Sexual assault victims in Wisconsin forced to wait for tests


http://www.jsonline.com/news/wisconsin/sexual-assault-victims-in-wisconsin-forced-to-wait-for-tests-b99753847z1-385494641.html

Wisconsin’s system for investigating sexual assault cases is forcing survivors to travel long distances and wait for hours to find nurses who can perform forensic exams.

On top of the emotional stress of waiting, the logistical difficulties can make victims give up on getting an exam or cause them to lose time-sensitive evidence. Cases can be lost before they’re started.

The exams — which involve medical attention and evidence collection by specially trained nurses — are provided by hospitals on a voluntary basis. While hospitals can get state funding to cover the exams, there’s a slew of non-reimbursable costs associated with them.

Nearly half of Wisconsin counties do not have nurses available to perform sexual assault exams, according to an estimate by the Wisconsin Coalition Against Sexual Assault.

Many hospitals choose not to offer the exams at all. Others offer them as a charitable service. Officials with Aurora, ThedaCare and Mayo Clinic Health System all said their exam programs operate in the red, relying on foundations and other revenue streams to support them.

While Wisconsin Attorney General Brad Schimel said the forensic exams are vital to catching offenders, he acknowledged that the system is relying in part on the generosity of hospitals.

“It has fallen on hospitals and it has been part of their charitable outreach because it’s frankly a money loser for them,” Schimel said.

Marcia Mason, an advocate for victims in Menomonie, remembers a woman who chose not to continue when she was told she needed to transfer hospitals after waiting for two hours at the first hospital.

“She said, ‘No, I’m done. I want to go home and just be with my dog,'” Mason recalled.

A cushy couch, a basket of candy, lavender scents and a TV are thoughtfully prepared in a room behind the emergency department at the Aurora Medical Center in Oshkosh. It’s where specially trained sexual assault nurse examiners talk with and comfort victims before they have to climb onto the hospital bed under the cameras.

Nurses there see patients from as far as 80 miles away. Unlike Oshkosh, most hospitals in the region do not offer sexual assault exams around the clock. From an eight-county area, victims may drive themselves to Oshkosh, or, if they decided to report to police, might get a ride in a squad car.

One of the areas patients come from — Green Lake — recently lost its examiner.

After a Community Health Network clinic there became part of ThedaCare, the program was consolidated. The stated goal was to create a stronger hub in Appleton that would be more reliable than the sporadic availability there had been at other locations, said Jennifer Fredriksen, who is helping to reorganize the program.

“The ideal world would be we meet the victims wherever they present, but we don’t have the coverage to do that right now,” Fredriksen said.

Fredriksen said ThedaCare would need 51 examiners to provide full coverage at each of its campuses. It has seven, with nine more in training. Victims from Green Lake and other locations are directed to the Appleton hub or a different hospital system like Aurora.

Victim advocates in Green Lake are concerned about the change.

“It’s hard to report a sexual assault. If someone’s brave enough to make that first step and be told they now need to drive 45 minutes away and disclose to another complete stranger — you talk about how difficult that is,” said Courtney Kolb, a case manager with the sexual abuse center for Green Lake County. “The bravery of coming forward is all lost.”

Patti Crump, a detective for Green Lake County, said in addition to the strain on the victim, traveling is bad for evidence collection and building a potential case against an attacker.

“It’s just not a good practice,” Crump said. “The more time that passes, the quicker you can lose evidence. How do you tell a victim they can’t go to the bathroom?

Fredriksen said ThedaCare will be re-evaluating its system after giving it a go with the new central hub. She said it may consider reinstating examiners at other locations, but she said she worried about nurses falling out of practice and competency in areas where populations are sparser and sexual assault cases are rare.

This lack of practice is often cited as a reason for the low supply and high turnover of examiners in rural areas. Only about half of nurses who are trained as examiners stick with it for a full year, according to the state Department of Justice.

“Once a nurse feels she’s not doing a good enough job, they would rather not do it than do it poorly,” said Jennifer Pierce-Weeks, CEO of the International Association of Forensic Nurses.

Brenda Doolittle, who coordinates Aurora’s program in Oshkosh, said she can understand why nurses would leave the job if not well supported and trained.

“When you’re taking care of people that constantly need emotional and physical help from a traumatic event, that can reflect on the caregiver and be hard on them,” Doolittle said. “It takes a special person, a special nurse to want to do something like this.”

Doolittle said it’s vital for sexual assault nurses to have access to continual training on the job — something she is able to provide in a coordinator position. As she packaged up a urine test at the hospital in May, she greeted forensic nurse Eve Baker, who wanted some practice on a new camera for exams.

“I’m a ‘If you don’t use it, you lose it’ type of person,” Baker said. “If I didn’t come in here, I don’t think I would be serving my patients well.”

There a few ways advocates say Wisconsin could expand the number of nurses with specialized training and provide more exams:

■Employ program coordinators. Coordinators like Doolittle can help nurses keep their skills fresh, ensure the hospital adapts to new technology, and check in with nurses on their own feelings after providing exams.

■Offer refresher courses. To prevent nurses from falling out of practice, IAFN recommends sending nurses to refresher courses where they can practice performing exams on real people. The state Department of Justice does not offer these courses.

Ask nurses to travel, and compensate them. Rather than asking victims to travel to meet examiners, hospitals could ask nurses to travel to meet victims at whichever clinic location is closest to them. The state compensates hospitals for the time nurses spend performing exams but not for time spent on-call or traveling to an exam location.

While Pierce-Weeks said she would like to see more hospitals “stepping up” to better support their examiners, there are also ways that federal and state dollars could contribute.

Acknowledging that the state relies on hospitals making the costly choice to support these programs, Schimel said he thinks some responsibility should ultimately fall with the criminal justice system to make sure exams are available.

“It is up to our criminal justice system to demand that this be available to everyone, and I think the state has a role in making sure resources are available throughout the state regardless of where you live,” Schimel said. “But it’s easier said than done.”

Schimel said he would look at the possibility of securing federal grant money to cover transportation costs of sending nurses to convenient locations for victims.

While he has confidence in the quality of the programs that do exist, Schimel said he thinks the state needs to ensure that they are widely available.

“This is important from a perspective of a victim who deserves justice, and the prevention of future victims,” Schimel said. “If an offender gets away with an act like this, they do it again.”

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