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SAFE Option Provides Care for Victims of Sexual Violence

Image of (From left) Evangeline Barefoot, Blanchfield Army Community Hospital Forensic Healthcare program manager shows Dr. Cynthia Tara Ferguson, Defense Health Agency Forensic Healthcare program director, protocols BACH follows for patients who come to the hospital after experiencing sexual violence. Barefoot said some victims may avoid medical treatment because they don’t want to report an assault, however seeking medical treatment does not obligate a service member to file an investigation or notify their command. (Photo: Maria Christina Yager). (From left) Evangeline Barefoot, Blanchfield Army Community Hospital Forensic Healthcare program manager shows Dr. Cynthia Tara Ferguson, Defense Health Agency Forensic Healthcare program director, protocols BACH follows for patients who come to the hospital after experiencing sexual violence. Barefoot said some victims may avoid medical treatment because they don’t want to report an assault, however seeking medical treatment does not obligate a service member to file an investigation or notify their command. (Photo: Maria Christina Yager)

A special medical exam available to survivors of sexual violence preserves lasting evidence that may aid in the prosecution of a perpetrator of sexual assault.

Called a Sexual Assault Forensic Examination, SAFE, the exam is conducted by a specially trained healthcare provider known as a Sexual Assault Medical Forensic Examiner, SAMFE. Within the Department of Defense, military treatment facilities with an emergency department, and provide care 24/7, must have at least one SAMFE. Smaller MTFs without emergency departments may partner with a local private or public healthcare agency to ensure patients have 24/7 access to a provider certified to perform SAFEs. 

According to Blanchfield Army Community Hospital’s Forensic Healthcare program manager, Evangeline Barefoot, seeking medical treatment is important for victims of sexual violence. 

One of nine SAMFEs at BACH, Barefoot explained that while television crime shows may emphasize the exam’s value in collecting evidence of a sexual assault from the victim’s body, her number one concern is the victim’s medical and emotional wellbeing following the trauma of sexual violence. 

“Sexual assault rarely leaves physical injuries that a victim can see themselves so they often dismiss the need for medical care. Forensic healthcare is the perfect marriage between recognizing when there is a medical need and a legal need,” said Barefoot. 

At BACH a SAMFE is available 24/7 to provide care and support to victims of sexual violence. 

After treating any acute injuries, the SAMFE will talk with the patient about things they might not be thinking about after a sexual assault—pregnancy, sexually transmitted diseases, HIV, behavioral health needs, and evidence collection. 

“Most of our patients tell us the exam was not what they were expecting,” said Barefoot. “I personally spend time getting to know my patient a little bit. I want to know who they are, what they do, and what their support system is before I ask them about what happened to them. We take as long as they need and make our patients as comfortable as possible because we are here for them.” 

The SAMFE can arrange for any additional tests or medications. They can also schedule follow-up care the patient may need. The exam is confidential and does not require notification of a service member’s command or law enforcement. 

“Fear of retaliation, shame, minimizing the event, uncertainty of outcome, alcohol, lack of interest in an investigation are among the reasons an individual may choose not to report a sexual assault,” explained Barefoot, “but that does not need to be a barrier to seeking medical care.” 

Having a sexual assault forensic exam ensures the patient receives any care they may need and that any forensic evidence is safely preserved in case the survivor later decides to file an unrestricted report. By law, evidence collected during a SAFE is required to be retained for 50 years. 

“We want the very best for our patients. They are seeing us on one, if not the worst, day of their lives and if we can reduce their fear, their anxiety, their pain, by even a little bit, that is successful healthcare,” said Barefoot. 

Forensic health professionals, like Barefoot, provide medical treatment and evaluation, have a specialized knowledge in injury identification, evidence collection and may provide testimony in court to assist with prosecution of individuals who commit acts of abuse. 

For more information about Sexual Assault Prevention and Response policy and initiatives in the DOD, visit the Sexual Assault Prevention and Response Office (SAPRO).

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On Oct. 20, 2022, the Secretary of Defense released a memorandum, “Ensuring Access to Reproductive Health Care,” directing the Department take a series of actions to ensure Service members and their families can access non-covered reproductive health care. On Feb. 16, 2023, the Department of Defense released those directed policies, which will be effective no later than 30 days from Feb. 16, 2023.

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The Department of Defense has released the directed policies on command notification of pregnancy, administrative absence for non-covered reproductive health care, and travel allowances for non-covered reproductive health care.

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This policy clarifies when a Service member’s pregnancy status is shared with commanders, standardizes and extends the timeframe for Service members to inform their commanders about a pregnancy, and reinforces that commanders must always exercise objectivity and discretion when handling reproductive health care issues.

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This regulation ensures Service members and eligible dependents are eligible for travel and transportation allowances to access non-covered reproductive health care services when timely access to non-covered reproductive health care services is not available within the local area of the member’s permanent duty station, temporary duty location, or the last location the dependent was transported on authorized government orders.

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This policy provides Service members the ability to request an administrative absence from their normal duty stations in order to access, or accompany a dual-military spouse or dependent to access, non-covered reproductive health care without being charged leave.

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Last Updated: February 01, 2023
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