by nodal officer in coordination with other coordinating departments like –

• obstetrics & gynaecology,
• Paediatrics,
• Surgery,
• Paediatric surgery,
• Psychiatry and
• Medicine

Q 2. Who is the coordinating officer in the hospital who brings in the relevant doctors to handle the patient’s case :

The Nodal officer in charge of center is the coordinating officer in the hospital who brings in related doctors to handle the case.

Q 3. Process for handling the victims test reports (Is it directly between the hospital & police OR is the family required to take them to and fro) :

• The samples collected from victim are sent to FSL Kalina through concerned police station for chemical analysis.
• The chemical analyser drafts a report that is sent by post to senior Police Inspector of concerned police station. Usually the reports are approved through the investigating officer. The documents can be relied upon in Court.
• From FSL, the police collect test reports related to medicolegal matter and in case of clinical management related tests, reports are collected and handled by the concerned doctors.
• In no way relatives or families have to collect or take them to and fro.

Q 4. What are the steps taken by the hospital staff to safeguard the patient/victim? (from media and police) :

• MCGM is the first public body in the country to start specialised services for examination of survivors of victims of sexual violence under one roof.
• The Nodal officer is appointed to coordinate and supervise the examination, treatment and rehabilitation of victim(s).
• Police personnel must not be allowed in the examination room during the consultation
  with the survivor.
• Only a female police officer in plain clothes allowed to be present as a custodian along with the blood/ immediate relatives of the victim.
• All such cases are kept in isolated rooms with restricted entry to treating doctors and custodian female police.

Q 5. Who is the coordinator between the hospital and the police :

The Nodal Officer from the department of Forensic Medicine is the coordinator between hospital & police.

Q 6. What are the precautions that should be taken by the victim before coming to the hospital :

• If there is excessive bleeding from the affected part then, pressure bags to be applied by the victim or accompanying person to decrease the amount of bleeding.
• In no way the clothes present on the body of the victim at the time of the incident washed, removed as far as possible.
• Using the toilet to wash up or urinate is to be avoided.
• If the circumstance leads to removal of the clothes, then such clothes are to be kept in paper material and not plastic.
• Such clothes are to be handed over to the police or medical authorities.

Q 7. What is collected as evidence from the victim :

• Biological swabs from genitals, blood, clothes and nails are collected as evidence from the victim.
• If victim is wearing the same clothes as worn during assault, when she undresses at the hospital, she is made to stand on plain white paper and do so. This helps collect stray DNA or evidence that could help with the investigation.
• All such evidence and contents are put in a sealed paper bag and forwarded to the concerned police authorities.
• Test for intoxicants or specific designer drugs is done case based, should there be a suspicion of the victim being drugged.
• It is mandatory to seek an informed consent/refusal for examination and evidence collection of the survivor.

Q 8. What does a sexual assault forensic evidence (SAFE) kit contain :

As such, there are no such designated criteria formulated by Government of Maharashtra regarding the rape kit. The materials which are used for the collection of evidences are:

• Forms for documentation
• Large sheet of paper to undress over
• Paper bags for clothing collection
• Wood stick for finger nail scrapings
• Urine sample container
• Glass slides
• Envelopes or boxes for individual evidence samples
• Lac (stealing wax) stick for sealing the evidence samples
• Gloves
• Comb
• Swab sticks
• Plain bulbs
• EDTA bulbs
• Catchment paper
• Sterile swabs
• Nail cutter and scissors
• Syringes and needles for drawing blood
• Cotton clothes, shower/hygiene item for survivor’s use after the examination

Q9. Which doctor administers the rape kit on the patient :

• The female gynaecologist on duty administers the rape kit.
• In case there is no female gynaecologist on call, a male gynaecologist should administer the test in the presence of a female nurse, in order to avoid delay in treatment and examination.
• Please Note – It is not mandatory for a gynaecologist to examine the survivor, any medical practitioner may do so.

Q10. Are invasive tests (finger test) allowed to determine rape :

• No, the finger test has been discontinued and outlawed after the Government (Union Health Ministry) issued fresh guidelines on medical care and procedures provided to rape victims.
• It has asked all hospitals to set up a designated room for forensic and medical examination of victims.

Q11. Is the hospital staff allowed to take photos of the victim’s bruises for documentation purposes to show as evidence during trial :

Such photos have no relevance in the trial procedure and are not taken usually.

Q 12. Can the victim give her statement to the police from the hospital :

Yes. She can give statement to the police from the hospital.

Q13. What if the victim goes to the hospital before going to the police station, what is the course of action of the hospital in that case :

• If the patient comes to the hospital directly without going to the police station, the hospital is bound to provide treatment and conduct the medical examination. Hospitals cannot deny admission to the survivor.
• If the survivor purely wants medical treatment and has no intention to lodge an FIR, the hospital is still bound to inform the police as per law. In such cases where the survivor has no interest in pursuing a police case, a MLC must be made and she should be informed that she has the right to refuse to file an FIR. The refusal must be documented.
• Hospitals cannot deny treatment to the survivor if she refuses to participate in the police investigation.
• All these activities are coordinated by Nodal Officer of OSHC .

Q 14. If the victim refuses to file a complaint, does the hospital take a statement from her for their own record :

In every medicolegal cases or in case of any patient admitted to hospital or seen on OPD bases, necessary history is recorded in detail as per protocol by the handling or managing doctors.

Q 15. What if the victim refuses to file a complaint or record a statement with the police, what is the hospitals role in this case :

Hospitals are obligated to inform the concerned police station regarding the alleged offence and to simultaneously provide treatment.

Q 16. Who handles all the expenses incurred :

As per law, in medicolegal matters, all expenses incurred towards diagnosis and management of cases are to be borne by the concerned hospital.

Q 17. If the victim insists on being admitted, is there a provision for the same :

Depending on the condition of the victim, either she is admitted in the hospital or handled on OPD basis.

Q18. What is the procedure in cases of transferred patients from other (private or public) hospitals :

• Transferred victims from other hospitals are usually accompanied with necessary details regarding history, management done and samples collected.
• In such cases, care is undertaken in accordance with the information provided in the referral letter of the transferring hospital.
• If victim is brought with no referral letter or information is not provided, the victim is treated as a fresh or new case and all due procedures are carried out.

Q19. In case of a foreign national is the process same or are there some other formalities :

As per hospital rules is concerned, procedure is the same as prescribed by the Law of Land. No special protocol or procedure is adopted in such cases.

Q20. What are the terms and conditions of counselling and rehabilitation :

Every case is examined and managed by Department of Psychiatry for psychiatric evaluation and rehabilitation. After complete evaluation, management protocol is prepared and implemented for management and rehabilitation of victims of sexual offences.

• Survivor’s of sexual violence should receive all services completely free of cost.
• Examination begins with the inspection of the body surface for bruises, scratches, bites and other injuries.
• Moistened swabs are used to collect smears from the oral cavity, bloodstains on the body, foreign material on the body surfaces, seminal stains on the skin surfaces and other stains. The swabs are air dried in shade before packing in respective envelopes. Note: Swabs must not be dried in direct sunlight.
• The survivor’s hair is then combed to collect any loose hair (of the rapist) or debris, which may serve as evidence.
• Material under the survivor’s nails is collected by using a moistened and pointed swab. Survivor’s nail clippings are then collected and placed in the respective envelopes.
• Survivor’s blood is then drawn and collected in two samples – First sample is kept for blood grouping and DNA analysis, Second sample is kept for assessing alcohol levels and drugs.
• Genital area is examined last. The perineum, vulva and labia are inspected for injuries, seminal stains and stray pubic hair. A note is made of any swelling, bleeding and tearing.
• In case of any suspected seminal deposits on the pubic hair of the woman, that portion of the pubic hair is clipped, allowed to dry in the shade and placed in an envelope.
• Pubic hair of the patient is then combed for specimens of the rapist’s pubic hair.
• Separate swabs are taken from the vulva, vagina and anal opening. The swabs are allowed to dry naturally in the shade and placed in marked envelopes.
• The colour, shape and size of all injuries should be noted in the diagrams provided in the examination form. An assessment of the emotional and mental state of the woman is made and recorded. Assessment of the age is included in this Form.
• After this examination, the survivor is then treated for injuries, sexually transmitted diseases and pregnancy that may have resulted from the assault.
• If the survivor is menstruating at the time of examination then a second examination is required on a later date in order to record the injuries clearly.
• Counselling and psychosocial support is offered.
• Follow-up is essential. The patient is called for re-examination 2 days after the assault to note the development of bruises and other injuries.
• A copy of all documentation must be provided to the survivor free of cost.

Sec 164A of the Code of Criminal Procedure further list the following :

1. The woman with whom rape is alleged or attempted to have been committed is to be examined by a registered medical practitioner with the consent of such woman or of a person competent to give such consent on her behalf within 24 hrs from the time of receiving the information of offence committed.
2. The report shall state precisely the reasons for each conclusion arrived at and the exact time of commencement and completion of the examination.
3. The report shall specifically record that the consent of the woman or of the person competent to give such consent on her behalf to conduct examination had been obtained. Without consent, the examination will not be considered as lawful.
4. The medical practitioner shall, without delay, forward the report to the investigation officer who shall forward it to the Magistrate.

Section 357C – Treatment of Victims

According to the Criminal Law (Amendment) Act, 2013:

All hospitals, public or private, whether run by the Central Government, the State Government, local bodies or any other person, shall immediately, provide the first-aid or medical treatment, free of cost, to the victims of any offence covered under section 326A, 376, 376A, 376B, 376C, 376D or section 376E of the Indian Penal Code, and shall immediately inform the police of such incident

• This is covered under Sec 53A of the Code of Criminal Procedure.
• When a person is arrested on a charge of committing or an attempt to commit rape, in order to find evidence, an examination of the accused/arrested person is conducted by a registered medical practitioner employed in a hospital run by the Government or by a local authority.
• The medical practitioner shall, without delay, examine such person and prepare a report stating :
  1. the name and address of the accused and of the person by whom he was brought,
  2. the age of the accused and any marks of injury on his body,
  3. the description of material taken from the accused for DNA profiling and test reports of his blood for alcohol/ intoxicants.
• The report shall state precisely the reasons for each conclusion arrived at and the exact time of commencement and completion of the examination.
  The medical practitioner shall, without delay, forward the report of the investigating officer, who shall forward it to the Magistrate

• Government hospitals are better equipped to deal with protocol regarding rape cases, therefore it is advisable to visit a government hospital over private hospitals for immediate care.
• The Survivor does not have to go to the police station first to file a complaint and then visit a hospital; she may directly seek help at a hospital.
• Further, she may give her statement to the police from the hospital itself.
• Survivors should avoid using urinals or tampering with clothes worn during assault before going to the hospital.
• The Medical Officer and Chemical Analyser’s report and statement during court proceedings are crucial. Their reports along with any forensic reports are treated as expert opinion and cannot be challenged.