Not so long ago, when someone in Northern Virginia suffered the trauma of rape, she or he might suffer a little bit more at the hospital afterward.
The wait for attention in the emergency room could last as long as 12 hours and averaged between three and six, according to Sue Brown, an Inova Fairfax Hospital nurse who used to work in the emergency room. During that time, the victim would have to remain in the clothes she wore during the assault, not use the bathroom and not wash off.
In the course of the exam, the victim might have to repeat the story of the assault to three or four people, including a lab technician, a doctor, a nurse and maybe even someone at the registration desk. After the exam, the victim was likely to leave the hospital dressed in a patient gown. Finally--and in the end, most significantly--the evidence collected might not be good enough to get a conviction in court.
Brown pushed for a change and eventually got one. A program started at Inova Fairfax Hospital in 1991 has improved each of those conditions and has spurred other similar programs in the region.
Initially, the hospital's Sexual Assault Nurse Examiner (SANE) program was one of a few such efforts in the country. Today, there are more than 200. Until three years ago, part-time staff members ran the clinic. Now, Brown, who is the program coordinator, and three other nurses treat 500 children, women and men from across Northern Virginia every year.
Victims of sexual assault from nearly every Northern Virginia jurisdiction--Alexandria, Arlington, Fairfax City, Fairfax County, Falls Church, Loudoun, and children from Fauquier and Prince William--are brought to Inova Fairfax for their exams.
The SANE clinic has a private waiting room with stuffed animals, a television and a couch. But victims rarely have to wait. A nurse who is an expert at treating and collecting evidence from sexual assault victims attends to the patient immediately, except in the rare case when two patients arrive simultaneously. That nurse is the only hospital employee to whom the patient will have to tell her story. And although there are no statistics yet, the potential for a conviction appears to be better than it used to be, in part because those nurses are considered expert witnesses in court.
Prosecution is more likely for a couple other reasons, as well. The nurses use a blue dye, which adheres to acute injuries so that the physical aftermath of the trauma is plainly evident. A $15,000 instrument called the Medscope makes it possible to hone in on that injury, magnify it and photograph it, all with a fairly noninvasive tool that resembles a microphone. In addition, lighting techniques help the nurses identify exactly where to find physical evidence, instead of guessing as they did before.
"The quality of care does increase exponentially when you have a program whose primary purpose is to collect evidence," said Sara Donahue, program coordinator of Alexandria's Sexual Assault and Response Awareness program, which works in conjunction with SANE.
The SANE nurses face intense stories: Brown's patients have included a 6-month-old infant, a retarded woman and a 98-year-old.
"You can't let every case bother you, or I would have been out of here a long time ago," she said.
Beyond the 20 stuffed animals and the scented soap in the bathroom are some other touches that help bring "a little empowerment back," Brown said. A couple of candy machines dispense goodies gratis--a perk the detectives as well as the patients like--and there are piles of clothes available for the patients so they can go home in something clean and free of reminders.
These touches are important--all the more so for children, who make up 60 percent of the clinic's patients.
Those young patients go on to Inova's Kellar Center, where Eliana Gil is coordinator of services for abused children. Gil said the SANE treatment sets the children up well for therapy.
"It's a very sensitive, non-intrusive exam and a warm environment," Gil said. "That makes a huge difference. All of us are so invested in making sure the children are not re-traumatized by the helpers . . . . When we get the kids here, we know that they've been in the best possible environment."
Some stories are disturbing in a different way: Brown estimated that 1 or 2 percent of patients are "out-and-out lying." In those cases, she said, the exam is still beneficial.
"It backs up that nothing happened," she said. "If she made a false allegation, there's something going on with her, and this helps get her into counseling . . . . You're not only helping to put some of these rapists behind bars, but you're helping to exonerate the innocent."
The national hot line for victims of sexual assault is 800-656-HOPE.