On a special episode of the 5 Things podcast: Every 68 seconds in the U.S. there is an attempted sexual assault. It is a staggering statistic that speaks to the urgency of addressing sexual violence. When a rape does occur, there is a scarcity of specially trained sexual assault nurses, a problem exacerbated by the federal government's failure to establish a national directory for them, despite a law mandating it. Roughly 50 years after the creation of forensic rape kits, why is it still so difficult for victims to find the right care and justice? Journalist Ileana Garnand with the Center for Public Integrity joins the 5 Things podcast to discuss the state of medical care for sexual assault victims.

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Dana Taylor:

Hello, and welcome to 5 Things. I'm Dana Taylor. Today is Thursday, October 26, 2023, and this is a special episode of 5 Things. Every 68 seconds in the United States, there is an attempted sexual assault. It's a staggering statistic that speaks to the urgency of addressing sexual assault issues. And when a rape does occur, there is a scarcity of specially trained sexual assault nurses, a problem exacerbated by the federal government's failure to establish a national directory for them despite a law mandating it. In the early 1970s, activist Martha Goddard revolutionized the way sexual assaults are investigated by advocating for the creation of forensic rape kits. Roughly 50 years later, why is it still so difficult for victims to find the right care and justice? Our guest is journalist Ileana Garnand with the Center for Public Integrity. Thank you for joining us, Ileana.

Ileana Garnand:

Thank you so much for having me.

Dana Taylor:

So last year, Congress reauthorized the Violence Against Women Act. Part of the mandate was to complete a national report on forensic exam services. When was the deadline and why hasn't the national report been completed by now?

Ileana Garnand:

The deadline was this past March. It was a year since the Violence Against Women Act was reauthorized and signed by President Biden. But when I looked for this resource, I couldn't find it. And so I reached out to the agency in charge, the Agency for Health Care Research and Quality, and they told me that they had not been appropriated any funds by Congress to complete that project. And so they hadn't pursued it. And they actually hadn't even pursued a cost estimate for the resource itself.

Dana Taylor:

So why is the report and the accompanying online map considered to be a crucial part in protecting the rights of victims of sexual assault?

Ileana Garnand:

A national database of sexual assault nurse examiners was a resource that came up time and time again in my conversations with nurses themselves, advocates and survivors. When you're having one of the worst experiences of your life, it's really hard to focus and plan out what you're supposed to do. There's not a playbook for it. And there's not a lot of resources out there. So even depending on the state where you're in, if you go to Google and you're trying to find the right hospital to go to, it's not as easy as going to the hospital right down the street. And it's not as easy as just Googling it and getting a clear easy table to see.

So a resource like this would be extremely helpful. Someone could just log on, type in their address, see where to go, what would be closest to them. And another really important part of this resource is that it would indicate whether the Forensic Nurse Services work 24/7 or if there was a time where they wouldn't be available. Some of the issues is that survivors will show up, but the nurse on call isn't working that day. And so they have to wait days, hours, which is unacceptable.

Dana Taylor:

Well, the original standardized sexual assault examination kit, often referred to as a rape kit, contained basic items such as cotton swabs, a comb and slides for collecting specimens. Administering the rape kit can last for several hours and includes a head-to-toe examination. So what's the role of a sexual assault nurse examiner or SANE in administering that exam?

Ileana Garnand:

SANEs are specifically trained for every step of that exam. They're also trained for patient first care and compassionate treatment. They're able to collect the evidence. Studies show that SANEs collect evidence more thoroughly than non-specialized medical practitioners. They're also trained to take forensic photographs. They also interview survivors if that's what they wish. They're trained to testify at trials as well. And SANEs are often equipped with community resources so they can give survivors tips of where they can go for long-term mental health resources.

Dana Taylor:

Are there hospitals that simply don't offer forensic exams?

Ileana Garnand:

Less than half of U.S. hospitals have a forensic nurse examiner on staff. So some of those will be able to offer a rape kit by standard medical practitioners, but some of them will just simply turn survivors away and say, "We don't do that. We don't have the staff who can do that."

Dana Taylor:

Well, I know that you spoke with a sexual assault nurse examiner who said that she knew a nursing school that she wanted to work with sexual assault survivors. And you mentioned some of the other things that they're able to offer survivors besides the proper execution of the forensic portion of the rape kit. How difficult is it for them? I would imagine in some hospitals, they're the only SANE available.

Ileana Garnand:

That's the case in many hospitals. If they have a SANE at all, there might just be one. Or there's on-call systems are quite popular from what I was told with my interviews with nurses, that there'll be a SANE who's in charge of doing forensic exams for multiple hospitals in an area. And when the need arises, they're called to each one. There's a lot of burnout in this industry. It's exhaustive work, but also because of emotional burnout, just the sensitive and traumatic nature of the work they do.

Dana Taylor:

Well, rape kits are required by federal law to be administered without cost, if you report a sexual assault at a hospital or medical center, are you automatically offered the option to undergo a rape kit examination?

Ileana Garnand:

If that hospital offers it, yes.

Dana Taylor:

And I know that you spoke with a man in Phoenix, a sexual assault survivor, who said that he wasn't offered the option after reporting his assault to police. What are the potential legal hurdles for survivors in seeking justice, especially if they don't undergo a rape kit examination?

Ileana Garnand:

Rape kits are often the largest piece of evidence for cases like this. And so the man I spoke to, his case was closed without charges. And specifically, one reason was because he wasn't able to get a forensic exam. I read the incident report myself, and that was one of the reasons given. I've also spoken to survivors who just experienced delays in getting the kit. They did end up getting a rape exam done, but prosecutors then told them that the evidence was inadmissible because it had taken too long to get the exam.

Dana Taylor:

One of the areas you focused on was Elko, Nevada. There is a sexual assault nurse examiner there, but none between Elko and Reno, which is about four hours away. So how are victims without access to a sexual assault nurse examiner receiving care?

Ileana Garnand:

Specifically in Elko, Norah Lusk has started an amazing program. It's a mobile nursing unit. She has a tractor trailer that she'll drive out, and then they can go to hospital parking lots, Walmart parking lots, wherever a survivor needs. And there's an examination bed inside of there. It's unmarked to protect a patient's privacy. But in situations and in locations where there isn't someone stepping up to fulfill that community need, it's really up to the survivor to be able to find their way there. And so not everyone can drive. Not everyone can afford the drive. Not everyone can take time off from work to go to a hospital that's potentially hours away.

Dana Taylor:

Well, nationally, what percentage of hospitals have SANEs? Should every hospital be required to have a sexual assault nurse examiner on staff? What's the solution here?

Ileana Garnand:

It's not an easy answer, but something that came up time and time again was the ideal solution would be every hospital has a competently trained sexual assault nurse examiner because you just know that you can go to your nearest hospital and you'll get that care. No questions asked, hopefully no days long wait times. And the problem again is this shortage of sexual assault nurse examiners. And from what I was told, it's not that people don't want to fill that role. Many nurses are excited and passionate to get that training. It costs hospitals money to hire these specialized nurses and not every hospital has the incentive to do that. A couple of states have tried to pass laws requiring a SANE in every hospital. Illinois passed a law in 2018 and the deadline was January 1st, 2023. When I reached out to their public health department, they were unable to confirm with me if there is a forensic nurse in every hospital emergency room in Illinois, but they're working towards it.

And West Virginia tried to do so as well this year, but a committee in their state house took out the requirement to have a nurse in every emergency room and instead parroted down to every hospital has to have a transport plan, which is great that people are trying to move towards solutions. But again, if you have these hours long gaps in between hospitals where you can go to, it could put survivors in a situation where they have to wait hours for that care.

Dana Taylor:

Ileana, thank you so much for joining me.

Ileana Garnand:

Thank you so much for having me.

Dana Taylor:

Thanks to our senior producer, Shannon Rae Green, for production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of 5 Things.