SANE programs emerged in response to the poor treatment rape victims encountered in hospital emergency rooms. Although victims are still instructed not to bathe or urinate after an assault in order to preserve evidence, prior to SANE programs victims were often made to wait for hours because their cases were not seen as urgent. Uneducated medical staff asked victim-blaming questions and did not understand that absence of bodily injury did not mean the victim was not profoundly injured psychologically. Untrained medical personnel were inept at evidence collection and sometimes resentful of the complex, hours-long examination process and detailed documentation required.

SANE programs were first established in the 1970s and became widespread in the 1990s. Today there are hundreds of SANE programs across the county, but far fewer than are needed. Because many communities cannot afford to establish or maintain SANE programs, many victims still experience long waiting times and are examined by whomever is on duty in the Emergency Department. Researchers are trying to address this unmet need with telemedicine, described later in this module.

Terri Slapak-Fugate, Director of Emergency/Urgent Care and the SANE Program Manager at Southwest Health Hospital in Platteville, Wisconsin, highlights the problems of medical forensic sexual assault examinations conducted by untrained medical professionals:

“Research shows that rape kits completed by health-care workers without special training are routinely compromised. One study conducted in Colorado and published in the Journal of Emergency Nursing found that 29 percent of such kits didn’t include the correct number of swabs for evidence, 25 percent were improperly sealed and 19 percent didn’t follow the proper chain of custody on their way to law enforcement. The integrity of the kits was much higher when specially trained nurses were involved.”¹