THE PRICE OF PROSECUTION?

N.C. hospitals bill rape victims

Advocates say the state should shoulder the cost of rape kits, which are needed to help put suspects behind bars

Mandy Locke, Staff Writer

Rape victims across the state are paying for their ill fortune in the most tangible of ways: a bill for the evidence kit needed to lock up the rapist.

The vast majority of the 3,000 or so emergency room patients examined for sexual assaults each year shoulder some of the cost of a rape kit test, according to state records and victim advocates. For some, it's as little as a $50 insurance co-payment. For those without insurance, it's hundreds of dollars left when a state program designed to help reaches its limit.

Advocates want the state to spare rape victims and fully pay the cost of the examinations, which collect biological evidence that an attacker may have left behind.

"Rape victims are being treated differently than any other victim of crime," said Monika Johnson-Hostler, executive director of the North Carolina Coalition Against Sexual Assault. "The county doesn't charge me for fingerprinting if my house gets broken into."

No one tracks what becomes of the hospital bills for rape victims who are privately insured.

But an analysis of state records and interviews with hospital officials and administrators at several of the state's major insurers suggest that charging the patients is a widespread practice.

In the cases of more than 2,500 people who receive rape kits each year, hospitals bill the patients' health insurer. Insurance companies, in turn, require emergency room co-payments and deductible costs.

For those without insurance, hospitals send the bills to the N.C. Department of Crime Control and Public Safety, which has a modest fund to help. Reimbursements are capped at $1,000; the average cost of the rape kit exam is $1,600.

Trauma, then a bill

A Chatham County woman who reported being raped on her 21st birthday in September never imagined she'd get a bill for enduring a four-hour exam at the emergency department at Central Carolina Hospital in Sanford. But six weeks after a specially trained nurse searched her body for a trace of the man she said raped her, a bill arrived.

For the nurse's trouble and time in the exam room, she owed $175, her share after her parents' private insurance paid some of the bill, she said.

For months, she ignored her bill. Late notices piled up. A few weeks ago, another bill arrived: $193 for the doctor's care that day.

"I couldn't believe they would send me a bill for this," said the Pittsboro woman. (The News & Observer does not generally identify people who report they've been sexually assaulted.)

"I didn't ask for this to happen," she said. "The whole point of me going was to get evidence for the case."

Leaders at the state Conference of District Attorneys were surprised to learn rape victims pay for their exams. They agreed women shouldn't have to pay for tests used to find evidence needed at trial, but they didn't know which agency should pay. Their budgets are already strained, and they hear similar complaints from law enforcement agencies, said Peg Dorer, executive director of the conference.

Payment of last resort

The state's Rape Victims Assistance Program was established in 1981 to help with these bills. The fund covers the cost of assembling about 3,000 rape kits each year.

The rest of the money, about $258,000, is used to help pay the hospital bills for uninsured rape victims. Each year since 2004, the program has helped between 411 and 469 women, a fraction of those given rape kit tests each year.

Janice Carmichael, executive director of the program, said she wishes she had enough money to pay everyone's claim. The program was designed as a payment means of last resort, she said.

Hospitals settle the balance -- which can top $1,000 -- with the victims. Sometimes, hospitals forgive the debt. Other times, they work out a payment plan.

'Where do you stop?'

"The bottom line is these services cost money," said Rebecca Andrews, WakeMed Hospital's vice president of finance. "We do sometimes forgive. It's case by case. But where do you stop? We treat gunshot wounds, stabbings, abused children. No one asked for that to happen."

In January, Central Carolina Hospital put the Chatham County woman they treated on a payment plan to settle her $175 bill. She feared the hospital would turn over her bill to a collector and her credit would be ruined. Each month, she shells out $44 of her unemployment check to make good on her debt. She hadn't begun to deal with the new $193 bill.

Each month, she is reminded of the invasive and embarrassing exam. After the attack, she had already felt her life unravel.

She said she lost her retail job after she left shifts, embarrassed, thinking customers could tell she'd been raped. She said she dropped out of a few of her classes at a local community college because she couldn't concentrate. She was scared to go anywhere alone. Police didn't charge the man she said raped her. She said he told police it was consensual sex. Investigators told her they didn't want to pursue a "he said/she said" case, she said.

She said this week she regretted going to the hospital for an exam.

"The rape was tough enough," she said. "I believed I was doing the right thing, not just for myself. Now, I've got these bills hanging over my head."

On Tuesday afternoon, after learning of her case, administrators at Central Carolina Hospital decided to forgive her bill.

"Our CEO was shocked," said Danyl Butler, the hospital's director of business development. "It simply slipped by us. We didn't know this was happening."

mandy.locke@newsobserver.com or (919) 829-8927

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