GREENFIELD — Hancock Regional Hospital officials have announced changes to patient care amid debate over procedures for handling victims of sexual assault.

The hospital’s policies for dealing with rape cases — specifically the practice of sending victims out of county for sexual assault exams — recently drew criticism from local law enforcement, prompting hospital officials to reevaluate their protocols and put additional staff in place in an effort to provide better care.

Hancock Regional Hospital has for years referred local rape victims to the Madison County Sexual Assault Treatment Center in Anderson, a policy law enforcement leaders worried could deter victims from seeking help.

Hospital officials said it would be impractical to put their nursing staff through the specialized training needed to deal with sexual assault, given the low number of rape cases reported locally. But new protocols place a counselor in the emergency room to talk with victims about the options for available for treatment.

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Transportation also will be arranged for victims who choose to have their rape kits done in Madison County and gas cards provided to those who choose to drive themselves, said hospital CEO Steve Long.

Hancock County Prosecutor Brent Eaton, who met with hospital officials to discuss changing the protocols, said his staff members are happy with the safeguards the hospital is working to put in place; they hope knowledge of the services offered at the hospital will empower victims to come forward.

But leaders of the newly-formed Indiana Coalition to End Sexual Assault say they’d like to see specially-trained nurses staffing all hospitals in Indiana, and they are working with counties across the state to improve victim assistance. Though they are glad to hear Hancock County is taking steps ensure victims are helped, leaders of the coalition say they wish more hospitals offered specialized care, eliminating the need to depend on outside facilities requiring patients who have already been traumatized to drive elsewhere for exams.

“There is always a shortage of (sexual assault nurse examiners),” said Tracey Horth Krueger, the interim executive director of the coalition. “The best practice is to have nurses available in every hospital.”

Referring sexual assault victims to special treatment centers, where nurses certified in sexual assault exams are available 24 hours a day, is not uncommon. Hospitals in 22 of Indiana’s 92 counties send their sexual assault patients to one of the state’s two sexual assault treatment centers, according to facility records.

Hancock Regional officials said the hospital does not handle enough rape cases — seven were reported at the hospital in 2015 — to employ someone who is certified as a sexual assault nurse examiner.

“It’s all very contingent on volume,” Long said. “The more volume you have, the more programs you have, and the more likely you are to have that certification.”

Addressing the issue

After a story in the Daily Reporter examined gaps in local sexual assault response efforts, hospital officials called a meeting with law enforcement leaders to address the issue.In an effort to better understand the barriers victims might encounter under Hancock Regional’s existing policies, Long walked through the reporting and examination process, visiting the emergency room and making the hour-round trip to the Madison County Sexual Assault Treatment Center on the campus of Community Hospital Anderson.

Long stands by the practices of transferring patients to the Madison County center, arguing it remains the best option for evidence collection and examinations. But he admitted there were areas where the hospital could have done more for victims, he said.

Going forward, emergency room staff will classify sexual assault victims as high priority, allowing them to bypass the waiting room and be escorted to an exam room immediately. A nurse and physician will be assigned to the case, and a victim advocate and police officer will be called if an adult victim wishes to report the crime.

The hospital plans to hire an additional social worker as well as shift existing counselors to the emergency room to assist with the process, said Tammy Strunk, the hospital’s vice president of nursing. A social worker will be at the emergency department for 16 hours a day with someone on call for the remaining eight hours, she said.

The social worker will walk victims through the treatment process and talk with them about the options available for care and reporting the crime, officials said.

A local doctor can perform a rape kit, but victims still will be encouraged to visit the Madison County Sexual Assault treatment center instead for more specialized care, Long said. Social workers will arrange transportation to and from the facility, even go with victims if they desire, or offer the victim a gas card to cover the cost of driving themselves, he said.

Doctors have always been able to perform rape kits locally on victims who do not want to travel outside of the county for care — a notion that hadn’t been communicated well to local law enforcement in the past, Eaton said.

Police officers said they thought victims were required to go to Anderson, putting an undue burden on those who might have preferred local treatment but didn’t know it was available.

Changing protocols

Hospital officials and prosecutors met several times in recent weeks to discuss changing local protocols. Part of that discussion included how to better improve the relationship between law enforcement and the hospital, Eaton said.Long said he wants to assure police that help will be provided to victims locally if they do not wish to travel out of county. He worries there were instances when a victim wasn’t brought into the local hospital because they didn’t know they had the option, he said.

Local doctors, too, seemed hesitant to conduct rape examinations, fearing inexperience would hinder the criminal possess, Eaton said.

Prosecutors need strong evidence to support criminal charges against an attacker, and sexual assault nurse examiners are best for the job because they are well-practiced in the process. But cases can’t be filed if no evidence is collected at all because an overwhelmed victim decides to go home rather than make the drive, Eaton said.

“We can’t let the perfect get in the way of the good,” he said.

Hancock County does not handle enough rape cases a year for a sexual assault nurse examiner to maintain their certification at Hancock Regional Hospital, Long said.

To maintain the certification, a registered nurse must log 300 hours in three years specializing in sexual assault cases.

Those hours are not limited to conducting rape kits. They include consulting on cases, taking continuing education courses or teaching other nurses how to treat sexual assault victims, according to the International Association of Forensic Nurses.

Staff members at the local hospital don’t see rape victims regularly enough to keep up with those demands, said Theresa Lueder, the hospital’s service director for women’s and children’s care. Instead, they are doing what they can to make sure a traumatizing experience isn’t made more burdensome for a victim, she said.

“We want them to feel like a survivor,” Lueder said.

Still, state victim advocates wish even more could be done, not just in Hancock County but across the state, said Kristen Pulice, a program coordinator for the Indiana Coalition to End Sexual Assault.

The coalition was formed in October with the aim of preventing sexual assault while serving victims through advocacy and increased public awareness. In its fledgling months, staffers have started mapping out the services available specifically to sexual assault victims in Indiana. They want to identify gaps across the state and help communities fill those voids.

Pulice reached out to county leaders after hearing about the situation at Hancock Regional, she said.

Ideally, all hospitals in the state would employ sexual assault nurse examiner to aid victims, Pulice said. And facilities saying they can’t support such a hire is a frustrating notion the coalition is facing all over the state.

It’s like the chicken and the egg, she said: failing to employ sexual assault nurses forces hospitals to send patients elsewhere for treatment; in turn, seeing few patients in their own facility deters medical providers from ever earning a certification that would allow them to expand local care.

“We don’t want to see victims traveling to other areas for services,” Pulice said. “For now, if that’s what they have to do, good. It’s a small step toward the bigger picture.”

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Caitlin VanOverberghe is a reporter at the Greenfield Daily Reporter. She can be reached at 317-477-3237 or