Billing for rape: Louisiana rape victims often face hefty bills for medical care

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She was questioned, prodded and photographed over the course of six hours. Nurses collected samples of tissue and fluid from her mouth and her body. They took her urine, drew her blood and bagged her clothes. They offered her drugs to prevent pregnancy, HIV and other sexually transmitted diseases. Then, they led her to a private shower and sent her home.

Her life, she felt, was now divided into two eras: Pre-rape and post-rape. Eight days into the shock of this new reality, she received a letter she couldn't comprehend.

The cost of some of the medical services she received totaled nearly $2,000, it said. Insurance would pay $1,400. She would owe the remaining $600 -- for her share of the cost of two HIV drugs and two other medications designed to stave off side-effects of those drugs.

She folded the papers, stuffed them in her purse and tried to calm down. A few days later, another bill would arrive, showing an additional $1,700 in charges for her care, including an $860 fee for her visit to the emergency room.

"You never really think, 'Is rape covered by insurance?'" the New Orleans woman said. NOLA.com | The Times-Picayune does not generally identify victims of sexual crimes.

The letter from the hospital was no aberration. In Louisiana, victims of sex crimes often face paralyzing bills for forensic medical exams and related care, even though state and federal guidelines require that many of these services be provided at no cost to the victim. And there's little continuity in how rape victims are treated from parish to parish and hospital to hospital.

While the state's Crime Victims Reparations Fund does permit victims to apply for reimbursement for some medical expenses, there are strict limitations regarding who can qualify, including a requirement that the victim file a police report. Research by the U.S. Department of Justice indicates nearly two-thirds of sex assault victims don't ever go to law enforcement.

Victim advocates worry that prohibitive costs will only increase the likelihood that rape victims will suffer quietly without seeking the medical assistance they may need.

"Sexual assault is already one of the most underreported crimes, period," said Amanda Tonkovich, a counselor at New Orleans Family Justice Center and coordinator of the New Orleans Sexual Assault Response Team. "Even if people don't want to report, we want them to come to the hospital and make sure they're OK, medically speaking."

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At Interim LSU, where trained nurses see about 20 to 25 sexual assault patients per month, nurses until recently were instructed to reassure victims they would not be billed. Although the public hospital was not required by law to do so, it for years absorbed the costs of these exams and all the related medical expenses, area sexual assault victim advocates said.

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Louisiana is one of only six states that look to local parishes and counties to pay for the exams, according to a report by AEquitas, an organization that provides training, information and technical help to prosecutors in sexual assault cases. Thirty-two other states pay through their state victim compensation funds.

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