By Jocelyn Anderson
Imagine this: You had a seizure and were taken to your local emergency room.
They stabilize you, complete a CT scan and find out you have a brain tumor. You need a neurosurgeon. Your local hospital doesn’t have a neurosurgeon on staff though, so the kidney guy is going to take your case instead.
Sounds ridiculous, doesn’t it? You would never tolerate this. You would stand up and demand the expert in brain surgery. And yet, for hundreds of Pennsylvanians who experience sexual assault, current Pennsylvania Department of Health policy leads to this exact situation, limiting patients’ access to experts in sexual assault care.
Current state policy requires that a patient receive medical and forensic care at the hospital to which they initially present, but that hospital may not have a trained sexual assault examiner available.
This policy in effect requires providers with no training in sexual assault care to perform this crucial medical and forensic care.
We know that access to trained sexual assault examiners improves health and justice outcomes. Patients are more likely to receive the correct medications to prevent HIV, and other sexually transmitted infections when a trained and competent sexual assault nurse examiner (SANE) is involved in their care compared to Emergency Department personnel without this specialty training. Research has shown that trained SANEs collect better evidence than untrained providers, and reported cases are more likely to move forward in the criminal justice system when a SANE is involved.
Now you’re thinking, “Wait, wait, wait, did she just say that a registered nurse could provide better care than physician?” Yes, I did. Not because physicians don’t care or are not awesome at their jobs. They just aren’t trained in the specialty that is sexual assault care. Medical schools and residency programs are not required to provide any training on sexual assault or trauma-informed care.
In contrast, the entry curriculum for the International Association of Forensic Nurses is 40 hours of classroom and 40 hours of hands-on clinical work that is overseen by an expert in sexual assault examinations. This training includes patient responses to trauma, working with sexual violence advocates, evidence collection and preservation, collaboration with law enforcement, injury identification and photography, and courtroom testimony. If you plan to work with children under the age of 13, more hours are required.
So what do we do about it? There are options.
Our neighbor to the south, Maryland, has designated regional centers for sexual assault care. This allows each region to consolidate its resources and response to support high quality, well-trained, competent nurse examiners at one site while keeping programs geographically spread enough to minimize travel for patients. Texas similarly designates hospitals as being “Sexual Assault Forensic Examiner (SAFE) – Ready” or not, and requires that patients be offered an opportunity for a non-cost transfer to a SAFE-Ready hospital for their exam.
The Department of Justice is currently exploring novel methods of using telehealth to allow collaboration between expert SANEs like myself and local providers in rural areas in which transporting patients or supporting a 24/7 team is not a feasible model. Community-based treatment centers, totally free-standing from hospitals, are already also being used in Milwaukee and San Diego.
Pennsylvania has made progress in other areas. The state has nearly doubled its numbers of multidisciplinary, community-based Child Advocacy Centers from 19 to 36 between 2008 and 2018. Why not build on this strength to serve more victims of sexual violence? Options exist.
As we close out Sexual Assault Awareness Month, I want to say #timesup. It’s time for the Pennsylvania Department of Health to change its policy to ensure that people who are sexually assaulted have the same evidence-based expert care that we expect with every other health problem.
Jocelyn Anderson is an assistant professor of nursing at Penn State and a Telehealth Sexual Assault Nurse Examiner.