**GAO-12-29**                      Published: Oct 26, 2011. Publicly Released: Oct 26, 2011.                  

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## Highlights

The Justice Department has reported that Indians are at least twice as likely to be raped or sexually assaulted as all other races in the United States. Indians living in remote areas may be days away from health care facilities providing medical forensic exams, which collect evidence related to an assault for use in criminal prosecution. The principal health care provider for Indians, which operates or funds tribes to operate 45 hospitals, is the Department of Health and Human Services' Indian Health Service (IHS). In response to a Tribal Law and Order Act of 2010 mandate, GAO examined (1) the ability of IHS and tribally operated hospitals to collect and preserve medical forensic evidence involving cases of sexual assault and domestic violence, as needed for criminal prosecution; (2) what challenges, if any, these hospitals face in collecting and preserving such evidence; and (3) what factors besides medical forensic evidence contribute to a decision to prosecute such cases. GAO surveyed all 45 IHS and tribally operated hospitals and interviewed IHS and law enforcement officials and prosecutors..

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## Topics

Health Care

Case management servicesCrime preventionDomestic violenceEvidence-based practicesHealth care facilitiesHealth care servicesHospital care servicesHospitalsInvestigations by federal agenciesJurisdictional authorityLaw enforcementMedical examinationsNative AmericansSex crimesPolicies and procedures

## Multimedia

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