After seeking help, rape victims in the biggest city in the largest state in the United States are being told to wait until daytime hours to proceed with the specialized medical exam necessary to build a case against their attacker. It's the result of a shortage of sexual assault nurse examiners in Anchorage, Alaska, a state where more than one out of every three adult women are estimated to be victims of sexual assault.
Rape is a violating crime, one in which the victim's body also becomes a crime scene -- a place where the attacker may have left evidence behind that can help police identify him and ultimately, hopefully, seek justice.
Nurses specially trained in the collection of this forensic evidence are part of a team of professionals with whom victims will interface in the early stages of an investigation. Sexual Assault Response Teams bring together a skilled nurse, law enforcement and an advocate so that victims only have to recount the events of their assault once, speaking with all of the team members at the same time.
Providence Alaska Medical Center is the only medical facility in Anchorage providing the exam space and nursing team for these SART exams. As of Oct. 1, it has eliminated overnight hours from its regularly staffed shifts.
"We are not doing overnight exams on cases that are triaged by law enforcement as potential ones that could wait. Our ideal situation would be to see everybody as they call and ask for help," said Jennifer Meyer, clinical nurse manager for Forensic Nursing Services of Providence.
"It's unfortunate that this is the solution that Providence came up with," said John Skidmore, Criminal Division Director for Alaska's Department of Law. Skidmore, who oversees all of the state's prosecutors, is sympathetic to the hiring and retention challenges within the specialized nursing discipline that responds to sexual assaults, but believes there may have been a better alternative than stopping overnight exams.
"I certainly described to them my concerns about the potential loss of forensic evidence, and potential re-victimization by having to have multiple interviews and sort of relive the same incident more than once. Having the victim have to repeat that several times isn't very helpful or humane," Skidmore said.
He also worries about whether law enforcement really can wait to conduct an interview with the victim until a daytime nurse can be scheduled. What if there is a scene that needs immediate processing? What if there is a dangerous suspect on the loose? These are questions police really can't wait on answers for, Skidmore said, adding that asking victims to delay a forensic medical exam "completely destroys" the team concept on which SART teams are modeled.
The idea is not to prevent exams when immediacy is necessary, Meyer said, but to delay for a few hours those exams which can wait, as determined by law enforcement. Evidence collected within 96 hours (four days) of the attack is considered valid by the state crime lab, Meyer said.
Currently, there are no overnight exams. To make do, Meyer is on the phone daily at 6 a.m., speaking with the Anchorage Police Department's Special Victims Unit. If a victim came forward overnight, she's told about it and then makes contact and arranges an exam time.
Eliminating overnight exams was a difficult decision, but the right one, Meyer said. In the last year, her staff of 16 nurses dwindled to just eight part-time nurses, too low to keep around-the-clock shifts without risking burnout and seeing the ranks thin even more. It's difficult work, something people do because they are either passionate about it or want something extra to do, Meyer said.
"Those people in this market and this economy are harder and harder to find," she said.
Providence's exam center, which runs on an annual budget of $700,000 -- $350,000 of which is a grant from the Municipality of Anchorage -- is staffed by part-time nurses and on-call nurses who may work elsewhere but are interested in picking up an extra shift here and there. Each must be specially trained in forensic evidence collection and working with victims. Providence "worked really hard" to get 16 nurses into the program, before life events -- divorce, school, medical needs, caregiving for family -- led to attrition, Meyer said.
She hopes to be operating around the clock by Feb. 1, if not sooner. Already she's hired two more nurses, one full-time and one part time, in addition to the eight she has available for on-call shifts. And, she's looking at finding out if any of her existing team would be willing to be on-call on an as-needed overnight basis, to cover exams that can't wait until morning.
Her nursing team sees as many as 280 victims in a given year, Meyer said, with victims coming from Anchorage, Elmendorf and Fort Richardson military bases, the Mat-Su, and occasionally from other cities or villages. Patients that might normally go to other local hospitals like Alaska Regional or the Alaska Native Medical Center are also seen at the Providence facility.
Meyer could need to expand her staff even more if more victims reported their assaults. The Justice Center at the University of Alaska-Anchorage estimates that in a given year, 1,494 women in Anchorage and 916 in the Mat-Su are sexually assaulted -- more than eight times the number of victims who come through Providence.
Skidmore said he has some alternative ideas for how to keep the SART exam center operating overnight, but declined to share those ideas publicly.
Contact Jill Burke at jill(at)alaskadispatch.com