Jennifer Bishara often meets people on the worst day of their lives.
Bishara, a nurse, is the director of the Sexual Assault Nurse Examiner/Sexual Assault Forensic Examiner program — or SANE/SAFE — for Littleton Adventist Hospital. She’s liable to be paged any time of day or night to meet with sex-assault victims, and to conduct a thorough evidence-gathering examination that could spell the difference between locking up sexual predators or watching them walk free.
In an era in which politicians, entertainers and business leaders are facing waves of accusations of sexual misconduct, Bishara and her colleagues want to get the word out that victims of sex assault can expect skilled and loving help from experienced professionals.
“When a patient comes in this room, they’ve had something taken from them,” Bishara said, sitting in a small examination room. “We give them their dignity and control back.”
The program also cares for victims of domestic violence and strangulation, and is beginning to branch out into elder abuse and child abuse.
The program has its origins in the 1970s, as forensic evidence collection commenced a sea change in how sex crimes were prosecuted. Today the program, overseen by the International Association of Forensic Nurses, is present in nearly 30 hospitals statewide — and soon expanding to Parker Adventist Hospital.
Treatment and options
When victims arrive at the hospital, staff page a SANE/SAFE nurse, who arrives within 45 minutes, regardless of the time, 365 days a year. Nurses must obtain explicit, informed consent from victims, who then provide a detailed account of the assault, Bishara said. They are then given a meticulous physical exam, in which nurses take swabs of physical evidence on the victims’ body, and use a device called a colposcope — essentially an oversized microscope — to examine and photograph injuries.
The examination also provides treatment for infection and pregnancy prevention. Victims are also connected with The Blue Bench, a Denver-based sex assault victims advocacy group, as well as other resources. Nurses ensure that each victim has a safe place to go after the examination.
Victims are not required to report the assault to law enforcement, though Bishara encourages it. Regardless, the forensic evidence and statement of the victim are collected and assigned a serial number and maintained under strict security, so that if the victim decides to pursue charges at a later date, the evidence remains intact and admissible in court. SANE/SAFE nurses routinely testify in criminal cases.
Victims can come in up to five days after an assault, though Bishara said the sooner the better, as evidence degrades with every passing hour.
Catching offenders
Evidence collected in a SANE/SAFE examination can be crucial to convicting sexual predators, said Chris Gallo, chief deputy district attorney for Colorado’s 18th Judicial District, which covers Arapahoe, Douglas, Lincoln and Elbert counties.
“Robberies can be caught on camera,” said Gallo, who heads the district’s Special Victims’ Unit, which prosecutes sex crimes and crimes against children. “Homicides have bullets and guns and people willing to testify. With sex assault, however, we have a crime that occurs often between two people behind closed doors. The victim often feels shame and embarrassment. The fact that there’s a trained professional who can collect whatever small amount of evidence could exist to prosecute a sexual assault is fantastic. Without that, we’re back to circumstantial evidence and the credibility of witnesses.”
Sex crimes occupy a dark niche in the world of criminal prosecution, Gallo said, because society has long held a distrust of accusers — a distrust Gallo said he sees waning.
“It’s gratifying to see the support for people who disclose they’ve been abused, and I say it’s about freakin’ time,” Gallo said. “Supporting programs like SAFE/SANE goes a long way toward furthering that goal.”
Doctors, too, rely on the expertise of SANE/SAFE nurses to address an otherwise difficult scenario.
“Sexual assault examinations are very time-dependent, and very time-consuming,” said Dr. Matt Brougham, an emergency physician at Littleton Adventist and the medical director for the South Metro SANE/SAFE Program. “It can take two to three hours to do it right, and that’s very hard for emergency practitioners. Also, it’s vital that the evidence be handled properly, because a good defense attorney can find ways to get evidence thrown out. This way, there are no mistakes.”
In hospitals without SANE/SAFE care, sexual-assault victims may wait for hours to be treated, Brougham said.
“These are very emotionally charged situations, and people may walk if they can’t get this care,” Brougham said. “This is a great benefit to the community, and it’s hard to practice in a community where this isn’t available.”
Impact on practitioners
Seeing sexual predators thrown in prison based on the testimony of SANE/SAFE nurses is rewarding, said nurse Stacy Hobson, who has worked in the program for 10 years.
“It’s greatly gratifying,” said Hobson, who has testified in more than 30 cases. “Sometimes our evidence is so impeccable they just take a plea deal.”
Hobson has the distinction of being among the longer-lasting nurses in the program, which can take an emotional toll on its practitioners.
“I have healthy boundaries,” Hobson said. “I’m good about not taking on vicarious trauma.”
The nurses in the program look out for one another, and help keep each other from getting overwhelmed, said Bishara, the program director.
“Detailed accounts of assaults can be traumatizing for nurses,” Bishara said. “If I have a particularly bad case, I dream about it all night. I have five kids. When I started doing this, I started feeling like everyone was a rapist. We see the worst of society — the absolute worst. It’s a sisterhood, and we help each other stay resilient.”
Bigger picture
Bishara said that while she’s grateful to be able to help victims, she’d like to see society do a better job of addressing the causes of sexual assault rather than just treating the symptoms.
“Sex assault starts with the culture,” Bishara said. “It’s about teaching sons about inappropriate touching and violence. I’ve got four sons — I tell them if a girl’s been drinking, hands off.”
Sexual assault is less about sexual gratification and more about power, dominance and humiliation, Bishara said, adding that she’s beginning to see more men report assaults, too.
Their suffering can be acute.
“Women are trained and conditioned to avoid sex assault, but men are not,” Bishara said. “I see more outward devastation from men.”
Regardless of identity, victims can expect a safe place and a wealth of resources and options in a SANE/SAFE facility, Hobson said.
“We start by believing you,” Hobson said. “I won’t force you to report. I just want you to come in.”
Bishara takes issue with elements of sexual assault nomenclature.
“I hate the word ‘victim,’” Bishara said. “I prefer the word ‘survivor.’ They’re being victimized out there, but here, they leave as survivors.”
Bishara’s survivors often leave her exam room on a path to healing, she said.
“We’re told not to hug them, but a lot of times, they hug us,” Bishara said. “It seems very cathartic to them. We tell them that this happened and it’s terrible, but it doesn’t have to define you. You can be more and you can be better. ”
