Rape victims seeking help during the night in Anchorage must wait hours for a forensic exam because the Providence health system is short of the specially trained nurses needed.
Delays can mean lost evidence and more trauma for victims who may be told not to shower, change clothes or even eat and drink, according to prosecutors and advocates.
On Oct. 1, Providence stopped doing rape exams between 6 p.m. and 7 a.m. because the number of trained sexual assault nurse examiners is down by half, from 16 to eight, according to Jennifer Meyer, clinical nurse manager for Forensic Nursing Services of Providence.
The specialized nurse shortfall dates back at least a year, she said in an emailed response to questions. Providence tried to fill the need for rape exams with the smaller crew but that proved too much of a strain.
"The decision to temporarily close overnight service was a difficult one and was postponed as we recruited for open positions and used alternate staffing solutions," Meyer said. "Ultimately, these solutions were not sustainable."
Providence is recruiting nurses and already has hired two new ones with forensic experience who will start next month. It hopes the problem will be resolved by Feb. 1, if not earlier, Meyer said.
John Skidmore, who oversees prosecutors around the state as director of the Department of Law's criminal division, said his concern for now is for victims as well as for the evidence. The message is the wrong one, he said.
"Jeez, you're raped in the middle of the night. Well, sorry, we don't have anyone available but if you could just do us a favor and not shower, don't change your clothes, stay in that condition for the next X number of hours, we'll be happy to see you just as soon as we can in the morning."
Victims often don't report sexual assaults right away as it is, said Amanda Price, executive director of Standing Together Against Rape, or STAR. Now the response system itself is adding another 13 hours of delay.
"Every time they shower, every time they use the restroom, every time they wash their hands or their face or their body, evidence is eroded," Price said.
Even eating or drinking can damage evidence, depending on the nature of the assault, said Lauree Morton, executive director of the state Council on Domestic Violence and Sexual Assault.
"That's just not right," making victims wait 12, 15 hours, Morton said.
So far, the overnight shutdown hasn't hurt investigations but the risk of critical evidence washing away is real, said Sgt. Paul Padgett, who supervises the Anchorage Police Department's special victim unit.
"To my knowledge, it hasn't affected cases yet but there is the potential that, absolutely, it could," Padgett said.
Since the change, Padgett said he was aware of at least two women who reported a sexual assault during the night and both agreed to come in during the daytime hours for an interview and exam. Others made their reports late enough in the morning that they only had to wait a few hours for a nurse to arrive, he said.
Evidence such as semen doesn't degrade or grow stale but simply can be lost over time. Padgett said samples can be collected as long as four days after an assault.
Since the month isn't complete, he only had partial numbers but said that as of Oct. 23, he had assigned 17 rape reports for investigation. In recent months, the number of rapes reported in Anchorage has fluctuated from 35 to 44, though not all end up meeting the criteria for investigation, Padgett said.
Between January and August, about 60 percent of the exams were done during the daytime shift, Meyer said.
Like a number of communities around the state, Anchorage has committed to a Sexual Assault Response Team, a threefold response to rape reports that involves an advocate, law enforcement and a nurse. The team works out of the same university-area building that houses Alaska CARES, a clinic for children reported to have suffered sexual or physical abuse.
Since 2008, Providence has provided the nurse exams. Its annual budget for forensic nursing is about $700,000, which comes from the Municipality of Anchorage, Southcentral Foundation and Providence Alaska Medical Center, Meyer said.
Two part-time Providence nurses trained in sexual assault exams share a full-time slot and are supplemented by a cadre of on-call nurses, Meyer said in the email interview. The on-call nurses work elsewhere, usually for the hospital, and during their off time take two 12-hour on-call shifts every two weeks for sexual assault exams, she said.
The team also serves the Mat-Su, which is working to get one of its own, both Price and Morton said. A number of communities already have their own teams, including Homer, Fairbanks, Kenai-Soldotna, Bethel and Dillingham. Juneau is working to create one, as is Cordova, Morton said. The council is conducting a week-long training for team members or would-be members, including nurses, in Kenai in November and again in March in Juneau.
Skidmore said teams typically rely on on-call medical professionals to activate around the clock.
"I've worked in Kenai, I've worked in Dillingham, I've worked in Bethel," Skidmore said. "When I worked in those places, we, meaning the team, knew how to get a hold of the medical provider."
With that multidisciplinary approach, a victim is spared having to repeat the story time and again, and one team member may draw out information that others didn't think of, said Skidmore and others.
While advocates and detectives still can respond in the middle of the night, all three need to do so for the approach to work, Price said.
In Anchorage, patrol officers now are handing out cards explaining how to make arrangements for an exam and advising victims not to shower or change clothes, and to save items that could contain evidence, such as sanitary napkins.
Victims who make reports during the night generally are being seen at 7 a.m., Meyer said. If they need medical attention, they can get that right away at the emergency department, she said.
Advocates, police and prosecutors say they are trying to help Providence find a solution even before February. Morton suggested having the nurses who now do exams of children also conduct the adult exams. But their training and skills are different, Meyer said.
Reach Lisa Demer at firstname.lastname@example.org or 257-4390.