A8 • Friday, July 8, 2022 | Seaside Signal | SeasideSignal.com
‘We need to take care of these
patients in our community’
A shortage of sexual assault nurse examiners leaves a critical gap in access
By ABBEY McDONALD
The Astorian
Most people who are sexually
assaulted on the North Coast do not
seek medical care afterward.
Shame, embarrassment, anxi-
ety and not knowing what to expect
are among the main deterrents. The
few survivors that do go to local
hospitals often have to wait hours
for forensic exams.
Many are referred to hospitals in
Portland instead.
“For someone who’s already
experienced trauma, knowing that
you have to take a two-hour trip
one way, and then wait for hours
at a hospital to have an exam done
and then find your way back here,
it’s really discouraging,” said Jes-
sica Klein, the deputy director at
The Harbor, an advocacy center in
Astoria for survivors of domestic
violence and sexual assault.
Few people opt to make the trip.
“The rest of the survivors typi-
cally just turn and walk out and they
leave the hospital without receiving
any care,” she said, “which is really
unfortunate because even if some-
one doesn’t get the forensic exam,
there’s still other services that are
available to them.”
According to advocates, law
enforcement and medical experts
on the North Coast, the medical
response to sexual assault does not
adequately meet the needs of sur-
vivors, a critical gap in access that
can compound trauma.
A survey last year by The Har-
bor found that 83% of survivors
who participated did not receive
any medical care after their assault
and only 15% reported their assault
to law enforcement. Thirty per-
cent did not know medical services
were an option, while 16% cited a
lack of transportation.
Insufficient funding, burnout
and limited opportunities for train-
ing have led to a persistent shortage
of sexual assault nurse examiners,
who are needed to treat survivors
and collect evidence.
A trained nurse can conduct
a sexual assault forensic evi-
dence exam within 120 hours of
an assault. The exam includes an
interview about the assault, which
takes the majority of the three-to-
five hour process, and a physi-
cal to look for injuries and gather
evidence.
The process also involves a
wellness check, a pregnancy test,
Plan B emergency contraception
and medication for sexually trans-
mitted infections and HIV pre-
vention. Each part of the exam is
optional.
The number of sexual assault
nurse examiners has been an issue
on the North Coast for over a
decade.
The state first required hos-
pitals to contract or employ the
trained nurses in 2011. In 2014, in
the aftermath of a sexual assault of
a 10-year-old girl who had to be
driven to a Portland hospital for
an exam, The Astorian reported
that Columbia Memorial Hospital
in Astoria had three of the trained
nurses and Providence Seaside
Hospital had five. Neither hos-
pital had a nurse who was certi-
fied to conduct the exams, which
is obtained by meeting the training
and clinical practice requirements.
Today, there is one Port-
land-based certified sexual assault
nurse examiner who works inter-
mittently at Columbia Memorial
and no certified nurse at Provi-
dence Seaside.
A handful of local nurses in
training for certification juggle
the cases that come in when time
allows. When trained nurses are not
available, survivors are told they
must go to Portland.
Facing long waits, some survi-
vors leave hospitals without getting
an exam.
“CMH offers compassionate
care to any patient who is a survivor
of sexual assault. We do our best
to see patients in a timely manner
and give them a comfortable space
to wait in when it is available,” the
hospital said in a statement to The
Astorian. “We are proud to have
several SANE-trained caregivers
who provide patients with a safe
space to talk about their experience
and discreetly obtain the necessary
information and evidence to move
forward with their case.”
Hospitals without a trained
nurse available to collect evidence
kits can still treat injuries caused by
Lydia Ely/The Astorian
Casseopia Fisher, a nurse supervisor at Columbia Memorial Hospital, discusses sexual assault nurse examiner training.
an assault, test for sexually trans-
mitted infections and take steps to
prevent pregnancy and HIV.
The exam and associated treat-
ment are free of charge for sur-
vivors within seven days of an
assault. Providers are reimbursed
by the state sexual assault victims
emergency medical response fund.
The crime victims’ compensation
program can also cover associated
expenses and treatment, not includ-
ing HIV prophylaxis.
Providers don’t always know to
tell survivors about available ser-
vices beyond the forensic exam,
said Savannah Powell, the sexual
assault nurse examiners coordina-
tor for the Oregon Attorney Gener-
al’s Sexual Assault Task Force.
Powell recently published her
master’s capstone project on the
medical response to sexual assault
on the North Coast in conjunction
with Providence Health & Services.
“If there’s not a (sexual assault
nurse examiner) available they
on a daily basis. It’s hard to main-
tain a specialist in a rural commu-
nity where they’re only going to
see their specialty one or two times
a month.”
Evidence kits improve the
chances an assault case will lead to
conviction. Along with collecting
physical evidence of the assault,
trained nurses are also able to mea-
sure bruises, take photographs and
collect DNA samples.
Choosing to open a case is still
a gamble for survivors, though.
Nationally, only 9% of reported
sexual assaults lead to felony con-
victions, according to the Rape,
Abuse & Incest National Network.
Over 1 in 3 women and nearly
1 in 4 men experience sexual vio-
lence in their lifetime, according
to the federal Centers for Disease
Control and Prevention.
These rates increase among peo-
ple of color, people with disabilities
and people in the LGBTQ commu-
nity, who are at greater risk of sex-
48 hours a month. Moen said she
limits burnout by paying well and
giving nurses sufficient time off.
“I’m paying somebody to sit
around and wait for a phone call that
might never come. That’s a really
hard thing for folks outside of these
systems to understand. I mean, our
program is about $220,000 a year.
That’s a huge amount of money,”
she said.
The majority of the response
team is funded by grants, foun-
dations and donations, including
money from the Victims of Crime
Act.
“I would hope that programs
coming in now would be able to
actually get the hospitals to provide
the majority of the funding. Unfor-
tunately, I didn’t know better when
we started, so my pitch to the hos-
pitals was, ‘Oh, this won’t cost you
anything,’” she said.
The response team does an aver-
age of 11 exams a month.
Before the program launched,
WHILE TRAINING AT COLUMBIA MEMORIAL, FISHER CAN COLLECT
EVIDENCE KITS, BUT CANNOT DO THE PELVIC EXAM, WHICH IS
OFTEN THE MOST UNCOMFORTABLE FOR PATIENTS. IF A SURVIVOR
CHOOSES TO HAVE ONE PERFORMED, WHICH CAN SOMETIMES BE
BENEFICIAL FOR BUILDING A CRIMINAL CASE, FISHER MUST ASK A
PHYSICIAN TO DO IT.
may or may not get the medication
that they need,” she said. “This is
because an emergency room physi-
cian has to know a lot of things, and
they may not understand the risks
and may not have the time to really
sit down and listen to every detail
of what happened in the assault and
the risk that patient has for these
diseases or for pregnancy.”
‘I’m always surprised’
Typically, a forensic exam after
a sexual assault is the first step
toward filing criminal charges.
For survivors who choose to
have an exam, DNA evidence will
be collected and sealed anony-
mously until the survivor decides
to pursue a case. Kits are stored for
up to 60 years.
Providers are required to report
to law enforcement if the survivor
is under 18 or over 65.
Exams on children under 15
require additional training certifica-
tion that no one working in Clatsop
County has at the moment. Anyone
under 15 is automatically referred
to Portland, like the 10-year-old
girl was when this issue was in the
spotlight back in 2014.
Ryan Humphrey, a detective
with the sheriff’s office who works
on cases involving sex crimes,
remembers one case where the vic-
tim was hours from her 15th birth-
day and a local hospital referred her
to Portland.
The detective has driven several
survivors to Portland with his part-
ner, who is a woman.
“I’m always surprised when
there is (a sexual assault nurse
examiner) available. Like, ‘Hey,
we need to go to the hospital, they
just did a (sexual assault forensic
evidence) kit.’ I’m like, ‘Oh, that’s
amazing. Great.’ That surprises me
more than when I get the call say-
ing, ‘Hey, the hospital just turned
this victim away, can you take them
to Portland?’ Because that’s been
the more common thing.
“And I know the hospitals want
to improve this, but again it’s like
anything else. There’s specialists
in Portland that handle this stuff
ual assault.
“Reporting these crimes to
law enforcement is not something
someone should ever be forced to
do because I’m aware of what that
entails. And it’s unfortunate that
it’s not a quick, clean and easy
process,” Humphrey said. “I can
understand why somebody would
not want that.”
When hospitals refer survivors
to Portland, they may ride in an
ambulance, with law enforcement,
or drive themselves.
Humphrey said he volunteers to
drive survivors because he doesn’t
want transportation to be a barrier.
“We want to investigate these
cases. We live in this community.
I don’t want rapists wandering the
streets of Astoria where I live,” he
said. “If somebody sees a barrier,
make me aware of that barrier and
I’m going to help tear it down.”
‘Gold standard’
Jackson County, which includes
Medford and Ashland, faced a
similar shortage of sexual assault
nurse examiners two decades ago.
The county has since become a
state model for effective medical
response.
It began in 2000, when Susan
Moen, who had worked at a Los
Angeles rape crisis center, and the
late Judy Ferris wanted to address
eight-hour wait times for exams at
local hospitals and improve the low
reporting rates for sexual assault.
They launched the Jackson
County Sexual Assault Response
Team, a nonprofit that educates
and trains nurses to contract to
hospitals.
“We decided the gold standard
would be a strictly on-call program
that would respond to the hospitals,
but was not associated with the
hospitals,” Moen said.
The response team employs
between 13 and 16 nurses at a time,
allowing for 24/7 on-call coverage
with response times under 30 min-
utes in Jackson County. The pro-
gram recently expanded to Jose-
phine County.
Nurses are typically on call for
around 40% of survivors who came
to hospitals reported their assault
to law enforcement. Now, that rate
ranges between 85% to 95%.
“Having that first contact of
the system be somebody who can
walk into that room and say, ‘I’m
really sorry, and I’m here just for
you,’ and answer all of their ques-
tions, and give them reassurance
that they’re OK, and get the med-
ications and get them resources
and connect them to whatever they
need afterwards, it is so crucial.
“I truly think it makes a huge
difference in how the rest of their
journey unfolds. Just kinder, gen-
tler first contact,” Moen said.
Powell, who works with the
attorney general’s sexual assault
task force , said she’s not sure if
a similar program would be real-
istic on the North Coast given the
region’s staffing challenges.
“It would be nice to have, in
each community, a couple of
SANE nurses who could travel to
other hospitals. Someone who’s in
Columbia County, someone who’s
in Clatsop County, someone who’s
in Tillamook County, that if they
are available and they would have
a network to communicate,” she
said. “Just so the patient doesn’t
have to drive, that would be ideal.”
While more robust state and
grant funding would be beneficial,
Powell said hospitals are in the
most immediate position to address
the issue. She recognizes that many
smaller, rural hospitals have budget
constraints.
“So it kind of puts a little bit
of weight on the ethics of it,” she
said. “Ethically, we need to take
care of these patients in our com-
munity and these survivors, and so,
are we willing to put funding there
as kind of a charitable aspect of the
hospital?”
‘It’s something the
community needs’
The Harbor, hoping to increase
the number of sexual assault
nurse examiners , has applied for
a $750,000 federal grant from the
Office on Violence Against Women
to train midwives at the Astoria
Birth Center.
The nonprofit will find out this
fall whether it will receive the
grant.
Local hospitals have been mak-
ing an effort to improve avail-
ability. Three nurses at Colum-
bia Memorial and two nurses at
Providence Seaside are training to
become certified.
“The (sexual assault nurse
examiner) program at Providence
Seaside has a formal connection
to, and the support of, the Provi-
dence medical forensic program
based in Portland to ensure access
to ongoing training opportunities
and 24/7/365 telephone consul-
tations with a goal of increasing
access to sexual assault services
within our community,” Mike Ant-
rim, the communications manager
for Providence Seaside, said in an
email to The Astorian.
Casseopia Fisher, a nurse super-
visor, is in training for certifcation
at Columbia Memorial.
Working as a supervisor, Fisher
said she saw the need and decided
to help despite knowing the
intensity.
“It doesn’t feel to me like it’s
hard to necessarily hear these
sometimes very sad and potentially
frightening stories as long as I feel
like I could come into that situation
and make a difference in and help
improve it,” she said.
Fisher started by taking the
national 40-hour online course
while recovering from a minor sur-
gery in 2018. Since then, she has
taken the state sexual assault task
force’s weeklong course and built
experience under mentorship.
While training at Columbia
Memorial, Fisher can collect evi-
dencekits, but cannot do the pel-
vic exam, which is often the most
uncomfortable for patients. If a
survivor chooses to have one per-
formed, which can sometimes be
beneficial for building a criminal
case, Fisher must ask a physician
to do it.
“We have really great physi-
cians at the hospital, and they’re
all very compassionate people. But
sometimes it’s difficult if I’ve just
been working with somebody for
a really long time and we’ve built
some trust together for me to bring
somebody else into that to do what
is oftentimes the most difficult
piece of the exam,” she said.
When she collects evidence kits,
Fisher lets survivors know that
every part is optional. She gives
recommendations, but asks for
consent every step along the way.
“The biggest, most important
thing that I want people to know
is that they’re in control. Because
they’ve just experienced something
where they didn’t have control, and
giving that back to them is proba-
bly the most important thing I can
do,” she said.
Certification requires an aver-
age of 16 hours a month in rele-
vant practice, court observations
and meetings with law enforce-
ment, the district attorney’s office
and advocacy organizations. It
also requires demonstrating com-
petence as outlined by the hospi-
tal. With the county’s low report-
ing rates for sexual assault, it can
be difficult to get training within
the community.
Dr. Regina Mysliwiec, the
emergency department director at
Columbia Memorial, who is also
on the sexual assault nurse exam-
iner certification board, said budget
and burnout are the biggest obsta-
cles to local availability.
“These survivors of assault are
coming to the department on their
own, or they’re being brought in by
police. They’re traumatized. They
just want it all to go away. They
want it to be over. And then what
we have to do is find a way to take
care of them as quickly as possible.
And limit the trauma as much as
possible,” Mysliwiec said. “But we
only have a handful of nurses who
are trained to do this process.”
Fisher was the nurse who col-
lected the two evidence kits taken
at Columbia Memorial so far this
year. She was called in a third time,
but the patient left before she could
get there several hours later.
“I personally have had to call
Cassie in to do these exams just
after she finished working. I imag-
ine her sitting down to have dinner
with her family and then just pick-
ing up the phone,” Mysliwiec said.
“It’s asking a lot, but it’s something
the community needs.”