Md. sexual assault victims face obstacles to forensic examinations

On what many describe as the worst day of their lives, sexual assault victims can find nurses at Maryland hospitals trained to take qualified forensic examinations while also meeting with victim advocates.

First, they have to go to the right hospital.

Sexual Assault Forensic Examination (SAFE) programs exist in at least one hospital in every Maryland county, as well as Baltimore City. But they’re not in every hospital, and victims can find themselves at a hospital emergency room only to be told they need to go to a different hospital if they want a forensic examination.

Often they are responsible for bringing themselves to another hospital because transportation is not covered by their insurance.

“I think it’s unfair to say to a rape survivor that you need to figure this out,” said Lisae Jordan, executive director of the Maryland Coalition Against Sexual Assault. “It’s an onerous imposition on someone who has just been raped.”

But for hospitals instituting the programs, providing the best quality of care means consolidating efforts into one building.

In 2014, state legislation created a committee to study access to sexual assault medical forensic examinations in the state.

The committee’s report criticized the burden placed on victims who do not go to a SAFE hospital.

“Victims who choose to have a SAFE must then go to another hospital, often resulting in hours of delay, possible loss of critical evidence, difficulty with transport to the SAFE facility, and may even lead to a violation of the victim’s privacy rights,” the report said.

One potential solution, mobile SAFE units, doesn’t seem to have gained traction in the state yet.

At Greater Baltimore Medical Center, a SAFE hospital, patients are taken to a private suite, separate from the emergency room. The unit is locked and unmarked.

In addition to sexual assault victims, the unit also sees victims of child abuse and intimate partner violence, said Laura Clary, who runs the SAFE program at GBMC.

In addition to nurses trained to perform the forensic examination, the unit includes victim advocates and works closely with the local police department.

Even after a sexual assault kit has been collected, a conviction for a sexual assault is far from certain.

There’s no guarantee that a kit contains usable DNA evidence; some kits can go untested for years.

Last week, the General Assembly passed a law that will require sexual assault kits to be sent to a law enforcement agency within 30 days.

Staffing issues could be a primary reason why most jurisdictions only have one hospital with a SAFE program.

Forensic nurse examiners require specialized training and must be certified by the Maryland Board of Nursing.

Several hospitals have one full-time staff member to run SAFE programs, but most nurses take on the certification in addition to their regular duties.

It can lead to staffing issues statewide, especially with burnout high among their ranks.

“I think that the problem that a lot of hospitals have is … burnout,” Clary said. “The work is difficult.”

At least part of the issue is funding, Clary and Jordan said.

The other problem with attracting nurses can be the lack of a career path, Jordan said. With most of these positions part-time, the nurses don’t have the incentive to continue working in these units.

Relaxing or changing some of the certification requirements for forensic nurse examiners could help bring more nurses into hospitals.

“I do think any kind of alleviation to the requirements could help,” said Nora Hoban, vice president of data & policy analytics at the Maryland Hospital Association. “I think the volume of rape cases is not necessarily consistent throughout the state, so the amount that could be done to make it easier to get certified and then stay certified could certainly help.”

More nurses available at more hospitals would help. The hospitals don’t all have to have SAFE programs, but should have a trained nurse, Jordan said.