RADFORD — Police investigators knew it was not an optimum situation: There was a good chance that sexual assault victims in the New River Valley who reported their attacks would be told to go home and come back hours later.
In the meantime, they probably would have been asked not to shower, not to brush their teeth, not to wash their clothes — possibly even asked not to eat or drink or use the bathroom.
It wasn’t how local law enforcement agencies wanted to conduct investigations, but without forensic nurses available to examine victims and collect evidence, they didn’t have much choice.
Christiansburg police Lt. Randy Bonds said investigators would frequently be forced to send victims home until a forensic nurse was available at any of the area hospitals. If they could find one somewhere in Southwest Virginia, the victim would be taken to that hospital — even if it was hours away.
“To try to tell someone who’s made the step to come forward and report a rape or sexual assault, ‘Hey we can’t do anything for you tonight, you have to come back tomorrow,’ it just puts them back through that trauma again,” Bonds said.
But since Jan. 1, no matter what day and no matter what time, police departments in the New River Valley have been able to get victims in front of forensic nurses right away.
Carilion New River Valley Medical Center near Radford now has coverage 24 hours a day, seven days a week. Four forensic nurses are on staff, with at least one typically on-site during the weekdays. And there is always someone on call.
“We have a one-hour response time,” said April Bennett, the coordinator of the forensic nurse program at Carilion NRVMC. “So if [Bonds] calls us and says, ‘I have a patient I’m sending your way,’ then we start in at the same time.”
In the first four months of 24/7 coverage, the forensic nurses had 91 cases, including consultations, which can be over the telephone or involve reviewing photographs without actually examining the patient, Bennett said.
Bonds said Carilion’s decision to provide this service affects how quickly law enforcement can collect potential evidence. But the greatest benefit, he said, is for the victim.
“If I were in that situation or my kid was [at the police department] at 10 o’clock at night, and I was told to go drive to Franklin County … for Carilion to step up and provide the New River Valley with this is a big deal,” Bonds said. “For a victim, even driving to Roanoke a lot of times is traumatic. They’re here already, and they don’t want to leave and start all over again.”
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Only one out every 10 hospitals in the country has a sexual assault nurse examiner program, said Kim Day, a spokeswoman with the International Association of Forensic Nurses.
Carilion NRVMC has a comprehensive forensic nurse program — meaning their forensic nurses see more than just sexual assault patients. The nurses see patients who have suffered from domestic violence, child abuse, child neglect, elder abuse, assault and battery — anything related to violence.
Even fewer hospitals have comprehensive programs, Day said.
“In urban areas, it might not be difficult, but in rural areas, finding a program might not even be an option,” Day said. “For your community to recognize that they need those services for people so they don’t have to travel is really admirable. For the hospital to make the investment, train the staff and recognize that there is a whole patient population that they have not been serving up to their standards.”
Only two comprehensive programs in the state are listed on the International Association of Forensic Nurses website: Carilion — at both the NRVMC and Roanoke locations — and Lynchburg’s Centra Health. Programs must voluntarily list themselves on the website, so it is not necessarily a complete index, but Bennett said she does not know of any others in this part of the state.
Although Carilion in Roanoke has a comprehensive program, it does not provide 24/7 coverage. It’s difficult to determine how many hospitals in the state provide that kind of coverage, even if only for sexual assault patients, but Bennett said she is unaware of any other hospitals in the area that do.
The forensic nurse examiner program has operated at NRVMC since 1998, but 24/7 coverage began in January after pleas to the hospital administration.
Bennett said the forensic nurse group asked for a stakeholders meeting and invited local police chiefs, sheriffs, investigators, representatives from social services and hospital representatives from both LewisGale hospitals in the New River Valley. After that first stakeholders meeting, the administration understood that the need wasn’t being met anywhere in the area, Bennett said.
A second stakeholders meeting was held — this time with commonwealth attorneys also invited — to update everyone on the changes that had been implemented in response to the first meeting.
Having a forensic nurse program is not a moneymaker for a hospital. The state Criminal Injuries Compensation Fund helps pay for sexual assault exams, and the state Department of Criminal Justice Services partially funds the one full-time forensic nurse on staff and some of the equipment the nurses need, Bennett said.
Day said another reason forensic nurse programs are so rare is that it’s difficult work.
“There’s a shortage of all nurses, but definitely forensic nurses,” Day said. “When someone comes in to have a baby, it’s something that has a good outcome. But [with forensic nursing] it’s always a bad beginning that brings people in. I think that people are not necessarily informed, and they think it’s like CSI on TV, and it always is that the good guy wins and the bad guy goes to jail. But it does not happen that way. And that can burn people out quickly.”
Many hospital administrations don’t think they need forensic nurse programs because they don’t have “that type” of patient, Day said.
“They don’t see huge numbers because people won’t come in and say that’s why they’re there,” she said. “They come in for STDs or emergency contraception or another injury, but won’t talk about what happened. Having these programs will help because people will be educated in the community and know they can go for those services and that they’re free.”
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All four of NRVMC’s forensic nurses — one full time, two part time and one flex time — have completed training classes involving both adult and pediatric patient care. The nurses had to do one year of clinicals and have to complete a minimum of 24 hours of training each year.
The forensic nurse’s job is to take care of the patient — whether victim or suspect — and the patient’s physical, mental and emotional health. While doing so, forensic nurses collect evidence that may paint a clearer picture of what happened during the violent confrontation.
If Bennett is treating a child with an injury, an investigator or a representative with social services might go into the child’s home and take photographs to send to her. That way, she can see if anything inside the home matches the pattern on the child — helping police figure out exactly how the child was injured.
“We look at all [patients] the same,” Bennett said. “It’s just that we have to have a search warrant for some of the suspects. But our goal is not just to prosecute, but sometimes it can also exonerate. If you have a suspect who does a PERK (Physical Evidence Recovery Kit), that can help exonerate him or her, as well as helping prosecution.”
The way a patient ends up at the hospital can vary. Someone might go to the police department to report an incident and then be brought to the hospital. Social services may be involved. Suspects might be brought in after an arrest, come in voluntarily or be taken there after being served a search warrant. Sometimes, Bennett said, people just walk into the emergency room.
Once at the hospital, an emergency room doctor does a medical evaluation on the patient before the forensic nurse begins the three- to six-hour exam.
The forensic nurse gets a history of the event from the patient, does a head-to-toe exam, takes several photographs, uses alternate light sources to look for bodily fluids and then starts with the PERK collection, which typically takes about an hour. The forensic nurse then talks to the patient about medications, including preventions for pregnancy, sexually transmitted infections and HIV. The forensic nurse talks to the patient about whether it will be safe to return home and gives the patient the numbers he or she might need for law enforcement, social services or resource centers.
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Although the makeup of their patient population has changed over time, Bennett said child abuse and neglect cases are “up tremendously.”
Recently, the nurses are seeing a lot of children who have been in contact with methamphetamine laboratories.
“It could be child abuse with neglect or it could be child abuse with the drug in their system,” Bennett said. “We will collect their urine for the drug testing, and we go back to the safety planning — before anyone goes home, we find out where they are going, if they have a safe place to go home to.”
Child abuse also comes in the form of sexual and physical assault, Bennett said.
“But a lot of times it does all relate back to the drugs,” she said. “Whether meth lab or physical or sexual.”
With their adult patients, Bennett said, the nurses see sexual assault cases more than domestic violence. It’s still difficult to encourage people to report incidents of domestic violence, she said.
Something she thinks is even more frequently underreported in the area is elder abuse.
“How do you go from dealing with an 88-year-old abuse patient to an 18-month-old patient in the same day?” Bennett said. “And how do you flip back and forth between the emotions this family has versus the emotions that this family has. So that’s probably the hardest part.”
Now that they can expect to work together, both Bennett and Bonds said their jobs have gotten a little easier.
“The investigators know all the forensic nurses. We have a relationship with them,” Bonds said. “When we come in and the victims can see us interacting, calling each other by first name, it helps put them at ease a lot, too. We’re at meetings together all the time. We get to know each other so you know what the other person is expecting out of you.”
Bonds said investigators no longer have to spend valuable time calling hospitals in an attempt to locate a forensic nurse. The NRVMC is their go-to place, and that has “increased our chances of having a successful investigation.”
“Every second that goes by, you could be losing potential evidence,” Bonds said. “A lot of times a sexual assault or a rape won’t be reported to us right away. A lot of times the victim will sit around and think about it, talk to friends, and they may come back 12 hours, 24 hours later. We’ve got a specific time frame we’re looking at for the evidence to be viable.”
Having medical personnel that he can rely on day or night helps him better understand the case from the beginning, he said. The sooner evidence is taken, the more quickly law enforcement can start sorting out what happened.
“It used to be that the forensic nurses did their thing and we did our thing,” Bonds said. “Now we’re looking at it all together, to better the case. It’s become more of a team.”
It’s always a bad beginning that brings people in. I think that people are not necessarily informed, and they think it’s like CSI on TV, and it always is that the good guy wins and the bad guy goes to jail. But it does not happen that way. And that can burn people out quickly.”