April is Sexual Assault Awareness Month, and in light of that, it's important that people know what resources are available to them in Kitsap County if they experience a sexual assault. One crucial resource is the Sexual Assault Nurse Examiner (SANE) program at St. Michael Medical Center in Silverdale, the only such program in Kitsap County.
The program was started in October 1997 to address deficiencies in the hospital’s treatment of sexual assault patients, said Kate Espy, who has been a sexual assault nurse examiner and clinic nurse for more than 20 years, and who manages the program at St. Michael.
“We weren't doing a very good job of taking care of sexual assault patients,” she said. “And that was coming from advocacy, and law enforcement, and patients.”
Kate Espy
Before the SANE program at St. Michael was launched, the wait time for sexual assault patients to be seen averaged five hours, because many sexual assault patients don’t have major injuries and so were determined to be lower priorities when they were triaged, Espy said. “But five hours is way too long,” she said. Under the SANE program, patients are seen within one hour.
The Silverdale hospital's SANE program was developed after talking to patients and advocates.
“It had been developed and used on the east coast, so we had to get the OK of the hospital,” Espy said. “We don’t charge our patients, and so it has a tendency to be an expensive program for the hospital." But the hospital has always been supportive of the program, and it will turn 25 years old this October, she added.
The program provides 24/7 call coverage, meaning any time a patient comes to the emergency department with a sexual assault complaint, a nurse from the program comes to see them; acute exams are only provided if the assault occurred within the past 120 hours, however.
“The reason we have that timeline is that is the recommended guideline from the state of Washington," said Espy, who added that she sits on the committee that makes those recommendations to the state, along with representatives from SANE programs at Harborview, Providence, and other hospitals, as well as the state's crime labs and law enforcement.
The main aim of the program is to support the patient, not to investigate the assault for law enforcement purposes, Espy said.
To that aim, if the patient doesn’t have any major injuries and therefore doesn’t need to be seen by a provider in the emergency department — e.g., a doctor or physician’s assistant — then they’re seen by SANE nurses.
“The first thing we do is take them to our clinic that is separate from the emergency department,” Espy said. “If you’ve ever been into the emergency department, it’s busy, it’s loud, there’s constantly announcements going overhead. It can be very, very traumatic just to sit through that.”
The clinic, located on the other side of the hospital campus, is quiet and secure, Espy said.
“They’re not going to get interrupted. They’re going to get one-on-one care. And then we start taking care of them. They’re patients to us first and that care includes a head-to-toe exam, forensic exam — meaning we do a forensic kit. We offer sexually transmitted infection antibiotics, and emergency contraception. But all of this is up to the patient. They decide.”
For patients age 18 or older, it’s their choice whether law enforcement is involved, Espy said. For patients 17 or younger, the SANE nurses are mandatory reporters and must call law enforcement and Child Protective Services, she said.
“But we let the patient know that, because then it’s their decision what they tell us,” she said. “Again, the first thing we want to do is take care of the patient on their terms and ensure that we get advocacy on board, law enforcement if they want, and any other help we can get them so that they can start their journey of healing.”
The SANE program is made up of either Registered Nurses or Nurse Practitioners, although currently St. Michael’s program is made up of all RNs, Espy said. Nurses in the program take 40 hours of training at Harborview Medical Center, and Espy provides additional training to newcomers.
“We have them shadow us and once they’re competent to do exams, then they’re on their own; of course, we evaluate each exam,” she said. “But the training is very important because we want to have the staff understanding why they’re doing it, what they need to do, and that it’s not about us believing them [or] not believing them. It is supporting them, giving them the support they need.”
The SANE program in Kitsap County consistently sees patients, Espy said. “We see [patients] out of county, out of state, out of country,” she said. “Anyone who shows up at our doors needing a sexual assault exam, we will do [it].”
Espy said it’s unfortunate that there’s still a stigma associated with sexual assault.
“Unfortunately, if your house gets robbed or a crime happens at a business, the first thing out of people’s mouths is not, ‘Are you sure that it happened?’” she said.
Male sexual assault victims can be particularly susceptible to stigma because of the perception that sexual assaults don’t happen to men.
“They’re supposed to be tough and powerful and masculine,” Espy said. “They’re usually thought of as the perpetrators, so they’re not going to be believed. I have seen many adult males that told me they didn’t think anyone would believe them.”
Having too much to drink or being drugged can leave anyone susceptible to sexual assault, Espy said. She said that she has seen society make some progress toward chipping away at the stigma.
"It’s getting better — again, I’ve been doing this for almost 25 years, so I have seen a change. I’ve seen a change in law enforcement realizing it can happen to men. I’ve seen a change in advocacy. So when the acceptance is out there that, yes, we know this happens to men, we know this happens to women … it could happen to anyone. It’s just really hard to get that message out to folks who think it’ll never happen to them.”
In addition to the SANE program, another local resource for sexual assault victims is Kitsap Support Advocacy and Counseling (KSAC), formerly known as the Kitsap Sexual Assault Center.
“If a patient isn’t going to see me, I want them seeing KSAC,” Espy said. “These folks need support to get through the system. They need someone to talk to.”
Because domestic violence is an element of many sexual assaults, the YWCA’s domestic violence advocates are another important resource, Espy said. “We work really close with them, as we do with KSAC,” she said.
And because many sexual assault patients may not have a primary medical provider, Peninsula Community Health Services and Planned Parenthood are great resources for medical care, she said.
Espy emphasizes that the No. 1 priority should always be caring for the patient.
“I’ve been doing this long enough and I’ve seen parents or grandparents who come into us with their kids or grandkids and tell me stories that they were sexually assaulted and they didn’t come in, they didn’t get seen, they didn’t report, because they were worried of the backlash, if anyone would believe them,” she said. “And unfortunately that still happens today.”
Ultimately, Kitsap is filled with people who work hard to provide support to people who are sexually assaulted, Espy said.
“I’m very proud of Kitsap County,” she said. “We do a good job. Can we do better? Always. But I think we work really hard to make sure we’re there for every sexual assault victim that there is.
