Low number of specially trained sexual assault nurses impacts S.C. victims

HARTSVILLE, S.C. (WMBF) - A young girl walked into her mother’s room just before 5 a.m. and said she was raped while in her bed.

The Hartsville Police Department described the incident in their report on May 26.

The girl was less than 14 years old and didn’t see the man’s face.

The police reported that they called the Durant Children’s Center for a forensic nurse to perform the sexual assault exam, but none were available.

Instead, the exam was scheduled at the Richland Memorial Hospital, over an hour away.

The way evidence is collected in any crime can make or break a case. In incidents of sexual assault, a victim’s body becomes part of the crime scene. Examining the individual and collecting the evidence in a detailed and timely matter is critical for the victim’s quest for justice.

“Evidence collection is huge. We want to get those children in as soon as possible and if it’s over a certain amount of hours, then the evidence collection goes down,” explained Durant Children’s Center Medical Director Elizabeth Morphis. “We want a trained nurse to be able to collect the evidence because the better the collection, the more evidence we can provide to the court systems.”

Morphis said if the evidence isn’t collected in 96 hours, it disappears.

Lack of evidence and delay in reporting are prime factors for why the majority of child sexual assault cases are dismissed. So, when there is evidence, proper and timely collection is that much more important.

Forensic nurses are specially trained in handling victims of crime. They know the best ways to document injuries, collect evidence and the right questions to ask.

Jessica Harvey is a forensic nurse in the Pee Dee. She said a forensic nurse provides better health and judicial outcomes for patients.

In January, Harvey began a mobile 24/7 response SANE program in the Pee Dee. When fully developed, the program will deploy sexual assault nurse examiners (SANE) to local hospitals when patients arrive at the ER.

“When I say I can come in and take care of the patients, I’m able to go in and provide one-on-one care with the patient with no call lights going off. No other patients need me and give them that time for just them to hear their story and to listen to them and provide the care they need,” Harvey explained.

Currently, it’s just Harvey, and she is only able to respond to sexual assault incidents involving children.

She said she doesn’t know why no one was available during the incident in Hartsville in May. It’s possible a former nurse was on-call or the need was never relayed to her.

“The children right now are having to go to Charleston or Columbia unless I’m available, which I’m available. But only if they call, they don’t call if they don’t know,” Harvey explained. “There may be an investigator or a nurse on that doesn’t know about us. But we have tried.”

While Harvey is still working to expand the awareness and services of the Pee Dee Forensic Nurses, other areas in the state have no nurses available 24/7.

Throughout South Carolina, there is a lack of trained and certified forensic nurses.

When forensic nurses aren’t available, victims wait, travel for an exam or receive an exam from an untrained nurse.

Sabrina Gast, the statewide forensic nurse examiner coordinator, estimated there is about 90 nurses across the state that either have some sort of training or are certified.

Certification is the highest form of training. Twenty nurses are certified in adult exams and only 15 are certified in pediatrics.

"I don’t feel like a person should have to go through confusion after going through a traumatic event like a sexual assault. I don’t think that they need to have to deal with nurses that are confused about pulling open the box and looking down the list of instructions that’s required to complete one of those kits,” said Janet Moore, a nurse at Conway Medical Center. “I wanted to know how to do it right, so I went back, got trained.”

Moore is one of seven forensically trained nurses at the hospital. She had never heard of a sexual assault nurse examiner (SANE) in 2007.

She can still remember when she was asked to first complete a sexual assault exam; untrained and unprepared.

“I said, ‘I've never done one.’ They said, ‘That's okay. The paperwork is in there and you can just read the instructions.’ And I thought, how unfair to me and to the patient. It was just unfair,” Moore said.

So, she decided to get trained. Training requires 40 hours of classroom training and a certain number of supervised exams.

Sexual assault exams are invasive and lengthy. They can take multiple hours to complete immediately after victims experience a traumatic event.

Knowing how to collect evidence is just one part of the job. Forensic nurses are also often called in to testify in the cases. Moore explained the cases can take years to prosecute so its vital nurses properly chart every detail of the exam.

Moore knows all to well how critical her role is in achieving justice for victims.

“We had a, ‘He said, she said’ case and it came down to nobody could prove it because nobody was there. But every one of my swabs hit DNA and the person was convicted,” Moore said “So, I think it's highly important that it's done properly, and it's done in a timely manner.”

Despite the impact of forensic nurses to criminal cases, they aren’t available to every South Carolinian.

“We certainly do not have enough certified nurses in the state to take care of the patient populations that are presenting to our facilities,” Gast said.

There are five forensic programs that have nurses on call 24/7 throughout South Carolina. Horry County is not one of the areas.

Gast is working with communities to increase this number.

Spartanburg, Columbia, Greenville, Charleston and Beaufort each have programs that make forensic nurses available 24/7 to multiple local hospitals.

While some communities don’t have a program, they may have forensically trained nurses working in hospitals but aren’t available 24/7.

Harvey explained even if ER nurses are specially trained, there are advantages to having an independent forensic nurse program.

“I think one of the main benefits of having our program come in and having a nurse come in specifically for that one patient is to be able to give them that one-on-one care to whereas if a staff nurse was there, they would have other obligations and other things taken up their time,” Harvey said.

The South Carolina Law Enforcement Division reported Horry County had the most sexual battery incidents in 2018.

Despite its ranking in the state, the county does not have a forensic nursing program providing 24/7 access to SANE nurses.

“Horry County has been kind of a hot spot for us to target because we really feel like the need is here,” Gast said.

Horry County has some trained forensic nurses, like Moore, but no established program.

Gast is working to change that by establishing a community based forensic nursing program to offer 24/7 nurses to every medical facility in the area.

The program wouldn’t fall under a hospital jurisdiction but partner with hospitals and be more of a one-stop-shop for sexual assault victims.

She said they’ve picked a location and are now focusing on building relationships and support in the community.

Gast was one of the first trained forensic nurses in the state back in 1998. Since then, she sees a lot of the same nurses who are involved.

“It’s kind of depressing to me is that we don’t have more nurses to fill those, those areas of needs,” Gast said.

She said the biggest obstacle is money.

“There's multiple areas in the state that we realize really need support. Unfortunately, we don't have the funding to support all of those areas at one time,” Gast said.

Creating programs is expensive. For individual nurses, training and certification cost them time and money.

Programs often rely on grants from state, federal and private sources.

“So, the grant monies are going down, but the demand is going up,” Morphis said of the Durant Children’s Center. “So, I’m not sure how that’s going to play out in the future… eight counties, two nurses is not the best scenario. We’re making it work right now.”

The Durant Children’s Center works with the Pee Dee Forensic Nurses who use to have two nurses but now just has Harvey.

Harvey said she thinks offering free training is one way the state can increase the number of forensic nurses.

“Most hospitals aren’t going to pay for these things because of this, like I said earlier, this sustainability of it and it’s hard to keep them. And a lot of times they go through these classes and they realize it’s not what they want to do, and they’re not cut out for it,” Harvey explained.

She said forensic courses can cost nurses around $400.

To overcome this obstacle, a free SANE course is offered at McLeod Regional Medical Center from January 28 – February 4.

Gast said online training is another way for nurses to get trained by saving time and money.

The job itself can also be grueling.

“Think of the patient population that you're seeing. You were seeing them on their very worst day, and you were hearing traumatic stories,” Gast said.

This leads to a high burnout rate in the profession.

Moore said the difficulty is what keeps her in the business.

“It's tough. It wears on your heart. It's hard to see somebody come in at one of the worst moments of their perceived life, you know? And that's the reason I've stuck with it is because I feel like maybe I make a little bit of difference. I can assure them that everything will turn out okay,” Moore said.

Despite the challenges and low numbers, Gast is optimistic.

“Targeting the areas that have the most reported cases and trying to get those nurses infiltrated into those areas is how we have chosen to try to correct the deficit within the state,” she said.

Gast thinks South Carolina is at the forefront of increasing forensic nurses.

At the beginning of the year, the state started a Forensic Nurse Task Force. The task force merges various players across the state to evaluate the need.

Currently, the task force is working on a forensic compliance report to understand how many sexual assault cases hospitals handle and how many forensic nurses are on staff.

A law enforcement survey will be also be going out in a few weeks.

“We're going to be only the third state in the country to do this massive type of report. So, we're very excited about that. South Carolina is working hard,” Gast said.

Gast hopes the final report will be available next spring or summer.

“It’ll help us identify gaps in funding, training, medical facilities where we need to focus our efforts and, and better attack the problems that we’re seeing,” she said.

For information about funding and the Pee Dee Forensic Nurses, you can contact Jessica Harvey at 843-601-4307.

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