commanding officers are authorized to deliver the patient when a proper warrant is presented, except in certain limited circumstances. A judge advocate of the Navy or Marine Corps should be consulted before delivery, if possible. If the treatment facility is located outside the jurisdiction requesting delivery, only a General Courts-Martial authority (as defined by the Uniform Code of Military Justice, Manual for Courts-Martial, and Navy Regulations) is authorized to arrange for delivery of such a patient. Extradition, return agreements, and other prerequisites to delivery will have to be completed.
When disciplinary proceedings involving military offenses are pending, the treatment facility should obtain legal guidance from a judge advocate before delivering a patient to federal, state, or local authorities if reasonably practicable. When the commanding officer considers that extraordinary circumstances exist which indicate that delivery should be denied, then the Judge Advocate General of the Navy must be notified of the circumstances by message or phone.
Prisoner patients fall into three categories of eligible beneficiaries: enemy prisoners of war and other detained personnel, nonmilitary federal prisoners, and military prisoners.
Enemy Prisoners of War and Other Detained Personnel
Enemy prisoners of war and other detained personnel are entitled to all necessary medical and dental care subject to the availability of care and facilities.
Nonmilitary federal prisoners are authorized only emergency medical care. When such care is being provided, the institution to which the prisoner is sentenced must furnish the security personnel to ensure custody of the prisoner and safety of others in the facility. Upon completion of emergency care, arrangements will be made immediately to transfer these individuals to a nonmilitary treatment facility or for return to the institution to which sentenced.
Status of Forces policy is to protect, to the maximum extent possible, the rights of U.S. personnel who may be subject to criminal trial by foreign courts and imprisonment in foreign prisons. Active duty members are generally not separated from the service until they have completed their term of imprisonment and returned to the United States. During this confinement, they will normally remain health care beneficiaries.
Military prisoners (those sentenced under the Uniform Code of Military Justice) whose punitive discharges have been executed but whose sentences have not expired are authorized medical and dental care. Individuals on appellate leave, awaiting execution of a punitive discharge, are also entitled to care. Military prisoners whose punitive discharges have been executed and who require hospitalization beyond expiration of their sentence are not eligible for care, but may be hospitalized as civilian humanitarian nonmilitary indigents until disposition can be made to some other facility.
Sexual assault and rape are criminal offenses, often associated with serious injury. The management of cases involving sexual assault and rape must be a joint medicolegal function. A Sexual Assault Investigation Kit, supplied by the Naval Investigative Service, is used to gather and preserve evidence of the crime. Included in this kit are step-by-step procedures for the examination of the patient as well as a checklist of specimens to be collected.
In order to safeguard and obtain evidence to be used in possible legal proceedings, liaison between the naval treatment facility, military and civil investigative agencies, and state and local service agencies (such as Child and Spouse Protective Services) should be established. It must be kept in mind that medical personnel are not to judge, defend, or prosecute the individuals involved. Every effort must be made to treat the patient with respect and courtesy and to provide appropriate privacy. In dealing with alleged victims of sexual assault, careful attention to psychological factors must be given to lessen the impact of the incident. This is especially important when a minor is involved and the reaction of adults may be more harmful than the actual assault itself. Tactful questioning and the use of appropriate terminology are of extreme importance throughout the history taking and examination.