Survivors of sexual assault and rape will soon be able to receive forensic exams at any Missouri hospital as part of a recently launched telehealth network put in place by the state’s Department of Health and Senior Services.
Specially trained nurses perform sexual assault forensic exams to collect evidence that can be used by law enforcement to identify the perpetrator. The evidence collected is commonly referred to as a "rape kit."
The nurses are also trained to deliver the exams in a way designed to avoid further traumatizing the patient.
But not every hospital has certified nurses available, and in the past, patients needed to travel to receive the exam, said Sarah Ehrhard Reid, head of the DHSS Department of Women’s Health.
The new telehealth network will mean exams are available at the state’s hospitals 24/7.
“Folks across the state were having to travel for at times four-plus hours to make it to one of these exams," she said. “A forensic exam can take anywhere between two to six hours. So if you can imagine someone having to drive even two hours for a six-hour exam, and then driving two hours home again, that's an entire day's worth of work.”
Time can be of the essence when it comes to the effectiveness of sexual assault forensic exams, Ehrhard Reid said. The more time that elapses between the exam and the assault, the less evidence will be able to be collected.
The statewide telehealth network contains several hub sites throughout the state. Some of the sites are hospitals and some are private agencies that employ forensic nurses. Each “hub” site will have an on-call certified nurse examiner who provides support through videoconferencing on a tablet to noncertified “bedside” nurses at other hospitals during a sexual assault exam.
The forensic nurse “will walk that survivor through every step of the exam, of what’s happening, and how to collect each piece of evidence based on what the nurse needs,” Ehrhard Reid said.
The videoconferencing assists on-site bedside nurses who may feel insecure about performing the exams. It can also support sexual assault-certified forensic nurses who may not have a lot of experience.
“We know that there's going to be some nurses who this will be their first time doing this, and they'll need a little bit more support,” she said. “There will be other nurses who have done this a dozen times, and they just need someone there to make sure they didn't forget anything after the end of a long shift.”
Maine and other states have put similar networks in place, said Matthew Huffman, a spokesman for the Missouri Coalition Against Domestic and Sexual Violence. The organization advocated for the passage of the bill that established the network.
Some health workers had reservations about the system at first, he said. Increased use of telehealth during the coronavirus pandemic showed that the system can be effective.
Nurses and other health workers using the network will need to be trained to use the telehealth equipment, but that training is not nearly as time-consuming and rigorous as what is required for a certified sexual assault nurse examiner.
“[We were] really explaining that whenever someone is getting a forensic exam through the telehealth network, you will still have a live person there,” he said. “You will have a trained healthcare provider performing the exam, but you will also have a registered sexual assault nurse examiner to be supervising.”
Starlyn Ritter, a forensic nurse examiner and a clinical educator at Phelps Health in Rolla, has worked as a telesupervisor for the new program. Phelps Health was one of the first hospitals to join the statewide network.
“Those patients are truly getting the best of the best right there on that screen,” she said, “They're getting assessments done by two different nurses. I mean, that's huge. That's absolutely huge for validation of a patient.”
If a patient doesn’t feel comfortable with an exam using a teleconference, hospital workers will transfer them to a nearby hospital with an in-person nurse examiner, Ritter said.
She hasn’t yet heard of a patient turning down a telehealth exam.
The exams can be grueling. A patient undresses on top of a large sheet of paper that collects hair, fibers and other evidence. The examiner will collect saliva, blood, semen and other biological samples and take pictures to preserve evidence of injuries.
At every point of the exam, the nurses will ask for consent. Ritter said that a patient can decline any part of the exam if they feel uncomfortable.
The kits are sent to the Missouri State Highway Patrol and other independent crime labs across the state, Huffman said.
Although federal grant dollars from a program called the Sexual Assault Kit Initiative allowed the state to cut down on its backlog of test kits, in recent years the number of untested kits has again started to increase. According to the Missouri State Highway Patrol’s tracker, the agency has more than 1,400 kits waiting to be processed. In June and July the agency completed 90 and 62 kits, respectively.
It’s possible that more evidence collection could mean that the state’s backlog could grow even more.
“Absolutely we have to address a capacity issue in crime labs. So part of what we know is that the crime lab is underemployed. There aren't enough specialized forensic experts to be able to keep up with the number of kits that come in,” Huffman said.
The Missouri State Highway Patrol does not anticipate a significant increase in test kits to the agency’s crime laboratory as a result of the new telehealth program, but “the patrol is prepared to handle an increase in submissions should one occur,” Lt. Eric Brown, assistant division director of the agency's Public Information and Education Division, said in an email.
The federal grant money allowed the agency to outsource testing to other laboratories, he said. Now that that money has expired, all testing is done in-house at the agency's crime laboratory.
“Naturally we will need to assess the volume and nature of the cases as they arise and we may need to adjust workloads and prioritize accordingly,” he said. “Nonetheless, we are confident in our ability to manage any increase successfully.”
The 2020 “Justice for Survivors Act” established Missouri’s telehealth network, which is funded through state and federal dollars. The 2020 bill also contains a “Sexual Assault Survivor’s Bill of Rights” that provides victims the right to consult with a worker at a rape crisis center during an exam and the ability to track where their evidence kit is.
