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Columbia lacks rape response team

Program disappeared from emergency rooms after 2 years.
Monday, August 9, 2004 | 12:00 a.m. CDT; updated 10:02 p.m. CDT, Wednesday, July 2, 2008

The scenario has tragically replayed itself perhaps hundreds of times. A woman is raped, whether by an acquaintance after a party or by a stranger in some unpredictable circumstance. Distraught and disoriented, she wonders what to do.

Should she go to the hospital? Tell the police? Call a sexual assault hot line?

Or should she keep the crime a secret?

Rape is among the most intimate of crimes, a violation on the most personal level. But reporting it can sometimes compound the trauma, especially in communities that provide little coordinated support for rape victims.

Columbia has been one of those places the past four years. The number of rapes reported annually in Columbia has long been fluctuating. Exactly why remains unknown, but an examination of FBI statistics from Columbia and other Midwest college cities reveals that women here do not report as many rapes as elsewhere.

It’s possible that sexual assaults against women simply aren’t as frequent here. But that would buck the trend in overall violent crime, for which Columbia ranked either highest or second-highest among the college towns from 2001 to 2003.

Women’s advocates, and even representatives of local government, acknowledge a key difference between the way Columbia and similar cities deal with victims of sexual assault.

Iowa City and Ames, Iowa, and Stillwater and Norman, Okla., each offer a “cooperative community response” to victims of sexual assault. These programs strive to ensure women aren’t victimized by the process of reporting and investigating a rape.

Some women’s advocates argue Columbia’s lack of such a program is why some victims don’t report. If they’re right, the obvious question is why Columbia — when it had such a program in the late 1990s — allowed it to die?

AN INCOMPLETE START

Christened the Sexual Trauma/Assault Response Team, or START, in 1997, Columbia’s cooperative community response program hoped to take “the victims of rape out of the emergency department and place them in an environment where evidence can be collected for successful prosecution, while also providing a much more compassionate environment for the victim to be examined,” according to minutes from a meeting at which the Columbia City Council gave $19,000 to the new team.

The team comprised rape victim advocates from The Shelter, a Columbia agency that works primarily with victims of domestic violence, and representatives of hospitals, the Columbia Police Department’s Major Crimes Unit and the Boone County Prosecuting Attorney’s Office.

The foundation of the team, however, lay in its use of volunteer sexual-assault nurse examiners, or SANEs. Emergency room personnel would call in these specially trained people when a victim of sexual assault was admitted.

As designed, victims assisted by START would be taken aside when they entered the ER. A rape advocate from The Shelter would be called, along with a SANE, who would perform a medical assessment, provide treatment and, if the victim was willing, process forensic evidence.

From the moment the woman arrived at the ER, and through the days and months that followed, rape advocates would remain in touch with the police, the prosecutor and the victim, whether her future included counseling and/or criminal prosecution.

Although prosecutors originally disliked the idea of having nurses do forensic exams, they changed their minds when they learned how well they were trained.

ER workers came to value the volunteers. Allen Garner, a registered nurse who worked in the ER at Boone Hospital Center in 1997 and 1998, said the START team and SANEs made life easier for him and his peers.

“It was easy to have START come in and do it,” he said. “They did it all.”

Sgt. Stephen Monticelli, investigative supervisor for the police department’s Major Crimes and Family Services units, worked with START. He said its initial success was due to a number of factors.

For one, it ensured participating hospitals had protocols for dealing with rape victims. When they came to the ER, for example, they were immediately taken to a private area. When officers arrived, they knew the victim would be in a quiet place where it was easier to talk.

The program also paid off outside the ER. Once a month, representatives from START’s member groups would meet to discuss individual cases and the overall program.

The communication helped them understand each other, Monticelli said. Cops began to understand why a prosecutor might not pursue a case. Victim advocates could hear why an officer might have responded to a victim in a certain way. Medical personnel could learn how their actions affected victims. Each group could effect changes in the others and examine whether mistakes were systemic or the result of individual errors.

In the end, the communication helped ensure smoother, more effective treatment of victims.

And then it fell apart.

INHERENT FLAWS

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Mary Martin, public health manager for the Columbia/Boone County Health Department, considers herself one of the “birth mothers of START in Columbia.” She’s been with the department since 1990.

Martin said, the program worked well for the most part, but the problems that ultimately would doom START were already in place.

First, University Hospital never participated, leaving Boone Hospital Center and Columbia Regional Hospital as the only facilities willing to let volunteer SANEs work with victims. When the largest hospital in the city — and the one most college students would use — refused to take part, it limited the number of people START could help.

Martin said the people at University Hospital rationalizedthat they provided all the same services internally and didn’t want outside volunteers.

Leigh Voltmer, executive director of The Shelter, argues the hospital’s protocols were simply inadequate at the time. It eventually allowed advocates from The Shelter to work with rape victims but never let SANEs do so.

When University Hospital bought Columbia Regional in the late 1990s, its policies were extended, leaving the ER at Boone as the only one participating in START and welcoming SANEs.

That compounded the challenge of retaining volunteers. When the program began, eight SANEs worked a rotating schedule, agreeing to be on call on a certain night in case a rape victim came into an area ER. But when Boone remained as the only START hospital, the number of calls was so low that some SANEs stopped volunteering.

That, coupled with normal attrition, reduced the number of SANEs to three by 2000. Now, on call one of every three nights, volunteers would be unable to go on vacation or make plans with their families. Volunteering began taking its toll.

“It was rough on people’s nervous system to have a full-time job and then have a pager go off at 3 a.m., 4 a.m.,” Martin said.

The final blow came in 2000, when Missouri began tightening rules on volunteer nurses.

Normally, when volunteers worked with victims, they were under the standing orders of a volunteer director who agreed to take medical responsibility for their decisions. When the director was out of town, however, the volunteers wanted designated doctors at the hospital to handle issues outside the range of nurse-examiner practice. But because the volunteers were not on Boone Hospital’s staff, administrators couldn’t let doctors act as temporary medical directors and assume liability.

Bill Cotton, who became director of emergency medical services at Boone when volunteers were looking for support, remembers trying to navigate the web of rules and laws that entangled START volunteers.

“In all honesty, we actively tried to look at our options,” Cotton said.

But in the end, there were none. SANEs disappeared from Columbia ERs. And just two years after Columbia had created a cooperative community response to rape, it was gone.

TOMORROW: The absence of a cooperative community response compromises medical experts’ and criminal authorities’ ability to work with rape victims.


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