Enemy prisoners of war and other detained personnel are entitled to all necessary medical and dental care, subject to the availability of care and facilities.

Nonmilitary Federal Prisoners
Nonmilitary federal prisoners are authorized only emergency medical care. When such care is being provided, the institution to which the prisoner is sentenced must furnish the security personnel to ensure custody of the prisoner and safety of others in the facility. Upon completion of emergency care, arrangements will be made immediately to transfer these individuals to a nonmilitary treatment facility or for return to the institution to which sentenced.

Military Prisoners
Status of Forces policy is to protect, to the maximum extent possible, the rights of U.S. personnel who may be subject to criminal trial by foreign courts and imprisonment in foreign prisons. Active duty members are generally not separated from the service until they have completed their term of imprisonment and returned to the United States. During this confinement, they will normally remain healthcare beneficiaries.

Military prisoners (those sentenced under the Uniform Code of Military Justice) whose punitive discharges have been executed but whose sentences have not expired are authorized medical and dental care. Individuals on appellate leave, awaiting execution of a punitive discharge, are also entitled to care. Military prisoners whose punitive discharges have been executed and who require hospitalization beyond expiration of their sentences are not eligible for care, but they may be hospitalized as civilian humanitarian nonmilitary indigents until disposition can be made to some other facility.

SEXUAL ASSAULT AND RAPE
Sexual assault and rape are criminal offenses, often associated with serious injury. The management of cases involving sexual assault and rape must be a joint medical and legal function. A sexual assault investigation kit, supplied by the Naval Criminal Investigative Service, is used to gather and preserve evidence of a crime. Included in this kit are step-by-step procedures for the examination of the patient, as well as a checklist of specimens to be collected.

In order to safeguard and obtain evidence to be used in possible legal proceedings, liaison between the naval treatment facility, military and civil investigative agencies, and state and local agencies (such as Child and Spouse Protective Services) should be established. It must be kept in mind that medical personnel are not to judge, defend, or prosecute the individuals involved. NAVMEDCOMINST 6310.3, Management of Alleged or Suspected Sexual Assault and Rape Cases, provides further guidance for the care, evaluation, and medico-legal documentation of the victim of an alleged rape or sexual assault.

Every effort must be made to treat the patient with respect and courtesy and to provide appropriate privacy. In dealing with alleged victims of sexual assault, careful attention to psychological factors must be given to lessen the impact of the incident. This is especially important when a minor is involved and the reaction of adults may be more harmful than the actual assault itself. Tactful questioning and the use of appropriate terminology are of extreme importance throughout the history taking and examination. OPNAVINST 1752.1, Sexual Assault Victim Intervention (SAVI) Program, and SECNAVINST 5800.11, Victim and Witness Program, provide guidance for the care and support of victims of sexual assault.

CHILD AND SPOUSE ABUSE AND NEGLECT

The nature of child and spouse abuse and neglect requires a careful patient history and physical examination to identify or rule out past and present injuries caused by abuse or neglect. The policies and guidelines established by the Navy Family Advocacy Program must be followed. This program was discussed earlier in this chapter and is outlined in SECNAVINST 1752.3 and BUMEDINST 6320.70.

SUMMARY
Retaining our high medical standards and the quality healthcare the fleet demands, as well as providing care for military dependents and a constantly expanding retiree database, requires a healthcare administration support structure that is second to none. DEERS management and the determination of patient eligibility are crucial components and only two of the areas discussed in this chapter. Also covered were many of the health-related programs established to benefit and support eligible recipients in the military community. These programs are often meant to eliminate the need for others. Good quality assurance, for example, creates better patient relations, thereby minimizing legal problems; substance abuse and family advocacy programs identify problems before they become unmanageable; and the physical readiness program helps build a healthier Sailor, thus eliminating needless patient visits.

This chapter also provided an overview of the Hospital Corpsman's responsibilities in the area of interaction with legal authorities. Sexual assault, spouse and child abuse, and drug and alcohol incidents require legal and medical teamwork. Many legal battles are lost because of failure to adhere to the proper administrative procedures. As a Hospital Corpsman, you must be aware of these procedures and ensure that they are followed precisely.