GALVESTON, Texas - There's a new breed of nurse in the Emergency Department of the University of Texas Medical Branch at Galveston these days.  Law enforcement officials frequently team up with these special nurses on a weekly, and sometimes daily, basis.

They are UTMB's sexual assault nurse examiners. The forensic evidence that the nurses have been specially trained and certified to collect has already helped put many sex offenders behind bars. It has also helped provide at least a modicum of closure and peace of mind for a number of sexual assault victims treated at UTMB. 

UTMB is one of the three level one hospitals in the Houston/Galveston area to have a Sexual Assault Nurse Examiner program. Memorial Hermann and Ben Taub Hospital in the Texas Medical Center are the other two, according to Nellie Loewen, coordinator of the SANE program at UTMB.

"We are the only hospital qualified to do these exams in this outlying area," Loewen said. "We've served patients from Galveston, Texas City, League City, Clear Lake, Alvin, Lake Jackson, Baytown, Port Lavaca-really from all over."

Loewen explained that when a sexual assault victim arrives at the Emergency Department the nurse on call for the SANE program is paged. The nurse interviews each patient and conducts a medical forensic sexual assault exam using a pre-packaged sexual assault kit to collect DNA and other evidence. The kits are the same for adults and children but the collection may be performed differently. Traditional photography and a colposcope, which can magnify abrasions and wounds up to 15 times their size and photograph them, are used to document injuries.

All evidence is packaged and given to law enforcement officials under strict protocols to help ensure the evidence can ultimately be used at trial. (In addition, SANE nurses usually testify about their findings at trial.) All patients are offered preventive treatment for sexually transmitted diseases and pregnancy. The nurses also provide information on any needed follow-up care and counseling options.

"We are trained to be considerate of the trauma a sexual assault victim-whether an adult or child-has been through. We always explain that the exam is strictly voluntary, but that it can gather solid evidence to help identify and/or convict the rapist," Loewen said.

Since sexual assault against minors is considered child abuse, very young children must undergo the exam regardless of the circumstances. But Loewen and her team do their best to ensure that the children feel as safe and comfortable as possible. They keep a bin of small toys and hand-held games to help ease the tension for the children.  "Pretty soon, they become so absorbed in the game that they don't pay much, if any, attention to the exam," Loewen said.

"We have a sexual assault exam room that we use both for adults and children. On the recommendation of a decorator, the room was painted a soothing color," she said. "The SANEs have contributed their own touches with flower arrangements, wind chimes and pictures. Only our staff members know where it is. Family members aren't allowed inside. It is monitored from the outside by security cameras, and locks from the inside, but you would never notice it was there. Most people simply think it's a closet.

"It's not unusual for the perpetrator to be a family member who might be waiting in the ER, so this helps keep the victim safe. Also, we have found on numerous occasions that people are more willing to open up and tell us their story if they know their location is confidential and secure."

Although Loewen could not speculate whether sexual assault is on the rise or whether more victims are simply coming forward, she said that the number of cases handled at UTMB has doubled since the SANE program began in 2003.

 In 2007, cases involving children surpassed those involving adults. The nurses have noticed an increase in the number of adult males reporting sexual assault.

"Many of the men we treat say that they would have been embarrassed to come in before, but they realized they will be taken seriously here. I think word is getting around, which is a good thing," Loewen said.

The SANE program currently runs on an on-call basis, but with more nurses completing training, the Emergency Department should soon be able to schedule at least one certified SANE nurse per shift.

To become a certified sexual assault nurse examiner, nurses must have more than two years of experience as a registered nurse, and complete SANE training provided by the attorney general of Texas. The training includes:

  • Observation of 16 hours of criminal felony trial proceedings;
  • 64 separate hours of classroom instruction from the attorney general's office;
  • at least 24 hours of well-child exams and adult speculum exams; and
  • at least 16 individual adult and pediatric exams with a preceptor present.

SANE nurses must be recertified every two years, but Loewen said the rewards she and her nurses receive by helping their victims and securing convictions are worth the effort.

"I remember one case in which a girl was raped by a relative two years prior to the case finally coming to court. Our nurse who did the exam had to testify about her findings. The girl was young, but she still remembered the nurse. Although our nurses aren't to make contact directly in court with the child, the child remembered the nurse and ran right up and gave her a big hug. And in that case, the rapist was sentenced to 30 years in prison," Loewen said. "That's when you feel good about what you're doing-when you know you're really making a difference."

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April is Sexual Assault Awareness Month. UTMB will also be hosting Sexual Assault Nurse training classes in July. For more information, please call or e-mail Nellie Loewen, SANE Program coordinator, at (409) 772-7115, or neloewen@utmb.edu. To apply for SANE training, please fill out the application form in the wall mailbox next to the ER manager's door. Return the completed application form to Nellie Loewen, SANE Program Coordinator.

The University of Texas Medical Branch at Galveston

Public Affairs Office

301 University Boulevard, Suite 3.102

Galveston, Texas 77555-0144

www.utmb.edu