June 8th, 2015

The Rape Kits Are Being Processed. Are They Being Created?

Recently, a friend posted this on FB:


A woman describes being drugged, subsequently raped and injured, going to Swedish Ballard's Emergency Department, being told they didn't have a SANE (sexual assault nurse examiner) on site or on call and the nearest hospital (about 6 miles away) which did was Harborview. They failed to document her injury (altho it is not perfectly clear whether an examination which could have documented her injury occurred or not). The victim (let's not lose track of the She's Been Drugged part) declined ambulance transfer (really, who could blame her), but at a later time went to Harborview, where her injury was documented but it was no longer possible to collect forensic evidence (time lapse, shower, etc.).

First, a little background. SANE's are RN's (so that's typically a bachelor's plus some additional stuff -- many of the nurses you encounter in primary care or when visiting someone in a rehab facility or in the hospital for a procedure or whatever are NOT RN's) with additional training and experience. They are more expensive and there are fewer of them. Second, while there are emergency departments with large staff and long waits, there are far more emergency departments with fewer staff and no wait at all. The ones with the large staff and long waits are currently the ones most like to have SANE's on staff. Ballard Swedish does not have long wait times. http://www.yelp.com/biz/swedish-hospital-ballard-emergency-seattle They also do not have a SANE on duty.

Back in the Bad Old Days (aka the 1990s), during the previous push to prosecute sexual assault, a big frustration for the police, medical professionals and victims (and society at large) was how poorly evidence survived from the crime. While victim advocates existed to try to connect victims with individual (I Am NOT Making This Up) doctors and nursing staff who were better at collecting evidence, it was a helluva maze to navigate in the short window of time after the crime in which evidence can be collected which will hold up in court. The SANE credential was created to identify these nurses and to create programs which would connect hospitals to a pool of credentialed nurses so that whether a sexual assault victim showed up first in the hospital or at the police department or was met at the location of the crime, a trained professional who understood medical needs of the victim and forensic needs of the justice system could be involved in the process promptly.

As a result, "rape kit" entered our vocabulary, altho, alas, SANE did not. Also, while a rape kit drastically improved the success rate of prosecution, the police fell down on the job and didn't actually process or prosecute this high quality evidence. Recently, this backlog has been identified as a problem by activists and they have successfully pressured the criminal justice system to work through the backlog, leading to additional successful prosecutions.

The next step is to make sure the rape kits are being produced appropriately by SANE's, and the article that showed up on my feed suggests that there is a problem there. The suggestion embedded in this and some other coverage:


is to get more SANE's into more hospitals.

But if the issue is connecting victims with people with the medical and forensic experience necessary to help them, it might be a lot more cost effective and faster to instead address the transfer issue. In this story, the victim (who had been drugged!) declined the ambulance transfer offered. In the wake of this event, the hospital has started to address the transfer issue.

From the KING5 coverage: ""Swedish began offering the option for patients who were victims of a sexual assault to be transferred to Swedish First Hill for a forensic exam during the summer of 2014. This service was added to ensure we continue to provide continuity of care and increase access to the best possible care and support for our patients," said a hospital spokesperson."" Harborview is also building out its network, and sending its nurses out to other area hospitals as needed.

Back in the Bad Old Days, RAINN and their hotline was how you got an advocate to help you find someone to get you through the medical and forensic maze. Today, you can go to an ER, but the ER might not have the experienced professional you need. But hopefully, we can pursue this model of connecting the ERs who DO NOT have such professionals to the ERs that DO have such professionals, and provide transportation without requiring victims to make a price based decision at a difficult moment.