Rape Survivor Suit Highlights Lack of Uniform US Care Standard

A recent episode of the HBO show The Pitt portrayed emergency department charge nurse Dana treating a rape survivor and performing a thorough sexual assault forensic examination.

Dana was calm, meticulous, explained every step, and asked for permission before swabbing the patient’s mouth, fingernails, genitals, and other areas. The patient’s frustration, fear, and anxiety were clearly portrayed.

But Andrea Hirsch, a partner in the Atlanta firm Cohen Hirsch, said that’s not always how it goes. She represents a woman suing a Florida hospital for allegedly botching her clinical assessment, making improper testing decisions, incorrectly handling and documenting samples, and improperly communicating her transfer-of-care to a rape crisis center. The center also is a defendant.

The hospital defendant hasn’t yet answered the complaint, and a spokesperson declined to comment.

The lawsuit, which appears to be the first of its kind in about a decade, presents novel questions about the standards of care that apply to forensic examinations. What are a hospital’s obligations? Could a medical facility be held civilly liable for failing to follow them? Do survivors have a remedy if mistakes prevent prosecuting the alleged rapist?

Raising Awareness

The Pitt‘s segment was the “best representation of a person providing care” to a sexual assault survivor she’s seen, said Sheridan Miyamoto, a nurse practitioner who teaches at Pennsylvania State University and directs the Sexual Assault Forensic Examination Telehealth Center.

But patients don’t necessarily know what good care looks like and don’t know how to report any dissatisfaction with it because there are no reporting mechanisms. “I’m surprised there aren’t more cases,” she said.

Miyamoto is a certified sexual assault nurse examiner who teaches, mentors, and helps prepare other nurses for certification, both in person and remotely.

Few people who have been sexually assaulted actually seek health care afterward, Miyamoto said. Fear, shame, and self-blame are powerful barriers—especially when drugs or alcohol are involved. Many people don’t know where to go, and medical facilities don’t do a good job of letting survivors know they have clinicians available to help them, she added.

The Pitt’s story line demonstrated yet another difficulty: Conducting the sexual assault examination took Dana away from her regular job for a considerable amount of time. Many emergency departments are overwhelmed as it is.

They can’t turn people away without screening them for emergency medical conditions, but also may not be properly staffed to handle sexual assault cases, Miyamoto said. There’s a nationwide nurse shortage, and relatively few nurses have received the specialized training to be certified.

Hospitals may not have a certified nurses on staff, depending on their finances and state requirements. State scope of practice rules may also limit the services nurses can offer. And state law may prohibit hospitals from billing patients for these services, as in California.

Hirsch said she has other suits in the works and already has filed another lawsuit against a California hospital, alleging that it refused to perform a sexual assault examination unless law enforcement officers approved it, then billed the patient for the care it did provide.

Uniform Standards Lacking

States have rape response protocols based on federal standards published by the US Department of Justice. These detailed guidelines for clinicians, law enforcement, and survivor advocates outline standards meant to meet a patient’s immediate needs and address evidence collection and preservation.

Not all states, however, require licensed emergency departments to provide sexual assault forensic exams. Some, like New York, have designated hospitals that must provide 25 specified services at a minimum. Nondesignated hospitals must provide all but eight of them.

Florida, where Hirsch’s suit arose, requires hospitals to arrange for the care and treatment of sexual assault survivors, but doesn’t mandate they provide it themselves. They can transfer patients to rape crisis centers for forensic exams.

Pennsylvania hospitals also must provide access to sexual assault exams, but any licensed clinician can perform one, Miyamoto said. Only eight states list sexual assault nurse examiners among their authorized providers.

Miyamoto and colleagues documented these inconsistencies in a report published in the Journal of Forensic Nursing. They concluded that strengthening state and local policies, especially by expanding use of forensic nurse examiners certified by the International Association of Forensic Nurses, is essential to guaranteeing consistent care access for rape survivors.

“Every community should have a response plan,” added Trisha Sheridan, an assistant professor at Emory University’s Nell Hodgson Woodruff School of Nursing.

Childress Case

Hirsch discovered issues with Kirsten Childress’ care while researching cases against eXp World Holdings Inc. According to a lawsuit against the realty company, Childress was raped while attending a May 2023 work event sponsored by the firm, which has been accused of promoting a “rape culture.” The case has been stayed and administratively closed pending resolution of a motion to compel arbitration, according to a Dec. 1, 2025, docket entry.

Hirsch couldn’t find records showing anyone had collected or preserved urine or blood samples for toxicology testing, despite Childress’ lack of memory of the event.

Without toxicology testing, which normally is done by law enforcement while preparing a case for prosecution, a survivor probably can’t negate a consent defense. Childress’ alleged rapist and eXp both claimed she consented, and law enforcement didn’t pursue her case.

The Feb. 16 complaint in the US District Court for the Middle District of Florida includes claims against the physician assistant who examined Childress at an Orlando Health Inc. hospital and a forensic nurse employed by the Victim Service Center of Central Florida Inc., as well as the center and the hospital. She is seeking damages for the emotional harm “foreseeably worsened” beyond the baseline trauma caused by the assault.

In Florida, a plaintiff must have an expert witness testify about the prevailing standards of care, how the provider breached them, how the breach caused the injuries, and damages.

Sheridan, acting as Childress’ expert, said in a pretrial filing that the hospital care breached standards identified in the DOJ, IAFN, and Florida Council Against Sexual Violence protocols. There are specific guidelines for drug-facilitated sexual assault, which caregivers should have suspected when Childress complained of memory loss, she said.

Blood and urine samples should be taken as soon as possible in a suspected DFSA, according to the Florida group. Urine should be collected within 72 hours after the assault. Blood can be collected up to 24 hours after the incident, it says.

“The opportunity to provide care was there, and failing to fully evaluate the patient doesn’t make sense,” Sheridan said. It was clear that Childress “wasn’t OK,” she said.

VSC said in its March 2 answer that Childress can’t bring medical negligence claims against it because it’s not a health care provider as defined by Florida law. The state’s statute of limitations also bars the suit, it said.

Hirsch disagreed, saying the medical negligence framework applies because VSC performed the exams through licensed clinicians. The statute of limitations had been extended, she also said.

Bush & Augspurger PA, which represents VSC, didn’t immediately respond to requests for comment.

Hirsch calls DFSA a “silent epidemic” because many survivors don’t report it due to memory problems, self-blame, shame, and a feeling they won’t be believed. “It’s impossible to estimate the number of cases” because they usually aren’t reported or prosecuted, she said.

National studies have shown that the odds against winning any medical malpractice case are low. But Hirsch said she wouldn’t file a case unless she “believed the claims were supported by the facts and applicable law.”

“The central issue here is whether the medical providers involved followed the prevailing standard of care when evaluating a patient who presented shortly after a reported sexual assault with symptoms consistent with possible drug-facilitated sexual assault,” she said. Her “position is that the appropriate clinical steps were not taken.”

Hirsch emphasized that “these aren’t bad people“—they just made mistakes. But the “same thing will keep happening if no one speaks up,” she said.

The case is Childress v. Orlando Health, Inc., M.D. Fla., No. 26-cv-372, filed 2/16/26.