RICHMOND, Va. -- The young woman who walked into an emergency room in Milwaukee began her journey about 12 hours earlier, at a Chicago-area hospital, more than 90 miles away.
She had been raped, but there was no one trained to do a forensic examination at the first hospital she went to — or the next, or the next, or the next. So she drove herself from place to place.
Finally, in Milwaukee, she met Jacqueline Callari Robinson, a sexual assault nurse examiner who spent hours with her, examining her physical injuries, collecting evidence from her body in a rape kit and trying to calm her down.
“She said she felt humiliated to walk into the hospitals," recalled Robinson. “The trauma was pretty overwhelming. We actually just sat in the interview room with her for quite some time before she was really ready to be examined.”
The United States is currently experiencing a nationwide shortage of sexual assault nurse examiners, known as SANEs.
In Virginia, only 16 of 122 licensed hospitals provide sexual assault forensic exams, and only about 150 of the state's 94,000 registered nurses are credentialed forensic nurses, according to a 2019 study by the Virginia Joint Commission on Health Care.
Many other states also fall short. A 2016 study of six selected states by the U.S. Government Accountability Office showed that the number of forensic nurses did not meet the need for exams, particularly in rural areas.
Leah Griffin was turned away by a hospital in Seattle after being raped in 2014.
"I told them what happened, and they shrugged their shoulders and said, 'We don't do rape kits here,'" Griffin said.
Hospital staff offered to transfer her to another hospital by ambulance, at her own expense. She said she was stunned, traumatized and still feeling the effects of a drug given to her by her attacker, so she went home. The next day, she drove herself to the second hospital, about 30 minutes away.
There, she was seen by a trained examiner. But the delay in getting the rape kit done was later cited by prosecutors as a factor that contributed to their decision not to bring criminal charges.
“You watch the crime shows on TV and you think you know exactly what to do if something like that ever happened," Griffin said. “It never occurred to me that hospitals wouldn't be equipped to collect evidence."
Griffin's story prompted U.S. Sen. Patty Murray, a Democrat from Washington, to sponsor the Survivors' Access to Supportive Care Act. The bill would provide funding for state-level surveys to determine where the biggest shortages of SANEs are, develop national standards of care for rape victims, and increase access to training, especially in rural and Native American communities.
Murray has introduced the bill every year since 2016, but it still hasn't been passed by Congress. She said many lawmakers don't know it's a problem.
Funding is also a major issue, as many hospitals cannot afford to provide specialized training to nurses or allow them to take time away from their regular shifts to do rape exams. Many SANEs work on an on-call basis so they can continue to do their full-time nursing jobs.
Some states recognize they may never have enough forensic nurses, so they've come up with innovative ways to treat sexual assault victims.
In Massachusetts, the Department of Public Health received a grant from the U.S. Department of Justice to develop a national telenursing center that has allowed sexual assault nurse examiners to use a videoconferencing system to remotely help clinicians conduct exams in rural, tribal and naval hospitals.
In Maine, hospitals have formed regional partnerships so that SANEs employed by any of the hospitals can respond when a rape victim goes into the emergency room.
And in Illinois, the state legislature passed a law last year that will require, beginning in 2022, that every rape victim be treated by a trained sexual assault forensic examiner. The providers must be available within 90 minutes of a patient's arrival.
Bonnie Price, co-founder of the forensic nursing program at Bon Secours Richmond Health System, said funding is one of the biggest obstacles. Price said it costs Virginia hospitals about $4,000 to $6,000 per patient to do a complete forensic exam. The state caps reimbursement at $1,200.
Even when hospitals have SANEs on staff, retaining them can be difficult. In the GAO report, Wisconsin officials estimated that the state trained 540 examiners over a two-year period, but that only 42 — less than 8% — were still practicing in the state at the end of that period.
“Being a forensic nurse can be emotionally toxic at times," Price said. “It is work that you can't carry home and talk to your family about.”
In Virginia, proposed legislation would establish a program to recruit more nurses and train hospitals on how to transfer victims so they aren't sent to multiple facilities.
Rebecca Courtright said she was forced to go to two different hospitals before anyone could treat her after she was raped in 2003.
“Those nurses make the difference between someone reporting (a rape) and someone just feeling defeated and going home," she said.