Guidleines 800-11: Health care response to sexual assaults of offenders

• Commissioner’s Directive (DC) 800 - Health Services
• Corrections and Conditional Release Act (CCRA), sections 85-88
• Privacy Act, paragraph 8(2)(m)

• To provide direction to:
  • Health Services staff responding to sexual assaults to ensure the provision of effective health care
  • non-Health Services staff for responding to sexual assaults when Health Services staff members are not present on site
  • all staff in conjunction with CD 574 - Sexual Coercion and Violence

Applies to all institutional staff

1. The Institutional Head will ensure that:
   1. all allegations of sexual assault, where there is the potential for physical injury or transmission of infectious diseases, are responded to as medical emergencies
   2. when an alleged threat of sexual assault is reported about an inmate, immediate operational measures are put into place to ensure the safety of the victim
   3. any alleged sexual assault or threat thereof is reported immediately to Health Services staff, in person or by phone if they are on site at the time, or when they are next on site
   4. a process is in place for the transportation of the victim to a community hospital with the capability to conduct a forensic examination of the victim.
2. The Correctional Manager will:
   1. ensure first aid is provided to the victim of sexual assault, in accordance with Guidelines (GL) 800-4 - Response to Medical Emergencies, with their informed consent
   2. ensure first aid is provided to the alleged perpetrator as needed, with their informed consent
   3. if Nurses are on site when the victim reports an alleged sexual assault, notify Health Services immediately. If required, a Nurse will collaborate with the Correctional Manager to transport the victim as soon as possible to a community hospital with the capability to conduct an assessment and a forensic examination, while taking into account any security considerations that may exist
   4. in the absence of an on-site Nurse, follow established institutional protocols for sending the victim to a community hospital that has the capability to conduct a forensic examination, as soon as possible, while taking into account any security considerations that may exist in accordance with procedures identified in Commissioner’s Directive (CD) 574 - Sexual Coercion and Violence and CD 566-6 - Security Escorts, and notify the Chief, Health Services, of the incident, by phone or in person, when they are next on site
   5. provide an extra set of clothing that the victim can change into following an assessment and a forensic examination at the community hospital
   6. in the absence of an on-site Nurse, ensure that the Immediate Needs Checklist - Suicide Risk (CSC/SCC 1433e) is completed for both the victim and the alleged perpetrator by an operational staff member, and entered in the Offender Management System (OMS).
3. Health care professionals will:
   1. assume the overall management of the health intervention, in consultation with the Correctional Manager for security risk-related considerations, when Nurses are present on site
   2. offer prompt health assessment and, when applicable and with consent, apply Nursing Clinical Protocols for Emergency Situations
   3. ensure confidentiality is preserved and consent is obtained, as required, for all procedures in relation to the victim as well as the alleged perpetrator
   4. if the victim or perpetrator refuses to consent for assessment or treatment, advise them that their refusal to consent will be documented and that they may request health services at any time in the future, as well as document both the refusal to consent and the offer to provide health services at a later time, as needed. Refer to Incident Reporting section.
   5. provide referrals and medical follow-ups for the victim and alleged perpetrator, as per Sexually Transmitted Infection Guidelines and GL 800-8 - Post-Exposure Prophylaxis Protocol for Managing Significant Exposure to Blood and/or Other Body Fluids
   6. complete the Suicide Vulnerability and Needs Classification Tool for the victim and alleged perpetrator, as appropriate, and document it in the Offender Health Information System-Electronic Medical Record
   7. ensure a trauma-informed approach is integrated within health care interventions offered to the victim and alleged perpetrator of sexual assault
   8. ensure that treatment and intervention are provided any time the victim or alleged perpetrator gives consent, since their decision to consent may evolve over time
   9. notify the institutional Physician and nursing staff involved in providing direct care to the victim or alleged perpetrator of the infectious disease status of the victim and alleged perpetrator, in order to provide appropriate and necessary medical intervention
   10. report to the local public health unit any reportable infectious disease/sexually transmitted infection status of the victim and alleged perpetrator, and release more information as required for the purpose of contact notifications by public health authorities
   11. notify the Chief, Health Services, the Chief, Mental Health Services, and the institutional Physician of the incident as soon as practicable
   12. document all health assessments and interventions in the electronic health care record.
4. The Director, Regional Clinical Practice and Accreditation Management, or delegate will:
   1. identify and provide the regional Security department and all Institutional Heads with the names of community hospitals capable of conducting a forensic examination in their region
   2. provide the Regional Administrator, Security, with an up-to-date list of community hospitals capable of conducting a forensic examination in their region, as required.
5. The Chief, Health Services, will:
   1. ensure that health-related policy and procedures pertaining to sexual assaults are implemented and administered appropriately within the institutions
   2. coordinate communication and care with the community hospital conducting an assessment and a forensic examination
   3. notify and keep the Manager, Integrated Health Services, updated about the incident and follow up steps
   4. report to the Manager, Integrated Health Services, any issues or deficiencies arising from health policies/procedures or their implementation.
6. The Chief, Mental Health Services, will:
   1. triage the referrals for mental health assessment and necessary follow-up
   2. ensure the victim and alleged perpetrator are provided with appropriate mental health assessment, treatment, and necessary follow-up, with their consent
   3. following receipt of reliable information that a sexual assault has been committed, ensure that appropriate assessments are completed with the perpetrator in accordance with the Integrated Mental Health Guidelines and applicable procedures in CD 705-5 - Supplementary Intake Assessments, CD 712-1 - Pre-Release Decision-Making, CD 712-2 - Detention, CD 708 - Special Handling Unit, CD 710-6 - Review of Inmate Security Classification, and CD 710-2 - Transfer of Inmates
   4. notify and provide the Manager, Integrated Health Services, with updates on the incident and follow up steps
   5. report to the Manager, Integrated Health Services, any issues or deficiencies arising from health policies/procedures or their implementation.

7. Immediately upon becoming aware of an alleged sexual assault, Health Services must be notified, in person or by phone, of the occurrence, as well as the identity of the victim and the alleged perpetrator. If no Nurses are on site, operational staff must inform Health Services staff, in person or by phone, of the incident immediately upon their arrival for the next shift. The Correctional Manager will notify the Chief, Health Services, of the incident.
8. All sexual assault allegations, where there is a potential for physical injury or transmission of infectious diseases, will be responded to as medical emergencies. The victim and alleged perpetrator will receive immediate emergency medical attention, according to GL 800-4 - Response to Medical Emergencies. Health care professionals will report incidents deemed as serious bodily injuries to their supervisor as per Guidelines on the Classification of Injuries as Serious Bodily Injury (SBI) and CD 568-1 - Recording and Reporting of Security Incidents without the prerequisite of the inmate’s consent.
9. If a Nurse is on site, they will immediately assess the victim, with their consent, and determine, in consultation with the institutional Physician or community hospital with the capability to conduct a forensic examination, whether the victim needs to be transported to the community hospital, and if so, what protocols are to be followed for the transportation and in preparation for the forensic examination. These include:
   1. advising the victim to refrain from eating, drinking, showering, chewing gum or brushing their teeth prior to being examined at the hospital, as it could interfere with the forensic examination and collection of evidence. However, the victim may choose to comply with or decline this professional advice
   2. advising the victim not to change their clothing prior to being examined at the hospital. In the event that the victim has changed their clothing, it will be collected as evidence as per CD 568-4 - Preservation of Crime Scenes and Evidence and CD 568-5 - Management of Seized Items, following the victim’s consent
   3. prior to leaving for the hospital, providing the victim with a change of clothing to use following the assessment and forensic examination. Upon return to the institution, the victim will be given access to a shower as soon as possible
   4. collaborating with the Correctional Manager to transport the victim as soon as possible to a community hospital with the capability to conduct an assessment and a forensic examination, while taking into account any security considerations that may exist.
10. In the event that no Nurses are on site, operational staff will follow established institutional protocols with respect to sending the victim to a community hospital with the capability to conduct a forensic examination, while taking into account any security considerations that may exist.
11. Victims and alleged perpetrators of a sexual assault will be provided with reasonable access to religious, spiritual, and culturally appropriate supports and resources.
12. Mental Health Services will be notified immediately by phone or in person, and this will be followed up immediately with the completion of the Referral to Health Services (CSC/SCC 4000-01e) form for the victim and the alleged perpetrator. An individual can submit a request to meet with a mental health professional. Access will be provided as soon as practicable.

13. Privacy and confidentiality of information with respect to the victim will be preserved throughout the above process. It will be consistent with professional practice standards and the Guidelines for Sharing Personal Health Information.
14. Personal health information will be documented only in the inmate’s health care file.

15. With informed consent of the victim, health care professionals will immediately report alleged sexual assaults to the Correctional Manager, Operational Desk.
16. If the victim does not provide consent or is incapable of providing consent to report an incident to Correctional Operations, the health care professional will immediately inform the Manager, Integrated Health Services, at the site, who will immediately consult with the Regional Director, Health Services, and the Director General, Health Program and Policy, in order to seek advice from the Access to Information and Privacy (ATIP) Division, to determine public interest as per paragraph 8(2)(m) of the Privacy Act.
17. Regardless of consent, for the purposes of section 19 of the Corrections and Conditional Release Act, in cases of serious bodily injury, the health care professional must report the incident in accordance with CD 568-1 – Recording and Reporting of Security Incidents.

18. Any evidence collected by CSC staff related to an alleged assault will be preserved according to CD 568-4 - Preservation of Crime Scenes and Evidence.

19. Strategic Policy Division
    National Headquarters
    Email: Gen-NHQPolicy-Politi@csc-scc.gc.ca

Assistant Commissioner,
Health Services

Jennifer Wheatley

• CD 001 - Mission, Values and Ethics Framework of the Correctional Service of Canada
• CD 228 - Information Management
• CD 566-6 - Security Escorts
• CD 567 - Management of incident
• CD 568-1 - Recording and Reporting of Security Incidents
• CD 568-4 - Preservation of Crime Scenes and Evidence
• CD 574 - Sexual Coercion and Violence
• CD 600 - Management of Emergencies in Operational Units
• CD 701 - Information Sharing
• CD 705-5 - Supplementary Intake Assessments
• CD 705-7 - Security Classification and Penitentiary Placement
• CD 708 - Special Handling Unit
• CD 710-2 - Transfer of Inmate
• CD 710-6 - Review of Inmate Classification
• CD 712-1 - Pre-Release Decision-Making
• CD 712-2 - Detention
• GL 800-3 - Consent to Health Service Assessment, Treatment and Release of Information
• GL 800-4 - Response to Medical Emergencies
• GL 800-8 - Post-Exposure Prophylaxis Protocol for Managing Significant Exposure to Blood and/or Other Body Fluids

• Guidelines on the Classification of Injuries as Serious Bodily Injury (SBI)
• Guidelines for Sharing Personal Health Information (March 2018)
• Integrated Mental Health Guidelines
• Interim Policy Bulletin 584 (Re: Gender Identity and Expression)
• Nursing Clinical Protocols for Emergency Situations
• Rights to Counsel and Caution
• Sexually Transmitted Infection Guidelines

Sexual assault is a form of sexual violence. It is any non-consensual act of a sexual nature where the sexual integrity of the victim is violated. It can range from unwanted sexual touching, kissing, or fondling to forced sexual intercourse. It can involve the use of physical force, intimidation, coercion, or the abuse of a position of trust or authority. Injuries can be non-existent or minor, or can result in wounding, maiming, disfiguring or endangering the life of the victim. Any person can be a victim of sexual assault, regardless of sex, gender identity, gender expression, sexual orientation, age, race, ability, religion, ethnicity, etc.

In a correctional setting, the percentage of sexual assaults being reported is low. This is due to, among other reasons: fear of the perpetrator; the shame and the stigma of being perceived as a victim, being perceived as having invited the sexual assault; the possible consequences of reporting and not being able to get away from the perpetrator; and the effects of previous trauma.

Groups with heightened vulnerability include, but are not limited to, LGBTQ2S and gender diverse individuals, women, and younger inmates. Moreover, sexual orientation, gender identity or expression, and sex characteristics intersect with other characteristics and vulnerability factors, such as age, disability, race, ethnic origin or religious background, in increasing the risk of becoming a victim of sexual violence.

All allegations of sexual assault must be viewed as credible by staff.