In his State of the State speech earlier this month, Gov. Doug Ducey claimed that women are being charged up to $800 in processing fees for rape kits—which would be illegal under federal law—but it’s unclear whether that’s actually happening.
To back up its claim, the governor’s office provided the Arizona Mirror a September 2021 letter from the Commission to Prevent Violence Against Women, an agency set up by Ducey’s administration to develop policy. In the letter, Co-Chairs Elizabeth Ortiz and Kate Brophy McGee wrote that victims of sexual assault are being charged consultation fees for forensic exams in certain Arizonan jurisdictions. Absent, however, was the $800 estimate.
The letter also didn’t specify which facilities or jurisdictions are charging consultation fees, nor did it include sources.
In an interview, Brophy McGee also could not clarify which jurisdictions were charging fees. The former Republican state senator said claims that women were being charged in hospitals, emergency rooms, care centers, doctor’s offices and other places in violation of federal law was anecdotal. The claims, she said, came from health care providers who spoke with the commission.
Ortiz did not answer questions about the letter when contacted, and instead noted in an email that McGee had more information on the topic.
The Mirror contacted the 29 forensic exam facilities spread across Arizona. All 17 that responded said that forensic exams were offered free of cost, and that sexual assault victims are not charged consultation fees.
In Maricopa County, the sole provider for sexual assault examinations is HonorHealth, which has forensic nursing units in Phoenix, Chandler, Scottsdale, Mesa, Glendale and Goodyear, as well as suites in several local family advocacy centers. The negotiated cost for forensic exams with the county is $700, but that bill goes directly to the Maricopa County Attorney’s Office, said Jill Rable, the clinical director of HonorHealth’s forensic nursing department.
“The way our billing system is arranged, the patient’s information never gets entered anywhere to send them a bill,” she said. “It’s one individual person who sends the bills directly to (the county attorney’s office).”
The director of the Yavapai Family Advocacy Center, Missy Sikora, said it’s against the federal Violence Against Women Act to charge victims, even if they don’t want to file an initial police report.
“Under statute, adults have the right to have exams without calling (law) enforcement with no charge,” she said.
The Violence Against Women Act, or VAWA, was enacted in 1994 and reauthorized last year. One of its provisions makes forensic exams, more commonly called rape kits, free of cost to victims of sexual assault. It requires states to pay, instead. Tasha Menaker, the chief strategy officer for the Arizona Coalition to End Sexual and Domestic Violence, said that’s where problems may arise.
VAWA doesn’t specify which entities in each state are responsible. In Arizona, state law directs counties in which the crime occurred to cover the costs, and that generally falls to the county attorney. Menaker says it’s been years since she heard about a case in which a county attorney’s office refused to pay and the bill ended up coming out of the victim’s pocket.
What’s more common is a victim mistakenly going to an emergency room for help and being charged for intake processes there instead of being referred to an appropriate forensic clinic. One woman Menaker met first went to Banner Health’s ER, was processed and sent to HonorHealth, where she again went through an initial physical exam to determine she was stable before being directed to the hospital’s forensic nursing unit. In the end, she racked up thousands of dollars in general medical care, which isn’t included in the forensic exam.
The best place victims can go if they aren’t sure where the local forensic nursing unit is located is a family advocacy center, which often has a forensic nurse in house. The Arizona Coalition to End Sexual and Domestic Violence keeps an updated list on its website.
Another pitfall of current law is that no accommodation is made for injuries or health care needs sustained in the course of a sexual assault: broken bones, x-rays, stitches and even STI tests aren’t covered. Those bills get sent to an insurance company, if the victim has health insurance—otherwise they’re left up to the victim to pay.
“The statute is very vague,” said Menaker. “Counties look at the (forensic exam cost) as purely just the evidence collection portion.”
The governor’s office has reached out to Menaker’s organization in advance of plans to support sexual assault victims. Menaker said the best way to construct policy would be to include forensic nursing units, county attorneys, law enforcement and family advocacy centers to discuss the issue.
“In an ideal world, (legislation) would include any health care costs that are associated with that initial visit for the survivor, even beyond the medical forensic exam,” she said.
Currently, victims can be reimbursed for costs related to their sexual assaults through the victim compensation program, but reimbursement isn’t guaranteed and it requires cooperation with law enforcement, as police reports are among the documents collected to determine eligibility.
More than 2,900 rapes were reported in Arizona in 2019 alone, according to data reported to the FBI from local law enforcement agencies. More than 1,000 of these occurred in Phoenix. It’s likely that the actual numbers are even higher. As many as 80% of rapes go unreported, according to a 2016 Department of Justice violent crime report.
For Rable, increasing public outreach is key in how the system can be improved. Better awareness of the specialized care provided by forensic nursing clinics, which isn’t always offered at every hospital, is necessary to ensure victims don’t end up paying out of pocket. Outreach is especially important when the window of time for examinations is as narrow as five days.
“The governor’s office could just help send the message that sex assault examinations are free of charge. The county attorney’s office in each county should be paying for those directly,” Rable said.
Ducey spokesman C.J. Karamargin said the governor’s office anticipates meeting with stakeholders soon and will have additional information on the issue then.