SALEM —“I’m an Oregonian and I had to cross state lines to get help after I was raped,” said Jessica Garcia. “I went into the hospital and was turned away.”
In 2014 after experiencing one the most horrific, traumatic events in her life, Garcia was told by staff members of an urgent care facility in Brookings that there were no Sexual Assault Nurse Examiners (SANE) there who could help her.
In Oregon, SANE nurses are specially trained to perform medical-forensic examinations, also known as SAFE kits, on patients who have reported a sexual assault.
The kit, which collects and preserves biological evidence, includes gathering hair samples with follicles, swabs from body cavities and other places as well as clothing survivors are wearing and other related items.
As she walked away from the urgent care facility in 2014, Garcia was tasked with having to find a SANE nurse in the area who could perform the examination she needed.
“At first I wasn’t even going to go in,” she said. “I just didn’t want anyone to know and was too embarrassed. I thought about just going home and forgetting all about it, but it isn’t really something that you can easily forget.”
After making numerous phone calls and contacting the nearest acute-care hospital, which in this case was Curry General Hospital in Gold Beach, Garcia learned at the time there were no SANE nurses qualified anywhere in Curry County to perform the examination.
She would have to either travel to Grants Pass, a round-way trip tallied at over four hours long, or to Coos Bay, also tallied at over four hours long, to undergo a SAFE examination. Garcia said she choose to go to a hospital in Crescent City, Calif., which was a 30-minute one-way drive to see a nurse.
“I wanted to do the exam as quickly as possible,” she said. “I have children to care for and I didn’t want a lot of people knowing about it. I just wanted to get it over with.”
For over 12 hours, Garcia spent travelling, undergoing the examination, filing a report, interviewing with numerous law enforcement officials, health care personnel and a sexual assault advocate. Having crossed state lines, she dealt with a number of different law enforcement agencies and was asked to repeat her story over and over.
“It was exhausting,” said Garcia. “I later learned my rapist (who decided to harm himself) was bleeding out when officers arrived to arrest him was able to get care whereas I was turned away. I know they were just doing their job, but I thought to myself this isn’t right. If this is happening here in Curry County where else is it happening and what can I do to help fix this?”
New law ensures victims get help
Last fall, Garcia reached out to a number of elected officials and staffers at the state capitol with the hopes of expressing her concerns and enacting change. She was directed to the offices of her local district representative, David Brock Smith (R-Port Orford).
“She explained everything to me and all that she had undergone,” said Brock Smith. “I knew immediately that I had to do whatever I could to help.”
Brock Smith and Rep. Cedric Hayden (R-Roseburg), who were the chief co-sponsors of House Bill 2375, introduced to the 2019 Oregon Legislature a bill that would require district attorneys in each county to include a sexual assault nurse examiner or hospital representative to their sexual assault response teams (SART).
The bill, which is an amendment of ORS.147.401 which was passed in 2017, now calls on a representative of a hospital to join the team even if they do not have a SANE nurse on staff.
“The hope and goal is to make sure every hospital in the state makes it a priority to have a SANE nurse on shift 24/7,” said Brock Smith. “We don’t want anyone to go through a situation where they are turned away after the most horrible experience in their life.”
The addition of the hospital representative will ensure that hospitals statewide adopt protocols addressing response of sexual assault victims. Nicole Broder, the SANE coordinator with the Oregon Attorney General’s Sexual Assault Task Force, said the state found a number of hospitals without SANE nurses not participating in the SART team at all.
As a result, Broder said there was a gap in patient services and support for sexual assault victims looking to undergo a SAFE kit exam. It put the burden on finding services on the patient, she said.
“Once a victim comes forward we want them to feel supported and to be really guided to whatever decision they’ve chosen to make as far as what services they want to seek out,” said Broder. “One of the difficult things to balance especially in smaller communities is trying to get survivors of sexual assault services within their own community and with as few barriers as possible.”
The bill, which passed in May, will help hospitals stay up-to-date on best practices as well as improve on their knowledge of resources and transfer protocols.
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“Again, we really want to keep the burden off of patient’s shoulders and make the process as smooth, efficient and easy as possible,” said Broder. “We know that rural care is a challenge not just in Oregon, but across the country.”
SANE nurses in rural communities
The Oregon Sexual Assault Task Force oversees the certification of SANE nurses across the state, said Broder. In order for interested nurses to become certified, a number of requirements must be met including completing 40 hours of didactic training, maintaining 16 hours a month of relevant active clinical patient care, completing 10 pelvic speculum exams as well as completing three sexual assault medical forensic exams, joining a ride-along with local law enforcement and observing a criminal court case to name a few.
The certification process is extensive, said Broder. The task force is working on providing more trainings and assistance programs to help encourage nurses in rural communities to at least begin the process and become SANE-trained, which is someone who has completed the minimum 40-hour basic training.
According to ORS.147.403, all hospitals, emergency medical service providers and a number of care facilities in Oregon shall adopt policies for the treatment or referral of acute sexual assault patients.
“By law the hospital is only required to provide a medical screening exam to patients,” said Bay Area Hospital’s Emergency Department Director and SANE-certified nurse Rebecca Davisson. “The forensic piece of it hospitals are not required to do.”
At BAH, the SAFE kits are only administered by SANE-certified nurses, said Davisson. As of now, the hospital has four SANE-certified nurses and three currently undergoing training.
“Our issue has historically been getting nurses interested in becoming certified,” said Davisson. “A lot of people who began the process oftentimes didn’t finish the training for whatever reason.”
So far this year, BAH has performed approximately seven SANE exams which include patients locally and from up and down the Oregon coast. In the past, Davisson said she’s helped patients from as far away as California because she was the only available SANE-certified nurse in the area.
Sandra Lucatero, a SANE-certified nurse at BAH, added for the longest amount of time the exams were done primarily by Davisson and herself as they were the only two certified nurses who could administer the exams.
“We don’t want a patient to leave a facility they go into to seek services,” said Lucatero. “It’s hard enough to get them to come in the first place…if those services aren’t there they may not go back. So, we try our best to take turns and be available when we can.”
She also added patients are told not to change clothes, bathe or talk to anyone that might interfere with the evidence that is collected during an exam. It can be further traumatizing to be in the state waiting until you can get help, she said.
In July 2017, Curry Health Network added a SANE-certified nurse to its hospital in Gold Beach. The hospital has also contracted the services of an additional SANE-certified nurse to respond when needed, said its Chief Executive Officer Virginia “Ginny” Razo.
According to Razo, the hospital is working on conducting an assessment around the region to better understand the issues surrounding the lack of SANE-certified nurses in the area. She said she hopes to have it completed later in the year and will use it as a guideline to improve its SANE services.
Looking toward the future
Now that the bill has passed, Garcia said she is redirecting her efforts to expanding this type of legislation to other states with the hopes that they adopt similar actions. She also wants to work on initiatives that help law enforcement officials better their interviewing skills with a more compassionate approach.
“I want to take what I’m working on here and just go out and find someone in each state that can use their voice like I did mine,” said Garcia. “One of the things I learned out of this whole situation is it is crazy insane how powerful one’s voice can be.”
Garcia said she could not do what she did without the support of her friends, family and numerous people along the way that helped make the bill a reality. She is hoping to continue her work at the capitol by advocating for a new bill giving victims of sexual assault the option to have their trails be open or closed to the public.
“It’s really hard to put in words how I feel right now,” said Garcia. “I think looking back it’s almost like holding your breath and then all of sudden you get to breathe. You can’t turn something that’s so evil into something that’s suddenly all good, but you can make something good out of it.
"I thought if I could use my voice and try to help someone else that maybe it can start the healing process for me and it has.”