ROCKFORD — Sexual assault is not a sex crime.
“It is a crime of ultimate violence and ultimate control over someone who is unable to defend themselves. It’s imperative that the public understands that,” said Marilyn Hite Ross, chief of the criminal bureau for the Winnebago County State’s Attorney’s Office.
Sexual assault nurse examiners, known as SANE or forensic nurses, understand that distinction better than most. They are registered nurses who have been specially trained to examine sexual assault victims, collect evidence and testify in court. Now, Illinois legislators are considering a proposal that would require hospitals, by 2023, to have a trained medical provider available with 90 minutes of a sexual assault victim’s arrival.
Among Rockford’s three hospitals, fewer than 10 nurses are SANE certified. While larger hospitals such as the three in Rockford will probably be able to meet the 2023 deadline, if they don’t already, smaller institutions like FHN Memorial Hospital in Freeport may find the 90-minute, 24/7 response requirement challenging.
“Survivors of sexual assault deserve to have compassionate and trained medical care when they go to the hospital,” Illinois Attorney General Lisa Madigan said in a statement released Wednesday. “I have tried for years to work with hospitals to voluntarily do what’s right for sexual assault survivors, but there is still a serious lack of appropriate care for sexual assault survivors in Illinois.”
Madigan is pushing for passage of the proposed legislation, House Bill 5245.
It is not clear what penalty hospitals would face for failure to comply with the requirement, should it become law, or who would enforce the regulation.
A vital role
Since 2003, Madigan’s office has provided classroom training to more than 1,500 clinicians across the state, yet only 300 nurses have completed the necessary clinical training to become SANE certified, largely because of a lack of support from the hospitals where the nurses work. Many hospitals do not provide paid time off, forcing nurses to use vacation time to attend training and their own money for travel expenses and exam fees. According to Madigan’s office, only 150 SANEs are practicing in emergency departments in Illinois hospitals and no hospital has a 24/7 SANE program.
Nearly 4,500 patients sought treatment in 2016 in Illinois emergency rooms for alleged, suspected or confirmed sexual assaults, according to the state Department of Public Health.
There were more than 1,200 reports of sexual assault in Rockford from 2012 to 2016, according to police data. It’s a number advocates say would be much higher if all instances were reported. Having a trained advocate on staff for a victim to confide in is the first step for the patient to gain trust in the health care system, law enforcement and ultimately the court system.
Few forensic nurses
According to the International Association of Forensic Nurses, less than 14 percent of U.S. hospitals have a forensic nurse on staff.
Chris Carter, OSF Saint Anthony Medical Center’s lone SANE nurse, was certified by the International Forensic Nurses Association in 2009.
Last week, she attended End Violence Against Women International, a four-day conference in Chicago at which Madigan spoke of the pending legislation and reiterated the importance of forensic nurses.
“I’m excited to see where the state of Illinois is going,” Carter said.
Sexual assault has long been and continues to be a grossly underreported crime, Carter said, partly because victims are victimized by the assailant and re-victimized by the community and even members of their own household.
Carter said being a SANE means knowing how not re-victimize, being an advocate, and providing “nonjudgmental” care.
Sherrice Fonseca and Lori Palmer, SANE nurses since 2014 and 2015, respectively, are two of six SANE nurses on staff at SwedishAmerican Hospital.
Both said they underwent the mandatory 40 hours of SANE training, performed clinical work and observed hours of sexual assault testimony in a courtroom, all to improve the continuum of care to sexual assault patients from the moment they walk into the hospital to the time they are discharged.
“When you have somebody who actually gets a conviction because of your evidence collection, then you start to realize it’s a big deal,” Fonseca said.
Palmer said the importance of SANEs hit home with her when she attended a training session in Springfield. One of the participants was a sexual assault victim who volunteered to have nurses perform a sexual assault examination on her.
“I asked her, ‘How can you put yourself through this time and time again?’ She said, ‘Because I want you guys to get better at what you are doing. I want you to know where we come from.’
Instead, treatment of juvenile sexual assault victims involves a program known as MERIT, said Dr. Jason Bredenkamp, medical director of the emergency department. The Medical Evaluation Response Initiative Team, located on the Mercyhealth campus, is a community service of the University of Illinois College of Medicine at Rockford. MERIT provides direct services to suspected child victims of physical and sexual abuse and neglect.
“They are the experts in Rockford at interviewing and collecting evidence from pediatric patients,” Bredenkamp said. “When a child presents with this complaint, the emergency department doctors will page whoever is on call for MERIT and follow their recommendations as the experts. Most often this means the child will follow up immediately or the next day with that program.”
As for adult patients, Bredenkamp said, all emergency department nurses are trained to collect forensic evidence.
“This means that 24/7 in our emergency department, we can perform the sexual assault kits as well as doing legal blood-urine collections for the police,” he said. “Our nurses are all trained during orientation to the department and undergo yearly skills assessments on these evidence collections. They perform several kits with a trainer before they are signed off to do the collections independently.”
At Freeport’s FHN Memorial Hospital, nursing director Denise Book said one nurse is in training to become a SANE. Meanwhile, she said all of the hospital’s emergency room nurses have been trained to collect evidence from sexual assault victims, but a doctor performs the physical exam.
“It’s going to pose a bit of dilemma,” she said. “How do you put someone on call 24/7?”
The bill, sponsored by Rep. Michael Unes, R-East Peoria, and Sen. Julie Morrison, D-Deerfield, is supported by a bipartisan group of legislators as well as the Illinois Coalition Against Sexual Assault, Illinois Sheriffs’ Association, Illinois State’s Attorneys Association, Chicago Alliance Against Sexual Exploitation, Rape Victim Advocates, Illinois NOW (National Organization of Women), International Association of Forensic Nurses — Illinois Chapter, and the Illinois Emergency Nurses Association.
State Rep. Litesa Wallace, D-Rockford, said the bill will likely be heard next week in a committee hearing before it is voted on by House and Senate members.
She supports the bill.
“We should be doing everything we can to help survivors, and that includes having properly trained medical officials to collect evidence to help convict their perpetrator,” Wallace said. “Survivors need to have someone in the hospital that they know is in their corner and will help them through the process.”
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