What could potentially add insult to injury in a rape case? The victim having to pay for her own rape exam and forensic testing, that is what. A startling new report found that this is exactly what is happening to some victims of rape and other sexual assaults in Louisiana and to varying extents across the nation.

The report, published by the Times-Picayune, reveals that many victims of sexual crimes have been receiving bills for their attack-related hospital visits. In some cases, the victims have been charged thousands of dollars in medical expenses.

In 2005, the Violence Against Women Act was amended to prevent victims of sexual assault should not be charged for medical forensic exams following their attacks. However, the range and scope of the act’s coverage is limited, covering only “an examination of physical trauma, a determination of penetration or force, a patient interview and collection of evidence.”

“By that definition,” wrote report author Rebecca Catalanello, “costs for procedures that are a regular part of the SANE screening — pregnancy tests and HIV tests, among them — could be considered extra. And, in many cases throughout Louisiana and the United States, they are.”

A sexual assault nurse examiner, or SANE, is a qualification for forensic nurses who have undergone specialized training to conduct rape or sexual assault evidentiary exams. Some women who reported being victims of sexual assaults were required to be admitted to an emergency room for their SANE exam, but then they were billed for the admissions.

One woman who was violently sexually assaulted is reported to have incurred expenses related to her post-assault medical examinations and tests that totaled $4,200. The mother of the victim told the Times-Picayune that she found it particularly frustrating in light of the fact that Angola Prison inmates receive free health care.

The Louisiana Department of Health and Hospitals responded to the report, saying, “We will work with the Legislature and the partners to address this and ensure sexual assault victims are provided the services they need, and also make sure we are doing everything we can to fight sexual violence.”