Chelsea Mosher
A HOMELESS YOUTH who's only nineteen and living on the street might already be considered a victim. But advocates for these youth, vulnerable as they already are, worry they are being further victimized by a health-care system meant to help them.

In April, Joe (not his real name) was kidnapped, drugged, and kept in a closet, where he was repeatedly raped. He finally escaped after several days and made his way directly to the Salvation Army Greenhouse Youth Shelter. Disoriented, he was escorted by one of Greenhouse's sexual assault advocates to Oregon Health Science University's (OHSU) emergency room. It was here that Joe's story turned from bad to worse: According to Outside-In, an agency that works with at-risk youth and was involved with Joe's case after the teenage rape victim was admitted, the police were contacted and a patrol officer came to interview Joe. When the Salvation Army advocate who had escorted Joe stepped out to use the bathroom, the officer arrested the young man for an outstanding warrant. Since that time, he has been in jail for five months.

Joe's story, told by Outside-In, illustrates flaws in Multnomah County's system for treating sexual assault victims. Outside-In believes police notification in cases of rape fails to address the primary health concerns of street youth and, in fact, has the potential to further harm sexual assault victims like Joe.

Concerned about the policies at OHSU, Outside-In has made an official decision to send all sexual assault victims who pass through their doors, not to the nearest hospital, but to St. Vincent's in adjacent Washington County. As a primary member of local agencies that work with the estimated 1,500 street youth in Portland, Outside-In's boycott marks an important vote of no confidence in Multnomah County's policies, and specifically in OHSU.

OHSU responded to Outside-In's claims by stating that they are misinformed. "If it is strictly sexual assault, we do not under any circumstances contact law enforcement without [patient] consent," said the Sexual Assault Program Coordinator at OHSU, who preferred to remain nameless. She went on to explain, however, that OHSU does need police authorization to collect forensic evidence in case of prosecution.

This means if a victim in Multnomah County was fearful of police involvement, he or she would be inclined to forego a rape examination and therefore forfeit any opportunity for future prosecution against their attacker. As a number of street youth have outstanding warrants for crimes such as theft and burglary, police involvement could result in their prosecution. By contrast, St. Vincent's in Washington County does not require police authorization to administer a rape-kit exam. OHSU denies they have breached the confidentiality of their patients. However, according to Anna Vail, who was Health Coordinator of Outside-In at the time of the assault, the word on the street has prompted homeless youth in Multnomah County to avoid treatment for sexual assault. It has also led to Outside-In's boycott of OHSU, the only hospital contracted by Multnomah County to provide care for sexual assault victims over the age of twelve.

"What we learned is that we don't take chances with street youth who have warrants," says Vail, of Outside-In's decision to take victims to St. Vincent's instead of OHSU.Vail tells a story about an 18-year-old woman who sought help from the youth agencies earlier this summer. The young woman's boyfriend had made some enemies who picked her up, gang-raped her, and broke her jaw. In the middle of the night, she sought treatment at Legacy Emanuel Hospital, where she received a mandatory screening exam that determined she was stable enough to be transferred to OHSU's emergency department. Afraid that OHSU would contact the police, the young woman instead fled to the Salvation Army Greenhouse; the Greenhouse, who works closely with Outside-In, contacted Vail.

Vail called OHSU to make sure they would not contact the police if the young woman went to the hospital for treatment. Vail claims they told her they would contact the police even when she "pleaded with them not to." The girl, who had multiple warrants, became increasingly paranoid as the negotiations took place and fled the Greenhouse. To their knowledge, said Vail, she was never treated for the broken jaw or the rapes.

John Duke, clinic manager at Outside-In, acknowledged that these cases were extreme but does often find that street youth and runaways get "cold feet" when state reporting procedures are explained to them. Of the eight assault victims Outside-In has attempted to help this past summer, three had devastating outcomes. "I think there are lots of assaults that go unreported because of the system in place," Duke surmised, "especially marginalized cases like ours."

Defending police procedure when law enforcement is contacted, Sergeant Keith Morse of the Sexual and Bias Crimes Unit says it would not be uncommon for the police to do a background check on a victim in order to determine who they are dealing with. If a prostitute were raped, for example, and there were warrants for her arrest, Morse explained, "I cannot give her blanket immunity for prostitution."

In an effort to broaden services in Multnomah County, the Portland Women's Crisis Line is in the process of forming their new advocacy program. Currently, a victim in Multnomah County would require police involvement in order to have advocacy; the only victim advocates in Multnomah County--present from the evidentiary exam through the course of prosecution--come from the district attorney's office. By contrast, the Rape Crisis Center in Washington County provides the same services, but exists independently from law enforcement. Additionally, the Crisis Center is contacted directly by the hospital when a victim seeks treatment--not through the police. Outside-In's confidence in St. Vincent's shows how simple policy differences can protect victims instead of potentially causing further harm.