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Straddling dual roles, nurses request training in administering sex assault exams

Bartlett Regional Hospital Foundation backs proposal for SANE certification

Posted: August 17, 2013 - 8:33pm  |  Updated: August 18, 2013 - 12:04am
Rose Lawhorne, director of the Bartlett Regional Hospital's Emergency Department, says the hospital needs to train their nurses in giving forensic sexual exams and is working with the BRH Foundation to procure funding.  Michael Penn / Juneau Empire
Michael Penn / Juneau Empire
Rose Lawhorne, director of the Bartlett Regional Hospital's Emergency Department, says the hospital needs to train their nurses in giving forensic sexual exams and is working with the BRH Foundation to procure funding.

When a victim of sexual assault walks into Bartlett Regional Hospital’s emergency room doors, medical professionals know how they’re supposed to respond. One of the E.R. nurses is assigned to the person and immediately screens them for any injuries, treating them as needed.

But once their medical responsibilities are complete, the nurses must take on another role, one they say they are not so familiar with: collecting forensic evidence as part of a criminal investigation.

It is in this legal arena that the nurses at BRH asked for additional training, citing a fear of jeopardizing cases and a desire to better the process victims.

Vying to receive funding from the Bartlett Regional Hospital Foundation — the nonprofit organization that can raise money to benefit the hospital — the nurses made a pitch to the trustees in April. A month later, the foundation selected their proposal over two others as their annual donation gift.

The foundation is now in the process of raising $40,0000 to provide training for 15 nurses to become SANE certified. SANE is short for Sexual Assault Nurse Examiner. The training includes a 40-hour course taught by Anchorage-based instructors and a complete clinical practicum.

“We’re very grateful to the role that BRH Foundation is playing,” Rose Lawhorne, the director of the BRH Emergency Room, said. “It’s very meaningful, and it will make a direct difference. It will make a direct impact on our friends and family that are in this community.”

Lawhorne is hopeful the SANE training and certification will help alleviate several problems with the system in place for collecting evidence of sexual assaults. BRH receives between 10 to 20 adult cases of sexual assault each year.

One of the major issues is staffing. Since BRH doesn’t have a nurse designated to administer the exam, they have to pull one of the three E.R. nurses who are on duty at a given time out of rotation. That leaves the E.R. one nurse short.

It’s also problematic since E.R. nurses prioritize patients based on the critical nature of their injuries, and evidence collection is not a medical issue.

The result is that the victim of sexual assault (who has already been medically treated by that point) can end up waiting, sometimes for hours.

“Often the patients just really want to get out of there,” Lawhorne said, adding that the wait adds stress to an already emotional situation.

Another issue is uneasiness among staff in administering the exams as none of them are certified. They only receive “basic, informal” training about gathering and documenting forensic evidence.

“New staff are shown the kit, they’re told how the process works and how to collect the evidence, but they still have some discomfort with this process,” Lawhorne said. “They realize there’s a certification — in nursing, we hold in high esteem of certification and specialized training — and so we feel like we’re not doing the best we could do for these patients when we’re not certified.”

Lawhorne noted that she has been hiring nurses for several years and has only seen one with the certification already on his or her resume.

The exam itself is lengthy and complex. Nurses go through a 20-page instruction document, checking every box off as they bag and seal DNA evidence from fingernail scrapings to swabs to strands of hair that they have to pull out of five different sections of the victim’s head.

“It’s not pleasant for victims,” Lawhorne said.

The exam is completely optional and victims can choose to skip any step they don’t feel comfortable with. An advocate with the local women’s shelter AWARE is on hand to provide emotional support.

The exam usually takes between an hour and an hour-and-a-half to complete. But victims can spend upward to nine hours in the hospital as they give statements to law enforcement, or await blood and STD tests.

When the forensic exam is over, the nurses place all the white evidence envelopes inside a box and lock it away in a cabinet until it’s picked up by the Juneau Police Department in order to preserve the chain of custody. JPD then sends it off to the crime lab in Anchorage.

The fear of jeopardizing cases lingers due to the complexity of the process and lack of formal training, Lawhorne said.

Assistant District Attorney Amy Williams, a member of Juneau’s interagency Sexual Assault Response Team, however, said she could not point to a case where a botched exam has foiled a case for prosecutors in her office.

Sex assault cases are hard to prosecute since they are complex in a number of ways, Williams said. The medical component is just one part of it; another would be a proper investigation by law enforcement.

She said her office works hard to partner with police, the medical community and “all the spokes of the wheel that goes into a successful prosecution” to strengthen the foundation of their cases. But, she stressed, thorough and accurate forensic evidence collection by the hospital does not just benefit prosecutors. She said it better serves everyone in the courtroom, from the defendant to the judge and the jury, as they seek the truth of the matter.

“The entire process is better served,” she said.

• Contact reporter Emily Russo Miller at 523-2263 or at emily.miller@juneauempire.com.

 

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If you want to donate:

The Bartlett Regional Hospital Foundation will be hosting its annual Seafood Gala & Fundraiser next month to raise the $40,000 requested for the SANE training.

The organization’s president, Holly Cerne, said the event will be held at 6 p.m., Saturday, Sept. 7, at Timberline Restaurant. The event will feature guest speakers and a meal prepared by celebrity chef Jesse Ziff Cool.

Tickets are $125 each (includes Tram ticket) and are available at the JACC, Hearthside Books, the Blue Heron Gift Shop and the Foundation office. For more information call 463-5704 or email brhfound@gci.net.

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