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Grady improperly billed rape victims

Grady charged victims for exams that state fund is supposed to pay.

The state’s largest public hospital improperly charged more than 730 rape victims for forensic exams, an Atlanta Journal-Constitution investigation has found.

Under state law, Grady Memorial Hospital is supposed to provide rape exams free to victims and send the bills to a special state fund — billing them is considered as unfair as a shooting victim paying police to dust the weapon for finger prints.

Instead, survivors were caught up in a two-year bureaucratic breakdown that shows how Grady, the sole rape crisis center for Fulton County’s nearly 1 million residents, fails to follow laws meant to protect victims.

In June, an Atlanta Journal-Constitution investigation found that the hospital conducted these grueling and invasive exams on as many as 1,500 rape victims, then locked the evidence away — even when patients asked that the rape kits be shared with investigators. State law requires hospitals to report and provide evidence on injuries that may be tied to a crime.

Grady needs to ensure victims are never charged again, said Atlanta State Rep. Scott Holcomb, D-Atlanta. Statewide, officials need to ensure that other hospitals are not making the same mistake, he said.

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“It’s like insult to injury,” Holcomb said of the bills. He plans to push for changes to state law during the spring legislative session that would improve how law enforcement tracks and tests rape kit evidence.

Grady spokeswoman Lindsay Caulfield declined to make officials available to answer the AJC’s questions. She said the taxpayer-supported hospital issued refunds to uninsured patients who paid their bills as of June 9, after the AJC asked about the improper charges.

Caulfield did not answer questions about insured patients who paid out-of-pocket expenses. One of these victims told the AJC that she has yet to be paid back.

‘Massive’ hospital bill

Grady should have known that billing victims for forensic exams is against the law. Federal authorities have warned against it for two decades.

Georgia law goes even further. Since 2011, the state has barred hospitals from billing patients “directly or indirectly” for the assessment, which can last six hours and be traumatizing for them to endure. Medical staff often swab the victim’s body cavities, take photographs of injuries, conduct interviews, and provide testing.

Private insurance is off-limits, although hospitals can bill Medicaid, which covers certain indigent, disabled and senior patients, said Nicole Jenkins, director for victim services at the state’s Criminal Justice Coordinating Council (CJCC), which administers the fund that pays for these exams.

“There is no other crime where a victim is expected to pay for a forensic investigation,” said Janine Zweig, an expert on billing for sexual assault exams at the Urban Institute. Other area hospitals have been reimbursed by the fund for years, according to a database of payouts.

Victims may be unaware they are entitled to free evidence collection and never complain, Jenkins said. One Grady patient interviewed by the AJC said she does not recall being told by staff. The AJC is not naming her because she is a survivor of sexual assault.

The woman, now 27, was visiting Atlanta from Tennessee in November 2012 when a man she just met followed her into a bar bathroom and forced her to have sex, she said. An ambulance took her to Grady.

The bill arrived within days, while her bruises were still healing, the woman said. Her mother broke the news.

“She said, I hate to say this … I definitely don’t want to present you with a bill right now, but this is what we’re dealing with,” the woman recalled.

The bill for the exam and additional services totaled more than $1,000 after private insurance, said the woman’s mother, who accompanied her to the emergency room. That included $10 or $15 the mother said she was asked to pay soon after they walked through the door.

“On top of anything else, you get this massive bill from the hospital,” the victim said. “But that’s America.”

An advocate at a Tennessee rape crisis center was supposed to help the victim sort through her medical expenses, but never called back. When a staffer for CJCC learned that Grady billed the woman and a second patient for forensic exams, she informed the hospital, according to emails between fund staff and Grady.

Four months later, the hospital had not sent the council an update on whether it fixed the billing mistake, according to an April 2013 email. The AJC found no record that she ever received one. The Tennessee woman paid her bill by digging into savings and getting help from her mother.

The head of Grady’s rape crisis center later told Jenkins that she did not think the hospital was routinely billing patients, Jenkins said.

Chasing Grady

Grady’s inability to provide basic information about their charges for rape victims raised alarms at CJCC, but council’s efforts to fix problems went nowhere. CJCC staff spent more than two years sending emails, making calls and holding face-to-face meetings with the hospital to make sure it was paid for more than 200 rape exams that Grady had billed to the fund.

Still, the hospital failed to verify and answer questions about the charges as the council required until May, after the AJC raised questions. By then, some of the expenses were nearly four years old.

“It was truly a process to get all of the right people,” Jenkins said.

What officials should do to improve Grady’s treatment of rape victims is unclear. The council could withhold some $100,000 in state and federal grants to its rape crisis center, but revoking funds could mean victims lose services, said executive director Jacqueline Bunn. She hopes to improve conditions statewide through the council’s new program to help local jurisdictions create specialized sexual assault response teams to respond to each case.

Fulton County has no local team, even though research shows that they increase the likelihood of finding and convicting rapists. Such a team might have prevented Grady’s backlog of untested kits, or could ensure it does not bill victims in the future, said Gwinnett Sexual Assault Center Executive Director Ann Burdges, who is serving on the program’s panel of experts.

“There is a little hope that we have a shot at fixing this,” said Burdges.

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