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Rape care becomes hospital priority

Area facilities step up efforts to care for sexual assault victims.
Wednesday, August 11, 2004 | 12:00 a.m. CDT; updated 12:33 a.m. CDT, Sunday, July 13, 2008

As Leigh Voltmer, executive director of The Shelter, looks at how victims of sexual assault have been treated the past four years by local agencies, she can’t help but think Columbia could do better.

The place to start, she said, is with the organizations that victims see first: the hospitals and the police.

Voltmer feels hospitals have underserved rape victims. She said that before University Hospital began a recent push to train nurses and others how to help victims of rape, its approach wasn’t even good enough to be called indifferent. Boone Hospital Center, she said, has done the best job possible with the resources it has.

And while she feels the treatment of rape victims at the police department too often depends on the sensitivity of officers involved, she understands “they’re cops, not social workers.” She would, however, like to see officers — especially those who make initial contact with victims — get further training.

Nothing will change, however, until enlightened leadership says this is going to take a lot of time, “but we’re committed to doing this,” she said.

The time may be at hand.

The Sexual Trauma/Assault Response Team program, or START, ultimately failed in 2000 because two of the three local hospitals were unwilling to work with volunteer Sexual Assault Nurse Examiners, or SANEs. And even the one willing to do so became unable to take liability for an increasingly overburdened and shrinking volunteer group.

But changes are afoot at the area’s major hospitals, and nowhere more so than at University Hospital.

Allen Garner, who recently moved from nursing in Boone Hospital Center’s emergency room, is now one of seven paid ER workers at University Hospital who are trained as assault nurse examiners . He’s part of a group trying to create an atmosphere where rape victims feel more comfortable.

John Yanos, chairman of the Department of Emergency Medicine, acknowledges University Hospital’s poor reputation on dealing with sexual assault. He argues, however, that it’s not because hospital staff members don’t care about women. Most of the nurses on duty, he notes, are 20- to 30-year-old women, very similar to most victims who come to the ER.

Rather, Yanos said, the problem lies in “the mechanics of the institution,” noting that sexual assault victims are most likely to come in at times when the ER is already overrun.

Still, Yanos concedes hospital staff in the past was not as comforting as it should have been. “They’d be sat in the waiting room with drunks and screaming kids,” Yanos said. “The impression was ‘we don’t give a damn.’ “

Yanos said he and his people are committed to changes. For one thing, having a woman — Cindy Grueber — directing the hospital makes a difference, he said. But more important is what happens in the ER every day. Things are changing there, too.

Seven full-time nurses were scheduled to complete their SANE training in July, but it has had at least one on duty at nearly all times for several months. In the event a rape victim comes in at a rare time when all of them are off, one is always on call.

Different environment

Yanos thinks people will see a change in the entire attitude of the ER. From the moment rape victims present themselves, the assault nurse examiners will care for them in an environment that meets their needs.

Yanos is quick to note that University Hospital has always provided the clinical basics of what the nurse examiners trained to deal with sexual assault do — counseling, evidence collection and medical treatment. But having the nurse examiners on duty will standardize and expedite care, he said, adding that trained nurses are preferable to doctors in rape situations.

“If you’ve just been sexually assaulted, the last thing you need is a 50-year-old doc to ask you if you’ve been sexually assaulted,” he said. “It’s much better to have a 25-year-old nurse who they identify with to do this.”

Yanos admits it’s taken far too long for University Hospital to make changes. “There’s no defensible explanation,” he said.

Tough financial times at the hospital things difficult because changes don’t come cheaply. For example, a colposcope used for vaginal and cervical exams can cost up to $20,000. And the cost of smaller-ticket items, including carts that hold everything a rape victim might need, add up.

Sororities and other groups, including the Women’s League, have held fund-raisers and donated sweatshirts and sweatpants for victims to use at the hospital. But there’s little they can do to cover the largest cost — that of staff salaries. That’s an expense the hospital is willing to underwrite, Yanos said.

One step at a time

Garner, a new nurse examiner at University Hospital, is trying to create methods to ensure the best care for victims, including a system through which all of the victim’s records could be kept under a fictitious name. Those records would be linked to files with her real name, but the assault file would be locked, with only limited access.

Other protocols have changed. All victims, for example, are now told they can see a rape advocate.

Yanos said that once the hospital has its protocols and personnel ready, it will let the community know it is fully equipped to make rape victims feel safe. He plans no public relations campaign, just some signs at the Student Health Center and a few other places.

“The rest of the community will learn about it,” he said. “Everybody will know about things that work right.”

Boone Hospital Center is also bringing back nurse examiners . Although the hospital has only two trained at this point, emergency medical services director Bill Cotton said he wants all his people trained. Further down the road, he plans to tackle some of the issues that killed START four years ago. He’d like to see on-call nurse examiners able to work with victims in any ER, regardless of which hospital they work for.

Where to re-START

When START collapsed in 2000, it was because the foundation upon which it was built was incomplete at best. But today, Boone Hospital Center, University Hospital and Columbia Regional Hospital are well on their way to restoring the program by paying nurse examiners and refining programs to assist victims of sexual assault.

It’s a goal shared by both the police department and the prosecutor’s office.

Stephen Monticelli, investigative supervisor for the Columbia Police Department’s Major Crimes and Family Services units, said he “fought heavily” to keep START before it dissolved and would welcome its return.

“I’d love to see it,” Monticelli said.

Boone County Prosecuting Attorney Kevin Crane said he, too, would like to resurrect a START-like program.

“It’s definitely doable,” he said.

Mark Koch, the prosecutor’s crime victim specialist, thinks the time is right. When he came to Boone County less than two years ago, he said, he was surprised at the attitude toward victims here.

“Coming from a rural community, or having worked in victim services in a rural community, I did not expect this office to be as enlightened as it was,” he said.

Many of the groups that would be involved in a new program already work together in other programs, such as the Domestic Violence Enforcement Unit, or DOVE.

Mayor Darwin Hindman added his name to the list of those who think START-like efforts are something “we ought to have.”

“If the hospitals, prosecutor’s office and police are interested in that again, and the proper relationships can be established, and a qualified funding method can be worked out, I personally would be interested,” Hindman said.

Voltmer, of The Shelter, said the success of a START-like program begins with a better community understanding of rape. While she called progress at University Hospital good news, she said it’s only the beginning.

“Once people understand that rape is the most rapidly increasing crime, according to theAmerican Medical Association, we think people will respond as a community,” she said. “We have to acknowledge there’s a problem.”


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