Child sex abuse victims have to go to ED

Child sex abuse victims are attending Galway University Hospital’s emergency department (ED) for examination because the State’s only 24-hour forensic treatment service for under-14s has closed.

However, the hospital does not have a doctor trained in pediatric forensic evaluation. The knock-on effect could be that child abusers will escape charges due to insufficient evidence.

Since the closure of Galway’s Child and Adolescent Sexual Assault Treatment Service (CASATS) on February 28, several children have required the specialist examination service. CASATS closed as the HSE would not agree to find additional funding of approximately €100,000 per annum, as requested by doctors, to enable a best-practice model of care

As there is nowhere in the West and Mid-West where a child who has been sexually abused can receive a forensic medical service, the only option is to attend an ED.

Joanne Nelson said any such child attending Galway’s ED will be in a busy environment and will have no-one trained to assess them. This scenario has already occurred, since the specialised clinic, for which Dr Nelson acted as clinical lead, has closed in recent weeks, she said.

Doctors at University Hospital Galway are not trained to take samples or to provide an informed professional opinion on the presence or absence of relevant physical signs in child sex abuse cases.

“Whilst children’s safeguarding needs can be met by the gardaí and Tusla, their forensic needs cannot — almost no forensic evidence can currently be collected following child rape,” said a hospital spokesperson.

Dr Nelson said children subjected to sexual abuse had health needs, as well as everything else. This involves evaluation of the risk of, and screening for, sexually transmitted infection.

In an acute assault, consideration needs to be given to preventing HIV or hepatitis B, by emergency treatment or vaccination. Emergency contraception needs to be explored, she said.

“Normally, all of this would be done smoothly, as part of a comprehensive assessment in our service, also addressing psychological needs, forensics, and safeguarding,” said Dr Nelson. “In the absence of our service, each component now has to be addressed separately. Unfortunately, not all components are currently being addressed, which is devastating for all concerned.”

Prior to closure, CASATS was operated by four doctors, rotated on an on-call, 24-hour service. Children often came from other parts of the country to access the service out of hours. The doctors had been asking the HSE to fund “integral components of a safe, quality-assured, and sustainable service” for some time.

“Given that €212,000 per annum will sustain, and maintain, the only 24-hour acute, and historic, forensic medical service for children under 14 years suspected of sexual abuse, anywhere in Ireland, this would seem a worthwhile investment,” said Dr Nelson.

Responding to the closure, a HSE spokesperson said discussions with the four clinicians that provide the CASATS service “have not been successful.”

“We have been informed, by the clinicians, that they are not prepared to sign the proposed contracts,” said the spokesperson. “Therefore, we have no alternative but to advise agencies that would refer to the service that we can no longer accept referrals.”