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117 CHAPTER FIVE DEVELOPING THE BODY OF EVIDENCE Sexual Assault Nurse Examiner Programs [T]hese rape kits . . . —are they worth all this work? (Kansas, urban) One of the most highly touted improvements in the systems response to rape is the wide-scale adoption of medical forensic examination protocols , often referred to generically as sexual assault nurse examiner (SANE) programs. SANE programs, which provide specialized medical care and forensic evidence collection in the wake of a sexual assault, are universally described by scholars, nursing professionals, and government agencies as a significant step forward in the effective investigation and prosecution of sex crimes (Campbell, Bybee, Ford, et al. 2009; Ledray 1999; Littel 2001; Nugent-Borakove, Fanflik, Troutman, et al. 2006). SANEs provide specialized post-rape care for victims, providing both a high-quality forensic examination and an understanding of the trauma associated with sexual assault. As the National Protocol for Sexual Assault Medical Forensic Examinations states, “A timely, well-done medical forensic examination can potentially validate and address sexual assault patients’ concerns, minimize the trauma they may experience, and promote their healing. At the same time, it can increase the likelihood that evidence collected will aid in criminal case investigation, resulting in perpetrators being held accountable and further sexual violence prevented” (U.S. Department of Justice 2004, 3). Sexual assault response teams (SARTs) expand on SANE programs by developing a coordinated, interdisciplinary response to rape which includes —at a minimum—three team members: medical providers (which typically includes a SANE), law enforcement (usually police and prosecutors ), and RCC advocates. SART members develop shared protocols for responding to reports of sexual assault which may include practices such as mandated notification of other partners and joint interviewing of victims. SART programs center on SANEs, but SANE programs do not necessarily involve a SART component. SANE programs have significantly improved outcomes for victims in communities. These benefits are borne out both in anecdotal evidence from local RCC advocates and in empirical studies. In areas such as victim satisfaction with medical care (Campbell 1998; Du Mont, et al. 2009; 118 Developing the Body of Evidence Ericksen, Dudley, McIntosh, et al. 2002; Fry 2007), completeness of medical attention (Littel 2001), proper collection of forensic medical evidence (Sievers, et al. 2003), and improved criminal justice outcomes (Campbell, Bybee, et al. 2009; Campbell, Patterson, and Lichty 2005), SANE programs far exceed the performance of their non-specialized emergency room peers. Scholars who have studied SANE-SART programs report that integrated medical and legal services are significantly more likely to result in better case outcomes than cases done by a SANE-only or without any SANE program (Burgess, Lewis-O’Connor, Nugent-Borakove, et al. 2006; Crandall and Helitzer 2003; Nugent-Borakove, et al. 2006). These benefits are extremely important and I do not mean to underestimate or dismiss them cavalierly. As I hope chapter 4 amply illustrated , ER-centered medical care for victims often fails to provide minimally competent or compassionate care. However, as Greeson, Campbell, and Kobes (2008, 32) point out in their toolkit for evaluating SANE programs, only about ten of the hundreds of SANE programs in the United States have been studied in-depth. Yet findings from this scant handful of programs are driving the demand for SANE services without careful consideration of the ways that programs may evolve differently in response to the kinds of local political and legal cultures, especially among law enforcement , discussed in the previous chapter. This rapid policy diffusion obscures the potentially troubling issues SANE and SANE/SART programs pose for feminists and victim advocates concerned about the state response to rape. The resources and praise being lavished on forensic evidence collection may fail to anticipate or remedy pre-existing problems with the criminal justice response to rape. SANE programs may exacerbate the kinds of problematic behaviors detailed in chapter 3, providing police and prosecutors with an additional tool to bully and intimidate victims of sexual assault. SANE programs sit uneasily at the intersection of medical and legal responses to rape; the medico-legal exam can be a means to reach aspects of a victim’s life that are irrelevant to the assault at hand but may discourage investigation or prosecution of her case. Finally, SANE programs present conflicts over the state’s response to rape, in particular, over which groups “own” and therefore define what medical care victims should get and why. Since local, state, and federal rights to post-rape care are usually justified by forensic evidence collection, SANE...

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