A sexual assault nurse examiner opens a rape kit at the Solace Center in Raleigh. File photo by Alicia Carter / Carolina Public Press

When people are raped in North Carolina, the best person to care for them and collect forensic evidence may not be at the nearest hospital.

Specially trained medical professionals, called Sexual Assault Nurse Examiners, or SANE nurses, do not work at every hospital. Rural areas are far less likely to have these nurses on staff than urban areas, and no state agency tracks where they work, according to a Carolina Public Press investigation earlier this year.

A $125,000 appropriation in the state budget will support a pilot project for SANE nurse funding in Cumberland County.

State Rep. Billy Richardson, D-Cumberland, said the pilot project funding is a first step to “see what works and what doesn’t work before we implement it statewide.”

“I feel confident as we learn and grow from this, we will put more resources into it because it’s needed,” Richardson said. 

A SANE nurse certification requires a person to have been a nurse for at least two years, complete dozens of hours of training and clinical work, and then pass a written exam by the International Association of Forensic Nurses.

Many nurses around the state have completed some training or have attended training with their hospital about how to treat sexual assault survivors but lack the full credential.

Rape Crisis Volunteers of Cumberland County will oversee the pilot project. Executive Director Deanne Gerdes said she alerted her state legislators to the lack of SANE nurses at the local hospital, Cape Fear Valley Medical Center in Fayetteville, and they discussed what to do.

In its response to CPP’s survey, Cape Fear Valley Medical Center said last November that it had zero nurses with a SANE certification but later clarified that it had eight people who had taken some training. 

In April, a hospital spokeswoman said the hospital had one SANE-certified nurse with seven more who have completed a 40-hour web-based course. CPP requested updated information from the hospital but received no response prior to publication.

Apart from the pilot project, the state budget also funds $125,000 for Rape Crisis Volunteers of Cumberland County’s domestic violence services, and $50,000 for renovations for its Phoenix Center.

“We literally have a family of squirrels living in the walls of the counseling room,” Gerdes said.

For the SANE nurse pilot program, Gerdes said she’s considering how best to use the money, whether it is direct funding for training SANE nurses or paying for a SANE nurse coordinator.

“I think that’s a great conversation to have with Cape Fear Valley and other stakeholders in the sexual assault community,” Gerdes said.

While any nurse or doctor can complete a sexual assault kit, which collects DNA and evidence of an assault, SANE nurses are trained to know where to look for bruises and scrapes. After dozens of hours of practice and training, they also know how to ask delicate questions about what happened so they know where else to look for harm.

They provide medicine to prevent pregnancy or sexually transmitted infections.

State Sen. Kirk deViere, D-Cumberland, who also pushed for the funding, said throughout his talks with law enforcement, advocates for sexual assault survivors and prosecutors, “SANE nurses continue to come up.”

Rape Crisis Volunteers of Cumberland County has “always struggled for resources,” deViere said, noting that the legislation helps with that problem “but also creates a structure around training for SANE nurses.”

The General Assembly approved the state budget this week. Gov. Roy Cooper, who has indicated that he plans to sign it into law. 

Paying for sexual assault examinations

SANE nurses have also stood as a bulwark against a victim being charged for the exam. It’s illegal in North Carolina to charge a rape victim for his or her examination, but sometimes hospitals do it anyway.

A bill unanimously passed by the state House would fine any hospital that bills a victim for his or her rape kit up to $25,000 per occurrence. House Bill 626, authored by Richardson and Rep. Edward Goodwin, R-Chowan, will be considered by the state Senate next year.

Nationally, hospitals have trouble retaining nurses in their SANE programs. Just about everywhere the nurses are in short supply, according to a 2016 six-state study by the U.S. Government Accountability Office.

Part of the reason is retention: Serving a sexual assault victim can be emotionally difficult, and a SANE nurse might be the only person with that credential in a hospital — potentially leading to an erratic work schedule and heavy workload.

And for victims who seek a qualified nurse, their wait can be measured in hours or even days. Some have crossed state lines to reach a SANE nurse, previous reporting by CPP has shown.

For the hours a SANE nurse might spend on a patient, hospitals can receive up to $800 for each rape kit performed from the state’s Rape Victim Assistance Program if they send in an itemized receipt. State records show not every hospital asks the state for reimbursement.

Senate Bill 561 filed earlier this year would have increased state funding to $1,400 per sexual assault exam, but the bill died in a committee.

“I would want to reintroduce the bill at the appropriate time in the future,” said bill sponsor, state Sen. Natasha Marcus, D-Mecklenburg. “We shouldn’t give up.”

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