By Emily Younker
Globe Staff Writer
JOPLIN, Mo. —
Ashley Qualls became active in a group that promoted sexual assault awareness while she was in college.
Ever since then, she has wanted to help victims of sex crimes.
“To me, rape is one of the worst situations a woman could ever be in,” she said. “Rape is a crime almost where they kill you and ask you to get up and keep living somehow.”
Click here to learn more about the Sexual Assault Nurse Examiner program.
One in six American women and one in 33 men has been the victim of an attempted or completed rape in their lifetime, though up to 60 percent of such crimes go unreported, according to the Rape, Abuse and Incest National Network.
Qualls, an emergency room advocate with Lafayette House, said the problem is a societal one.
“I think our society is really bad about turning away from the victim,” she said. “It’s a lot easier to believe that a woman was just promiscuous and chose to have sex with somebody and just denies it later.”
Qualls now finds herself as part of a local group of nurses, law enforcement officers and advocates from Lafayette House working to help sexual assault victims through a treatment and assistance program launched in 2009.
The Sexual Assault Nurse Examiner, or SANE, program requires participating nurses to complete 40 hours of training designed specifically for sexual assault cases and includes lectures, clinical components and courtroom observation time, said SANE coordinator Karen Scott.
‘Chain of custody’
Nurses are trained in forensic examination, which can include photographing injuries; collecting clothing, fingernail, blood or urine samples; conducting a pelvic exam; and maintaining the “chain of custody” to ensure that the evidence is properly taken care of and delivered to law enforcement, Scott said.
Victims seeking treatment are taken into a private exam room, where one nurse will spend up to six hours with them, completing the forensic exam, treating any medical needs and following up with law enforcement and Lafayette House, a local organization for abused women and children.
The process of SANE is the same for male and female victims; victims younger than 18 are referred to the Children’s Center for care and treatment, Scott said.
Freeman Health System began the program in 2008, launched it in April 2009 and subsequently applied for a grant from Missouri Foundation for Health to help with funding. That grant, totaling $150,000, was awarded in September 2009.
Scott said the grant helped expand the program, going toward the purchase of a colposcope — a magnifying camera designed to take pictures inside the vagina or rectum — as well as a black-light lamp that illuminates fluids on the skin. The grant has also funded the training for the hospital’s eight SANE nurses.
Scott, who has worked most of her 15 years at Freeman in the emergency room, said the SANE program provides a streamlined approach to helping sexual assault victims.
“I saw so many instances where this was just such a terrible way to handle these types of situations,” she said, referring to the way victims often had to wait hours in the waiting room to eventually be seen by several different physicians and nurses. “We just tried to make it more comprehensive as opposed to (the victim being) another ER patient.”
Since the program began in April 2009, SANE nurses have treated 57 victims, up from the average of 25 sexual assault cases that the hospital saw annually in years past, Scott said. For the year funded by the grant, which began in September and runs through August, staff expected to treat 30 victims and have instead seen 41 so far, she said.
“We’ve had significantly more than we thought,” she said. “I don’t think there are more (rapes) now. I just think more people are coming forward.”
Stigmatized crimes
Qualls said many people are uncomfortable talking about rape or showing support to the victim, which can lead to the revictimization of the individual through the questioning of her story.
“It’s the only crime where we question the victim that way,” she said. “Nobody looks at somebody whose house was robbed and asks, ‘Why weren’t you at home?’”
Amy Lane, assistant director of community services at Lafayette House, said such stigmas can sometimes lead the victim to believe that it’s her fault she was assaulted, a myth that Lafayette House staff work to dispel.
“There’s still, ‘What did she have on? What was she wearing? How much was she drinking?’” she said. “In all those cases, it doesn’t matter. Rape is wrong; no is no.”
Lafayette House volunteer emergency room advocates are called by Freeman when a victim comes in seeking treatment, Lane said. The advocate provides support for the victim, friends or family, and she also informs the victim of her rights and the resources that Lafayette House provides, such as counseling and shelter services.
Lane said she thinks the SANE program has helped Lafayette House provide aid to more sexual assault victims.
“There are a lot of good steps in place to make this as easy as possible for the victim,” she said. “Now our number of calls (to the emergency room) has definitely gone up; I think we’re reaching more victims than before.”
Prosecution difficult
Just as there is a discrepancy between the number of sexual assaults that occur and the number that are reported, there also remains a discrepancy in the number of sexual assaults reported and the number of arrests or convictions in connection with those crimes.
In 2008, the most recent year for which data is available, there were 1,605 reported rapes in the state and 569 arrests for rape, according to the Missouri State Highway Patrol’s Statistical Analysis Center.
Additionally, the Rape, Abuse and Incest National Network estimates that only 6 percent of rapists ever spend a day in jail.
Locally, the numbers show similar discrepancies. According to the Joplin Police Department, 41 rapes were reported in 2009, compared to 38 in 2008 and 41 in 2007. But Dean Dankelson, prosecuting attorney for Jasper County, estimates that his office receives about one sexual assault case with an adult victim per month.
Lt. Mike Hobson said that once the police department receives a call about a sexual assault, officers review the scene of the assault for evidence and interview the victims and possible suspects. But there are many obstacles that can prevent the case from moving through the court system toward a conviction for the rapist, he said.
“Sometimes victims don’t want to prosecute, but even if the victim doesn’t want to prosecute, we still do incident reports to keep track of numbers,” he said. “Sometimes there are incidents of untruthfulness on the victim’s part. Sometimes we are unable to identify suspects.”
Hobson said his department works to identify the suspect, should the victim choose to press charges.
“This is the type of case you want to get someone on because you’ve got somebody out there victimizing the public,” he said.
Another obstacle to taking a rape through to a conviction is the nature of the case, which depends on physical evidence, Dankelson said. Prosecution of rape cases, which usually boil down to the victim’s story versus the suspect’s story, is “always difficult,” he said.
“What helps these days, and what I think this program is designed to help, is finding the forensic evidence to help support the testimony of the victim,” Dankelson said. “In cases where there is that type of scientific evidence, I think it greatly enhances the ability to prosecute those types of cases.”
Although most sexual assault victims seeking treatment end up at Freeman Hospital — some have been referred there from Lamar and Pittsburg, Kan., Scott said — other medical centers aren’t without procedures to assist victims.
St. John’s Regional Medical Center in Joplin requires nurses, primarily those who work in the emergency room, to go through an orientation process in which they learn how to use rape examination kits, said Drew Alexander, emergency room director.
A physician will collect physical evidence from the victim, he said, and a nurse will help document injuries, package the evidence and deliver it to law enforcement, he said. After medical needs are met, St. John’s directs victims to the Lafayette House, various churches or local health departments for additional support and services, he said.
Qualls said she has had nine calls from Freeman Hospital since she began as an emergency room advocate in October. Each time, she has offered her comfort and support to the victim and provided resources to help the victim cope afterward.
“Just being able to give those resources to them is very helpful,” she said. “I think having somebody there in the hospital with them is a good thing. They need to have somebody there to be a true support for them.”
