Protect yourself if you are a sexually assaulted athlete
Learn where to go in California for help if you’ve been raped or sexually assaulted as an athlete and what to expect from a forensic exam
An athlete who has been raped or sexually assaulted will usually feel a swirl of emotions ranging from fear to anger and confusion.
What do you do – call a friend? The coach of your team? SafeSport? A doctor? The police?
If you’re hesitant to involve the coach of your team, SafeSport or the police, you can still seek no-cost professional help because the Violence Against Women Act requires states to provide sexual assault forensic exams free of charge. The exams, commonly known as “rape kits,” are conducted by specially-trained nurses, usually in a private setting away that’s been designated for that purpose.
So, if you’re medically OK, don’t just head to the nearest emergency room because they may not provide the service you need.
“It’s a good assumption that if an emergency room is open then you should be able to get care there for anything,” forensic nurse Kim Walker said. “The issue with these exams is they’re very specialized. The nurses that we use are emergency room or obstetrics or ICU nurses, who are highly specialized already. Only now you add medical and forensic skills, so it’s a skill set that is not ordinarily taught – it’s something you have to be trained on separate from what you already know.”
Walker is the nurse manager of Santa Clara County’s SAFE Program, the Sexual Assault Forensic Examiner Program. Nurses trained in this program are known as SANE nurses or Sexual Assault Nurse Examiners.
Santa Clara County has anywhere from 15 to 20 SANE nurses on staff at any given time and operates a separate unit for children 11 years old and younger.
The programs are based at Valley Medical Center in San Jose, with numerous satellite locations.
“It’s more trauma-informed for us to be able to respond to where the patient is rather than only having only one location where the patient has to go,” Walker said.
The Santa Clara County SANE nurses conduct about 500 tests per year, with each test taking an estimated three to five hours. Since 2015, the county has experienced a 10 percent annual increase in the number of forensic exams.
“It’s a pretty extensive process and we explain what’s involved up front,” Walker said. “First, we register the patient, draw blood, then we send the blood off to be analyzed and move to a private room for a confidential interview. We ask about what happened to get an idea of how extensive the exam needs to be. Not all exams are the same – it depends on what happened.”
Whatever the case may be, immediate medical needs are addressed first, Walker said.
The Santa Clara SAFE program is one of 49 in California. Although the state has 58 counties, some counties share resources. See below for the 24/7 SAFE program hotlines.
Help for sexually assaulted athletes in San Diego County
In San Diego County, the director of Forensic Health Services for Palomar Health, Michelle Shores, is responsible for multiple locations where nurses perform forensic exams. Their response time is about an hour.
Last year, Shores’ team saw a slight decrease in sexual assault cases over 2019, possibly due to COVID-19 lockdowns, but domestic and child abuse cases increased. The nurses administered a total of 1,408 forensic exam tests in 2020.
“We saw 578 sexual assault patients, 277 intimate partner patients and 312 children,” Shores said. “I have a team of 13 nurses all cross-trained in pediatric, adolescent and adult sexual abuse, as well as domestic violence, elder abuse, gang violence, strangulation and human trafficking. So, my forensic medical program is comprehensive.”
San Diego’s SANE nurses deal primarily with adults; children under 18 who are sexually abused are examined by pediatricians at a children’s center.
No one is turned away, Shores said, no matter where they go for help. To make sure that happens, a county-wide program, San Diego CARES, trained health care providers to make detailed referrals to forensic health professionals.
“Of course, patients can come directly to us,” Shores said. “They don’t have to pass through an emergency department. But we did a lot of community education to make sure health care providers know what to do if a patient does come in the door.”
A lot of referrals are made by law enforcement officers and victim advocates, who connect sexual assault patients with any services they may need. The advocates often act as a sounding board, too, helping patients navigate through their trauma.
That’s why empathy is a core job description, Walker said.
“It’s important to understand what you can expect from someone who’s been through a trauma,” she said. “You want to make sure that you don’t discount someone’s story just because they’re acting jovial or laughing. That would not be an accurate assessment. When you meet a patient you ask the questions you need to ask, you provide the care they need and you understand all the different ways a patient in trauma may act during an exam.”
Sooner is better than later
There are no hard and fast rules regarding the timing of a forensic exam but Walker said, “The sooner you can come in the better.”
“There’s a hard 72-hour window where we can provide HIV medicine,” she said. “For evidence, we can see patients for up to 10 days after an assault. We’ve had patients who have had DNA found even after they’ve showered and after waiting a couple of days to come in. So, it just depends. We don’t not do an exam based on they’ve taken a shower because we never know. And we don’t want to discourage someone from coming in just because they’ve had a shower or they’ve changed clothes because it may not stop us from be able to find DNA or other evidence.”
What does mandatory reporting mean?
All states mandate that health care workers report sexual assaults and/or child abuse to law enforcement authorities.
Since SANE nurses are mandatory reporters, Shores makes sure her patients understand what that means.
“I tell them, ‘I want you to know before we go on that I’m a mandatory reporter, so I have to document everything we talk about.’ I want to make sure my patients understand that we are not investigators for the police; we collect and submit evidence to the crime lab and they process it.”
Walker also elaborated on the mandatory reporting requirement.
“SAFE nurses are confidential except for the part where a crime has been committed against a person – that we have to report,” Walker said. “But the patient does have the option to have a full sexual assault forensic exam and not have it reported to law enforcement. We do the same exam and we still get a case number and police pick-up the evidence but the patient is in charge of what happens. This allows the patient to have time to figure out what they want to do. They might not be up to a full report to law enforcement or an investigation but they want to preserve any evidence that’s available. Of course, it’s limited because it’s only the evidence we can collect form the person’s clothing or body, it’s not going to include surveillance tapes or witness statements or suspect exams but it does at least preserve evidence and they have time to figure out what they want to do.”
Child sexual abuse has different rules in California that say a child 12 or older can consent or decline an exam, no matter what their parents want them to do.
The San Diego County District Attorney’s Office hired a nationally-certified lab to address the issue of untested sexual assault kits. Excluding the San Diego Police Department, which does its own testing, the county had 2,030 untested kits.
That number was reduced to 1,983 untested kits as of February 16, 2021.
The San Diego Police Department estimates it will clear its backlog by May 2022. A 2020 state audit found SDPD had 1,627 untested kits.
The audit found there were at least 13,929 untested kits statewide. But the audit may be an incomplete accounting since only 149 police agencies and crime labs participated.
For example, it does not list the San Jose Police Department as one of the agencies that submitted figures.
Santa Clara County District Attorney Jeff Rosen, meantime, issued a news release saying the county’s backlog of 269 untested kits had been cleared as of February 2020.
Statewide, the backlog is being cleared up in part due to AB 1496, which requires law enforcement agencies to submit new kits for testing within 20 days; crime labs then have 120 days to process the tests. The bill also requires kits collected before Jan. 1, 2020 be sent to a crime lab within six months and tested within 120 days.
April is Child Abuse prevention and Sexual Assault Awareness Month
Every April, Shores oversees the installation of a field of pinwheels at Palomar Medical Center, representing each child abuse or sexual assault survivor seen by her team in the previous year.
“Each fan is one of our partners working together,” Shores said. “They have to work together for the pinwheel to flow. People stop when they see 1,000 pinwheels blowing in the wind and ask what is that? It’s beautiful.”
It’s also recognition of the dedication SAFE nurses bring to a difficult job.
“This is a calling, a passion,” Shores said. “It’s amazing what people with passion can do, especially with a supportive organization and community.”
Hotlines for rape and sexual victims
Forensic nurse Hannah Wright, who belongs to the St. Joseph SART in rural Northern California, points out that many victims don’t want to report their rape or sexual assault to police because “they’re legitimately afraid for their lives.”
“While most of the calls we receive are initiated by police, in a small community some will say they don’t want the police involved because the suspect might find out who reported them,” Wright said.
If you don’t want to contact police but do want to talk to a confidential professional, find out if you’ve been exposed to an STD or preserve evidence for a possible future criminal case, you can call RAINN’s National Hotline at 800-656-4673 and be directed to an advocate in your area.
A list of California SART teams is available at calsafe.net but some numbers may not be available 24/7.
Here is a list of 24/7 hotlines for the San Diego, North Coast and San Francisco Bay areas, along with select hospitals that have Sexual Assault Response Teams.
San Diego 888-211-6347
Pomerado and Palomar hospitals, University Community Medical Center and Rady Children’s Hospital.
North Coast 707-445-2881
Serving Humboldt, Mendocino, Del Norte and parts of Trinity counties.
San Francisco Bay Area
Alameda County 510-845-7273
Valley Care, Washington and Highland hospitals, and Children’s Hospital of Oakland
Contra Costa & Marin counties 800-670-7273
Napa County 707-255-6397
San Francisco County 415-437-3000
Zuckerberg San Francisco General Hospital
San Mateo 650-692-7273
Santa Clara County 408-885-5000
Valley Medical Center, Stanford hospitals, Children’s Advocacy Center San Jose; and St. Louise Hospital beginning June 2021.
Santa Cruz County 888-900-4232
Watsonville and Dominican hospitals
Solano County 866-487-7233
Sonoma County 707-545-7273