Cape Fear Valley Medical Center in Fayetteville, seen here in 2021. Melissa Sue Gerrits / Carolina Public Press

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A loose coalition of community leaders has formed in hopes of bringing millions of dollars to Cumberland County to increase the number of sexual assault nurse examiners in the region.

Partly at issue at Thursday night’s meeting of law enforcement, prosecutors, government officials and nonprofit leaders was Cape Fear Valley Medical Center’s precipitous drop in the number of SANE nurses in just a few years’ time.

“At some point five years ago, I had 20 SANE nurses,” said Dr. Michael Zappa, chief clinical officer at Cape Fear Valley Medical Center at the Thursday night meeting. “Right before COVID, I had eight. I’ve got one today.”

Ideally, he said, Cape Fear Valley, which serves a multicounty region, would need around 20-30 SANE nurses to guarantee sexual assault victims would not have to wait long to be treated. The hospital has the 10th-largest emergency room volume in the country.

A SANE nurse takes dozens of hours of training, not only in how to collect forensic evidence but also in how to react around people who have just endured the most traumatic moment of their lives.

Assistant District Attorney Alicia Flowers said she prosecutes cold-case rapes, and it’s essential to those cases to have a qualified SANE nurse helping victims.

“Knowing the history of SANE nurses has allowed us to put several serial rapists behind bars because of the excellent work SANE nurses have done in our community.”

SANE nurses should not be optional, said state Rep. Billy Richardson, D-Cumberland. 

“This is a crime against the state of North Carolina, not just the victim,” Richardson said. “It’s the state’s responsibility to make sure we get this perpetrator off the streets and make people safe.”

Cape Fear Valley is certainly not alone in needing more SANE nurses. Hospitals nationwide have a shortage of SANE nurses. A Carolina Public Press investigation last year showed that of around 130 hospitals in North Carolina, few in rural areas have even one SANE nurse and many urban areas only had a few.

A groundswell of support for SANE nurses has since blossomed in North Carolina and around the country:

  • Around the state, 50 nurses, largely from rural hospitals, started training earlier this year to obtain a SANE certification, thanks to $2 million from the state Attorney General’s Office.
  • Legislators approved $125,000 for a pilot project in Cumberland County to train SANE nurses. Fayetteville State University, a historically black college, intends to train about 10 nurses to get their SANE certifications under Dr. Sheila Cannon.
  • Congress approved $30 million per year for the next several years to train and retain SANE nurses, with a focus on rural and tribal communities. The legislation includes a focus on SANE nurses for child patients.

State Sen. Kirk deViere, D-Cumberland, said he’s asked for $3 million to extend the FSU pilot project to train SANE nurses at Fayetteville State University. Senate Bill 872 is currently in the appropriations process.

“They have the capacity of their nursing program and can reach across a multicounty area,” deViere said after the meeting. “And we can build the capacity for SANE nurses right here locally.”

Sustainability?

One question the meeting addressed was whether the plan would be sustainable. 

“I think it’s sustainable if we make it a priority,” said Deanne Gerdes, executive director for Rape Crisis Volunteers of Cumberland County.

Once FSU’s program becomes more established, perhaps, some attendees said, the area would be well-poised to qualify for some of the $30 million in federal grants approved through Congress earlier this year.

Nationwide, the SANE nursing shortage is also now compounded by a pandemic-fueled nursing shortage, and some nurses are leaving jobs in their communities to pursue more lucrative travel contracts.

SANE nurses are trained to collect forensic evidence after a sexual assault and help treat victims to prevent sexually transmitted infections. Of those served by a SANE nurse, 72% are more likely to report the crime to law enforcement, studies have shown, compared with half who were served by a nurse without the training.

Aspiring SANE nurses must take dozens of hours of classroom and in-person training and attend clinical work. Finally, to get their credentials, nurses must pass a written exam.

All of that costs time and money — money to pay to take the exam, money to pay for the training and money to pay for a hotel if the training is outside of their community. Also, nurse trainees need to have the time off from their regular jobs to get the training in the first place.

Cape Fear Valley Medical Center averages one sexual assault victim per day, Zappa said.

“Ideally, I’d like somebody dedicated (to treating that person),” he said.

Nurses would likely have to take rotating on-call shifts to ensure service at all hours, Zappa said. At times, hospitals depended on nurses’ goodwill to be available without pay. That’s not how it works for other specialties like cardiology or neurology, he said.

“We are very fortunate in this community to have 30 board-certified cardiologists,” Zappa said. 

“We have an on-call system set up that guarantees the trained person is available and in the right shape and says, ‘Nope, I can’t have a beer and I can’t have a glass of wine. I’m at the ready and I come in when I get the call.’ ”

Then there’s the cost of the exam itself to the hospital. The state reimburses hospitals up to $800 for a physician or SANE nurse to conduct an exam, and hospitals are required to accept that money “as payment in full.”

However, those reimbursement figures are at least a decade old. A bill by Sen. Natasha Marcus, D-Mecklenburg, would nearly double that reimbursement figure.

For years, however, rape victim advocates have said victims are being billed anyway.

“Victims are being billed for the difference, and that shouldn’t happen,” Marcus said Friday.

Up to legislators

Richardson and state Rep. Edward Goodwin, R-Chowan, introduced legislation last year that would fine hospitals $25,000 per instance if they bill victims for the cost of sexual assault exams.

Marcus’ and deViere’s bills are currently under consideration by the state Senate appropriations/base budget committee but have no Republican sponsors.

Kate Martin

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

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