clear indication that evidence of a crime may be found and there is reason to believe that the delay involved in getting a warrant or authorization will result in the destruction of evidence, the nonconsensual extraction may be made without a warrant or authorization. (Such situations are refered to as exigent circumstances.) Involuntary extraction of fluids must be done in a reasonable fashion by a person with appropriate medical qualifications.
The following procedures should be adhered to when a search warrant or authorization for extraction of bodily fluids is present or extraction is ordered on the basis of exigent circumstances.
The patient should be requested to give written consent to the procedure.
If the patient refuses to give consent, then he or she should be clearly advised of the existence of the search warrant or authorization and ordered to submit. If the patient allows extraction, it should then proceed. . If the patient will physically resist extraction then the command or authority issuing the search document will be immediately contacted to determine whether forcible extraction will be attempted. In reaching this decision, one must consider all factors including, but not limited to the seriousness of the alleged offense; the need for the fluid sample; the level of resistance anticipated; medical contraindications to extraction; and the need for trained law enforcement assistance to ensure the safety of staff and other patients. If for any reason the medical staff and the initiating command do not agree on a course of action then the medical facility commanding officer will be immediately notified.
Samples drawn pursuant to a search authorization or warrant or under exigent circumstances should be documented and processed using a chain of custody form. Each person taking custody of the form must sign the form before taking custody of the sample. The sample must not be left unattended unless it is placed in a secure location that has extremely limited access (e.g., a safe or locked refrigerator).
PROBABLE CAUSE SEARCH OF CIVILIANS
If law enforcement authorities request extraction of bodily fluids from a nonmilitary person pursuant to a federal, state, or local search warrant, the medical staff should immediately contact the hospital judge advocate or the Naval Legal Service Office for guidance.
FAMILY ADVOCACY PROGRAM
During the early 1970s, increased awareness of child maltreatment prompted the Surgeon General to advocate a program dealing with both the medical and social aspects of the problem. In 1976, the Navy established its Child Advocacy Program to provide protection to dependent children who were abused, neglected, or abandoned. In 1979, the medical program was expanded to include spouse abuse and neglect, sexual assault and rape, and was redesignated as the Family Advocacy Program. At the same time, the Navy and Marine Corps began to develop formal servicewide management of family support programs.
The objective of the Family Advocacy Program is to prevent family maltreatment through information and education to deter illegal actions, and to provide treatment and support for the persons involved.
The Director of Naval Medicine is responsible for providing the resources, professional services, and technical assistance required to support the health care requirements of the program. To carry out these responsibilities, naval hospitals have established local Family Advocacy Programs, appointed Family Advocacy Committees to review management of individual and community problem situations relating to child abuse/neglect, spouse abuse, and sexual assault and rape incidents, and have designated a social worker or senior member of the command as the Family Advocacy Representative (FAR) to manage the local Family Advocacy Program.
POLICIES AND RESPONSIBILITIES
In those cases where the victim of child or spouse abuse is considered to be in real and present danger of death or serious bodily harm, the medical officer shall initiate immediate action to remove the victim from the situation placing them in danger, to provide required medical care, to secure protective custody in the case of child abuse, and to secure and provide shelter care to ensure health, welfare, and safety needs are met.