Sexual assault victims arrive at hospital emergency rooms, traumatized in body and mind, for a crucial exam, one that is supposed to provide urgent medical attention as well as evidence for prosecuting the assailant.
St. Tammany Parish Coroner Charles Preston, elected just over a year ago, thinks local hospitals can do a better job of administering those exams, and he has a plan for helping them to do it.
The idea is to shift the job from mostly overworked emergency room physicians to specially trained sexual assault nurse examiners — known as SANE nurses — who have the expertise to provide care as well as testify later in court.
Preston, whose own background is in emergency medicine, argues that ER doctors simply aren’t in a position to provide the same level of attention.
“You’re in an emergency room working 40 cases in a 12-hour shift, and unfortunately, the sexual assault case is occurring at the same time as a heart attack, an acute abdominal pain and a motor vehicle accident,” he said.
The nurse examiners Preston wants to hire would be there solely to tend to sexual assault victims. They would take a more thorough history from patients and perform a far more thorough physical exam, he said.
A typical ER doctor doesn’t take finger nail scrapings from a rape victim, he said, but a nurse examiner typically would.
Nurse examiners also often perform a procedure known as a colposcopy, using a special instrument to take pictures of the cervix that can show tears and other injuries.
“By collecting more evidence, they build stronger cases,” Preston said.
Having nurse examiners in place also may encourage more women to come forward when sexual assaults happen, he said, given that women are sometimes reluctant to report being raped because they fear receiving inadequate care or not being taken seriously.
Preston said the effort would dovetail with measures passed during the recent legislative session in Baton Rouge that were aimed, among other things, at ensuring that sexual assault victims are not required to pay for their exams and are allowed to get an exam without making a police report and still apply to the victim reparations fund.
Nurse examiners aren’t new — they’ve been used in New Orleans for years — and Preston did not come up with the idea of employing them in St. Tammany on his own.
Paulette Lill, a SANE nurse who lives in Mandeville, was the spark behind Preston’s initiative.
She stresses the important follow-up work that she and her colleagues do after initial exams, such as additional medical treatment and counseling.
Last year, Lill met with each of the candidates who ran for St. Tammany coroner to gauge their support for the idea. After Preston was elected, she continued to make her pitch. She has been working with Preston for months on designing a program for the north shore parish.
Preston made his commitment public this month when he asked the St. Tammany Parish Council to increase his agency’s property tax rate. The council had reduced the Coroner’s Office millage after the corruption scandal that ended Peter Galvan’s tenure as coroner. Preston told the council that hiring sexual assault nurse examiners was one of the things he needed more revenue to accomplish.
The council acquiesced, but the millage increase won’t kick in until next year. The coroner said he is looking for funding to start the program sooner and believes he can provide 24-hour coverage for less than $100,000.
His plan is to hire one full-time SANE nurse and several part-time nurses to work on an on-call basis.
Orleans Parish, which launched its program 15 years ago, has one location for its 15 SANE nurses — originally Charity Hospital and now the Interim LSU Hospital, program spokeswoman Aleis Tusa said. The first in the state, it serves women, men and transgendered patients 15 and older.
In St. Tammany Parish, Preston is planning a different approach. The nurse examiners will work for his office, not an individual hospital. And they’ll go wherever they are needed.
“I’m not in favor of taking someone who’s just been traumatized by a sexual assault and moving them from one hospital to another,” he said. “We have to go where the victim is.”
Nurse examiners are only one part of forming a sexual assault response team. In Calcasieu Parish, Tammy Vincent, a SANE nurse, launched the first sexual assault response team in the state, and that interagency team is the model that Lill has been studying.
Besides the forensic nurses, the district attorney, law enforcement agencies and the crime lab would be part of the team, Lill said.
She and Preston have met with representatives of the 22nd Judicial District Attorney’s Office to talk about the program, and she said she is encouraged by the response.
Vincent said the biggest challenges for a new program will be building a pool of nurses and getting all the agencies on board and building public support.
Educating the public also will be important to the new initiative, Preston said.
The driving force, he said, is not whether there is a large load of assault cases but doing a better job with them.
“If, God forbid, my wife or daughter were the victim of a sexual assault, I would want them to have a thorough, complete forensic medical exam,” he said. “It’s an issue of public safety.”
Follow Sara Pagones on Twitter, @spagonesadvocat.