Sexual assault victims cannot get help at just any North Carolina hospital, but some lawmakers and activists want to change that.

A recent Carolina Public Press survey of 130 hospitals and community programs revealed sexual assault victims cannot get help from a certified sexual assault nurse examiner, or SANE nurse, everywhere in North Carolina. The resulting two-part investigation published in January showed hospitals in urban areas often have 24-hour coverage of SANE-certified nurses, while for rural hospitals, it’s hit or miss.

Now the N.C. Healthcare Association is surveying hospitals throughout the state about their SANE programs and is working closely with N.C. Coalition Against Sexual Assault to craft solutions.

“Legislators are interested, and the hospital association will do an informal survey,” said Monika Johnson Hostler, executive director of NCCASA. “Everyone wants to know what should we be doing. I feel like we still need quite a bit of information — as much as we can — before we have any bill written.”

SANE nurses train extensively on how to collect forensic evidence from assault victims, while also treating a victim’s medical needs and providing medication to prevent HIV or hepatitis from taking hold. Victims are often suicidal after an attack, and a SANE nurse can recognize the signs.

Nurses interviewed for the series said they had seen victims who traveled or waited a combined 17-19 hours, at multiple emergency rooms, before finally finding one where they could get help.

Activists say it shouldn’t be this hard.

“Every emergency room should have some written policy or procedure about how they are going to treat victims of domestic violence and sexual assault,” said Lauren Schwartz, director of sexual assault services and the director of the Solace Center, located at InterAct Family Safety and Empowerment Center in Wake County.

“Just like, if a patient reports with chest pain or GI issues, it should be the same for sexual assault or domestic violence.”

SANE training takes time. Not every hospital bears the costs. Often a passionate nurse will pay for his or her own training, which includes taking time off work, traveling, and paying for hotel and food.

Ultimately, Johnson Hostler said, it would be great to have a SANE nurse in every community. But is that realistic?

“We create so much legislation that nobody’s going to do because it’s not possible,” Johnson Hostler said. “I actually want to know what is possible. I don’t know if it’s possible for every hospital to have a SANE nurse. Who’s going to pay for that?”

Lack of tracking

CPP’s survey of 130 hospitals and community programs was necessary because no agency or organization in North Carolina accurately tracks where SANE nurses work. The N.C. Department of Health and Human Services did not track them, nor did the state Department of Justice. The state Board of Nursing also did not have a list, and one posted online by the International Association of Forensic Nurses was out of date.

Johnson Hostler said the hospital association plans to ask questions similar to those asked by CPP when investigating SANE nurses in North Carolina. Those questions included: Does your hospital have at least one SANE certified nurse on-site? If so, how many and when do they work?

Not all hospitals responded with enough detail to determine how many or whether they had credentialed SANE nurses, and representatives for 40 hospitals did not reply at all. The hospitals may reply to the survey by their trade group, however, even though the survey is considered “informal.”

“This, for me, is a good time for us to take a look at what’s actually happening,” Johnson Hostler said. “If a SANE nurse isn’t at a hospital, what are they doing, and where are (victims) being sent? If they stay there, who is treating them?

“We’ve all wanted this information for a long time.”

She said the survey may have to be done on a continuing basis. Nurses often move around, and it is difficult to maintain certification as a SANE nurse.

The state Healthcare Association said in a statement: “NCHA is in contact with our members and NCCASA on the topic of SANE nurses in North Carolina in order to gather information and discuss how to improve the landscape for SANE access. We are working collaboratively to identify how we can support North Carolina hospitals to consistently offer the best care for victims of sexual assault.”

Results may be presented to members of the General Assembly.

‘Not an acceptable situation’

When asked last month what opportunities he saw for change in the state, Attorney General Josh Stein said rural residents shouldn’t have to drive far or wait long to get help from a SANE nurse.

“That’s just not an acceptable situation,” Stein said.

“That’s why I believe every hospital system in North Carolina should have SANE nurses trained to deal with these types of crises to serve people in need. And I think a requirement that (hospitals) have them would address the situation.”

Sexual assault victims live everywhere in the nation, and every community must have a response to a sexual assault victim, Johnson Hostler said.

“Every hospital needs to have an emergency department or program in their community that can actually comprehensively do a sexual assault exam for a survivor,” Johnson Hostler said. “Survivors don’t think about where they’re going to get a rape kit until they’re raped.”

Rep. Billy Richardson, D-Cumberland, said North Carolina’s gaps in coverage for sexual assault victims must be addressed by the General Assembly.

“Should the hospitals bear that cost alone?” Richardson said. “No. It would be unfair to mandate that to the hospitals without giving them the resources to do it.”

He said he’s spoken with several lawmakers who are interested in the issue, but they want to wait to see “how deep this problem is and how do we fix it.”

Hospitals do turn sexual assault victims away. It happened in early 2019, when two victims approached Cape Fear Valley Medical Center and were turned away, according to an article in the Fayetteville Observer. A hospital spokesman at the time said nothing had changed.

The hospital also billed at least 17 rape victims for the cost of conducting their kits, according to a WRAL article in early 2020. State law says medical facilities must provide free forensic medical exams for sexual assault victims. The exams can last for several hours, and hospitals can claim up to $800 for each exam from the state’s Rape Victim Assistance Program.

“It comes down to money,” said Deanne Gerdes, executive director of Rape Crisis of Cumberland County. “The reimbursement rate is very low. They aren’t making any money off of SANE nurses, and it’s a poor investment on the business end.”

Cape Fear Valley Medical Center’s spokeswoman initially responded to CPP’s survey by saying the hospital had no SANE-credentialed nurses. Two months after that initial response, and as CPP was in the midst of interviews for the series, the hospital said there were eight nurses in training.

The conflicting information was “concerning to our organization,” wrote Pamela Carver, president of the Fayetteville chapter of the National Organization for Women, in a letter she sent in late January to both the hospital and members of the board of trustees. So far, Carver hasn’t heard back from either group.

“With the many needs placed on hospitals in our current pandemic, we would like to stress the importance of having SANE available to these patients,” Carver’s letter states. “SANE can provide the medical attention and the moral support these patients need.

“We request updated information on this situation.”

All seven Cumberland County commissioners serve on the 22-member board of trustees for the hospital, as does the county manager. 

CPP sought comment from both the hospital and the county Board of Commissioners. The hospital did not return a request for comment. Requests for comment from a county spokeswoman were not returned because she said the hospital is not county owned.

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Kate Martin is lead investigative reporter for Carolina Public Press. Email her at