Examinations can connect victims with medical care, resources
During the past year, significant attention has been focused on Oklahoma’s historical handling of rape kits and the value of testing those kits.
But undergoing an exam after a sexual assault isn’t just about looking for possible clues.
The exam is an important step toward connecting sexual assault victims with medical care and resources that can help them start to cope with what happened.
“It’s so much more than just the evidence that’s collected,” said Karla Docter, senior legacy officer for the YWCA Oklahoma City. “It’s a first step in the healing process for someone who’s been assaulted.”
For nearly a year, a task force Gov. Mary Fallin created has worked to gather data about the number of untested rape kits in Oklahoma and to develop recommendations for their handling in the future. Through a statewide audit, the task force identified 7,270 untested kits, some dating as far back as 1980, that law enforcement agencies chose not to submit to a laboratory for analysis. About 120 law enforcement agencies did not respond to the audit directive, so the total number of untested kits in the state is likely higher.
On Friday, the task force submitted recommendations to the governor and state legislative leaders outlining, among other things, how the state should address the large number untested kits and how it should handle testing in the
future. Docter said she doesn’t want all the talk surrounding Oklahoma’s untested kits to deter someone from getting an exam.
Sexual assault victims can choose to have a forensic exam to collect any evidence left behind from the assault. The medical professional who conducts the exam preserves the evidence in a sexual assault evidence collection kit, commonly known as a rape kit.
The exam is sometimes called a Sexual Assault Nurse Exam (SANE) or a Sexual Assault Nurse Examiner exam.
People might think the exam is a scary process, but forensic nurses who perform the exams make sure they do everything in a traumainformed, therapeutic way that won’t retraumatize the patient, said Amanda Kemp, senior director of prevention, sexual assault and forensic programs for the YWCA Oklahoma City.
“We explain each part of the process, and I let them know that a lot of it is just talking and answering questions so not to be too scared about the physical part,” Kemp said.
Every part of the exam is the victim’s choice. Victims can consent to some parts of the exam and decline others.
“They get to determine the direction of their own life and their own healing process,” Docter said. “We’re just here to support them throughout that.”
Sexual assault and domestic violence are about taking power and control away from the victim, Kemp said, so the nurses work to empower the victims and to make sure the victims know that they are in control of the exam process.
Victims who are 18 or older are not required to report their assault to law enforcement.
SANE programs in Oklahoma
The YWCA Oklahoma City has a team of 12 nurses who are available to conduct SANE exams 24/7, along with a group of advocates who provide emotional support, resources and referrals. They also help the victim with safety planning.
“We don’t just make sure that they’re safe and medically treated at that point,” Kemp said. “We care about what this looks like when they go home.”
The nurses rotate between three hospitals in the metro area — Alliance Health Midwest, Integris Southwest Medical Center and Integris Baptist Medical Center, although they sometimes respond to other hospitals depending on the patient’s needs.
The forensic nurses know how to identify and document symptoms of strangulation and how to refer patients to the care they need. They provide prophylactic medication for sexually transmitted infections but not everything can be treated prophylactically, so they encourage victims to follow-up with testing.
The exam and the medications are provided free of charge to victims of sexual assault.
Anyone who has been assaulted within the past 120 hours, or five days, can request an exam. Regardless of whether someone has an exam, that person is still eligible for the resources and services the YWCA Oklahoma City offers, including free counseling and Victim Protective Order assistance. The YWCA tries to ensure the same advocate helps a victim throughout the entire process.
Their team is specialized in working with crime victims and understands the neurobiology of trauma, Kemp said.
Memory is stored in the brain differently during traumatic events. Understanding that helps the nurses and advocates know what questions to ask, Kemp said. Often, victims experience something called tonic immobility in which they freeze during the assault, she said. Many patients don’t realize what they’ve experienced.
“There’s a lot of shame and guilt just associated with that tonic immobility state, which isn’t something that you choose to do, it’s something that your body does,” Kemp said. “... Explaining that to someone can really lift that shame and guilt.”
About 30 to 35 Sexual Assault Nurse Examiner programs are scattered across Oklahoma. Some are run out of hospitals. Others are operated by domestic violence agencies.
Kathy Bell, forensic nursing administrator for the Tulsa Police Department, said people often think of SANE nurses as evidence collectors and picture takers. Although they do all of that, Bell said their basic role is as a registered nurse and to provide a health assessment and health care to the victim.
“People don’t realize that as we’re doing that exam, we’re making nursing diagnoses and we’re educating that patient and we’re referring,” she said. “We’re doing all the things that nurses do.”
Tulsa uses an exam facility at Hillcrest Medical Center for its Sexual Assault Nurse Examiners program. Law enforcement agencies from about a 50-mile radius around the city bring people there for exams. The nurses see about 500 patients a year for sexual assault exams, Bell said. They’ve conducted more than 10,000 exams since the program started in 1991.
In 2012, the city of Tulsa received a federal grant to develop SANE programs across the state and to fund a statewide SANE coordinator. The grant funding was renewed once but ended in 2017, so the statewide position had to be eliminated. Bell has applied for a grant that will be decided in August in hopes of reinstating that position.
“We know there’s the need out there to have a coordinator, somebody that they can all turn to and somebody to keep everybody connected,” she said.
‘We owe it to our community’
Kemp encouraged people who might be scared or unsure about having a sexual assault exam to reach out.
“Come talk to us,” she said. “Let’s talk about what you’re comfortable with, what you’re not and then let’s just do the parts of the exam that you’re comfortable with.”
One of the most important parts of the exam is the narrative, when the patient tells the nurse what happened, Kemp said.
There is a medical exception to hearsay, she said, meaning that anything that is told to a medical provider can be admissible in court.
“This allows a jury to see what happened through that patient’s eyes,” she said.
The narrative also helps guide the nurse who is performing the exam. If a victim tells the nurse they were hit somewhere, the nurse will assess for injuries. If the victim tells the nurse the perpetrator ejaculated in a certain area, the nurse can collect that evidence. Some nurses have gotten positive fingerprints off glasses based on what the victim reported to them, Kemp said.
“Forensic nurses have to have the ability to think outside the
box, be that therapeutic, trauma-informed care provider, but also know what pieces of evidence might be really important for that case to be processed,” Kemp said.
During the exam, nurses use elongated Q-tips to take swabs. Often when they are collecting evidence, they lightly brush the Q-tip on the person’s skin. They dry the swabs, package them and place an evidence seal, documenting everything.
In order to help preserve evidence, medical professionals suggest that victims avoid drinking, eating, showering or bathing, going to the bathroom, brushing their teeth, changing their clothes and combing their hair before having the exam. However, if a victim has done any of those things, evidence can still be collected and it’s still important to seek medical attention, officials said.
The untested rape kits that are sitting on shelves in police evidence rooms are only a small snapshot of what’s happening in the state.
In general, rape and sexual assault are underreported crimes.
Nationally, only about 310 out of every 1,000 rapes are reported to law enforcement, according to the Rape, Abuse and Incest National Network, a national anti-sexual violence organization.
Culturally, there is a lot of shame and guilt associated with sexual assault, Kemp said.
It takes a tremendous amount of courage for victims to come forward and share one of the most intimate, horrific experiences of their lives.
“I think we owe it to our community to try to do a better job to stop these kinds of perpetrators and to provide support to victims that come forward,” Kemp said.