Kentucky’s acute care hospitals soon to be SANE-ready



Goal of provision implemented by 2016 General Assembly is to provide high-quality healthcare to sexual assault victims.

By Eileen Recktenwald

Kentucky’s acute care hospitals soon will be able to seek certification as Sexual Assault Nurse Examiner (SANE)-ready facilities under a measure passed into law by the 2016 General Assembly.

The Sexual Assault Forensic Evidence (SAFE) Act is a comprehensive measure designed to address the backlog of untested sexual assault evidence kits and other issues related to sexual assault investigations uncovered by former Auditor Adam Edelen last year. The bill, which enjoyed broad, bipartisan support, was championed by Senators Denise Harper Angel of Louisville and Whitney Westerfield of Hopkinsville. It passed both chambers unanimously.

Among other provisions, the SAFE Act seeks to improve the quality of care sexual assault victims receive by establishing a SANE-ready designation for acute care hospitals that have a SANE nurse on call 24/7. The Cabinet for Health and Family Services will be charged with annually certifying SANE-ready hospitals, posting a list of those hospitals on its website and providing the list to the Kentucky Board of Emergency Medical Services. The state Board of EMS, in turn, shall share that list with the local EMS providers.

Former Auditor Edelen’s special report found a shortfall of SANE nurses in Kentucky, resulting in troubling experiences for victims. The Auditor’s office surveyed community hospitals in Kentucky and found that 61 percent of those responding did not have a SANE nurse on staff.

SANEs undergo 40 hours of didactic training in a classroom setting and extensive field and hands-on training before they may apply to the Kentucky Board of Nursing for their SANE credential. The training is voluntary and hospitals are not required to have SANE nurses on staff. Hospitals don’t get credit toward any accreditations for having SANE nurses and training opportunities are limited, as are resources to support training.

Yet, we know from research that having SANEs offers many benefits to victims, hospitals, emergency room physicians and non-SANE nurses. These examinations are time consuming, highly invasive and often re-traumatizing for victims. The specialized training SANE nurses receive – and the fact that nurses who have received the training generally do so out of a desire to help victims – increases the likelihood that the trauma of the exam is minimized and that victims receive compassionate, responsive care.

State law requires that healthcare facilities that offer emergency services provide these exams at the request of patients who present with a complaint of rape or sexual assault. That means that physicians and nurses who lack SANE training must perform the exams if a SANE nurse isn’t on staff or on call. Yet we know from the regional rape crisis centers that there is sometimes confusion by hospital staff over the requirements and that ER physicians generally don’t want to conduct these exams because they are so time consuming. In the worst-case scenarios, hospitals have wrongly turned victims away or made them wait up to six hours to be seen. For victims who haven’t showered or changed clothing, this only adds to their trauma.

We believe the SANE-ready designation has the potential to go a long way toward improving the care sexual assault victims receive. It is modeled after the stroke designation implemented by the Legislature via Senate Bill 1 in 2010. Prior to the passage of that bill, Kentucky had about a dozen primary stroke centers. According to the American Heart Association, we now have 21 primary stroke centers, three comprehensive stroke centers and one acute stroke center – and EMS know where those centers are located. Time is of the essence in treating stroke victims, and the rate at which the lifesaving, clot-busting drug is administered has more than doubled.

Time also is of the essence when treating sexual assault victims. We know they are the most vulnerable in the hours immediately following an assault, and they may change their minds about reporting the crime and seeking the care they need. We also know that mental health and other medical problems develop or are exacerbated for far too many victims of sexual assault, turning them into heavy utilizers of our healthcare system down the road. They are 26 times more likely to abuse drugs, 13 times as likely to abuse alcohol, six times as likely to suffer PTSD, four times as likely to contemplate suicide and three times as likely to suffer from depression.

We believe that hospitals have a unique opportunity to partner with victims’ advocates in providing high-quality, responsive care at the outset, as well as prevention, early detection and treatment of other medical issues. KASAP believes that begins with compassionate, dedicated SANE nurses who are available 24/7. We are hopeful that many of the state’s acute care hospitals will bring SANE nurses on board and seek the SANE-ready designation.

Eileen Recktenwald is the executive director of the Kentucky Association of Sexual Assault Programs.