SB1191 included language requiring all ERs to provide forensic evidence collection exams as well as language regarding training of persons who would collect forensic evidence. However, among the 13 hospitals in our sample without a SANE program, 3 did not offer exams. Interviews revealed reluctance by nurses, hospital administrators and criminal justice officials to have non-SANEs conduct medical forensic exams.
SB1191 left the decision of what constituted “basic” training to perform medical forensic exams to the appropriate licensing body. Training requirements mandated by the Board of Nursing in response to SB1191 involved minimal change from requirements in effect previously. Staff training at hospitals we spoke with was often brief and online. Interviewees acknowledged that this training is insufficient to prepare a nurse to meet the needs of a traumatized sexual assault victim or to defend her collection of evidence in a courtroom.
Hospitals with few sexual assault patients face significant challenges in conducting medical forensic exams. With fewer than one or two victims per month, a SANE nurse would not be able to maintain her skill level and certification. With reduced expertise, criminal justice officials have less confidence in evidence collected and that nurse would face a more difficult cross-examination from defense counsel in court. Small hospitals are also challenged by the fact that daily ER nursing coverage may be insufficient to spare a skilled nurse for the several hours it takes to properly conduct a forensic exam.
SB1191 did not include requirements for how sexual assault victims should be transferred from the hospital where they present to a hospital that can provide a competent exam. As a result, transfers take a variety of forms, but victims are often left to transport themselves while in a state of trauma to a facility that, in rural area, may be far away. According to hospital staff we spoke with, an unknown number never arrive at the transfer site and do not receive an exam.