The Rape Solution: How crucial are nurse examiners?

Officials wonder if more women report assaults if SANEs are available. (Second in a three-part series)
Tuesday, August 10, 2004 | 12:00 a.m. CDT; updated 5:12 a.m. CDT, Saturday, July 5, 2008

When trying to understand why Columbia’s reported number of sexual assaults is lower than peer communities, one question local experts are asking is whether it matters if sexual assault nurse examiners, or SANEs, are in emergency rooms as part of a cooperative community response.

After the city’s Sexual Trauma/Assault Response Team, or START, ended in 2000, Boone Hospital Center continued many of the protocols it had during the START years. Victims were taken to private areas away from the waiting room, a doctor or nurse would call The Shelter and ask for a rape advocate, and trained doctors would use rape kits to collect forensic evidence.

Even so, Leigh Voltmer, executive director of The Shelter, thinks the absence of SANEs from ERs was “a crisis” that might help explain Columbia’s low number of rape reports. Although SANEs have begun returning to ERs in recent months as part of a larger effort to redevelop a cooperative response to rape, Voltmer believes the SANEs’ lengthy absence carried long-term consequences.

Without SANEs, for example, doctors are the only ones who can tend to a rape victim’s medical needs. That means some might wait for hours while the doctors treat patients with more critical and immediate medical needs.

Voltmer also worries that many doctors aren’t trained as well as SANEs in the use of a rape kit and the psychology of working with rape victims. This not only affects victims but can hinder or complicate future prosecution of attackers.

“Even if you have a victim well treated emotionally and have a good case in the eye of the prosecutor, the evidence has a much greater margin of being compromised because there is so much to learn and so much to know,” she said.

The protocols are extensive. To avoid tainting evidence, for instance, the nurse or doctor can’t leave the room during the exam. The victim’s clothes can’t leave the room, either, and must be in a locked place at a certain temperature.

SANEs also learn how to deal with the psychological issues that come with being sexually assaulted. In the time immediately after the assault, this can be invaluable, Voltmer said.

There are several protocols SANEs are trained to follow. They know, for instance, that they should sit down when interviewing victims so it doesn’t appear they’re looking down on the victims. And they learn how to encourage the use of a rape kit, which is critical to successful prosecutions.

Bill Cotton, director of emergency medical services at Boone Hospital Center, said he heard defense attorneys at his previous hospital in Kansas City pretty much give up when their clients were fighting rape-kit evidence.

“They would just plead out,” he said.

Voltmer cited two more primary problems since START dissolved: misunderstandings between relevant agencies and the lack of a system to ensure advocates remain in touch with victims. Although she says she has good relationships with police, prosecutors and Boone Hospital Center, she knows things could be better.

It’s “not as if no one knows what they are doing,” she said. “We have a process by which (the victim) goes to the hospital, and the advocates work with the hospital and whatever law enforcement happens to show up. But that’s where it ends; there is no follow-through or follow-up. The agencies are not holding each other accountable.”

That means a system that’s supposed to protect women is instead creating the potential for harm, Voltmer said.

“If she is well supported and there is a structured process from the community about how this is going to go forward, then she is much less likely to be revictimized by the system itself,” Voltmer said. “If she is aware people are working together and there are designated personnel that work together, then her experience after rape is going to be much different.”

Often, without a cooperative response, victims don’t know their options and fail to seek help, Voltmer said. “She is less likely to want to seek help. She is more likely to think getting help is futile; she is more likely to think there is nothing she can do about it.”

Voltmer believes that’s one reason there are fewer reported rapes in Columbia.

But is it really that simple? Boone County Prosecuting Attorney Kevin Crane doesn’t think so. “I don’t think when women decide whether or not they’re going to report they think about whether or not we have a START program,” he said.

Crane said the lower number of reported rapes here is the result of several factors, including fewer actual rapes. He conceded, however, that he doesn’t know.

Indeed, no one from the police department, area hospitals or the prosecutor’s office really knows why Columbia ranks so low in reported rapes compared to Ames and Iowa City, Iowa, and Stillwater and Norman, Okla., especially when it had far more violent crime overall than any of those cities from 2000 to 2003.

Like Crane, members of START’s former agencies said there are a number of variables to explore: Do all these cities have dry campuses? How aggressively does each pursue certain types of violent felons? How many people in Columbia never report rape because they’ve sought help with nonlegal entities such as women’s services on campus?

Each of the four comparison cities, however, has SANES in its hospitals and a cooperative community response team. In those cities, women’s advocates don’t think it’s a coincidence that more rapes are reported.

In Ames, nine agencies make up Story County’s Sexual Assault Response Team, or SART. Law enforcement, the medical field, women’s advocates, counselors and prosecutors work together to see victims through the process, no matter how far into the legal system each pursues her case.

“The purpose of the team is to have all the people who might work on that case come to that person and say, ‘This is who I am, and this is what I can do for you,’” said Heather Priess, Story County SART team coordinator. “The goal is make all the resources immediately available and let her choose what she wants to do.”

Iowa City’s Rape Victim Assistance Program responds similarly and relies heavily on SANEs. Executive Director Karla Miller said the program tries to place SANEs anywhere someone might go to report a sexual assault, including local hospitals and clinics.

Stillwater’s team includes SANEs and a trained advocate from Stillwater Domestic Violence Services. The entire team will respond up to 72 hours after a crime. After three days, forensic evidence is no longer viable, but the team will still get involved.

Norman has always been a leader in helping victims of sexual assault, with one of the nation’s first independent women’s centers in the country. On March 8, Norman opened what it hopes all cities will have within the next few years: a Rape Crisis Center where women can be seen outside the often chaotic hospital environment.

“The Rape Crisis Center is where the victim goes and everyone comes to her,” said Joanne Smith, executive director of the Women’s Resource Center in Norman. “We have people from the hospital, the city police department, the county and the university.”

Do these programs increase the rate of rape reporting? Smith feels unequivocally that they do.

“If you can make them feel comfortable, they are more likely to be cooperating in the investigation,” she said. “I’ve said for years and years if it happened to my daughter that I would encourage her to go through the system.”

There’s evidence to suggest Smith is right.

Since Ames’ program began in 1997, Priess said, they’ve seen a “huge change” in the number of women using it. “In the first year we had five, in the second year 37 and in the next years 50 to 60 cases a year,” she said.

While Smith’s numbers don’t match the statistics for reported rapes in Ames, she said some women who use the program choose not to go to police. They hope that in the long term, the program will prompt more women to prosecute.

Brenda Gill, senior counselor at Stillwater Domestic Violence Services, said that in the six years the program has existed in that city, reporting has gone up. More than that, she said, unified investigations “produce better evidence and minimize secondary trauma to the victim.”

“Our long-term projection is that reporting will go up and long-term prosecutions will go up because of better evidence collection,” Gill said.

While unwilling to commit to the idea that START’s absence reduced rape reports in Columbia, some area officials say something is wrong.

Sgt. Stephen Monticelli, investigative supervisor of the Columbia Police Department’s Major Crimes and Family Services units, said that while SANEs knew how to examine victims, he has seen a doctor have to read instructions before using a rape kit. Voltmer also knows women who have waited hours because no doctor on duty knew how to use one.

After START had been around a few months, University Hospital began telling rape victims they had the right to see a volunteer counselor. That practice ended with START’s collapse, though Monticelli said he knows one doctor who did it anyway.

Voltmer said failing to give victims that option is a major problem. Most accept when it’s offered, she said. She knows because Boone Hospital Center has offered such assistance for years.

Police have also done things Voltmer doesn’t understand. She feels they are inadequately trained to understand the reactions of rape and sexual-assault victims. “This particular crime requires — demands — much more sensitivity to look at the whole picture and understand there is no typical response from a rape victim,” she said.

“(The officer) goes to the ER, and the rape victims laughs hysterically,” she said. “With their amount of training, they don’t understand that would be a response a rape victim would give.”

Monticelli said officers receive annual training in dealing with victims of domestic violence and sexual assault. He also acknowledges that each officer brings different experiences to each victim he or she contacts.

When the START program was functioning, these issues could be addressed, and misunderstandings were less likely. That’s why the agencies that built START seven years ago are interested in trying again.

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