Washington needs more sexual trauma nurses, but who trains them becomes a statewide debate

17 Feb

A 2019 Department of Commerce report found that nine counties across the state have no hospitals with Sexual Assault Nurse Examiners (SANEs). Nineteen counties have only one hospital each with SANEs. There are 290 SANEs practicing in the state, but rural counties, many of which are in Eastern Washington, continue to be underserved.

Now, state lawmakers are attempting to fund the training of more SANEs in rural communities.

Advocates say a program should be created and funded at Washington State University. But the UW’s Harborview Medical Center is balking at the idea, arguing that they should remain the sole training program, and that an additional program would jeopardize its already unstable funding.

Rep. Gina Mosbrucker, R-Goldendale, introduced a bill last year to fund a SANE training program at WSU, and is pushing for the funding again this year in the form of a budget proviso, as lawmakers are halfway through their 60-day session.

“There’s been pushback from Harborview Medical Center, which is very frustrating,” Mosbrucker said.

This is not the first time the UW has opposed an expansion in WSU’s medical education. In 2015, the Legislature approved the creation of WSU’s medical school, which had intense opposition from the UW, which had previously monopolized medical education in the state. Some lawmakers who had to mediate the spat saw it as a territorial feud.

“Us or them”

In Washington, 45% of women and 22% of men experience sexual violence in their lifetime, according to the Commerce report. But just a fraction of victims report their assaults, often citing, among other factors, how re-traumatizing the process can be.

Administering a rape kit involves performing an invasive forensic exam that can take hours. Yet, they are recognized as being vitally important in helping preserve DNA evidence in sexual assault cases that land in court.

As part of Harborview’s training, nurses undergo five days of trauma-informed training, learning how to administer the multistep forensic exams. Nurses are given in-field experience and are trained on how to testify effectively when a rape kit is introduced as evidence in court.

Some advocates say Harborview’s monopoly on SANE training has led to the regional disparity in access to SANEs.

Once or twice a year, Harborview’s SANE program travels to a rural community to provide training, but the trainings are abbreviated and less in-depth.

“These are rural, small hospitals that don’t have the ability to call in another nurse and to send you to Harborview,” Mosbrucker said. “Plus, they have to take care of daycare, plus they have to pay for a hotel … we can just do so much better as a state.”

Because of these barriers, some rural nurses are administering rape kits with informal and inadequate training, according to the Washington State Nursing Association. The association says these nurses fear losing their licenses, but administer rape kits anyway so that rape survivors aren’t turned away.

WSU’s College of Nursing has been pushing to start its own pilot training program with the eventual goal of getting accredited by the International Association of Forensic Nurses (IAFN) — something Harborview’s program doesn’t have.

According to Kim Day, grant projects director at IAFN,  there is no reason why a state, especially one as geographically divided as Washington, could not have multiple training programs.

Terri Stewart, Harborview’s SANE program director, argued that a second training program may not be up to Harborview’s standards, and that the programs are “exceptionally expensive.”

Stewart said there should only be one program — “us or them.”

However, Wendy Williams-Gilbert, program director for the WSU College of Nursing, says other kinds of nurses are trained in different nursing schools throughout the state and country.

“Just think about how many nursing programs we have, and they all produce good nurses,” Williams-Gilbert said. “That argument is a weak argument.”

Stewart would not disclose the cost of Harborview’s program, but the Department of Commerce estimated that a more “robust, reliable state-level training,” with more frequent trainings, more locations, and scholarships to cover travel expenses would cost $375,000 annually.

Williams-Gilbert said WSU would need $50,000 from the state to start its pilot program.

Lawmakers are currently working on a supplemental budget, which would adjust the current $52.4-billion, two-year state operating budget they passed last year.

Williams-Gilbert said the college already has the community support, with volunteers offering to help start the program. She added that the college has reached out to Harborview in order to collaborate, to no avail.

“I was shocked,” Williams-Gilbert said. “I assumed we would all just work together because it’s so important for our communities to have these hospitals.”

Moving forward

Last year, lawmakers passed a bill limiting the amount of time hospitals can delay telling a sexual assault victim that they cannot, in fact, administer a rape kit. Untested or destroyed rape kits have also been a topic of discussion.

But the issue of hospitals being able to administer kits in the first place remains unresolved.

Last year, Commerce report concluded that in order to address the lack of SANE availability and access, Washington needs a “more robust, state-wide approach.”

It cites Massachusetts, which has a state-wide SANE program funded with $3.8 million from the state budget. The state has 178 SANEs and 29 hospitals staffed with SANEs, according to Joan Meunier-Sham, director of Massachusetts’ SANE program.

Although Massachusetts only has one training location, Meunier-Sham said it’s not an issue in the relatively small state, as nurses rarely have to drive more than two hours for training.

“Our program often gets looked at as a golden standard across the country,” Meunier-Sham said.

Oregon has a statewide certification system and multiple training locations. But its sexual assault forensic task force says there’s still a lack of SANE-trained medical staff.

Without a statewide system, Washington is struggling to get hospitals to coordinate sexual assault care. Currently, SANEs can only administer rape kits at hospitals they have been contracted with, Stewart said.

“We can’t even send a nurse to the UW without a contract,” said Stewart about Harborview.

Sen. Manka Dhingra, D-Redmond, is sponsoring a bill that would require the Office of the Attorney General to create a task force with the ultimate goal of developing protocols for hospitals to have “coordinated community” responses when rape victims present.

Dhingra said the hope is that every hospital, whether they can administer a rape kit or not, will have a plan to help victims in a timely and trauma-informed way, letting victims know their resources and helping them get to a facility that can provide proper care.

Andrea Piper-Wentland, executive director of the King County Sexual Assault Resource Center, expressed support for the bill, saying hospitals’ responses to victims is a “critical point” where individuals need to be connected to all of their resources.

While testifying in favor of the legislation last month, one woman told lawmakers that after being raped, the closest emergency room “shrugged their shoulders and said ‘we don’t do rape kits here,’” telling her instead to go to Harborview.

“I was drugged and was in no position to drive, and I could not afford an ambulance, so I went home,” she said.

Another survivor testified that the emergency room she went to after being raped couldn’t administer a rape kit, and sent her “on her way as if I was asking for brunch reservations.”

“I sat in front of her (ER staffer) sobbing,” she said. “You’re left to figure it out alone in trauma.”

Senate Bill 6158 has passed the senate and is scheduled for a public hearing in the House Feb. 20.

By Claudia Yaw