On Sunday, a woman in Monterey County, California, called 911 to report that she had just been sexually assaulted. In the pre-coronavirus era, she would have been told to go to the hospital for a sexual assault exam conducted by a nurse. Instead, the following day, she met for an interview on Zoom with a forensic nurse, a police detective, and an advocate from the local rape crisis center. Then the detective drove to her home and dropped off a do-it-yourself rape kit that had been donated by a controversial company called the Preserve Group.
While the detective waited outside, and the forensic nurse and advocate observed over video conference, the woman swabbed and collected samples from her mouth, genitalia, and other parts of her body. She then sealed the kit inside its box and left it on her doorstep for the detective to retrieve and book into evidence. She had just completed the county’s first-ever remote sexual assault exam.
The unorthodox procedure was conducted under a temporary protocol adopted last week by Monterey County’s sexual assault response team in response to the coronavirus pandemic, according to Lana Nassoura, a deputy district attorney. With all but two of the county’s forensic nurses reassigned to COVID-19, the team’s remaining nurses will only conduct in-person sexual assault exams on particular survivors, such as children and people with injuries from their assault. Under the new system, survivors who are asked to do remote exams may meet a nurse in a hospital parking lot to pick up medications and drop off urine for pregnancy and STI testing. “We believe that during a pandemic, this is the safest method of collecting evidence and providing medical treatment for all the victims and sexual assault team members,” Nassoura says.
As health care workers struggle to treat the surge of COVID-19 cases, forensic nurses are reporting a “dramatic” drop in the number of patients seeking care after being sexually assaulted, according to Jennifer Pierce-Weeks, CEO of the International Association of Forensic Nurses. During a recent webinar held by the Academy of Forensic Nursing, 69 forensic nursing programs reported a decrease in the number of patients they were seeing, says Diana Faugno, a nurse who previously led the organization. As they look for ways to serve survivors without potentially exposing them to the coronavirus, some forensic nurses have been conducting exams in clinics or other locations outside emergency departments. And a handful are considering doing exams via telemedicine and asking survivors to self-collect physical evidence, as was done in Monterey.
While it’s unclear if virtual sexual assault exams will catch on, it is clear that the pandemic has created an opportunity for the two DIY rape kit companies, the Preserve Group and the MeToo Kits Company, to put their products in the hands of nurses and survivors. The Preserve Group donated the kit used earlier this week in California after being contacted by a nurse there, according to Jane Mason, a retired FBI agent who is the company’s cofounder. Last week, the joint chief of staff of the MeTooKit Company wrote to lobbyists in New Hampshire, predicting that sexual assault rates are about to skyrocket, and promoting its kit as a way to “save countless lives.”
“We want to give our first 10,000 kits to the frontlines of COVID as a donation,” Madison Campbell, the 24-year-old cofounder of the MeToo Kits Company, told me. “That’s how we’re going to enter the market. From a venture capital perspective, if we’re able to get these kits into the hands of folks, and it becomes something that is commonplace, we can figure out how to make money later.” Mason says she has donated 125 kits to forensic nurses so far during the pandemic and recently added a contact form to her website for nurses to request donations. She plans to keep giving kits away unless the federal or state governments shut her down. “I wouldn’t be shocked if that happened,” she adds.
Last fall, the Preserve Group came under fire for launching its at-home “sexual assault evidence collection” kits for $29.95 on Amazon. So did the Brooklyn-based MeToo Kits Company, which had recently started advertising its “swab, spit, seal” DIY rape kits in emails to university administrators, offering to give the kits to colleges for free. On the company’s original website, MeToo Kits claimed its product, soon available for preorder at a “pocket-friendly” price, would “empower survivors to accurately collect evidence in a setting and timing of their choice” and could even act as a deterrent to sexual assault.
Forensic and legal experts quickly called out the rape-kit companies, with some accusing them of trying to profit off trauma. (No MeToo Kits were sold; only the Preserve Group sold about 15 kits, many of which went to journalists, Mason says.) Advocates for survivors pointed out that in order to get certain federal funds under the Violence Against Women Act, states must provide survivors with free in-person sexual assault exams, which include urgent medical care along with evidence collection. Julie Valentine, a forensic nurse in Utah and professor at Brigham Young University who bought one of the Preserve Group’s kits out of curiosity, says she is concerned that DIY testing ignores survivors’ medical and psychological needs. Valentine says the kit she bought “does not come with any medication. It doesn’t come with any assessment of their injuries”—not to mention tests for HIV or other sexually transmitted infections or access to counseling.
In a cease-and-desist letter sent to the MeToo Kits Company last August, Michigan Attorney General Dana Nessel wrote that the marketing materials for DIY sexual assault kits could mislead survivors into thinking they had collected evidence that would be admissible in court. “This company is shamelessly trying to take financial advantage of the ‘Me Too’ movement by luring victims into thinking that an at-home-do-it-yourself sexual assault kit will stand up in court,” Nessel said in a statement. (The National District Attorneys Association says self-administered kits probably would not be allowed as evidence.) A dozen AGs followed Nessel’s lead, sending subpoenas or cease-and-desist letters to the kit companies or warning the public against buying their products.
The Preserve Group pulled its kits off Amazon, and the MeToo Kits Company scrubbed its website of any promises about what its product would do. But Campbell, a survivor herself, vowed to “never stop fighting.”
Following the backlash, the kit companies focused on getting out of legal hot water. “I’m trying to learn from my mistakes,” Mason tells me. The MeToo Kits Company, which consists of Campbell, another co-founder, and a small team of part-time college students and interns, recruited an advisory board that includes forensic nurses, regulatory and medical experts, and a host of lawyers who, Campbell says, have helped “retool everything.” She now plans to begin selling kits in bulk to universities and companies starting in October for about $15 apiece, along with an app that will give survivors access to virtual counseling and telemedicine with forensic nurses or physicians. Mason says PreserveKit and MeToo Kits Company are currently in talks to merge. (Recently, Campbell’s company began identifying itself as Leda Health in emails and company documents.)
Both founders argue that no one really knows whether DIY evidence would be admissible in court. And they insist their products are intended to serve the roughly three-quarters of sexual assault survivors who do not contact the police, rather than those survivors who would otherwise choose to get a standard sexual assault exam at a hospital. “Isn’t it better for a crime victim to have one need met instead of none?” Mason asks. She is less concerned that her kit might dissuade some survivors from seeking professional medical care. “Just because somebody in the minority might choose their own self-collection—which I still think has a potential of being admissible in court,” she asks, “does that mean we shouldn’t help the vast majority?”
As the decision to seek medical care has become significantly more complicated for survivors during the pandemic, Campbell’s team has been stepping up its outreach efforts. Alex Bowen, a college junior who works as Campbell’s joint chief of staff, recently sent an email to lobbying firms in New Hampshire, where the state House passed a bill in March banning the sale of DIY rape kits. (The bill is awaiting consideration by the state Senate, though the legislative session is currently suspended.) The message predicted that sexual assault would rise by “an estimated 200% in the next two years,” in part because “the longer folks are isolated, the higher chance they have of exhibiting adverse behaviors, including but not limited to, long amounts of time without sexual intercourse leading to forced sexual penetration.”
Kevin Swartout, a Georgia State University professor who studies perpetrators of sexual assault, says that research actually shows no significant relationship between men’s social isolation from women and their likelihood of sexually assaulting someone. Experts are concerned about a potential uptick in domestic abuse, which could include sexual assault, as abusers are aggravated by stay-at-home orders and financial strain. According to Pierce-Weeks, of the International Association of Forensic Nurses, fewer victims are making the choice to go to the hospital, potentially concealing an increase in violence. “People are afraid to go to the hospital now because they’re afraid of the virus,” she says. “If you live with an abuser, and that abuser is now out of work—a dangerous situation—there’s a good chance you’re not going to be allowed to leave, never mind leave to go to the hospital and seek care.” Yet Campbell’s company’s eye-catching prediction that the incidence of sexual assault is about to explode appears to be an unscientific guess based on a broad reading of news reports and studies.
Even if there is an increase in sexual assault, Pierce-Weeks, Valentine, and others do not think that DIY rape kits are a solution. “I think this is just an attempt to profiteer off of a pandemic, in a crisis, and to provide sexual assault survivors with misinformation driven by fear,” says Amanda Grady Sexton, the public affairs director of the New Hampshire Coalition Against Domestic & Sexual Violence. “I am just disgusted that anyone would use COVID-19 as an opportunity to make a quick buck,” says state Rep. Kris Schultz, who sponsored the bill to ban do-it-yourself kits. (Both Campbell and Mason emphasize that they are not currently selling kits.) After learning of the lobbyist email and Mason’s offer to donate kits to nurses, Pierce-Weeks sent a letter on Tuesday to US Senate and House leaders urging them to ban the kits altogether. “As more victims of violence choose to avoid hospital emergency rooms due to COVID-19, several companies are again marketing DIY rape kits,” she wrote. “These products have no health care value and may have detrimental effects due to chain-of-custody issues and lack of admissibility in court.”
Campbell is disappointed that her company continues to face resistance even though it plans to donate, not sell, kits in response to the current public health crisis. “We’re like this black hole that no one wants to get involved with,” she says. “People hate the fact that we’re not a nonprofit. They’ve hated it from the very beginning.” But during the pandemic, she says, “if we don’t all work together, we will not only see the death of so many loved ones, but also so many survivors who could have gotten help and they didn’t.” The approach that was just launched in California could be a model. “We can utilize the same protocol that they’re using in Monterey,” Campbell says. “Nationally, we want to be able to do that.”
Interest in remote exams and self-collected evidence appears to be picking up. Last week, members of the Academy of Forensic Nursing discussed the possibility during a webinar titled “Evidence Collection Decisions Within a Pandemic.” And a forensic nurse involved in designing Monterey County’s new protocol has already discussed it with sexual assault program coordinators in several states, according to Nassoura, the deputy district attorney.
Nassoura says Monterey’s sexual assault response team chose to use a DIY kit, not a standard hospital kit, in part because the evidence swabs could be packaged while still wet. (Hospital swabs would have required an hour to dry before the survivor could place them in the kit.) She’s anticipating extra courtroom challenges if cases involving DIY kits do make it to trial, but she believes that the protocol will avoid most chain-of-custody problems while ensuring survivors get a form of medical care. “Our main priority was not to compromise the resources available to the victim and also not to compromise the evidentiary value of the evidence collected,” she says.
“It’s not our first-choice scenario, if there wasn’t a pandemic going on,” she adds. “But this is the hand we’ve been dealt.”