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For Rape Survivors, Specially-Trained Nurses Offer A Bridge To Justice

A rape kit (pictured) is used to collect evidence after a sexual assault. How well the kit is completed matters in a prosecution.

Four years ago, Cait Hogan woke up in her bed on a Sunday morning after a night of drinking in the small college town of Athens, Ohio. Her entire body hurt. Her arms and legs were covered in blood. She realized she’d been raped.

“I didn’t really remember anything,” says Hogan. “I don’t remember when I first started remembering.”  

Later that day, Hogan, who was 24 at the time, called a friend to accompany her to the local hospital to get a rape kit completed.

Unfortunately the staff member who completed her kit at O’Bleness Hospital had only minimal training in the process. There were problems with the kit that led investigators to inaccurate conclusions. Police dropped Hogan’s case. For months, her attacker, a man she once considered a friend, was at large.

Credit Cait Hogan
In 2013, Cait Hogan (left) was living in Athens, Ohio after graduating from college two years earlier.

In small towns and rural areas, when a victim goes to the hospital to complete a rape kit, there’s no guarantee staff will have the expertise to complete it correctly. Though a rape kit is designed to be completed by a nurse with minimal or no training, researchfunded by the Department of Justice, found that the chances of a getting a prosecution increase when a kit is completed by a nurse who has undergone a special 40-hour training, called Sexual Assault Nurse Examiner (or SANE) training.

Hospitals in larger cities, try to keep these trained nurses on staff around the clock. But in places like Athens, it’s not as common.

Collecting Good Evidence

After a person has been raped or sexually assaulted, they have a 72-hour window to complete a rape kit, also known as a sexual assault examination kit. Wait too long and the most useful DNA evidence is lost.

A rape kit is typically a cardboard box about the size of a lunch box. The contents are simple: papers with step-by-step instructions; a list of questions to ask the patient; bags to collect articles of clothing; and several cotton swabs for collecting DNA. The O’Bleness Hospital director of emergency services, Lianne Dickerson, says it’s just like CSI—you’re looking for DNA evidence.

“If they can match that DNA we’ve got a prosecution,” says Dickerson.

Nurses completing rape kits use swabs and combs to collect forensic evidence. They also must ask survivors a series of questions, capturing information that can make or break a case. Dickerson says the training and experience that sexual assault nurse examiners have makes them better at this delicate task. Research shows they're more prepared to work with traumatized patients and provide emotionally sensitive care—they even testify in court.

Credit Esther Honig
Lianne Dickerson oversees the five SANE trained nurses and SAFE trained staff at the O'Bleness hospital.

In the last three years, the O’Bleness hospital has increased the number of SANE trained nurses from just one or two to five--that's still not enough to cover 24 hours a day, seven days a week. The rest of staff are required to undergo a more basic four-hour training.

Dickerson says, larger cities have the resources to hire groups of these trained nurses, dedicated to completing sexual assault examinations.   

“It’s one thing if you’re in a big city hospital,” says Dickerson. “It’s different when you’re in a small hospital.”

When Hogan arrived at O’Bleness for her rape kit, she was taken immediately into triage and then to a private examination room. She remembers waiting there, until a staff member came in, placed a kit on the counter and told the nurse: “It’s not hard, just follow the checklist.” Hogan says it looked like no one knew what they were doing.

“You go to the hospital, and these people who are supposed to be professionals and it’s like ‘oh you’re training?” she says.  

The nurse who signed off on Hogan’s rape kit was not a sexual assault nurse examiner. As she filled out a questionnaire on medical history she asked Hogan “had contraception been used?”

“Essentially to clarify I said ‘Like a condom?’ I didn’t know if they meant if I was on birth control currently,” says Hogan.  

The nurse wrote down that a condom had been used, despite the fact that moments before Hogan told her she had an allergy to latex. The nurse also mislabeled a DNA swab.

“I do feel strongly if at any point someone had known what they were doing, apparently it wouldn’t have weighted the whole case,”says Hogan.

Lianne Dickerson from O’Bleness says every nurse who completes a rape kit at their hospital has undergone the required four-hour training.

After several months, the Athens police dropped Hogan’s case. The investigator said there was not enough evidence to pursue criminal charges. Hogan says she was told the mistaken idea that the attacker used a condom implied she had consented.

The Importance Of SANE Training

SANE training gives nurses the knowledge they need to avoid common mistakes like those that happened to Hogan’s kit. The training is important for giving victims a chance at justice, explains Alison Rerko, a SANE trained nurse who also works for the Ohio Alliance to End Sexual Violence.

“We know how to collect the evidence, we know how to document [it],” she says. 

In Ohio, the number of trained nurses have increased in the last few years.  But they're still lagging in rural areas where just one may serve several counties.

“I think the challenge is a lot of hospitals don’t know how to set up a program,” she says. “And then, is it cost effective to maintain?”

Like many States, Ohio will reimburse hospitals for the cost of SANE training, but that training is often several hours away from rural hospitals, in larger urban areas. Research by the Government Accountability Office shows that the difficult nature of this work and its demanding hours leads to a high rate of burnout among SANE nurses. That can make it a challenge to keep these professionals on staff, even in a college town like Athens.

The GAO says other rural hospitals that operate on a tight budget may be reluctant to train nurses if they only treat a few sexual assault cases each year.

Delayed Justice

After police closed her case, Hogan contacted the county prosecutor. She knew her attacker was still out there and wouldn’t stop until she’d exhausted every option.

“I couldn’t be complicit in another woman’s rape,” says Hogan. “It was very much speaking for the next women.”

Credit Esther Honig
Keller Blackburn, Athens county prosecutor, agreed to reopen her investigation and eventually prosecuted her attacker.

Athens County Prosecutor, Keller Blackburn agreed to reopen the investigation. More evidence was collected, and it was discovered that the attacker, Dedrick Peterson, was a serial rapist. Blackburn says the police made a number of errors in their investigation, but it was the rape kit that led them to inaccurate conclusions. He says his office has dealt with this problem in the past, before the O'Bleness hospital managed to hire more SANE nurses.

“It’s caused us to have to resolve sexual assault cases either with lesser or non-sex offense, or reduced prison terms,” he says.

Blackburn says the issues with the rape kit prevented them from winning a rape conviction in Hogan’s case, so they pursued a sexual battery charge instead. His office sought the testimonies of the three other women, and with the combined weight of their testimony he charged Peterson with three charges of sexual battery, 16 months after he sexually assaulted Hogan. On February 23, 2015, Peterson pled guilty and he was sent to prison for five years.

Conor Morris contributed additional reporting to this article.

This story was produced Side Effects Public Media, a news collaborative focused on public health. 

Correction: an earlier version of this story said Peterson was found guilty by a jury. The text has been updated to note he pled guilty without going to trial.