PLATTSBURGH — Time is evidence.
No one knows that more than Gail Bjelko, BSN, one of eight who comprise the Sexual Assault Nurse Examiner (SANE) programs at The University of Vermont Health Network – Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, which was one of the first in New York State.
The hospital marks 22 years of providing comprehensive care to patients who have been sexually assaulted and has an unidentified room exclusively for their care.
“We will collect evidence up to 96 hours after the assault, and that’s it,” Bjelko said.
“The sooner that we can get there, the more credible the evidence is going to be.”
The SANE program launched in 1997 with four nurses.
Now, the team of eight registered nurses offer specialized medical care and emotional support to victims of sexual violence as well assist in the collection of information and evidence from the crime.
The service is provided 365 days a year, 24 hours a day and seven days a week for those in Clinton, Essex and Franklin Counties.
“There are around 276 SANE programs in this country so having a team like ours here is a tremendous asset for our community,” CVPH Chief Nursing Officer Carrie Howard Canning said in a news release.
Bjelko became a part of SANE by default in 2003.
“Because the person prior to me was the manager in the Emergency Department (ED), and she left,” she said.
“I was interested in it prior and actually got my training prior but wasn’t really all that involved. But then once she left, it was kind of like okay, now you got to take ownership of it. Got to do it.”
When she became sexual assault nurse, she went down to Albany and did three 12-hour shifts of training on a Friday, Saturday, Sunday.
“Then came back and went to Planned Parenthood and did pelvic exams there and then did a case here watching somebody and did a case with somebody watching me,” Bjelko said.
“Now, each CVPH SANE nurse completes a 40-hour course online, 16 hours of clinical time and works side by side with another certified SANE nurse.
The nurses don’t have a prior notification of when a patient will come in.
“They just show up,” Bjelko said.
“The nurse will get their vital signs and just get the basic like I was sexually assaulted. We don’t have them get a lot of information because we don’t want the story to change. So if they tell the triage nurse one thing and tell the sexual assault nurse something different, it doesn’t say much for their credibility.”
The triage nurses get the basics to determine whether or not the patient is safe to be seen by the sexual assault nurse.
“If they have injuries that need to be treated first, that’s always the first priority,” Bjelko said.
“If they were strangled or they stopped breathing or anything like that, those are injuries that need to be cared for first. But once the sexual assault nurse gets them, they’re stable and our job is to collect evidence.”
SANE has strict policy and protocol around evidence collection.
“There’s a blood test that needs to be collected,” she said.
“There are certain assessments that need to be done. We’re looking for trauma or evidence. If they say that the assailant bit them, we find out where were you bit. You assess that area. You may also need to swab it because there might be saliva on that area.”
What the nurses do is based on the story the patient tells.
“If they say they scratched the person, well then part of the evidence collection is to scrape under their fingernails,” Bjelko said.
“You are looking for any trace evidence that there may be. That’s all based on the story. If it happened outside, were their leaves, grass or something like that? If it happened on a carpet, are there threads or fibers we can collect.”
The average collection runs about 2.5 hours long.
“It depends on if you have to take regular photographs,” she said.
“If they do have injuries, you have to take regular photographs. You have to burn those to a CD. If they want post-exposure medications, there are a lot of medications that have to be administered and that’s very time consuming because you have to explain each one and explain what it’s for. You have to document it.”
Medications are administered to counteract the risks of pregnancy, HIV and sexually-transmitted diseases.
The time factor is also dependent on the willingness of the patient to communicate.
“Sometimes, they are so broken up about it, it takes a long time,” Bjelko said.
“Sometimes it’s a long process just getting through the interview to find out what happened to them. We just have to be patient and that is the beauty of us versus the physicians. They’ve got 10 other people that they need to see. They are focusing on the heart attack or the stroke, something like that. That’s the beauty of the sexual assault nurse. We’re trained to be patient. We’re trained to do some motivational interviewing and we have the time. We are dedicated to that one patient.”
The SANE 8 are all voluntary and not on call.
“The charge nurse will pick up the phone and kind of just call through the list to get somebody to come in,” Bjelko said.
That could be Gina Carbino, RN or Elizabeth Craigmyle, RN or Kelly McDonough, RN, one of the first to help survivors have a voice.
The majority of patients they see are between 19 and 30, but there are certainly some outliers.
“We see 13-year-olds,” Bjelko said.
“A fair share of those are kind of boyfriend/girlfriend, but then mom finds out that this 19-year-old boy is having sex with her 13-year-old daughter. We do have some, they met on the internet, they meet in person, and then worst comes to worst.”
There have been some instances where concerns have been expressed about an elderly patient.
“We’ve done some patients in the ICU who were found unconscious, and then there’s a question as to was there an assault,” she said.
Bjelko said the unit also sees many cases from the area prisons with inmates claiming sexual assault.
“We don’t have any men sexual assault nurses and if our prison population increases, then we may have to consider recruiting one,” she said.
One of the peak times SANE is busy is when area colleges open in the fall.
“Then, it kind of settles down because they have a little education and it settles down but usually the first few weeks in the fall when school opens,” Bjelko said.
All evidence collected is stored in a refrigerator.
Bjelko said they are figuring out how to deal with new regulations that call for collection kits to be maintained for 20 years.
“The hospitals are only responsible to figure out how to store them until some time late 2020 or early 2021, then that gives the state time to figure out where they’re going to store them. But in the meantime, we have to figure out where in the hospital are we going to store a year or two years worth of kits.”
If the patient releases to law enforcement and tell SANE she wants the police to know that this happened to her, SANE will call whatever agency is involved to come and get the kit.
“Then, it’s their responsibility,” Bjelko said.
“Then it’s for those that don’t want to report to law enforcement we then have to store the kit in case they decide.”
The statute of limitations is 20 years.
“That’s a long time,” she said.
“A lot of times you think why are they coming here and going through all of that if they’re not going to report it. That is always a question in my mind. Why are you going through all of this if you don’t want to report it?”
The patients are at their most vulnerable and may fear the reactions of significant others or parents finding out about the assault.
They may also be leery of getting the perpetrators in trouble and the resulting aftermath.
“Because their boyfriend is going to be irate that this happened to them, and they’re like ‘I will go to the hospital to get checked out,’” Bjelko said.
“That’s a lot of it. Another is not knowing. They wake up in a strange place. They were out drinking. They wake up in a strange place. Guys are there. Maybe their clothes are half on and disheveled, and they’re like ‘did it happen to me?’”
SANE nurses explain that there is no litmus test that says when a person is raped.
“Our job is to collect evidence, to take pictures, to look but we can’t tell if you were or you weren’t,” she said.
If patients come in and are confused and want to be checked out, SANE checks.
“We collect everything we can possibly collect in case they decide to report it if something did happen,” Bjelko said.
Patients are referred to Northern Adirondack Planned Parenthood rape crisis counselors.
“They are really the experts in supporting the patient as they navigate the legal system or if they need emotional support and follow-up,” Bjelko said.
“We use them a lot to help the patients in those regards. We do explain to the patient, we are the experts in the evidence collection. We are the medical people.
All cases are billed to Crime Victims, a New York state funded program.
The hospital started that policy years and years ago because the vast majority of the college students would not report if their parents could see it on a bill.
“We don’t get a lot of reimbursement,” she said.
“It’s like $800 per case. If you give one HIV med, it’s like a $1,000 so it doesn’t cover labs or the physicians bill. If they want emergency contraception, we provide that. If they want post-exposure meds of STIs and HIV, we do that. If they want evidence collected, we do that.”
Evidenced can be collected with and without a pelvic exam.
“We’ll scrape their fingernails if necessary,” she said.
“We’ll swab their mouths. We will take pictures. Swab any potential saliva or semen or anything and we won’t do the pelvic. So it’s really patient centered. We will do whatever they want. They’ve been traumatized enough. We will let them call the shots.”
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