CHICAGO -- Getting up the courage to report a sexual assault and endure a physical exam may be necessary if a victim wants to pursue criminal charges, but the process can further traumatize a victim unless it's handled sensitively and professionally.
That's where a coordinated response comes in. A local task force has proposed a new plan for emergency responders that calls for nurses trained to do forensic exams, advocacy services by rape crisis centers and a "victim sensitive" approach from investigators and prosecutors. The task force was set up by the Illinois Coalition Against Sexual Assaults and the Cook County Survivor Response Improvement Group. While it has no funding authority, the task force plans to take its findings to law enforcement and hospital administrators in Chicago and Cook County.
A recent lawsuit filed by a University of Chicago student highlights the need for consistent and coordinated response. The suit alleges that the staff at the student health clinic where the woman was treated neither offered to collect medical evidence for use in a possible criminal case nor advised her to go to an emergency room. As a result, the Cook County state's attorney's office declined to prosecute, said Kaethe Hoffer, the woman's lawyer.
Such situations could be reduced if the first responders to sexual assaults followed the recommendations of the task force, which include creating specialized sexual assault centers, where rape victims would be treated.
"It is crucial that the emergency department response to rape victims is specialized medical care and coordinated intervention," ICASA executive director Polly Poskin said in a statement. "The improvement of this first interaction among rape victims, health care staff and criminal justice personnel is critical to the future health and well-being of the victim and to the potential criminal justice outcome."
Under the proposal, nurses would be trained to conduct meticulous forensic exams, counsel victims and collect evidence.
This is being done in some places. In Cook County, sexual assault nurse examiners, or SANE nurses, became part of the sexual assault response team in 2003 through the efforts of Shauna Boliker, chief of the criminal division of the Cook County state's attorney's office, which handles 800 to 900 sexual assault cases a year, she said.
"That experience in the emergency room really shapes the rest of the experience for the victim, including whether they will pursue their case through the criminal justice system," Boliker said.
"Emergency rooms are incredibly busy, and the exam is time-consuming and difficult for physicians and nurses who are multitasking," said Julia Busta, who works at Advocate Illinois Masonic Medical Center in Lakeview and is one of only 51 certified SANE nurses in Illinois.
"When that sexual assault survivor comes in, I can dedicate my attention solely to her or him," she said.
That attention might mean the difference between a successful or failed prosecution. If a victim chooses to prosecute, the rape kit -- which Busta likened to a "smoking gun in a murder case" -- can be crucial, along with the testimony of a SANE nurse, who can establish that the evidence was handled properly.
Dawn Rodriguez of Oak Forest can attest to that. In 2005, Rodriguez was raped outside her home as she was returning from work in the early morning. She never saw her assailant but said the physical evidence was key to convicting him.
It is the Tribune's policy not to identify victims of sexual assault unless they choose to be named.
"They swabbed my ear, and they got a DNA sample from my attacker's saliva off of that," said Rodriguez, 40, who was treated by a SANE nurse at Advocate South Suburban Hospital in Hazel Crest. "A regular nurse might not think to do that."
"I can see why women don't always want to go in and report this stuff," Rodriguez said. "You are just going on adrenaline at that point. You're not thinking. ... The first thing you want to do is get clean."
Nancy Healy, who treated Rodriguez, heads the SANE program at Advocate South Suburban, which is the only program in the state to offer SANE services around the clock, she said.
Improving the handling of rape cases would be costly. The training required for certification for SANE is expensive and time-consuming, experts say. Many hospitals lack advanced digital cameras and other equipment necessary for nurses to adequately document injuries related to sexual assaults, the task force found.
Rape victims advocates and police officers are the other emergency responders who play a key role in the physical, emotional and legal outcomes for rape victims.
At rape crisis centers throughout the city, advocates provide crisis intervention and counseling from emergency room to trial. But the state is slashing $581,000, or 10 percent, from the centers' budgets. Added to a 26 percent cut in federal funds this year, Poskin said that will leave a shortfall of $824,000.
"Sustaining the 24-hour service and availability that's needed for this problem in the face of significant budget cuts becomes a huge challenge," said Sharmili Majmudar, executive director of Chicago-based Rape Victim Advocates, a non-profit organization.
Police officers are often the first to respond to a sexual assault, but many are not properly trained to deal with rape victims, advocates say.
"Patrol officers are often newer, have myriad things to do and aren't specialized in this area," Poskin said. "We are a culture that still retains its prejudices about rape, and police officers are part of that culture."
The Chicago Police Department has incorporated training on sexual assault into its curriculum at the academy, said spokesman Roderick Drew.
"Our training concerning this matter has increased in the last 10 years," said Drew, and includes a two-hour Rape Crisis Counseling class that was added in the last two years and is given by Rape Victim Advocates. The organization also developed a video course last year for the Police Department focused on helping sexual assault survivors.
But victims advocates say there is room to improve.
"We frequently have concerns about how some investigations are performed," Majmudar said. "But we also work with detectives who do a great job and are sensitive to the victim."
A committee of the task force spent two years looking at ways to improve police response. Members called for more training and production of a handout a responding officer would give a victim listing the officer's badge number and what support services are available.
The goal is to make sure that victims' treatment is not hit-or-miss. "Consistency yields better results and better treatment for survivors," Majmudar said.