Lauren Schwartz is director of sexual assault services and the director of the Solace Center, located at InterAct Family Safety and Empowerment Center in Raleigh. Alicia Carter / Carolina Public Press

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Getting help after experiencing sexual violence can be confusing and difficult. Not every hospital has a nurse who is certified to treat a sexual assault victim. Some tell victims to go to other hospitals for help.

Sexual violence can include a range of unwanted actions, including nonconsenusal touching over or under clothing, penetration and sexual assault. And in North Carolina, it is now considered sexual assault if anyone has sex with someone who has been incapacitated through their own drinking or drug use.

The perpetrator can be someone you know, even an intimate partner, family member or friend.

It can be difficult deciding whether or when to get help, 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.

“Sexual violence is the most underreported crime in the world, that survivor is not alone, and (what happened) was not their fault,” Schwartz said. “Sexual abuse is never an acceptable consequence of any action or behavior. I always tell my survivors that the only person that could have prevented this from happening is the abuser.”

Here are a few answers to frequently asked questions for people who have experienced sexual violence or are helping a family member or friend through the process.

Q: I want to be able to help friends or loved ones in case they are assaulted. What should I know?

Familiarize yourself with your community resources, such as area rape crisis centers, the phone numbers for emergency rooms and locations of hospitals, Schwartz said.

Like many states, North Carolina does not require every hospital system to employ these highly trained nurses, known as sexual assault nurse examiners, or SANE nurses. Many hospitals say it is difficult to retain the nurses, while others seem to resist providing the training to certify their workforce.

“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,” said Monika Johnson Hostler, executive director of the N.C. Coalition Against Sexual Assault. “Survivors don’t think about where they’re going to get a rape kit until they’re raped.”

Q: I or a loved one has been sexually assaulted. What should I do?

Sometimes it’s tough to know where to start, Schwartz said.

“If it was me, I would probably call emergency departments to see if they offered that,” Schwartz said.

You have to call first because no agency in North Carolina tracks where SANE nurses work, a Carolina Public Press investigation showed.

A hospital may prefer that you show up at a different campus where a trained staff member can help you. If that hospital does not offer that care, ask for the closest hospital or community program with a SANE nurse. These are nurses with a specific credential, which indicates they have trained and passed an exam to become a sexual assault nurse examiner.

Not every hospital has a SANE nurse, and some hospitals don’t have them working all the time, which means some victims could be waiting for several hours before they get help. 

While any doctor or nurse can administer a sexual assault kit, SANE nurses are trained to help treat a victim’s medical needs and collect forensic evidence from an assault.

Calling ahead to the emergency room can help you better plan where to go. You can also call the National Sexual Assault Hotline, which routes you to your nearest rape crisis center based on your area code, Schwartz said.

The Rape, Abuse and Incest National Network created and maintains the hotline at 800-656-4673.

Fewer than half of North Carolinians live in a county where a SANE nurse is available 24 hours per day, seven days per week, the CPP investigation into SANE nurses showed.

Q: Why should I go to a hospital after I’ve been assaulted?

TV crime shows focus on sexual assault exams, but that’s only part of how medical professionals help sexual assault victims.

SANE nurses are experts at collecting and cataloging the evidence of the assault, which can be used in a criminal investigation and prosecution. They also help prevent sexually transmitted infections after an assault. SANE nurses’ training helps them provide a sympathetic ear after a tumultuous event. 

“We know there’s a really high prevalence of suicidal ideation in these patients, and we make sure that you’re connected with community resources,” said Catherine Rossi, president of the Academy of Forensic Nursing and the forensic nursing program coordinator for Cone Health in Guilford County. Rossi spoke to CPP earlier this year.

Q: If I get help at a hospital, do I have to report what happened to the police?

One of the hardest decisions for many people, whether to involve law enforcement, doesn’t have to be made right away, Schwartz said.

“If they choose, they can have a kit collected either anonymously, or they can decide later on whether to report to the police. There is no statute of limitations (for rape) in North Carolina,” Schwartz said.

Crimes such as first- and second-degree sexual assault, commonly known as rape, are felonies. Felonies have no statute of limitations in North Carolina, which means you can report the crime at any time.

An anonymous kit means the victim prefers to have evidence collected but will wait to decide whether to talk to police. The state of North Carolina stores these anonymous rape kits in a climate-controlled warehouse until, and if, the victim decides to notify the police.

Q: Should I go to the hospital or talk with law enforcement first?

“I would suggest that if they’re in the time frame for evidence collection and medical care, that they go to the hospital,” Schwartz said.

“Hopefully, they will be connected to an advocate and trauma-informed health care provider who can help explain their options and be there with them if they decide to report.”

Q: What if I don’t have transportation?

If you do not have transportation, call the National Sexual Assault Hotline at 800-656-4673. Schwartz said calls to that line will redirect to a rape crisis center in your community based on your cellphone’s area code. There is also an online chat helpline for men who have been assaulted or abused at www.1in6.org/helpline.

Often a rape crisis center has a way to help you get the transportation you need, Schwartz said.

Q: What should I expect of the forensic exam?

Depending on where you go, you may wait in a room separate from everyone else who arrived at the emergency room. You’ll be called to an exam room, and a nurse or doctor will evaluate your injuries and ask if you want a forensic exam. A forensic exam means nurses collect evidence from your body that the perpetrator may have left behind.

That evidence can include bodily fluids, hairs, saliva or scrapings from beneath your fingernails, which is collected using tools in a sexual assault kit.

The forensic exam can last more than an hour, and sometimes multiple hours depending on the situation.

Q: Should I bring anything to the hospital?

Officials say it is best to not remove your clothes before arriving at the hospital to keep evidence in place. If you have already removed your clothes, place them in a paper bag and bring them with you to the hospital, Schwartz said.

Whatever you do, refrain from performing your own DNA collection. The state attorney general said in 2019 that self-administered sexual assault kits are “likely to undermine law enforcement investigations.”

Q: It has been a few days. Can I still get help at the hospital?

Yes. Nurses can order lab tests and prescribe medications to stave off sexually transmitted infections or prevent pregnancy. In some cases, time is of the essence.

Nurses can prescribe emergency contraception or medicine to prevent sexually transmitted infections up to five days after an assault, Schwartz said earlier this year. DNA and other evidence degrade over time. Schwartz said the state crime lab recommends all sexual assault kits be completed within five days of an assault.

Q: Do I have to pay the hospital for the exam?

No. State and federal law says victims do not have to pay for sexual assault kits. Hospitals should also not bill your insurance. North Carolina has the Rape Victim Assistance Program, which pays hospitals for these exams.

“If they do get a bill, they should reach out to their rape crisis center to help advocate on their behalf to talk to the billing department,” Schwartz said.

When victims contact her with a bill, Schwartz said she calls the hospital and tries to negotiate dropping the bill or writing off the charges.

If victims report their crime to law enforcement, they can also get reimbursed for expenses related to the crime through the state crime victim fund.

Q: What else should I keep in mind?

When people go through a traumatic event, their brain tries to protect them. This can mean victims remember facts out of order or may forget certain details. Medical practitioners and law enforcement call this phenomenon “trauma brain.” If your thoughts are disjointed, this may be why.

You should ask for paper and something to write with so you can take notes, Schwartz said.

“It can be a little bit overwhelming,” she said. “You’re trying to share your story. They are asking questions or even if you are talking to law enforcement and you have questions or points you want to make, I recommend just writing those things down so they don’t get overwhelmed and are able to share that effectively.”

If the crime is reported to police, the DNA from the kit will be uploaded to a database called CODIS. That DNA is compared to other samples that have already been uploaded. Sometimes police find a match. And in some cases, law enforcement identifies serial rapists who have assaulted multiple people.

Q: How long will it take for police and other law enforcement to prosecute my case?

Many victims never see their assailants prosecuted for what happened to them. Few people report what happened to them. Of those who do, police do not investigate all of them. Of those crimes referred to district attorneys, not all of them end up with someone charged with a crime.

A CPP statewide investigation of court records showed fewer than 1-in-4 people who were charged with sexual assault were eventually convicted in a 4 1/2-year period. 

However, having evidence collected by a certified SANE nurse is likely to improve the chances of a successful prosecution.

Q: What should I do if the hospital tries to turn me away?

“I would probably ask to speak with a patient advocate or somebody else within the health care system,” Schwartz said.

“There should be somebody they can talk to or make a complaint to within the hospital. Also, know that this should be collected completely free of charge. The kits are completely free. They are tested for free. This should not be any burden on the victim.”

Kate Martin

Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.