Like many other states across the Midwest, there is a severe shortage of sexual assault nurse examiners in the state of Indiana.
What is the problem?
Sexual Assault Nurse Examiners (SANE) examiners provide services to patients that have been impacted by crime or violence. When a SANE is assigned to a patient, they stay with that individual throughout the entire hospital stay.
“We do all of the things we would do in the emergency room. We do a triage, make sure they are medically clear and medically stable before we start the forensic part of the exam,” Angie Morris, Indiana’s SANE training project, said.
If the patient decides to press charges and get a forensic exam, the SANE will examine the patient from head to toe. They will document any evidence and findings and turn that information over to law enforcement. All the while, the SANE provides mental and emotional counseling.
If a patient decides not to press charges, the SANE will explain what the repercussions of that could be.
“They can do as much or as little as they want,” Morris said.
Morris said the reason it is so important for sexual assault victims to see a SANE instead of any practitioner is that the SANEs specialize in knowing what to look for.
“They kind of have to anticipate those types of things; things that are just a little off. You’re like, ‘this might be something, it might not be anything,” Morris explained.
The SANE Training Project says out of Indiana’s 92 counties, more than 60 do not have a single forensic nurse. That means victims are being treated by uncertified examiners or having to drive hours somewhere else.
“Frequently what happens is that patient will terminate care altogether,” Morris said. “They will just be like, ‘oh, ok, well now I have to go here, or I have to go there. I wasn’t prepared for that.’ Then, when they find out the examination itself will take a few hours, they’re just – they’re not – they have lost their motivation.”
Morris believes nurses are not getting certified to be SANEs for several reasons. The training costs money and the hours can be demanding. Hospitals, she said, also appear to be skeptical.
“A lot of hospitals feel like this training is expensive and it is,” Morris said. “We do have a lot of nurses that are interested throughout the state. Their facilities just aren’t supportive of them doing this service at their hospital.”
CBS4 found that out of 115,000 registered nurses, only 45 are certified to work with adult and adolescent victims. Fifteen are certified SANEs that can work with children.
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What do sexual assault victims say about this?
First, a little about Eileen Potenza. She was sexually assaulted in 2013. She woke up at 5:30 in the morning to six men in her bedroom. While her husband was held against his will with a gun to his head and covered with a blanket, four of the suspects forced Potenza to drive to an ATM. They shot her twice and sexually assaulted her. Her daughter, Allison, was sexually assaulted as well.
Potenza remembers a lot of the home invasion. At 7:30am, when it was over and the armed robbers left their home, she and Allison went to the hospital. They each saw sexual assault nurse examiners.
“We got immediate attention,” Potenza said. “We both had all the testing done and I know for Allie, that was a huge relief. She was very worried about pregnancy and STDs, something that could be really harmful to her future.”
Potenza recalls her SANE walked them through the process.
“They treated us with such dignity. It was never a question of feeling uncomfortable or unsafe,” she remembers. “They knew what to do so that we could go back to real life as much as possible.”
Potenza credits her SANE with helping her rehabilitate.
“I have this image of my sexual assault nurse with a halo still. She was just so kind and always right there when I needed anything,” she said.
When CBS4 asked Potenza what she thought about the SANE shortage, Potenza said something needs to change.
“They were critical, I think, really critical at that very beginning stage,” she said.
While Potenza feels her family got justice, she knows that the system doesn’t work the same for everyone.
“I’m passionate. We need to help everyone in the same way that we got help. I know that’s not happening,” she said. “It needs to be taken care of right away so that other people aren’t victims.”
What is the solution?
Right now, the SANE training project is working to get more registered nurses certified. They have a grant that now allows them to pay for the required training.
“If ever was a time to do it, now is the time because there is that financial assistance,” Morris said.
In the meantime, they are working with hospitals to figure out a staffing plan.
“Not everyone is going to be set up like a trauma center with someone in-house, 24/7, ready to go but if you can’t be there, what can you do?” Morris pointed out.
While an on-call schedule is not ideal, the SANE Training Project believes it is better than not offering anything at all.
“I think hospitals are very narrowly escaping litigation,” Morris said.
Other states have faced the same issue. In 2018, Illinois passed a law that will eventually require emergency departments to have SANEs. The Attorney General’s office also adopted a SANE program to increase its staff statewide. It offers basic and advanced training free of charge.
We asked the Indiana Attorney General’s office if they would consider doing the same. A spokesperson sent us a statement:
“The Office of the Indiana Attorney General does not certify Sexual Abuse Nurse Examiners, but the Office is responsible for investigating and prosecuting licensing violations related to many professions, including nurses. The Indiana Professional Licensing Agency would be a likely source for information related to any Sexual Abuse Nurse Examiner certification or license in the State of Indiana.”
CBS4 then reached out to the Professional Licensing Agency. A spokesperson said:
“The state does not track certification of nurses beyond their initial licensure. A nurse, once licensed, may pursue any certification programs that they wish to pursue such as sexual assault, pediatric, forensic, or dozens of other fields. We at PLA do not track or keep the data on what specialties that they ultimately achieve. Building on that, we do not advocate for any one particular specialty or field of study; rather for nursing as whole.”
We also asked Senator Michael Crider, who has been very involved with getting rape kits tested and audited. He introduced a law that would allow sexual assault survivors to track their own rape kits. He told CBS4 that there is nothing on the books right now regarding the number of SANEs in Indiana.