1. Although the SANE Council of the International Association of Forensic Nurses (IAFN) decided in 1996 to use the title of sexual assault nurse examiner or SANE, different terminology has been used across the country because programs developed independently. For the purposes of this bulletin, the term SANE is used.
2. Phone interview with Judy Casteele, Associate Director, Women's Resource Center of the New River Valley, Radford, VA, June 25, 1999.
3. Linda E. Ledray, SANE Development and Operation Guide, Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice, Washington, DC, 1999, p. 69. In a review of 372 hospital emergency department cases of sexual assault, 68 percent of the victims had no injuries, 26 percent had mild injuries, 5 percent had moderate injuries, and less than 1 percent were severely injured.
4. Linda E. Ledray and Kathy Simmelink, "Sexual Assault: Clinical Issues, Efficacy of SANE Evidence Collection, A Minnesota Study," Journal of Emergency Nursing, 23(1), 1997, p. 75.
5. Phone interview with Jamie Ferrell, SANE Program Director, Sexual Assault Prevention and Crisis Services Division, Office of the Attorney General, Austin, TX, July 5, 1999.
6. Phone interview with Suzanne Brown, SANE Coordinator, Inova Fairfax Hospital, Fairfax, VA, December 17, 1999.
7. Phone interview with Linda E. Ledray, Director, Sexual Assault Resource Service, Hennepin County Medical Center, Minneapolis, MN, July 2, 1999.
8. Information drawn from IAFN's Web site, June 1999.
9. Victims usually enter the system by calling law enforcement or the sexual assault crisis hotline or by going directly to the hospital emergency department or SANE facility.
10. An adequate number of SANEs should be available to promptly respond to calls and to handle multiple calls simultaneously.
11. For more information on drug-facilitated assaults, review the training materials produced by the American Prosecutors Research Institute on the prosecution of rohypnol- and GHB-related sexual assaults (see the publications list in the Resources secton of this bulletin).
12. IAFN, SANE Standards of Practice, 1996, p. 2.
13. Ledray, SANE Development and Operation Guide, p. 97. See pp. 97-99 for more information on consent, confidentiality, and reporting in cases involving minors.
14. Ibid., p. 114. States have different laws regulating mandatory reporting for child sexual abuse, vulnerable adults, felony sexual assaults of adults, and statutory rape. It is important for SANEs to be aware of these laws and applicable federal laws.
15. Ibid., p. 123124.
16. Ibid., p. 21.
18. Phone interviews with Pat Speck, Coordinator of Nursing Services, City of Memphis Sexual Assault Recovery Service, Memphis, TN, June 22, 1999, and Suzanna Parkinson, Coordinator, Rape Crisis Center, City of Memphis Sexual Assault Recovery Service, June 28, 1999.
19. Ledray and Simmelink, "Sexual Assault: Clinical Issues, Efficacy of SANE Evidence Collection, A Minnesota Study," Journal of Emergency Nursing, 23(1), 1997 p. 77.
20. Ibid., p. 76.
21. Other agencies that may be part of the response system include hospitals and other medical facilities; public health departments; mental health agencies; victim compensation offices; battered women's programs; schools; organizations serving victims from underserved populations; social and human services; civic, faith-based, and neighborhood groups; youth organizations; and sex-offender management programs.
22. Phone interview with Jill Poarch, SANE Program Coordinator, Meriter Emergency Services, Madison, WI, July 5, 1999.
23. Phone interview with Eileen Allen, SANE Program Coordinator, Monmouth County Prosecutor's Office, Freehold, NJ, June 22, 1999.
24. Phone conversation with Speck, September 13, 1999.
25. Phone interview with Chris Dunnuck, Coordinator, YWCA Nurse Examiner Program, Grand Rapids, MI, June 28, 1999.
26. Phone interviews with Cecelia McKenzie, Director, July 14, 1999, and Jamie Ferrell, July 5, 1999, Sexual Assault Prevention and Crisis Services Division, Office of the Attorney General, Austin, TX; James A. Gilson, Deputy Attorney General and Project Director, New Jersey Sexual Assault Standards Implementation Project; and Val Sievers, SANE Coordinator, Colorado Coalition Against Sexual Assault, CO, June 28, 1999.
27. Some communities may not have a sexual assault victim advocacy program. In these circumstances, SANEs should identify community resources that can help victims through this difficult period (e.g., 24-hour crisis lines, counseling services and support groups, programs that provide financial assistance, and victim/ witness programs that guide victims in the justice system). They can also encourage the community to develop an advocacy program with a medical-legal advocacy component.
28. Most community-based sexual assault advocacy programs have internal confidentiality policies that prohibit advocates from disclosing information about victims to third parties without victim consenta protection based on state statute in some states. If victims oppose sharing requested information, advocates typically will contest attempts to obtain their records. If a subpoena is upheld despite challenges, however, an advocate must disclose the requested information or risk being held in contempt of court. (Exceptions to these policies include cases of sexual assaults of vulnerable adults; sexual assaults of minors perpetrated by family members, caretakers, or persons in positions of authority over them; and sexual assaults of minors that are the result of parental neglect. Confidentiality is also limited in cases with clients who indicate that they are in imminent danger of serious harm to themselves or others.)
29. Phone interview with Sharon Moscinski, Advocacy Program Coordinator, Santa Fe Rape Crisis Center, Inc., Santa Fe, NM, June 25, 1999.
30. Phone interview with Sara Donohue, June 25, 1999.
31. Phone interview with Gail Hutchison, Sexual Assault Services Coordinator, Virginians Aligned Against Sexual Assault, Charlottesville, VA, June 17, 1999.
32. Phone interview with Casteele, June 25, 1999.
33. Phone interviews with Debbie Andrews, Executive Director, Rape, Abuse and Incest National Network, Washington, DC, June 24, 1999, and Moscinski, June 25, 1999.
34. Phone interview with Mark Purcell, Detective, Sex Crimes Unit, Alexandria, VA, Police Department, June 24, 1999. Purcell works with the SANE program at Inova Fairfax Hospital in Fairfax, VA.
35. Phone interview with Pat Calhoun, Sergeant, Sex Crimes Unit, Tulsa, OK, Police Department, June 25, 1999. Additional comments by Calhoun in this paragraph come from the interview.
36. Phone interview with Pat Groot, Co-Chair, National Alliance of Sexual Assault Coalitions, Charlottesville, VA, June 29, 1999.
37. Ledray, SANE Development and Operation Guide, p. 22.
38. Ledray and Simmelink, "Sexual Assault: Clinical Issues, Efficacy of SANE Evidence Collection, A Minnesota Study," Journal of Emergency Nursing, 23(1), 1997, p. 76.
39. Phone interview with Patricia A. Smith of the Matanuska-Susitna Valley Sexual Assault Response Team, Palmer, AK, June 25, 1999.
40. Phone interview with Sandra Sylvester, Assistant Commonwealth's Attorney, Office of the Commonwealth's Attorney, Prince William County, Manassas, VA, June 1999.
41. James A. Gilson, Deputy Attorney General, New Jersey Division of Criminal Justice, Trenton, NJ, provided the information for this section on case law.
42. An upcoming OVC bulletin will further explore case law pertaining to SANE testimony.
43. Phone interview with Ledray, July 2, 1999.
44. Phone interview with Stacey Lasseter, Coordinator, Forensic Nurse Examiners, St. Mary's Hospital, Richmond, VA, June 24, 1999.
45. Phone interview with Gilson, June 23, 1999.
46. Ledray, SANE Development and Operation Guide, p. 50.
47. Phone interviews with McKenzie, July 14, 1999, and Ferrell, July 5, 1999.
48. Phone interview with Sievers, June 28, 1999.
49. Phone interview with Poarch, July 5, 1999.
50. Ledray, SANE Development and Operation Guide, pp. 3536.
51. Ledray, "Sexual Assault: Clinical Issues, SANE Program Locations Pros and Cons," Journal of Emergency Nursing, 23(2), 1997, p. 183.
52. Ledray, SANE Development and Operation Guide, p. 38.
53. Ibid., p. 39.
54. Phone interview with Poarch, July 5, 1999.
55. Phone interview with Kathy Bell, Coordinator, SANE Program, Tulsa Police Department, June 23, 1999.
56. Phone interview with Ledray, July 2, 1999.
57. Communications with Mary Szaro, President, New Jersey Chapter of the Association of Forensic Nurses.
58. Phone interview with Allen, June 22, 1999.
60. Phone interview with Ledray, July 2, 1999.
61. Phone interview with Bell, June 23, 1999.
62. Ledray, SANE Development and Operation Guide, p. 38.
63. Phone interviews with Speck, June 22, 1999, and Parkinson, June 28, 1999.
64. Phone interview with Sievers, June 28, 1999.
65. Phone interview with Dunnuck, June 28, 1999.
66. Phone interview with Allen, June 22, 1999.
67. Ledray, SANE Development and Operation Guide, p. 26.
68. Ibid., p. 25.
69. Ibid., p. 32.
70. Ibid. In these cases, medical facilities may then either cover the remaining costs or attempt to bill the victim for any additional medical services.
71. Phone interview with Lasseter, June 24, 1999.
72. This section was drawn from a phone interview with Brown, June 23, 1999.
73. Communication between D. McDonald, Inova Fairfax Hospital, Fairfax, VA, and Ledray, September 5, 1997. Information from Ledray, SANE Development and Operation Guide, p. 101.
74. Phone interview with Brown, June 23, 1999.
75. Phone interview with Carol Odinzoff, Nurse Coordinator, SART Unit, Bethel, AK, June 28, 1999.
76. Phone interview with Smith, June 25, 1999.
77. Phone interview with Brown, June 23, 1999.