A sexual assault exam has the potential to be nightmarish.
That’s because, even with the most caring nurse, “you’re kind of treated like a piece of evidence,” said Megan Lorincz, the only Washington nurse east of Wenatchee who has gone through the 300-hour certification to give sexual assault exams, she said.
While all nurses are trained in evidence collection, the first experiences after a sexual assault require special understanding, Lorincz said.
“This is a very invasive exam,” Lorincz said. “It feels like it’s stripping away their humanity, which was already done to them. Their humanity was already taken away, so you have to try to give that back to them.”
For years, those invasive experiences did not often result in justice, either. Washington has invested millions in a goal to, by Dec. 21, test every rape kit that has been sitting in wait. The number of untested kits reached a peak of 10,000 in 2015. By 2019, there were about 4,500 kits in wait and another 2,000 in the process of being tested.
Legislators are filling in other pieces of the puzzle, too. In June, a Washington bill, opposed by the Washington Association of Sheriffs and Police Chiefs (WASPC), went into effect that required law enforcement to hold rape kits even when survivors haven’t decided whether to file a police report.
Even as the backlog unclogs and legislation clears up some previously murky waters, survivors must jump through hurdles to get justice.
The Washington State Patrol Crime Laboratory system, including a lab in Spokane, processes 153 sexual assault kits per month on average, based on the past six months, WSP spokesperson Mary Kellar said.
About one-third of sexual assault kits WSP processes are a bust. They’ll screen negative for the presence of a body fluid or male DNA and will not be tested further, Kellar said. And as of August 2020, the average processing time for a kit was 212 days, though as the backlog clears out, labs will be able to work faster to reach the legislated 45-day turnaround time, Kellar said. That 45-day limit takes effect in May 2022.
But another two of every three kits do result in useful evidence. Every time a kit leads to a DNA profile attributed to a perpetrator, the profile is updated to a DNA database called CODIS. It works – 15% of tested sexual assault kits will match to a person in the CODIS database.
The possibility of justice is what drew Lorincz to specialize in the exams.
“Survivors can say, ‘Yes, you did this thing to me, but I’m going to get my power back and do whatever I can to make sure you can’t do this to somebody else,’” Lorincz said. “I find that empowering.”
But reaching that justice takes incredible strength, she said. Despite Lorincz asking for consent at every step of the way, collecting evidence for a rape kit is inherently difficult for survivors to stomach.
Survivors will have the best bet getting DNA attributed to a perpetrator if they don’t bathe after an assault. If a survivor has to use the restroom, “as gross as it sounds, don’t wipe, because you could wipe away evidence,” she said.
Lorincz will come to the room, explain every part of the exam and go through options – a purely medical exam looking for injuries, evidence collection for law enforcement or anonymous evidence collection if a survivor isn’t ready to press charges.
Then she’ll ask the patient to describe what happened. That’s where she’ll determine where to swab.
The patient must strip down. Clothes worn during the assault go into evidence.
“Start head-to-toe, looking for any areas of tenderness or pain, did they pull your hair, do you have chunks of hair missing?” Lorincz said. “If you have a matted area in your hair, we can swab that, or if it’s at the end we might cut it out. What is that substance?”
She might check the neck for marks from strangling and swab the skin for saliva evidence.
She’ll swab under finger nails and brush through pubic hair for debris or hair evidence. Some people refuse the speculum exam, others want to be swabbed but not inspected, others want both. If they believe they were drugged, Lorincz can take a urine sample.
There are differences in Spokane County and Kootenai County exams, too, she said.
In Kootenai, she can use a black light to scan the body for bodily fluids to swab. There is also the option to photograph injuries on the genitals. In Spokane, that’s off the table because the local legal community considers it violating, Lorincz said, to show photos of genitals “blown up in a court room.”
Patients can also receive treatments to prevent sexually transmitted infections and Plan B to prevent pregnancy.
If a survivor goes through with the exam, it may be only the beginning of a period of scrutiny involved in pressing charges, said Erin Williams Hueter, director of Lutheran Community Services Northwest, the only accredited community sexual assault program in Spokane.
Next, they’ll face a perpetrator in court, their integrity will be called into question, they will be nitpicked on the stand and asked to repeat a terrible experience again and again, grilled on the timeline and any details they struggle to remember in a fog of trauma, Williams Hueter said.
A nurse who approaches that first contact with medical personnel with sensitivity and who expresses belief in a survivor can “change the trajectory of someone’s healing process.”
“If we ultimately want to curb sexual assault, we need to start by believing people and not take into consideration what people were wearing, what they were consuming, who they were with,” Williams Hueter said. “If somebody said, ‘My car was stolen from my parking lot at night,’ we wouldn’t say, ‘Well, why did you park it there?’”
Lorincz works through Lutheran part-time, Tuesdays and Thursdays, and is ready for a call to complete an exam then. She also works part-time in Kootenai Health’s Emergency Department, but can sometimes get work covered to collect evidence for a sexual assault kit.
She knows nurses who can’t believe she’s able to focus on sexual assault due to the vicarious trauma.
“I always knew I would never be a hospice nurse. I don’t know how you’re surrounded by death everyday. But on the flip side, those people look over and say, ‘I don’t know how you do this,’” Lorincz said.
The fast-paced emergency room environment doesn’t allow for much one-on-one care, she said. A sexual assault exam gives her an opportunity to help somebody at the most crucial time.
“I truly believe your first encounters with law enforcement, medical, they set the stage for your journey,” Lorincz said.
“It’s obviously an awful experience to have to go through. But if somebody treats you like a person and gives you an opportunity for empowerment, you’re already starting on a better platform than if you’re trying to go at it alone.”
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