GREENFIELD — When a victim of sexual assault arrives at Hancock Regional Hospital’s emergency room, their bumps and bruises are treated; but if a patient needs a rape kit, they are referred to a facility about 25 miles away.
Often, they drive themselves.
Local doctors say sexual assault reports are so infrequent in Hancock County — there were seven made at the hospital last year — that they worry they don’t maintain the level of expertise needed to give a rape exam. They refer patients to a sexual assault treatment center in Madison County to assure victims receive the best care, they say.
It’s not an uncommon practice, but some members of local law enforcement worry that protocol puts additional stress on those already suffering great emotional trauma, while also risking a loss of evidence — or a victim changing their mind — on the way to get follow-up care.
Building a case
Locally, after victims receive treatment for any injuries, they are given the address of the Madison County Sexual Assault Treatment Center and the name of a victim advocate, who arranges to meet them there and walk them through the process.Not every victim goes immediately to the center. In January, a rape victim told police she couldn’t make the one-hour round trip; she was starting a new job the next morning and worried she’d be fired, court records state.
She stayed at the hospital to receive stitches and talk to police, but the exam had to wait. She scheduled an appointment at the center for the following day after work.
That delay, Prosecutor Brent Eaton said, can damage a criminal case. The chances of DNA evidence being lost increases over time; the best evidence is collected within hours of an assault, he said.
“Good evidence makes for good prosecution,” Eaton said. “The closer in time we (get) the evidence, the more it’s going to tell us.”
Specialized care
Hospital officials want victims of a sexual assault to receive an expert’s care, said Rob Matt, Hancock Regional’s chief operating officer. The emergency room doctors strive to treat a victim with the utmost dignity and respect, and provide them with the best initial care possible but then refer them to a specialist, he said.The Madison County Sexual Assault Treatment Center, located in Anderson and operated by Community Health Network, is one of two freestanding facilities in the state focused on treatment for sex crime victims. A similar facility is located in Fort Wayne.
Any emergency room doctor is certified to administer a rape kit, but because the exams are meant to gather evidence to be used in court, they are long and tedious, said Holly Renz, the director of the Madison County Sexual Assault Treatment Center. The process can last longer than three hours — usually more time than a busy emergency room physician is able to dedicate to one patient, Renz said.
Madison County’s treatment center has a nurse certified in sexual assault examinations on call 24 hours a day, seven days a week. And that person’s sole focus is to administer rape kits, which can be performed up to a week after an attack, Renz said.
Differing guidelines
Madison County’s center has treated about 50 patients, including three from Hancock County, so far this year. Four Hancock County residents were referred to the center in 2014. Five went for treatment there in 2015.Hospitals in 22 of Indiana’s 92 counties send their sexual assault patients to one of the state’s two freestanding facilities, according to treatment center records. Three more counties refer their patients to Floyd Memorial Hospital, which employs a large team of certified sexual assault nurse examiners in the southern part of the state, according to the Indiana Coalition Against Domestic Violence, which tracks where patients are sent for care.
Henry County Hospital, for example, transfers all sexual assault patients to the Madison County center; while hospitals in Rush and Shelby counties employ their own sexual assault nurse examiners.
If a sexual assault patient comes to Rush Memorial Hospital, its specially-trained nurse is called to perform the rape kit examination, said Carrie Tressler, vice president of nursing. If that nurse is unavailable, the emergency room doctor does the rape kit.
Major Hospital in Shelbyville has three sexual assault nurse examiners on staff, said nurse Valerie Miller. In the rare case one of them is not available, the victim is referred to Franciscan St. Francis Health in Indianapolis.
Hancock Regional Hospital used to employ a sexual assault nurse examiner, but that was phased out in recent years in an effort to provide specialized care, Matt said.
‘You are the crime scene’
The Madison County Sexual Assault Treatment Center is located on the campus of Community Hospital Anderson. The facility shares space with Alternatives Inc., which specializes in advocacy for victims of domestic violence and sex crimes and runs a domestic violence shelter. It’s common for victims to be helped by both organizations once they arrive at the doorstep, officials said.Evidence collection is careful work, and rape kit examinations can average five hours, Renz said. Every inch of a victim’s body is inspected, and all injuries are photographed and documented.
Kelly Buzan, a victim advocate for Alternatives whose office is based at the Greenfield Police Department, often accompanies patients to these appointments.
Buzan ushers them through the process after an initial report is made at the hospital; she often sets up appointments at the treatment center for the victims and reminds them not to shower, brush their teeth or change their clothes before they arrive.
“With this sort of crime, you are the crime scene,” Buzan said. “You carry all the evidence.”
But patient care at the center goes beyond evidence collection, Renz said. There is an informal counseling element as well; nurses at treatment centers are able to give each victim undivided attention, to assure them they are safe, healthy and will recover, she said.
Reassuring victims
When a victim has a rape kit collected in an emergency room, there is a risk the doctor could be pulled away to help a patient with more critical injuries; at the center, a nurse is never pulled away, Renz said. They take the time to talk with patients about their bodies, walk them through every moment of the exam and also educate them about additional resources for victims.Law enforcement officers tout that specialized care when encouraging victims to follow through with treatment, said Detective Sgt. Bridget Foy, who handles most sexual assault cases reported to the Hancock County Sheriff’s Department.
Because a medical professional is always available to assist, officers can assure a victim the drive is worth it, she said; that they will be helped promptly, and the exam will be conducted in a way that will stand up in court.
But there is always an underlying concern: what if the drive will seem overwhelming for a victim, who, already traumatized and scared, will decide they would rather go home, Foy wonders.
It’s happened before, Buzan said. In some cases, victims plan to follow Buzan for the 35-minute drive from Greenfield to Anderson. She knows several victims over the years who have turned around and gone home.
Lingering concern
Eaton, who campaigned for prosecutor on the promise to provide better care for victims, said his team met with Hancock Regional Hospital staff soon after he took office in January 2015. Amid a wealth of conversations about the relationship between the prosecutor’s office and the local hospital, the facility’s sexual assault patient protocols came up, Eaton said.Eaton said he respects the hospital’s leaders for doing what they believe is best. He also recognizes that sexual assault victims are already traumatized when they come to the hospital and wonders whether requiring them to drive elsewhere for additional care adds to their burden.
“If it was my daughter, … I’m going to be so infuriated that we have that gap in our system,” Eaton said. “I think that’s probably a reaction a normal person who is protecting their family will have. Once it happens to them and they have to live through it, … they probably would be really frustrated or upset.”
But the hospital is doing what it believes is best for victims, said Matt, who recalls the meeting with Eaton. Referring someone for specialized care, no matter what their medical needs might be, is the best service the hospital can provide any patient, he said.
“We believe we are doing the best for the patient under the circumstances,” Matt said. “We would be doing something different if that weren’t the case.”
Buzan echoed those sentiments. Madison County’s center is the best option for thorough evidence collection in the area, and, like Foy, she tells victims they’ll receive specialized treatment there.
“Wouldn’t you want to go where you’d receive the best care?” she said.
Similar situations
One of the benefits of utilizing a specialized treatment center is the guarantee patients will see a healthcare professional who regularly performs exams that must be done flawlessly to hold up in court, said DeKalb County Prosecutor ClaraMary Winebrenner.Victims in DeKalb County are referred to the Fort Wayne Sexual Assault Treatment Center.
“We have smart people here (at our hospitals),” Winebrenner said, “but you’re not going to compete with the volume they have in (Fort Wayne). Our rural county hospital can never have the same experience in (treating victims of sex crimes).”
Wesley Schemenaur, Jay County’s prosecutor, said officials in Jay County opted to use the Madison County Sexual Assault Treatment Center for similar reasons. Doctors and nurses at the local hospital don’t perform rape kit examinations regularly enough to stay practiced, he said.
But Schemenaur admits he has concerns about the protocol, which he admits isn’t perfect.
Law enforcement officers do their best to encourage victims to make the one-hour drive to Anderson, but he knows that can be a burden, he said.
And if a victim can’t visit the center immediately, he added, the arrangement could hinder the ability to collect good evidence — the kind that helps put their attacker away.
Leading change
Since Eaton took office, he said he has been working to standardize protocols for dealing with sexual assault cases.Currently, the county has no formal system for tracking reports of assault, and an effort to start a Sexual Assault Response Team in 2011 never got off the ground. Efforts to resurrect such a team, which would take the lead on sexual assault investigations, are ongoing, Eaton said.
Deputy Prosecutor Georgeanna Teipen, who joined Eaton’s staff last fall, will have a key role in that effort, as she specializes in prosecuting crimes against women and children.
As the prosecutor’s office works to create guidelines for handling sexual assault cases, Teipen will seek victims’ input, she said.
She’ll use their experiences as a measuring stick, she said, to identify gaps in current protocols and gauge if changes need to be made.
Mimi McKee, a leader of the Hancock County Coalition Against Domestic and Sexual Violence, said the organization was started a year ago to help bring attention to domestic and sexual issues in Hancock County and lead the implementation of a coordinated response to such crimes.
The organization hopes to standardize how sexual assault cases are handled in the county, from initial report to prosecution, McKee said.
Their effort to improve local response to sex crimes is still a work in progress, McKee said. The organization hopes to see total sexual assault care provided locally, she said.
“Maybe one day,” McKee said.