How we care for sexual assault survivors

Sexual assault is a sensitive topic, no matter how we discuss it. But it’s an important topic to discuss honestly and openly. People who have been sexually assaulted need to know that they can get help and medical care in an understanding environment that’s specially designed for these sensitive cases.  

In an ideal world, no one would ever be sexually abused or assaulted. But that’s not the world we live in. Crime data from the Metropolitan Police Department in Washington, D.C., show that there were 346 reported cases of sexual abuse in the metro area in 2016—that’s almost one per day. Sexual assaults are underreported, and it is estimated that only 28 percent of cases are ever reported to law enforcement.  

Many victims just want to move past what happened and get on with their lives. Regardless of a person’s desire to report sexual assault to police, the person still needs medical attention as soon as possible. If you are sexually assaulted, call 911 right away. When you arrive at MedStar Washington Hospital Center, you’ll be cared for by a dedicated, specially trained sexual assault nurse examiner, or SANE nurse.  

Dedicated care for District patients who have been assaulted

We are the only hospital in the Washington metro area with SANE nurses, so all adult victims of sexual assault in the area come to MedStar Washington Hospital Center for examinations. Sometimes patients come here directly, sometimes they go to other hospitals and are transferred here, and sometimes they’re brought here by police after reporting an assault. In 2016, we saw 411 patients who had been sexually assaulted.

Our emergency medicine doctors have a great deal of empathy for all our patients. And we’re keenly aware of the physical and emotional trauma victims of sexual assault go through, whether they’re coming to see us hours, days or weeks after the incident. We try to make them feel at ease. The first thing I say to a patient who’s been sexually assaulted is, “I’m very sorry this happened to you.” Then we talk through the care they’ll receive from the doctors and SANE nurse.  

The initial examination process

Some patients who have been sexually assaulted have other injuries, such as severe bleeding, broken bones, sprains or injuries related to choking. People who have been choked may have damage to the blood vessels leading to the brain, which can lead to a stroke without treatment.

We provide diagnostic testing as soon as possible to rule out injuries that may not be obvious at first glance. If a patient shows signs of abuse in the home environment, we speak to the patient privately and try to determine if that person feels safe at home or needs help.  

The most common question I get from patients who have been sexually assaulted is whether they’re at risk for sexually transmitted diseases (STDs). During the examination, we offer treatment to protect them from any STDs they might have contracted during the assault, including gonorrhea, chlamydia and HIV. For women of childbearing age, we also offer emergency contraception—commonly known as the morning-after pill—for pregnancy prevention. Patients can take all the time they need to ask questions before we move on to the next step.  

When the patient arrives, we contact a dedicated patient advocate who will stay with the patient throughout the entire process. As much as possible, we work to minimize the trauma of the hospital experience for patients. We have a dedicated family room area where a patient can wait with family members and their advocate away from the emergency department’s general waiting room  

Care from the sexual assault nurse examiner

SANE nurses are employees of the District of Columbia Forensic Nurse Examiners (DCFNE), a separate not-for-profit program we work with as part of the District of Columbia Sexual Assault Response Team (DC SART). DCFNE partners with the Network for Victim Recovery of DC (NVRDC) to provide advocacy, case management, legal services and therapeutic programs if necessary and desired.  DC SART is a network of agencies in the Washington metro area that provide coordinated responses to sexual assault.  

SANE forensic nurses are in our hospital 24 hours a day, so they’re always available when they’re needed. If a patient is too badly injured to be transferred here, SANE nurses travel to other local hospitals.  

The SANE nurse will take the patient into our dedicated exam room, which is designed and set aside for victims of sexual assault. This room provides a private area with a locked door where the nurse can perform a detailed examination of the patient. The examination includes:

  • A conversation with the patient to find out what happened
  • Documentation of the patient’s injuries, including photographs
  • Evidence collection  

Many patients are unsure if they want to press charges. While this is a personal and sometimes difficult choice some people must make for themselves, in most cases, we reassure them that they don’t have to press charges or go to court just because they’re having an examination and having evidence collected.  We are legally required in special, mandatory reporting circumstances to report suspected sexual assault to the police.  Examples of this include:

  • When the victim is younger than 18
  • When the victim is cognitively or physically disabled
  • When a firearm is involved  

For most victims, getting their story, documenting their injuries and collecting evidence by the SANE nurse makes it possible for the victim to press charges later if they decide to do so. Unless it’s a mandatory reporting situation, no one will pressure victims to press charges if they don’t want to. We don’t work for the police or the prosecutors. Our top priority is empowering patient victims and providing the medical care, support, and resources that they need.  

Related reading: Specialized Equipment, Training Needed for Sexual Assault Patients

The value of dedicated sexual assault forensic nurses

SANE nurses are specifically trained to work with patients who have been sexually assaulted. When a patient who’s been sexually assaulted comes in, the SANE nurse is focused on just that person for however long the process takes.  

SANE nurses are forensic nurses, which means they are extremely well-trained and experienced with collecting evidence for these cases. Studies conducted by the National Institute of Justice have found that SANE programs have many benefits for the community. In addition to better health care for patients who have been sexually assaulted, the benefits of SANE programs include:

  • Higher-quality forensic evidence
  • Increased ability of law enforcement to collect information, file charges and present cases to prosecutors
  • More successful prosecutions

In hospitals that don’t have SANE nurses, the doctor, nurse practitioner or nurse works with patients as they come into the emergency department. They see many patients during a normal shift and have to care for several patients all at once. They may see only a handful of sexual assault cases per year—maybe only one a year or every other year. So they’re not as familiar with the evidence-collection kit. They may not get as much evidence or do so in a way that’s completely compliant with the kit’s requirements.  

If the case goes to trial, doctors or nurses may have their experience questioned during testimony. It’s hard for someone to present themselves as an expert witness when they’ve only done one evidence collection for sexual assault in the past two years. It’s potentially a much stronger case with a SANE forensic nurse who can testify in court, “I’ve done 50 sexual assault exams in the past six months.”

In an ideal world, we wouldn’t need special exam rooms and dedicated SANE nurses. Unfortunately, these resources are necessary. And we won’t waver in our dedication to caring for and supporting people in our community who have to face emotionally and physically traumatizing sexual assault.  

For local support resources and more information, please visit the following:

HIV: Get Tested. Get Treated.

In the United States, there are 1.2 million people living with Human Immunodeficiency Virus (HIV), but the Centers for Disease Control (CDC) estimates that 13 percent of those people are unaware of their diagnosis. Washington, D.C. has been hit particularly hard by HIV. Approximately 2.7 percent of the District’s population is living with the disease.

“Unfortunately, many people do not know that they are infected with HIV, and don’t present for medical care until the infection has severely damaged their immune system,” says Glenn Wortmann, MD, section director of Infectious Diseases at MedStar Washington Hospital Center. “In order to help people get diagnosed earlier, the CDC now recommends that all people aged 15-65 get an HIV test at least once in their life, and those with risk factors for HIV get tested more frequently.”

The only way to know if you have HIV is to get tested. Your primary care physician or other healthcare provider can test for the disease with a simple oral swab or finger prick blood test. Many medical clinics, hospitals, and community health centers also offer testing.

Most insurance covers the cost of HIV/AIDS testing and treatment. If you do not have insurance, some facilities have resources to help patients pay for the cost of treatment. MedStar Washington Hospital Center is the recipient of Ryan White HIV/AIDS Program funding, the largest federal program designed specifically for people with HIV/AIDS. Through this grant, the outpatient clinic provides medical care, case management, social work and peer navigator services to individuals and families affected by HIV/AIDS.

Evolving Treatment and Care

HIV is most commonly spread through sexual contact, contaminated needles, or from mothers to their children during pregnancy, birth or breastfeeding. The virus attacks the body’s immune system and makes it difficult to fight infections and certain cancers. If left untreated, HIV can lead to AIDS (acquired immune deficiency syndrome).

There is no cure for HIV, but early testing and revolutionary treatment options can dramatically improve the quality and length of life for those living with the virus.

“Over the past 30 years, advances in treatment have seen HIV evolve from a uniformly fatal condition to an infection which can be managed with medications.  However, the control of infection requires taking a pill every day, and regular adherence is critical,” says Dr. Wortmann.

The treatment is typically a combination of drugs called antiretroviral therapy (ART). The use of ART to treat HIV has drastically reduced the number of infections and deaths from the disease.

Before the introduction of ART in the mid-1990s, HIV could progress to AIDS in a matter of years. Now, with early diagnosis and treatment, people with HIV can live nearly as long as those without it. Taken regularly, ART can help control the disease, keep immune system healthy and even decrease the risk of infecting others. The World Health Organization estimates that there are approximately 17 million people currently using these life-saving medications.

“By getting tested and linked into care, patients can start life-saving medications, and can expect to live a normal lifespan,” Dr. Wortmann concludes.

Reducing Hepatitis C in the African-American Community

hep-C-infographicWorld Hepatitis Day was celebrated this week, a day set aside to raise awareness about viral hepatitis, which affects 400 million people worldwide. It also marks a historic moment for the hepatitis community – the launch of NOhep, the first global movement to eliminate viral hepatitis.

In the United States, it is estimated that between 2.5 million and 4.7 million people are living with chronic hepatitis C (HepC), a liver infection caused by the hepatitis C virus (HCV).  The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force recommend that anyone of any age with high risk behaviors such as current or past injection drug use should get HepC tested once yearly. They also recommend baby boomers or people born from 1945 to 1965 should be tested at least once for HepC due to high prevalence. Baby boomers are five times more likely to have HepC, and most of them don’t know they are infected. 

HepC has been called a “silent epidemic” because most people with the disease don’t know they are infected. Over time, HepC can cause inflammation and gradual liver fibrosis or scarring, which can lead to cirrhosis. It is also a leading cause of liver failure, liver cancer, liver transplantation and liver-related death. And according to a recent CDC article, more people die each year from HepC than from 60 other infectious diseases, including HIV. Yes, HepC kills more people each year than HIV.

For the African-American community, HepC is a relevant yet neglected disease. In fact, HepC is more prevalent among African Americans than among persons of any other racial group in the nation. And although African Americans represent about 13 percent of the overall U.S. population, estimates suggest they represent around 22 percent of all HepC infections. Additionally, African-American baby boomers have twice the rates of HepC infection as other baby boomers. This picture is equally revealing at the hospital level. In a recently published article in the journal Public Health Reports, we found a HepC prevalence rate of nine percent among baby boomers within MedStar Washington Hospital Center’s Primary Care Clinic. This was significantly higher than the U.S. prevalence of 3.3 percent and the D.C. prevalence of 2.5 percent (among all ages). Within this group, the HepC positive rate among African-American men was 16 percent, substantially higher than the CDC rate of eight percent.  

So what does this mean, and what can you do? The National Black Leadership Commission on AIDS launched the first National African-American Hepatitis C Action Day four years ago, with the intention of mobilizing the community to reduce the burden of HepC on the Black community, and impact a neglected health disparity by promoting education, testing, linkage to care and treatment. So for everyone, especially people of the African-American community, it starts with a test, it’s that simple. HepC is curable. CURABLE. But one of the biggest barriers to HepC elimination is a lack of identification.

Lastly, but importantly, the Centers for Medicare and Medicaid Services (CMS) now covers the cost of a HepC antibody screening test – in a primary setting – if the following conditions are met:

  1. A screening test is covered for adults at high risk for HepC infection. “High risk” is defined as persons with a current or past history of illicit injection drug use; and persons who have a history of receiving a blood transfusion prior to 1992. Repeat screening for high risk persons is covered annually only for persons who have had continued illicit injection drug use since the prior negative screening test and have not been.
  2. A single screening test is covered for adults who do not meet the high risk as defined above, but who were born from 1945 through 1965.

So take the HepC challenge and ask your primary care provider to be tested. If you are chronically HepC infected and not currently in care with a specialist (Infectious Diseases, Hepatology, or Gastroenterology), please contact the HepC Linkage to Care Navigation program at MedStar Washington Hospital Center for assistance.

Phone: 202-877-0679 or 202-877-3296

Email: [email protected] or [email protected]

In this video, patient Sharon Billings kept her hepatitis C diagnosis a secret and lived in silence for 18 years. She shares her story of overcoming HepC.

Have questions?

We are here to help! If you have any questions about MedStar Washington Hospital Center, call us at 202-877-3627.

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