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Posts tagged as “Sexual assault”

Duke Hospital sends bill collectors after student rape victim

In the early morning on Dec. 13, 2018, a Duke student was sitting in her apartment’s common room in the university’s Central Campus. She was cramming for her organic chemistry final when a man she didn’t know opened the door. She said the stranger entered, threatened her with a knife, and raped her.

The student, then a sophomore, immediately went to the Duke Hospital emergency room. She wanted a sexual assault nurse examiner to collect a rape kit, an invasive evidence collection process that often takes hours and requires victims to describe the details of their assault. But that kit could provide crucial evidence for police to catch her assailant.

Police have not announced any arrests in the case. But six months after the assault, the student received a call from a number she didn’t recognize. 

“This is a call from a debt collection agency for Duke Health,” the person said, according to the student. The caller informed her that she owed hundreds of dollars for her emergency room visit for the rape examination.

“Before that, I had no idea I owed any money,” the student, who asked not to be identified, told The 9th Street Journal in an interview. “I asked them to talk to my mom because it was really traumatic and hard, but they didn’t do that. They kept calling me over and over again.”

*  *  *

Rape victims are not supposed to be charged for sexual assault exams, but the rules have loopholes.

The federal Violence Against Women Act requires that all states cover the cost of the exams. But beyond the exams themselves, each state can decide what additional hospital services they’ll cover.

North Carolina’s interpretation is called the Rape Victims Assistance Program. The program offers hospitals up to $800 for a sexual assault exam: $350 for the sexual assault nurse examiner, $250 for the hospital facility fees, and $200 for “other expenses,” including sexually transmitted disease antibiotics or pregnancy tests for the victim. Victims should never be directly billed by a hospital for the examination, according to the North Carolina Department of Public Safety.

But Molly Chadbourne, a former sexual assault nurse examiner in Durham, said victims still get charged for other services. 

“There are still fees for checking into the hospital, for getting an X-ray, or for needing other care,” she explained. “All that other stuff, patients can get charged for. Sexual assault patients definitely get bills.”

Chadbourne said some states cover all of a sexual assault victim’s other hospital bills, while others cap their payments at a certain amount. She noted the $800 cap in North Carolina and said, “$800 is nothing at a hospital.”

Though the Violence Against Women Act is supposed to protect victims from being billed after a sexual assault, many women have reported experiences like the student’s, according to accounts in news articles and websites. The practice is caused by a combination of state policy, billing mistakes, and poor communication between debt collectors and hospitals.

*  *  *

When the student went to Duke Hospital last December after being assaulted, she didn’t bring her insurance card.

“They said that was fine at the time,” she said. She was told that she wouldn’t have to pay for her sexual assault exam and that she didn’t have to worry about billing.

A few hours after the assault, police sent a Duke Alert, the university’s warning system for crime and severe weather. “A student reported that between 1 a.m. and 3 a.m. this morning… she was awakened by a white male with short brown hair and a perfume smell about him,” read the alert emailed to students, faculty, and staff. “He threatened her with a knife, put on a condom, and forced her to have sex.”

The student was embarrassed by the detailed university-wide alert. “Reading the email was really hard,” she said. “They never asked me if it was okay to send out that email, or if I even wanted to talk to the police. They just said, ‘You need to talk to this officer,’ and I did it because it felt like I had to.”

Months after the assault, she was beginning to heal. She was put in contact with the Duke Women’s Center and started seeing a psychiatrist.

Duke Hospital has an online billing system. But the student said she didn’t think she would have bills, so she never checked it. After four months, Duke Health sends all unpaid medical bills to debt collection agencies.

Then, she got the first call from a debt collector. The calls kept coming.

“We are (a) debt collector,” a voicemail message from the agency said. “This call is an attempt to collect a debt and any information obtained will be used for that purpose.”

“They’re always from a random number, and never the same number twice,” the student said. “I told them my insurance card information, and I got confirmation that everything was worked out over the summer. But they continue to call and say we owe them even more.”

When she called Duke Health to report what was happening, the billing office told her that she had an outstanding charge. She asked that the debt collectors contact her mom instead so she wouldn’t have to explain her situation to strangers. She and her mom are still working through the bill.

Her bill from her emergency room visit on Dec. 13 is labeled “Accounts with Collections Agency” in Duke’s online billing system. But she said she has difficulty determining how much she owes because the collectors have a separate billing system. 

The collectors keep calling, every few months.

The student authorized Duke Health to discuss her bills with The 9th Street Journal, but a Duke Health spokeswoman declined to comment on the student’s situation. 

*  *  *

Across the country, victims have reported getting billed by hospitals after a sexual assault.

“We definitely hear about this,” said Grace Frances, the director of community parternships at End Violence Against Women International, a nonprofit that educates professionals about sexual assault. “It is definitely still a problem.”

In 2017, a study published in the American Journal of Public Health found that the average hospital bill after a rape was $6,737. After billing insurance, sexual assault victims were left with an average of $948 to pay out of pocket. And 88% of medical records indicated that victims were charged on the day they visited the hospital.

“Oftentimes, the charges that they’re seeing aren’t the cost of the rape kit,” said Ashley Tennessee, the lead researcher on the study and an assistant professor at the Medical University of South Carolina. “Most people who are sexually assaulted have additional costs. They might want tests completed, or treatments for physical abuse.”

Tennessee sees the problem as twofold: Victims are sometimes mistakenly charged for their rape kit exam. But more often, they’re billed for treatment related to their sexual assault. 

If victims check into the emergency room, they can also be charged a facility fee. Duke itself acknowledges that going to its emergency room will cost patients “at least $1,000.” 

Asked if Duke Health has a policy about charging for sexual assault exams, a spokeswoman declined to comment.

Tennessee recommends that states broaden their policies to reimburse hospitals for more than just the sexual assault exam. She also hopes that hospitals will charge sexual assault victims through a separate billing process to ensure that no mistakes are made.

“Someone has to pay for it,” she said. “At this point, it’s the victim.”

*  *  *

For sexual assault survivors who have been billed by hospitals in North Carolina, there is another option: the crime victim compensation fund. Victims of violent crime can apply for medical compensation up to $30,000, including physical treatment and future counseling. 

But there are bureaucratic hurdles that can be challenging for survivors of sexual assault. To submit a claim, a victim must provide a police report. That means they have to report their rape to police before they’re eligible for the compensation.

“I think you should be able to come into the emergency room and say, ‘I was sexually assaulted, I want to get medical care,’ and get that for free,” Chadbourne said. “But that’s not how it works.”

Even for victims who are eligible to apply to the compensation fund, there are still barriers. They have to collect documents and get them notarized before submitting their application, and will likely wait months to receive compensation. And in the meantime, they’ll still be billed for their sexual assault exam visit.

“It’s unacceptable,” Frances said. “You’re telling victims that you don’t care what it means to them when they get a bill in the mail, and their family sees it.”

“It’s putting the responsibility on the victim to get themselves reimbursed,” Chadbourne said. “And that’s hard.”

For the Duke student, it is also confusing.

“We’re unsure about what the bill is for at this point, because we’ve already paid so much,” she said.

She also feels betrayed by the institution that failed to protect her while on campus. 

“I hated their whole response,” she said. “They just sent us to a collection agency.”

9th Street Journal reporter Cameron Beach can be reached at  cameronbeach6@gmail.com

The life cycle of a sexual assault evidence kit

It starts when the emergency room door opens.

A victim walks in. She may have been sexually assaulted an hour ago or a day ago, but now, she’s decided to see a doctor. She might walk in with a friend or a parent, or she might sit alone and wait for the sexual assault nurse examiner to arrive.

“I just introduce myself at the beginning,” says Molly Chadbourne, a former sexual assault nurse examiner in Durham who currently trains other nurses. “I explain who I am and why I’m there to talk with them. Then, I ask them what they want. Do they want a kit?”

This is where a sexual assault kit begins. Its life cycle may last months, or even years.

The nurse ushers the victim into a small hospital room where they have privacy. Chadbourne likes to start with the easier questions: “What’s your medical history? What types of medicine do you take?” Then, she’ll ask the harder question. “Can you tell me what happened to you?”

The nurse listens, letting the victim take breaks and reminding her that it’s okay to tell her story imperfectly.

“We know that some people aren’t going to remember everything right away, and they might not remember it linearly,” Chadbourne says. “We have to give people permission to start talking about whatever they can, even if it’s not at the beginning.”

Then, the nurse starts to assemble the kit, a small white cardboard box with “Sexual Assault Evidence Collection Kit” printed on the front. 

The nurse starts collecting “known” samples, or the victim’s DNA. She’ll gently swab around the victim’s cheeks, gums, and lips. She’ll ask the victim to take off her underwear and seal it in a bag labeled “Underpants”. She’ll pluck exactly 50 hairs out of the victim’s head and then comb through her pubic hair, securing any hairs that fall off into a small envelope. 

Then the nurse collects “unknown” samples, which could include the assailant’s DNA. The nurse will swab any place on the body where the victim says she was assaulted. “It’s anywhere that was licked, bit, or touched by the assailant,” Chadbourne says.

She says “anything that’s on their body might be relevant”. Victims and nurses alike understand that the victim’s body is a crime scene.

The nurse takes photos of the woman, documenting any cuts, scrapes, or bruises. “I offer to let people look at the pictures,” Chadbourne says. “I try to give them as much control over the process as possible.” At any point, she notes, a victim can stop the kit collection.

After two hours, the nurse has packed away dozens of cotton swabs, photographs of injuries, and envelopes of hair into the sexual assault kit. She closes the lid of the white cardboard box and places it in storage, where the kit waits for law enforcement to come pick it up the next morning.

***

When the kit arrives at the police department, an officer will take a first look. That officer might notice if the kit is connected to a consent case, a case in which the victim and the perpetrator both agree that they had sex, but disagree on whether it was consensual. Three years ago, a consent kit would get put back on the evidence shelves at the police department instead of getting tested. It could stay there for over 30 years.

“When I was seeing patients, I couldn’t say to them, ‘Your kit will never get tested, because you know the person that assaulted you,’” Chadbourne says. “Doing this really invasive process and knowing in the back of your mind that this kit will probably never be tested… it’s a really hard pill to swallow.”

But today, with the statewide push to send all kits to the State Crime Lab, that kit won’t sit on an evidence shelf if it doesn’t meet testing requirements. Instead, an officer will log it into the North Carolina State Crime Lab’s database. A technician at the lab will accept the kit, and the officer will drive it to Raleigh, where the State Crime Lab is located.

“We place the kit into a vault until it’s time to be worked,” says Jody West, forensic sciences manager at the State Crime Lab. “Then we open it up, and start with inventory.”

Every sexual assault kit is a little different “It’s a box, but it’s not a one-size-fits-all box,” according to Chadbourne and the State Crime Lab takes note of every swab, photo, and hair inside.

A lab technician first takes a tiny portion of the swab and uses a chemical to tease out the DNA from its cotton. “It’s like cracking open an egg and removing the yolk,” West explains.

Lab technicians then use a machine to separate the yolk — human DNA — from any other type of genetic material. In sexual assault cases, they’re usually looking for male DNA. “This is the decision point,” West says. “If we determine there’s not enough male DNA, we’ll stop.”

If the kit moves ahead, it goes through amplification, or copying the yolk. The assailant’s DNA fragments are heated and cycled through a hefty gray machine — in just thirty cycles, a billion copies of that DNA are made.

The last step is electrophoresis, or separating the yolk. Analysts use an electric field to detach different fragments of DNA. The result is a complete DNA profile. “It looks a lot like a heartbeat,” West says.

After hours in the emergency room, days with law enforcement and up to five weeks at the lab, this is what a completed sexual assault kit looks like: A series of peaks on a computer screen.

Those peaks the DNA profile of the assailant will be entered into a database of millions of offenders across the country. A computer will scan each offender’s profile, checking for a perfect match. If the all of the peaks line up, the computer spits out a name. Then, it’s up to the police to investigate the sexual assault.

That is the life cycle of one sexual assault kit. To clear the backlog of 15,160, North Carolina has thousands more to go.

“Most people, if they’ve ever heard of a rape kit before, it’s from watching Law and Order SVU,” Chadbourne says. “They think it gets solved in 60 minutes. The truth is, it doesn’t. It really doesn’t.”

A sexual assault evidence kit. Photo provided by Molly Chadbourne

Resources for survivors:

Durham Crisis Response Center

Rape, Abuse & Incest National Network: What is a sexual assault forensic exam?

North Carolina Sexual Assault Kit Tracking 

North Carolina Office for Victims of Crime: Crime compensation

Police make three arrests after testing old sexual assault kits

In 2017, Michael Brooks Jr. was arrested for kidnapping, assaulting, and raping an elderly woman. Now, after testing evidence from a sexual assault kit that went untested for three years, police say they believe Brooks committed another rape a year earlier.

Brooks, 45, is one of three men Durham police suspect of committing multiple rapes after evidence in old sexual assault kits revealed DNA matches in separate crimes.

After discovering a backlog of over 1,700 untested sexual assault kits in 2018, the Durham Police Department has begun to pull those kits off the shelves and test their contents. Now, just over one year into the process, police have made their first three arrests connected to the testing of old kits.

***

In March 2018, the North Carolina State Crime Lab announced that law enforcement agencies had 15,160 untested sexual assault kits across the state. That discovery prompted movement in the capital and among individual law enforcement agencies. After decades of stasis, police and sheriffs’ offices began sending in their untested sexual assault kits.

So far, North Carolina law enforcement offices have submitted over 8,000 kits to the State Crime Lab for testing. Cities from Winston-Salem to Charlotte have reopened cold-case sexual assaults and charged suspects.

The Durham Police Department — the jurisdiction with the largest backlog in the state in 2018 — is joining those cities by charging three suspects identified through the testing of old kits.

Brooks was served an arrest warrant for a 2016 rape while in jail, where he waits to stand trial for rape and assault charges from 2017. Police also arrested Isiah Anthony Townes Jr., 22, and indicted Ronnie Porter, 45, for rapes committed in 2016 and 2014, respectively. 

“We’ve had some good success stories,” said Lieutenant Stephen Vaughan, assistant commander of the Criminal Investigations Division. “We’re looking at sending every kit we can.”

Vaughan estimates that the Durham police have sent in around 400 kits for testing so far. But the process is complicated by the different statuses of kits in the police inventory. 192 of Durham’s 1,711 kits are related to cases that have already been resolved in court, and 166 are marked as “unfounded.”

Kits marked as “unfounded” means that the officers who originally investigated the case believed that no crime occurred. But Vaughan and his team are still reviewing those cases to make sure the original designation was correct. “If there are any questions, we’re going to reopen that case and send the kit as well,” he said.

Police are even looking through cases that have already been resolved in court. In some cases, defendants who faced multiple charges accepted a plea deal that did not involve any sexual assault charges. Now, they could be held accountable for those crimes, too. 

***

Sending kits for testing at the State Crime Lab is just the beginning of the process for clearing the backlog at the Durham Police Department.

Take Brooks’ case. The State Crime Lab checked DNA evidence from the sexual assault kit with a federal database that contains DNA profiles from convicted offenders across the country. That’s when they found a match: the unknown DNA profile from the kit matched Brooks. 

After that, the Durham Police Department reopened the cold case and got to work. But they haven’t been working alone.

Durham’s Sexual Assault Response Team also includes the Durham Crisis Response Center, the District Attorney’s Special Victims Unit, and the Sexual Assault Nurse Examiner program at Duke Hospital. 

“When the Police Department started getting to the point where information from the Crime Lab was coming back, they realized they needed to have a plan for how to contact the victims,” said Charlene Reiss, coordinator of the Sexual Assault Response Team at the Durham Crisis Response Center. Her team helps police form relationships with victims who may experience trauma from reliving a sexual assault.

“We sit in a room and go through these cases as a group,” Reiss explained. “We really try to figure out how to keep the victim’s needs at the forefront as the Police Department figures out how to move forward.”

***

The Police Department still has hundreds of kits to prepare for testing, including some that date back over thirty years. But the Sexual Assault Response Team is determined to clear the backlog.

“These are the cases that most need to be prosecuted,” said Kendra Montgomery-Blinn, lead prosecutor in the Special Victims Unit. “We’re getting CODIS hits on serial rapists.”

Even so, she knows that the process is only just beginning. “I think the goal for this is roughly six years,” she said. “And that’s only to test them all. If the last cold case kit gets tested 5 years from now, it’ll be 7 years from now before it goes to trial.”

Brooks’ case will also likely take years to reach its conclusion. This week, the District Attorney’s office will meet with Brooks’ victims to attempt to work out a plea deal for both the 2016 and 2017 rape cases. Brooks is currently in jail on a $1,750,000 bond. His lawyer estimates that both cases will come to trial in the summer of 2020.

Sorority sisters and partners in law enforcement: Deberry and Davis discuss sexual assault

District Attorney Satana Deberry always wears a red beaded bracelet with a little white elephant. On its own, this might seem like an odd choice for a progressive Democrat. But Saturday, as a sea of red sweaters, Greek letters, and all forms of elephant decor filled the conference room in the Durham County Human Services Complex, the bracelet made a lot more sense.

The elephant is the unofficial symbol of the historically black Delta Sigma Theta Sorority, of which Deberry and Durham Police Chief C.J. Davis are both alumnae. The sorority’s Durham Alumnae Chapter hosted a panel discussion called “Sister to Sister: A Talk on Sexual Assault.” The discussion was moderated by fellow sorority sister Jasmine McGhee, who is special deputy attorney general and director of the Public Protection Section at the North Carolina Department of Justice. 

Jasmine McGhee (left) moderates a panel discussion with Police Chief C.J. Davis (center) and District Attorney Satana Deberry (right). | Photo by Erin Williams, The 9th Street Journal

Deberry lauded her sorority sisters and fellow panelists for their accomplishments, and emphasized the significance of them holding those positions as women of color.

“The chief and I are unicorns almost,” Deberry said. “It is rare that you are in a jurisdiction in which the chief of police and the district attorney are not just women, but black women.” 

She said that this is particularly significant in a conversation about sexual assault in a southern state, where sexual politics have been deeply intertwined with racial discrimination. The history of the American South is rife with the sexual exploitation of black women – free and enslaved – and their inability to access the protections of the criminal justice system. Deberry emphasized that the South is also a place where false accusations of sexual assault have been used to justify the lynching of black men.

Davis said, “Being an African American female in this work I think is quite relevant. I think we are lucky when we have African-American women who don’t just know what they are doing, but they can also make their work personal.”

According to Deberry, black women today are typically those who pay bail, visit people in jail or prison– and are increasingly incarcerated themselves. 

“To the extent that the criminal justice system has a customer, it’s black women,” she said. 

“But the dirty little secret of the criminal justice system is that black and brown women are also the people most likely to be victimized,” Deberry said. “And we are the least likely, especially when we are children, to be believed.”

In 2017 Youth Risk Behavior Survey of Durham Public School students, black high school students were nearly twice as likely as white students to report being raped; Latinx students were almost three times as likely.

The audience included educators, social workers, public health advocates, and survivors of sexual assault. Their questions ranged from what to do in situations when a child is sexually assaulted to how immigrants who are living in the country without legal permission should handle an assault.

Deberry responded that when survivors come through her office, she will not ask about their citizenship status. “It does not matter one bit to us,” she said.

Another audience member asked about the statute of limitations for criminal sexual assault in North Carolina. The panelists said that, unlike other states, there isn’t one. 

Before ending the talk, the panelists emphasized this issue concerns men and boys, too. 

“We talk about believing women and girls, but also talk to your sons,” Deberry said. While more than one in three women have experienced some form of contact sexual violence, almost one in four men have too, according to the National Intimate Partner and Sexual Violence Survey.

While the audience was mostly women, there were some men too — most notably Clarence Birkhead, the Durham County Sheriff. He was invited to say a few words to introduce the panel and he stayed until the end. “It is a really awesome team of law enforcement officials that you all have here in Durham, with me being right here with them working hand in hand,” he said. 

As the panel concluded, Deberry emphasized that her office is working with the Sheriff’s Office and the Durham Police Department to address sexual assault. The Special Victims Unit of her office now works closely with Chief Davis’ Special Victims Unit. 

“That has not generally been how it works,” Deberry said. “But that trust goes a long way in getting your cases dealt with.”

Durham accepts $1 million to clear sexual assault kit backlog

On Nov. 4, the Durham Police Department secured $1 million from the federal government to help clear the city’s sexual assault kit backlog.

In a unanimous vote, the City Council approved the Sexual Assault Kit Initiative grant. Since 2015, SAKI grants have been used to fund overburdened crime labs, test over 47,000 sexual assault kits across 35 states, and even help catch one of the deadliest serial killers in U.S. history.

Now, the Durham Police Department will use the grant to tackle its backlog of 1,711 sexual assault kits — the most of any jurisdiction across North Carolina.

***

In 2017, the North Carolina State Crime Lab began counting all untested sexual assault kits across the state, joining 36 other states that had audited their inventories. It discovered the largest backlog of any state in the country: 15,160 untested kits.

Nowhere in North Carolina was the problem larger than in Durham, where police found 1,711 kits from assaults dating back as far as 1988.

“It came as a shock that Durham had so many,” said Charlene Reiss, the Sexual Assault Response Team coordinator at the Durham Crisis Response Center.

The State Crime Lab noted that some of those untested kits may have been resolved in court or marked as “unfounded,” which means that police believed a crime didn’t occur. The rest of the kits — those that were never given a reason for remaining on the shelf — are marked as “other”.

Not only did Durham police find the largest backlog of untested kits, but they also harbored one of the largest portions of “other” kits — those that remained untested for no given reason.

Why, especially in a city as progressive as Durham, did sexual assault kits pile up?

Some factors were outside their control, police wrote in the 2018 SAKI grant application. The State Crime Lab changed their policies about which sexual assault kits were eligible to be tested, causing confusion among officers. And some of the kits in Durham police’s possession were connected to cases already resolved in court.

But police also found that some investigators didn’t know a sexual assault kit could be submitted. Other officers “overlooked sending it,” according to the grant application.

Those familiar with the backlog hesitate to blame police. “There are definitely things that fell through the cracks,” Reiss said. “But for many years, the State Crime Lab was so backed up that it took years to get results back.”

That’s when the State Crime Lab asked police jurisdictions to stop sending consent cases, or cases where both parties admit that sex did occur, according to Reiss.

“Testing that kit wouldn’t help in that particular case,” Reiss said. “In those situations, it doesn’t come down to proving whether or not sex happened; it comes down to proving consent. So a lot of things on the shelf in Durham were consent cases, and they were told not to send those.”

Now, as part of the effort to clear North Carolina’s backlog, the lab is asking police to send all their untested kits. Durham, with the support of its SAKI grant, is beginning to do that.

***

Durham police, prosecutors, and victim advocates agree that to tackle a backlog this large, they need help.

“Our office is already understaffed,” said Kendra Montgomery-Blinn, an Assistant District Attorney. “Right now, the older cases that are coming through — we’re just adding them on top of our duties. It’s too much.”

Each sexual assault kit costs about $700 to test, according to the North Carolina Attorney General’s office. With Durham’s 1,711 kits, that puts the cost of testing the backlog at nearly $1.2 million.

But that estimate doesn’t include the cost of the investigative work that often happens after testing.

“With such a large backlog … the DPD does not have the resources to investigate these backlogged cases and also focus on current cases,” the SAKI grant application says.

That’s why Durham police are using the grant to create a new investigative team: the Cold Case Unit.

The Cold Case Unit will have two full-time investigators dedicated to reopening sexual assault cases and a bilingual witness assistant to support victims through the justice system.

SAKI grant money is also going to the Durham Crisis Response Center, which will fund a new advocate to assist with calling victims. The District Attorney’s office will also hire a full-time prosecutor to bring cold case sexual assaults to trial.

District Attorney Satana Deberry is ready to reprioritize sexual assault in her office.

“Part of the reason that sexual assault is underreported is because people don’t feel comfortable coming to the justice system,” Deberry said. “It’s important for us to signal to the community that we take these things seriously.”

“We spend a lot of time talking about the violence in our community, but often we don’t talk about the violence against women and children,” she added.

The District Attorney’s office is now prosecuting three cold cases in which sexual assault kits were tested after years of sitting in the backlog. With the new hires from the SAKI grant, they expect more charges to come and a new energy behind the process.

“I think everybody in Durham was surprised when they did the inventory,” Reiss said. “But things have changed.”

Deberry agreed. “Now we’re cleaning up what this system may have let sit for a while.”