When a Laurens County woman was taken to the hospital after reporting a brutal sexual assault last week, there was no nurse specially trained in dealing with rape victims there to examine her.
Instead, the traumatized woman was given the option of going to another hospital about 45 miles away for that kind of nurse — a situation the Laurens County Sheriff’s Office called “unacceptable.”
Scenes like this play out time and again all over the Upstate, and around South Carolina, according to victims’ advocates.
In fact, more than half of all victims of sexual assault in the state are not seen by a Sexual Assault Nurse Examiner, or SANE, said Gina Carbino, statewide forensic nurse coordinator for the South Carolina Victim Assistance Network.
In 38 of the state’s 61 hospitals, these victims are typically seen by general ER nurses and doctors, she said.
“We serve seven hospitals in the Upstate,” added Jamika Nedwards, crisis program director for the Julie Valentine Center, a Greenville nonprofit that provides confidential services to victims of sexual assault and child abuse.
“Sometimes there are SANE nurses and sometimes not.”
Nine hospitals in the state have full SANE programs, which consist of a SANE coordinator, at least three SANE nurses and a physician medical director, Carbino said.
Four of them offer pediatric sexual assault programs, she said, and just three of them - Palmetto Health in Columbia, Aiken Regional Medical Center, and the Medical University of South Carolina in Charleston - provide 24/7 SANE coverage.
The other six are AnMed Health in Anderson, Baptist Easley Hospital, Orangeburg Regional Medical Center, Piedmont Medical Center in Rock Hill, Spartanburg Regional Healthcare System, Tidelands Health in Georgetown and Tuomey Regional in Sumter, she said.
In South Carolina, sexual assaults increased 12 percent between 2014 and 2015, Carbino said. And the state's rape rate has exceeded the national rate since 1982, according to the Valentine Center.
In 2015, there were 5,152 sexual assaults reported to victims’ advocacy agencies, Carbino said. Of those, 2,253 were reported to law enforcement and 243 arrests were made, she said.
Greenville County has the highest incidence in the state, with 296 sexual assaults reported in 2015, according to the Valentine Center, which last year logged 375 hotline calls, provided rape crisis services to 397 people, and accompanied 141 victims in the ER.
SANE nurses have a background in emergency or critical care plus specialized forensics training in the neurobiology of trauma and victimization, sexual assault exams and collection of evidence, Carbino said. They can also provide expert testimony in court when cases are prosecuted.
The Laurens County victim was held against her will, cut with a sharp instrument and brutally sexually assaulted, Capt. Robert Wilkie said in a release. After deputies arrived, she was taken by ambulance to Laurens County Memorial Hospital, which did not have a SANE nurse on duty.
Dr. Catherine Chang, chief medical officer for Greenville Health System, which owns Laurens Hospital, said it’s general practice to have a SANE nurse at GHS facilities. But if one is not available, sexual assault victims are offered the option of being taken to a hospital where one is on duty.
For those who don’t wish to travel to another facility, a doctor can perform the exam so long as the patient consents. If the patient doesn’t consent or wants to leave, she said, the hospital must respect the patient's wishes.
“While we cannot discuss the specifics of this particular case due to patient privacy,” Chang said, “I can assure you that we followed the law and that all appropriate medical protocols and policies were followed.”'
Contributing to the problem is a limited number of SANE nurses in South Carolina, said Shauna Galloway-Williams, executive director of the Valentine Center.
“Sometimes there are SANEs available to provide the exams and sometimes there are not at certain hospital ERs or at certain times during the day,” she said. “It’s important for the community to know there are real challenges in meeting the needs for victim services.”
The Center has accompanied 79 victims to the ER so far this year, and all received a sexual assault exam, she said. But she did not know how many were seen by a SANE nurse or not.
There are no state regulations requiring hospitals to have SANE nurses, Carbino said, but professional associations recommend that SANE nurses care for sexual assault victims.
Research shows that protocol is less traumatic for the already traumatized victim, making it more likely the victim will press charges, and it results in better care, she said. There are also more arrests and prosecutions when a SANE nurse does the exam, she said.
South Carolina has 30 SANE nurses who are certified by the International Association of Forensic Nursing, she said. Another 200 plus have taken the SANE training, but are not certified, she said.
Carbino said she has no hard statistics on the number of victims seen by a doctor or taken to another hospital because hospitals don’t report them, but she estimates that more than 50 percent don’t see a SANE nurse.
While it’s not ideal to go to another hospital or be seen by a doctor when there’s no SANE nurse, it will do when there are no other options, Galloway-Williams said.
But these circumstances pose additional challenges for victims.
Barriers and challenges
“It’s hard enough as a victim to walk through the hospital door and ask to have the exam done,” she said. “Any additional barriers put in place, such as a long wait or moving to another facility, present additional challenges.”
And those challenges can prevent victims from seeking help and going forward with charges, she said.
Carbino adds that when a patient is transferred, the advocacy agency in the original jurisdiction may not know there was a victim, who then may not get follow-up services.
Still, while going to another hospital is a hardship for the victim, expert care is best, she said.
“It’s a Catch 22. Do you want a victim of violence going to a small community hospital that doesn’t have the trained staff?” she said. “Or would it be best to transfer them to a facility where a trained SANE nurse can take care of them?”
Carbino said her preference would be regional programs modeled after Palmetto Health's, which has one full-time SANE coordinator and five full-time SANE nurses who work on-call to respond to sexual assaults, including for children, and domestic violence cases.
When called, these nurses drive to the hospital where the victim is, do the exam and collect the evidence, she said.
Each nurse sees about 130 victims a year, making them true experts, she said. They also serve on community sexual assault response teams to develop policies around sexual violence.
Day or night
Chang said that GHS wants to have SANE nurses for victims of sexual assault because research shows they often establish good relationships with victims.
"These nurses are also equipped with information about additional resources available to assist victims in the days ahead," she said.
Any registered nurse with at least two years of experience can pursue SANE training, which involves a 40-hour course, she said.
GHS has 15 SANE nurses who work across the system and 10 more in training, Chang said. None of the nurses have been certified yet.
Meanwhile, over the past year, GHS has been looking at ways to enhance its program, including expanding the number of SANE nurses and developing an on-call system that could dispatch a SANE nurse to any ER at any time of day, she said. Hiring a SANE coordinator is part of that plan.
"We recognize that a call system ensuring 24/7 coverage for each hospital would be best for patients," she said. "We continue to work closely with community agencies, including rape-crisis centers and local law enforcement, to develop best practices to meet the needs of our community.”
Galloway-Williams said that's what victims really need.
“Our desire would be that any victim could present at any ER any time of day or night,” she said, “and get an exam provided by a SANE nurse.”