How we care for sexual assault survivors

by Lindsey White, MD, Emergency Medicine Physician
August 2, 2017

Sexual assault is a sensitive topic, no matter how we discuss it. But it’s an important topic to discuss honestly and openly. People who have been sexually assaulted need to know that they can get help and medical care in an understanding environment that’s specially designed for these sensitive cases.

In an ideal world, no one would ever be sexually abused or assaulted. But that’s not the world we live in. Crime data from the Metropolitan Police Department in Washington, D.C., show that there were 346 reported cases of sexual abuse in the metro area in 2016—that’s almost one per day. Sexual assaults are underreported, and it is estimated that only 28 percent of cases are ever reported to law enforcement.

Many victims just want to move past what happened and get on with their lives. Regardless of a person’s desire to report sexual assault to police, the person still needs medical attention as soon as possible. If you are sexually assaulted, call 911 right away. When you arrive at MedStar Washington Hospital Center, you’ll be cared for by a dedicated, specially trained sexual assault nurse examiner, or SANE nurse.

Dedicated care for District patients who have been assaulted

We are the only hospital in the Washington metro area with SANE nurses, so all adult victims of sexual assault in the area come to MedStar Washington Hospital Center for examinations. Sometimes patients come here directly, sometimes they go to other hospitals and are transferred here, and sometimes they’re brought here by police after reporting an assault. In 2016, we saw 411 patients who had been sexually assaulted.

Our emergency medicine doctors have a great deal of empathy for all our patients. And we’re keenly aware of the physical and emotional trauma victims of sexual assault go through, whether they’re coming to see us hours, days or weeks after the incident. We try to make them feel at ease. The first thing I say to a patient who’s been sexually assaulted is, “I’m very sorry this happened to you.” Then we talk through the care they’ll receive from the doctors and SANE nurse.

The initial examination process

Some patients who have been sexually assaulted have other injuries, such as severe bleeding, broken bones, sprains or injuries related to choking. People who have been choked may have damage to the blood vessels leading to the brain, which can lead to a stroke without treatment.

We provide diagnostic testing as soon as possible to rule out injuries that may not be obvious at first glance. If a patient shows signs of abuse in the home environment, we speak to the patient privately and try to determine if that person feels safe at home or needs help.

The most common question I get from patients who have been sexually assaulted is whether they’re at risk for sexually transmitted diseases (STDs). During the examination, we offer treatment to protect them from any STDs they might have contracted during the assault, including gonorrhea, chlamydia and HIV. For women of childbearing age, we also offer emergency contraception—commonly known as the morning-after pill—for pregnancy prevention. Patients can take all the time they need to ask questions before we move on to the next step.

When the patient arrives, we contact a dedicated patient advocate who will stay with the patient throughout the entire process. As much as possible, we work to minimize the trauma of the hospital experience for patients. We have a dedicated family room area where a patient can wait with family members and their advocate away from the emergency department’s general waiting room

Care from the sexual assault nurse examiner

SANE nurses are employees of the District of Columbia Forensic Nurse Examiners (DCFNE), a separate not-for-profit program we work with as part of the District of Columbia Sexual Assault Response Team (DC SART). DCFNE partners with the Network for Victim Recovery of DC (NVRDC) to provide advocacy, case management, legal services and therapeutic programs if necessary and desired.  DC SART is a network of agencies in the Washington metro area that provide coordinated responses to sexual assault.

SANE forensic nurses are in our hospital 24 hours a day, so they’re always available when they’re needed. If a patient is too badly injured to be transferred here, SANE nurses travel to other local hospitals.

The SANE nurse will take the patient into our dedicated exam room, which is designed and set aside for victims of sexual assault. This room provides a private area with a locked door where the nurse can perform a detailed examination of the patient. The examination includes:

  • A conversation with the patient to find out what happened
  • Documentation of the patient’s injuries, including photographs
  • Evidence collection

Many patients are unsure if they want to press charges. While this is a personal and sometimes difficult choice some people must make for themselves, in most cases, we reassure them that they don’t have to press charges or go to court just because they’re having an examination and having evidence collected.  We are legally required in special, mandatory reporting circumstances to report suspected sexual assault to the police.  Examples of this include:

  • When the victim is younger than 18
  • When the victim is cognitively or physically disabled
  • When a firearm is involved

For most victims, getting their story, documenting their injuries and collecting evidence by the SANE nurse makes it possible for the victim to press charges later if they decide to do so. Unless it’s a mandatory reporting situation, no one will pressure victims to press charges if they don’t want to. We don’t work for the police or the prosecutors. Our top priority is empowering patient victims and providing the medical care, support, and resources that they need.

Related reading: Specialized Equipment, Training Needed for Sexual Assault Patients

The value of dedicated sexual assault forensic nurses

SANE nurses are specifically trained to work with patients who have been sexually assaulted. When a patient who’s been sexually assaulted comes in, the SANE nurse is focused on just that person for however long the process takes.

SANE nurses are forensic nurses, which means they are extremely well-trained and experienced with collecting evidence for these cases. Studies conducted by the National Institute of Justice have found that SANE programs have many benefits for the community. In addition to better health care for patients who have been sexually assaulted, the benefits of SANE programs include:

  • Higher-quality forensic evidence
  • Increased ability of law enforcement to collect information, file charges and present cases to prosecutors
  • More successful prosecutions

In hospitals that don’t have SANE nurses, the doctor, nurse practitioner or nurse works with patients as they come into the emergency department. They see many patients during a normal shift and have to care for several patients all at once. They may see only a handful of sexual assault cases per year—maybe only one a year or every other year. So they’re not as familiar with the evidence-collection kit. They may not get as much evidence or do so in a way that’s completely compliant with the kit’s requirements.

If the case goes to trial, doctors or nurses may have their experience questioned during testimony. It’s hard for someone to present themselves as an expert witness when they’ve only done one evidence collection for sexual assault in the past two years. It’s potentially a much stronger case with a SANE forensic nurse who can testify in court, “I’ve done 50 sexual assault exams in the past six months.”

In an ideal world, we wouldn’t need special exam rooms and dedicated SANE nurses. Unfortunately, these resources are necessary. And we won’t waver in our dedication to caring for and supporting people in our community who have to face emotionally and physically traumatizing sexual assault.

For local support resources and more information, please visit the following:

Category: Healthy Living, Our Center     Tags: assaultDr. Lindsey WhiteHIVpregnancy preventionSANE nursesexual assaultsexual assault nurse examinerSTD