When a victim is raped, convincing them to go to the hospital can be tough. That’s just the first hard step after a horrific trauma. But what survivors have to do once they walk in the doors of a hospital is a challenge all its own, one law enforcement relies on to make a case.
In any investigation, the crime scene is crucial. But, when the crime is sexual assault, it's not a place that provides the most evidence, it's a person. Rape survivor Kate Rush-Cook can testify to that.
"You have your body plucked and swabbed and every piece of your clothing is taken from you - your socks, your shoes, your underwear, your shirt, your pants," she said. "A lot of people don't realize that."
When survivors of sexual assault decide to move forward with pursuing a case against their attacker, they may be required to go under a microscope themselves.
We're not talking a standard medical once-over. What happens is something much more invasive.
It's called a forensic exam and it's key to providing detectives and eventually prosecutors with the material they need to make a case.
"They do it in a safe, secure environment. They know how to maintain the chain of custody and the evidence so that's where they become enormously important," Baltimore City State’s Attorney Gregg Bernstein said.
But it’s not detectives who do the exams. Instead, forensic nurse examiners are the people who perform them. They’re designated technicians who become the first investigator in the case when someone says they've been sexually assaulted.
"It's definitely not something any practitioner could do. Specialized training is required," said Linda Kelly, a forensic nurse examiner and the coordinator of GBMC’s SAFE (Sexual Assault Forensic Exam) program.
Kelly says hours of specific training make FNEs de facto detectives of the emergency room. They are taught how to swab, examine and photograph victims of sexual assault in designated hospitals throughout the state. It’s a rigid process with a multitude of steps that uses state police and local law enforcement protocols to collect evidence the FNEs could later have to testify about.
“This kit, once it's been sealed, will be brought into court. And they'll see how I've sealed my evidence," Kelly said.
The evidence can't be collected at every hospital in Maryland. Only some of them volunteer and become designated as having a "SAFE” program, which is capable of doing sexual assault forensic exams.
For each rape kit that's done, the participating hospital is reimbursed by the state through federal programs. Records from the Maryland Department of Health and Mental Hygiene show hospitals were paid $2.9 million in rape kit reimbursements in the last three years.
DATABASE: Rape kit reimbursements
For the hospitals, it can be a huge commitment to offer the SAFE program. While some facilities do just a handful of rape kits each year, others do far more. For instance, state records show Mercy Medical Center, the designated hospital for victims in Baltimore city, has done more than 1,200 rape kits in the last three years.
Bernstein says it’s a crucial service, "Not only are they conducting the physical examination but they're getting information from the victims about the offense itself. They're getting statements, narratives if you will, that tell us what happened."
FNEs help to put together the pieces of a sexual assault, while helping a victim who may have been hesitant to come to the hospital in the first place. Kate Rush-Cook, one of the rape survivors we spoke with, says it’s a decision survivors often struggle to make.
As a result, she says forensic nurses must walk a fine line, using compassion as they help solve a crime.
"The way a rape is treated in the beginning sort of sets the tone for everything," she said. "There are so many things that can devastate you down the road and re-traumatize you if they're not done properly."