A sexual assault nurse examiner (SANE), Norah Lusk is trained to care for survivors of violence. SANEs conduct forensic exams, collect evidence, provide follow-up care, advise survivors on their reporting options, testify at trials and more.
Lusk works in an emergency room in Elko, Nev., a four-hour drive from Reno. In between the cities, there is nowhere for sexual assault survivors to receive forensic exams, which are essential for law enforcement investigations. Survivors in the area might have to travel hundreds of miles for proper medical care. The burden is on them to know where to go and how to get there − all after experiencing a major trauma.
“There’s a victim population that is not being served at all,” Lusk said.
Across the U.S., forensic nurses are equally scarce, reports the Center for Public Integrity. “Nobody really knows where SANE exams are available,” said Leah Griffin, a sexual assault advocate and survivor who, in 2014, was turned away from a Seattle hospital that did not provide forensic exams.
Despite a 2022 law requiring a national directory of sexual assault nurse examiner locations, there is no comprehensive national resource to direct survivors to the nearest forensic exam. Congress tasked the Agency for Healthcare Research and Quality to create the resource but did not allocate funding.
Though more than half of states have their own SANE databases, some are incomplete or outdated − out of 30 databases, eight haven’t been updated in a year or more. Twenty states do not have directories for post-assault medical care at all.
“If you’ve experienced violence, I guess you’re just supposed to know what to do,” said Jennifer Johnson, president and co-founder of the Academy of Forensic Nursing. “And I think that’s a cop-out.”
The Rape, Abuse and Incest National Network estimates that someone is sexually assaulted in the U.S. every 68 seconds. Medical care afterward is key to addressing physical and mental health needs and collecting evidence.
Forensic exams − commonly known as rape kits − are voluntary and required by federal law to be free. Depending on patient need and consent, the exam can include urgent medical treatment, a full body examination, DNA collection and photographic documentation.
Forensic nurses provide more comprehensive care and more accurate evidence collection than other medical staff, according to the U.S. Department of Justice’s Office for Victims of Crime. SANE involvement increases sexual assault reporting rates, the number of charges filed, conviction rates and the average sentence times for offenders.
Jennifer Pierce-Weeks of the International Academy of Forensic Nurses recounted stories of survivors traveling hours for SANE care, sometimes via costly ambulance rides. Others simply went home “because of the complexities of going to one place, not being provided care, and then trying to keep up that will to continue to seek care.”