I recently spoke with Kimberly Hurst, the Executive Director of the Wayne County Sexual Assault Forensic Examiner’s (SAFE) Program, who told me about her work starting Detroit’s SAFE program and caring for victims of sexual assault.
Sarah Tofte: Thank you for taking the time to speak with me today. Would you talk about your current work and how you got here?
Kimberly Hurst: I am the Executive Director for the Wayne County Sexual Assault Forensic Examiner’s Program. I founded the program in 2006, and we are the only non-profit provider of sexual assault exams in Detroit. We are the largest SAFE program in the state and the busiest. We provide medical and forensic care, as well as community- based advocacy and crisis intervention services. We provide a comprehensive and compassionate continuum of care in order to improve the community’s response to sexual assault and set a higher a standard.
I am a licensed physician’s assistant and my training is in Emergency Medicine. I have been practicing for ten years. When I was in school, I had a strong interest in the forensics and the pathology. I had done a rotation doing autopsies and I was very intrigued by that side of medical care. I learned about the Sexual Assault Nurse Examiner training program, but since I am not a nurse, I didn’t think it would apply to me. When I realized that physician assistants could get trained to be a SAFE, I did it. Basically, the training gives medical personnel the knowledge base and skill set they need to effectively and expertly meet the medical-forensic needs of the sexual assault patient.
My first job out of school was working in Detroit in a busy Emergency Department. Here I saw a huge need for SAFEs. I realized how much sexual assault occurred in Detroit, and yet there was no SAFE program for victims to go to—they all were being treated in the hospital by whatever nurse or doctor was on duty or being referred to another county to receive these specialized services. It didn’t seem to make sense that there was no program in Detroit, given the great need for it. You could see how the exam would not get done correctly in the ER, that there was no specialized equipment, that the crisis support wasn’t there. There were just so many missed opportunities. I decided we needed to get these services in Detroit, and that is what inspired me to start the Wayne County SAFE Program.
ST: Was there anything during the course of your SAFE training that surprised you about the level of skill and care involved in the process?
KH: I was surprised at every point. The first exam I ever did on a rape survivor was as a student while doing a rotation in the emergency room, before I had any training. My attending physician handed me a rape kit, told me there was a patient in the exam room who needed a rape kit, and told me to go do one. I opened the rape kit and read the instructions, in front of her, and then did the examination. We never had one hour of training in PA school on how to do a rape kit, not one. There was nothing offered, so I was not prepared. When I looked into how I would go about getting training, and I went to the training, I was blown-away by what I did not know and about the amount of information I was not given during my medical training.
ST: Why do you think that medical schools don’t offer much in the way of training on rape kit collection?
KH: I think that some of it is that the primary focus for doctors when someone is coming into the emergency room is on the provision of medical treatment, and so evidence collection or the ‘rape kit’ is treated as an afterthought. I think that, traditionally, medical schools feel that a doctor is going to encounter a rape victim so infrequently that they don’t need to invest too much in training during medical school for it. We just have never really given sexual assault patients the time or consideration they deserve.
ST: OK, so you decide to start this program. How did you go about making it happen?
KH: Well, I first needed to just figure out the basics of how to become an incorporated entity and how to become a non-profit. I went to see some leadership in one of our county’s health systems and they directed me towards Blue Cross Blue Shield of Michigan, and they were generous enough to give us our start-up funding. I also made sure to talk to all the stakeholders in the community, especially in the medical and victim advocates’ communities, to get their sense of what they needed from a SAFE program.
We have four large health systems in our county. Our first year we worked with one of the four health systems, and had about 130 patients. The next two years, we were collaborating with two health systems and had about 205 and 240 patients, respectively. Then one of the largest and busiest health systems in the city offered to donate space, supplies and equipment to accommodate us and this allowed us to open a second clinic site within that hospital. The idea caught on with doctors, many were relieved at no longer having to do rape kits in the emergency department. People were seeing that we were doing good work, with good results. We saw the number of patients coming to see us more than double annually. We have now seen a total of over 2,000 patients, 697 patients alone last year. We have a staff of three full-time directors, one part-time director, two full-time social workers and a staff of about 20 contracted nurses. We are open 24/7, and provide care at three different clinic sites in the county being able to meet the victim at whichever clinic they want to go to.
It did take some convincing of some of the physicians to trust what we were doing, that we were taking care of the patient medically, providing STD and pregnancy prophylaxis if the patients wanted it. We worked a lot with law enforcement. The police were very happy to have people with special training collecting the evidence. They knew we would get them quality and comprehensive evidence, and make their jobs easier. In addition, we provide evidence collection of suspects as well.
ST: How are survivors directed to your services?
KH: 80% of the time, we are contacted by the ER after a patient presents at the hospital and either presents as being sexually assaulted, or the fact comes out during a medical exam. It is our policy to call back within ten minutes of the page. We only see adolescents and adults, so no children under 12, unless they have already started their periods. If the assault occurred within 96 hours of the call, we will do an exam.
We have a very strong empowerment philosophy, so we never force the victim to have a kit done. We want it to be their choice and if they want to stop the kit collection at any point, we try to empower them to do that. If at any time the patient decides they want to stop, that is their right to do so. We don’t require any involvement with law enforcement. We will hold the evidence indefinitely until the patient decides whether they want to go forward with a police report or not.
When we get a call from the ER, we first need to figure out if they are medically stable to come to our clinic sites, or, if not, we dispatch a staff member to the ER. The staff will get to the patient within an hour. Usually the hospital can provide transportation but we make sure the patients have safe transportation home, and we make sure to pay for them to get safe passage to and from the hospital. We use a cab company with the option of female drivers. If the patient decides to report the rape, the police then pick up the kit from one of our clinics.
As for ongoing treatment, if there is a concern for injury that needs to be re-documented or re-evaluated, we will have them come back to see us. Otherwise, we refer them back to their primary care doctors or other community health clinics for follow up care. When it comes to the advocacy piece, we have advocates that follow them and provide emotional counseling and advocacy services.
ST: What difference has the program made for law enforcement and hospitals?
KH: The program has made a huge difference. It offloads our busy ER departments from the time they are tied up with sexual assault patients. The ER staff are also aware that they have not necessarily been providing the best of their time and the best evidence collection. They are relieved that there is somebody like us here now to do that. Law enforcement feels that they are getting better communication from us about what is being found during the exam. We are also seeing better prosecutions and increased rates of prosecution because we are documenting things better, we are more available to provide expert testimony and we have provided a much higher standard of care for survivors. It is consistent, so every rape kit is being collected in the same way, with the same level of expertise.
ST: What did you think when you first heard about the backlog of 10,000 or so untested rape kits in Detroit?
KH: My initial thought was that I was not surprised there were a lot of kits sitting around, but I was surprised about the actual number of kits in our backlog. Really, until I started reading around, I didn’t realize what a national problem this is. I am still awed by our numbers, and I am very interested in recommendations for improving our community’s response to rape victims and the processing of rape kits .
For our patients, we are dealing with a lot of questions—is this going to go anywhere? Is my kit even going to get processed? How do I know when it will get processed? All I can tell them is they are working hard to test all the kits, and sticking with it and finding out where their kit is in the whole scheme of things. It has an effect on patients wanting to come forward, and in a day and age when there are so many TV shows about the importance of DNA and how much it is used now patients think, this kit is it, and to think this kit is not going to be processed, or processed at all, is hard to digest. I try to educate patients on the realities of some of these things.
The best thing to come out of the backlog news is awareness among law enforcement and prosecutors and members of the public. I hope that, in turn, our community response to sexual violence will receive the time, money and focus the issue deserves and needs. It’s difficult to problem-solve when the city has as much crime as it does, and has the issues with funding that it does and when we are in a period where we are supposed to do more with less. But the community is taking ownership of our own problem, and figuring out together how to move forward.
ST: Would you give me an example of how rape kit testing conducted at your center helped resolve a case that might otherwise have remained unresolved?
KH: We had a serial rapist here in Detroit a few summers ago. Our organization did several of the kits, and one was done by an area hospital. Currently, there are not enough envelopes and swabs in our kit to be able to handle every area you might wish to swab. At the hospital, they only swabbed the areas for which they had labeled envelopes for the area (for example, vaginal swab, pubic combing). But we are trained to think outside the box, so when we learned from the victims that the perpetrator had, for example, licked a breast, even though there was no envelope specifically for breast swabs, we collected a swab anyway. It turns out the only place where we got a DNA profile was from the breast swab. It hit the offender’s profile in the CODIS system, and prosecutors got the guy. Without the breast swab, they may not have. In this case, when you look to the DNA evidence we were able to get from our kits, and compared it to what was in the hospital’s kit that they collected, hands down ours was the more effective kit. Our staff was able to testify in the case, and I think it was our expertise in evidence collection that helped seal the case.
There have also been cases where we collect evidence, and no DNA is found that can be tested, however, the thoroughness of our documentation of additional injuries helps to make the case strong and we were called into collect suspect evidence, our expertise helped.
I do want to say, though, that there are no small cases for us. In every case, you never know what to expect, and every case is treated the same. We take them all seriously, and we collect evidence on every patient, and make all kinds of cases.
ST: Your program is very successful, but what is on your wish list?
KH: Funding is always helpful. We always need additional funding for more equipment, more staff. Funding is always a struggle.
We also want to bring more program services to more people in our county.
ST: How do you stay well in the work?
KH: For me personally, I have a great support system. I have a great family support system. I have great staff that I talk to on a daily basis, and involve in decision-making. I have some great advocacy and social work staff that are there to help, especially when you have a hard case and need to talk about the effect its having on you.
On a larger scale, I stand back and look at what we have accomplished and I can’t believe it. I look at the number of patients we have seen and when I go back through and look at our case logs and see their actual names, I remember that we were there for that one person in the aftermath of a terrible moment in their life. My hope and gut feeling is that we were there to help them start the healing process and, if nothing else, they encountered someone who was caring and compassionate no matter what the circumstances. We were there to provide the very best care we could for them. We are seeing more and more survivors at our clinics, not because there is more sexual assault, but because our services are being more recognized in the community. That is how I stay positive—I know we are making a difference.