IV. Rape Kit Evidence Collection in Illinois
Special care is required in the collection of rape kit evidence. Sexual Assault Nurse Examiners (SANEs) are nurses who receive special training in how to provide appropriate medical, forensic, and emotional care to rape victims, and can provide 24-hour, first-response care to sexual assault patients in a medical setting. In contrast, emergency room physicians and nurses often have little or no training on the medical treatment of rape victims, or on how to conduct a forensic rape kit exam. The importance of SANEs is reflected in the creation of a SANEs’ training program out of the Illinois Office of the Attorney General, which has classroom-trained more than 530 nurses through its free training program.
While no system exists to track SANE resources in Illinois, experts Human Rights Watch spoke with during the course of our research agree that, despite a robust training program, there is still a shortage of SANEs in the state, in part because of hospitals’ unwillingness to support the hiring and training of such nurses full-time. Shannon Liew, SANE Coordinator for the state of Illinois, estimates that of the over 530 nurses participating in the attorney general’s SANE training in the past five years, only approximately 100 nurses have become fully SANE certified (that is, have received both classroom and clinical training), and of these, not all are necessarily practicing and most are not full-time SANEs. National experts estimate that to adequately meet the needs of a community, there should be an average of 15 full-time SANEs per 1 million people, although many jurisdictions around the country do not meet this recommendation. This means Illinois, with a population of nearly 13 million, would require 195 full-time SANEs, or about twice the estimated number fully trained and certified in the past six years. However, the 15 nurses to 1 million residents recommended ratio assumes that nurses are accessible to victims; considering the large rural population in Illinois, the required number of SANEs is probably higher. A significant obstacle for nurses who wish to obtain SANE certification in Illinois is that they are not reimbursed for the cost of clinical training nor paid for their time away from work. Numerous sexual assault experts and nurse examiners told Human Rights Watch that the lack of hospitals support for sexual assault nurse examiners is the primary cause of the shortage of SANEs in the state.
SANE programs were established, in part, to address the logistical and emotional difficulties victims face when reporting their rape to a hospital emergency room. The lack of SANEs can have a negative impact on a victim’s experience at the hospital. An Illinois rape victim told Human Rights Watch of arriving at a hospital in the hours after her rape. The emergency room doctor came into the room and began questioning the rape victim about the details of her rape. When she told him the rape occurred while on a date, the doctor questioned whether there was any need for him to collect a rape kit: “I don’t want to waste my time if people can’t agree whether or a not a rape even occurred here.”
Untrained ER personnel’s inexperience with collecting a rape kit can be just as traumatizing to rape victims as their judgmental attitudes. A rape victim advocate told Human Right Watch about emergency room doctors who have never seen a rape kit before, nor administered one. One doctor read out loud the instructions on the rape kit package as he performed each step. National research has shown that rape victims who are treated by emergency room doctors and nurses are more likely to characterize their experience as “upsetting” and “distressing,” and report feeling “re-victimized” during the rape kit examination.
The shortage of sexual assault nurse examiners can have an impact on the successful collection and testing of rape kit evidence. In Illinois, crime lab personnel, prosecutors, and police told Human Rights Watch of instances in which the way the rape kit evidence was collected negatively impacted progress of the case. A prosecutor told Human Rights Watch of a case where an emergency room doctor failed to collect DNA swabs from every place where the victim indicated the perpetrator had ejaculated, and instead only swabbed her vaginal area. The prosecutor told us,
The victim claimed that the suspect had ejaculated in her belly button. The suspect … denied ejaculating in the victim’s belly button. I had hoped to test a swab taken from the victim’s belly button in order to back up the victim’s version of events and discredit the suspect at trial.… [T]he lab informed me that the doctor had not swabbed the victim’s belly button … it was incredibly frustrating to move forward without crucial evidence.
In a letter to Human Rights Watch, the DNA criminalists in charge of sex crimes at the DuPage County Crime Laboratory noted,
All of our policies [on sexual assault kit testing] assure that sexual assault evidence submitted to [the lab] will be analyzed with the utmost of care. What cannot be assured, however, is that all sexual assault evidence will be collected in the best manner possible, or even that it will be collected at all.… Many hospitals in DuPage County are not adequately staffed with SANEs. Some hospitals have SANEs but not on all shifts.… If the emergency room personnel are not adequately trained to recover and preserve this evidence, analysis of that evidence and later arrest and prosecution of a sexual predator may be compromised.
A shortage of SANEs in Illinois may be one reason why only 31 percent of reported rapes lead to the collection of a rape kit in Illinois. National studies have shown that the availability of SANEs impacts the criminal justice process. For example, a 2009 National Institute of Justice study found that rape cases in which a sexual assault nurse examiner collected the evidence had a greater chance of leading to successful prosecution.
Once a rape kit is collected from a victim who reports the crime to the police, the rape kit will be taken into police custody (booked into police evidence) for storage before testing. Many rape victims assume their rape kit will be tested, but Human Rights Watch research in Illinois indicates thousands of rape kits in police storage were never sent to the crime lab for testing.
 Human Rights Watch telephone interview with Jennifer Pierce-Week, president, International Association of Forensic Nurses, Arnold, MD, March 23, 2008. For more information on the collection of rape kits, see for example, The Sexual Assault Nurse Examiner-Sexual Assault Response Team web-site at http://www.sane-sart.com (accessed January 20, 2009). Human Rights Watch observed the simulated rape kit collection process in Illinois during a visit to the Cook County Child Advocacy Center on January 11, 2009. A model process would look like this: After intake and counseling, which includes assessing and treating any critical care needs, the patient is interviewed to obtain a history of the assault. Then, a nurse practitioner conducts the medical and forensic examination. The victim undresses while standing over a large sheet of paper, and anything that falls from the clothing or body that may provide links to a perpetrator or a crime scene (for example, hairs, debris, and carpet or clothing fibers) is collected and placed in the rape kit. A sexual assault nurse examines the victim on a gynecological table with stirrups. The nurse scans the body with an ultraviolet light to find what may be otherwise undetectable semen or saliva that might contain the assailant’s DNA. The nurse then swabs every part of the victim’s body that the ultraviolet light fluoresces. The victim is examined from “head to toe” to identify any physical injuries sustained during the assault, which can include scratches, bruises, bite marks, ligature marks, and burst blood vessels caused by strangulation. Every visible physical injury is photographed. A magnifying digital camera called a colposcope—which is noninvasive and can photograph inside body cavities without requiring insertion—is placed near the anal, vaginal, and oral cavities to record any lacerations or other injuries inside those areas. The nurse then collects other samples, such as fingernail scrapings, pubic hair combings, and urine and blood, placing each in separate envelopes and or tubes. The swabs are labeled and sealed in containers with evidence tape. All of the evidence is then placed in a large white envelope—the rape kit.
WK Taylor, “Collecting evidence for sexual assault: The role of the sexual assault nurse examiner (SANE),”International Journal of Gynecology and Obstetrics, vol. 78 , September 2002, pp. S91-S94.
Annette Amey and David Bishai, “Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey,” Annals of Emergency Medicine, vol. 39, June 2002, https://secure.muhealth.org/~ed/students/articles/AnnEM_39_p0631.pdf (accessed May 13, 2010), pp. 631-638; WK Taylor, “Collecting evidence for sexual assault: The role of the sexual assault nurse examiner (SANE),”International Journal of Gynecology and Obstetrics, vol. 78 , September 2002, pp. S91-S94.
 Illinois Attorney General, Sexual Assault Nurse Examiner webpage, http://www.illinoisattorneygeneral.gov/victims/sane.html (accessed June 24, 2010).
Human Rights Watch telephone interview with Shannon Liew, RN-BSN, SANE coordinator, Office of the Illinois Attorney General, Chicago, Il, January 6, 2010.
Human Rights Watch telephone interview with Joanne Archambault, president and training director, SATI, inc., Addy, WA, November 7, 2009.
US Census Bureau, “State and County Quick Facts: Illinois,” http://quickfacts.census.gov/qfd/states/17000.html (accessed February 16, 2010).
Linda Ledray, “Counseling victims of rape: Their needs and a new treatment approach,” in HJ Scheider, ed., The victim in international perspective (Berlin: Walter de Gruyter, 1982); Diane DiNitto et al., “After rape: Who should examine rape survivors?” American Journal of Nursing, vol. 86, no. 5, May 1986, pp. 538-540; Linda E. Ledray, “SANE Development and Operation Guide, Office for Victims of Crime,” Office of Justice Programs, US Department of Justice, Washington, DC, 1999.
Human Rights Watch telephone interview with rape victim, northern Illinois, August 21, 2009.
Human Rights Watch telephone interview with rape victim, Springfield, IL, October 9, 2009.
Rebecca Campbell et al., “Preventing the ‘Second Rape’: Rape Survivors’ Experiences with Community Service Providers,” Journal of Interpersonal Violence, vol. 16, no. 12, 2001, pp. 1239-1259.
Human Rights Watch telephone interview with prosecutor, central Illinois, October 22, 2009.
Letter to Human Rights Watch from Tamara A. Camp, forensic scientist, DuPage County Criminal Laboratory, June 30, 2009.
 Rebecca Campbell et al., “Systems Change Analysis of SANE Programs: Identifying the Mediating Mechanisms of Criminal Justice System Impact,” no. 226497, prepared for the United States Department of Justice, January 2009,
http://www.ncjrs.gov/pdffiles1/nij/grants/226497.pdf (accessed February 16, 2010).