You asked for information on states that require hospitals to provide forensic nursing or sexual assault crisis services.

SUMMARY

Sexual assault nurse examiners (SANEs), one of many subspecialties of forensic nursing, are health care providers who provides an objective forensic evaluation for sexual assault patients.

SANEs are registered nurses (RNs) who have advanced educational and clinical backgrounds. The International Association of Forensic Nurses (IAFN) began offering the country’s only national certification examination for SANEs in 2002. Several states currently offer certification exams; the IAFN test is the first one offered on a national level. The certification is valid for three years and recertification is available by examination or continuing education. (More information on certification is available at www. iafn. org/certification. )

The SANE specialty, a combination of science and nursing, emerged in the 1970s when health care providers sought more compassionate ways to treat sexual assault victims. Their responsibilities include (1) obtaining a patient history, (2) obtaining as history of the reported incident, (3) performing a physical examination, (4) collecting evidence, (5) treating patients and referring them for medical treatment, (6)

documenting findings, (7) interacting with patients in a neutral manner to help make informed decisions, and (8) giving expert testimony in court trials as either a defense or prosecution witness.

SANE programs are at various stages of development in hospitals, communities, and other facilities across the country. According to IAFN, only a handful of states, including New Jersey, Kentucky, Ohio, Texas, and Illinois, have implemented laws or regulations providing for a forensic nursing response to sexual assault victims. This report focuses on New Jersey, Kentucky, and Ohio.

KENTUCKY

Under Kentucky law, hospitals providing emergency services must have 24-hour access to either a SANE or physician to exam a sexual assault victim (Kentucky Revised Statutes (KRS) § 216B. 400). The law defines a “sexual assault nurse examiner” as an RN who has completed the required educational and clinical experience and maintains a current credential from the Kentucky Board of Nursing to conduct forensic examinations of victims of sexual offenses under the medical protocol issued by the State Medical Examiner (KRS § 314. 011(14)).

Kentucky law also directs the state nursing board to adopt regulations creating a SANE program. The regulations must address, at a minimum:

1. educational requirements for SANEs and statewide standards for providing the education;

2. the application process for RNs submitting to the board documentation of required education and clinical experience for credentialing as a SANE;

3. continuing education requirements for maintaining the SANE credential;

4. methods of monitoring overall program implementation; and

5. procedures for obtaining input from the Sexual Assault Response Team Advisory Committee established under Kentucky law. (see KRS § 314. 142).

Kentucky’s regulations require that the SANE course include a minimum of 40 hours of didactic instruction addressing the following topics:

1. the role and responsibilities of a SANE;

2. application of the statewide medical protocol;

3. principles and techniques of evidence collection, identification, evaluation, preservation, and chain of custody;

4. injury assessment, including injuries of forensic significance;

5. physician consultation and referral;

6. medicolegal documentation;

7. victim’s bill of rights;

8. crisis intervention;

9. testifying in court;

10. criminal justice system overview;

11. available community resources;

12. cultural diversity and special populations;

13. ethics;

14. genital anatomy; and

15. developing policies and procedures (201 Kentucky Admin. Regs. (KAR) 20: 411).

The regulations also require a minimum 60-hour clinical practice experience including:

1. supervised detailed genital inspection, speculum examination, visualization techniques, and equipment (26 hours);

2. supervised mock sexual assault history taking and examination techniques (10 hours);

3. observing relevant civil or criminal trials, meeting with attorneys, or similar legal experience (16 hours);

4. meeting with rape crisis victim advocates or mental health professionals (4 hours); and

5. meeting with law enforcement officials (4 hours); (201 KAR 20: 411).

OHIO

Ohio has established “The Ohio Protocol for Sexual Assault Forensic and Medical Exams” in order to provide comprehensive, standardized, non-judgmental, equitable treatment of survivors of sexual assault. The protocol is issued under the authority of the Ohio Public Health Council, which is charged by the Ohio General Assembly to establish procedures for gathering evidence for victims of sexual offenses. The protocol is intended to promote the provision of consistent, comprehensive health care treatment to include emotional, social, and crisis intervention, as well as provide information about available follow-up services in the community.

The Ohio Attorney General’s office requires hospitals to use the protocol in order to be eligible for reimbursement for costs of evidence collection from the Ohio Victims of Crime Compensation Fund. (It is unlawful in Ohio to bill the victim or the victim’s insurer for the cost of a sexual assault examination conducted to collect evidence; see http: //onlinedocs. andersonpublishing. com/revisedcode/. ) A hospital or other emergency medical facility must use a sexual assault examination kit that meets the protocol to qualify for reimbursement.

In Ohio, all communities are encouraged to establish a Sexual Assault Response Team (SART) and a SANE program. A SART includes representatives from health care providers, the local rape crisis program, law enforcement, the prosecutor’s office, and other social services agencies involved in responding to sexual assault survivors. Ohio’s protocol defines a SANE as an RN who (1) has been specially trained to provide comprehensive care to the sexual assault patient, (2) demonstrates competency in conducting a forensic/medical examination, and (3) has the ability to be an expert witness. If a hospital does not have a SANE program, emergency department physicians conduct the exam with nursing assistance. All physicians and nurses who will be doing such exams should attend a training program in the use of the sexual assault protocol.

NEW JERSEY

New Jersey law requires the attorney general to establish a Statewide Assault Nurse Examiner program in the state Department of Law and Public Safety (N. J. Stats. § 52: 4B-51). Following implementation of a certification process for a forensic sexual assault nurse examiner, each county prosecutor must appoint or designate a certified SANE to serve as program coordinator for the county’s program. The law requires the attorney general and the State Board of Nursing to jointly establish a certification process for SANEs. An applicant for certification as a SANE must be a New Jersey-licensed RN in good standing with the board and also meet the following:

1. a minimum of two years of current nursing experience as defined in regulation;

2. certification verifying the completion of a forensic sexual assault nurse examiner training program that meets requirements of the attorney general and the nursing board; and

3. demonstrated clinical competence in performing a forensic sexual assault examination. (N. J. Stats. § 52: 4B-53).

The attorney general and the board must certify an applicant meeting the above requirements as a forensic sexual assault nurse examiner.

Each program coordinator must:

1. coordinate the county SANE program according to standard protocols for providing information and services to sexual assault victims;

2. perform forensic examinations on victims of sexual assault according to standards developed by the attorney general and appropriate medical and nursing standards of care;

3. designate one or more licensed physicians or certified SANEs to perform the examinations;

4. develop and implement standardized guidelines for the examinations;

5. develop and implement a standardized education and training program;

6. establish, in cooperation with licensed health care facilities, private waiting rooms and areas designated for forensic sexual assault examinations, and protocols for storage of forensic evidence;

7. provide appropriate services to sexual assault victims; and

8. collaborate with law enforcement officials and the county rape care program to ensure that the needs of sexual assault victims are met in a compassionate manner (§ 52: 4B-52).

(The relevant New Jersey law is attached. )

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