Hospitals Turn Away Rape Victims, Blame State Rules

A new series of stringent, time-consuming procedures for examining rape victims has prompted more than a dozen privately owned hospitals in Los Angeles County to stop admitting sexually abused women and children, and has forced police to scramble to find emergency rooms willing to take them.

The hospitals, which are scattered throughout the county, include some of the busiest and most prominent in the region.

Although authorities say they are working on ways to ease the crisis, the dearth of examination facilities is so acute in some areas that police have reported delays of as long as eight hours, first to find a hospital and then to wait for medical personnel to see the victim.

“It’s putting a hardship on the officer and more so on the victim,” said Los Angeles Police Detective Steve Laird. “We had just gotten to a point where these victims were treated nicely . . . now they are becoming victims of this as well.

“It’s destroying all the advancements we have made in the care . . . of these victims.”

Last year there were more than 4,400 reported rapes in Los Angeles County, state officials said.

Aside from county-run emergency rooms, where victims still are examined, a Times survey of more than 40 area hospitals showed that about one-third of the privately owned facilities are sending victims away. Several others said they were likely to begin referring them elsewhere within the next few weeks.

Many hospitals that refuse to perform the rape examinations said they will, however, treat victims for other injuries suffered in the attack before directing the victims elsewhere.

In Inglewood, for example, both Daniel Freeman Memorial Hospital and Centinela Hospital Medical Center are not performing rape exams. The South Bay area’s Little Company of Mary, Bay Harbor and Torrance Memorial hospitals no longer provide the service.

Nor does the San Fernando Valley’s busy Northridge Hospital or Holy Cross Hospital. In Culver City, Brotman Medical Center refers patients elsewhere. So does Los Angeles’ Beverly Hills Medical Center. The city’s Queen of Angels Medical Center will begin referring victims within a month.

“Victims are being denied care by a large number of hospitals in the city and the county,” said Gail Abarbanel, director of Santa Monica Hospital Rape Treatment Center.

“After being raped, they have to drive 50 miles. That’s not OK for people who are that traumatized. There are horror stories.”

Changes in Procedures

In effect statewide since July 1, the changes were instituted by California’s Office of Criminal Justice Planning to make examination and reporting procedures more uniform. Officials said they drafted the changes at the request of state legislators who felt that sexual abuse cases would fare better in court if improvements were made in the way evidence is collected.

Often, prosecutors cannot obtain a conviction without the kind of medical evidence obtained in the examinations, and authorities will not even seek a criminal complaint unless the victim agrees to be examined.

The new procedures, called protocols, are characterized by state officials as refinements of already-existing exam requirements. Until the new protocols went into effect, most hospitals with emergency rooms were required to perform the exams. But the new rules permit them to drop them. And many have done just that.

Although some hospitals say they have discontinued the service because the new protocols are too complicated, some state officials suggest that the real reason is that medical centers are losing money on the examinations.

“It appears that the protocols are being used . . . and I think that’s really unfortunate,” said G. Albert Howenstein, executive director of the criminal justice planning office. Some hospitals that have begun turning away rape victims say they always have lost money on the examinations, and with the changes their losses would be greater.

Scant Pay for Hospitals

“The decision has been made by a whole lot of hospitals to centralize these activities in a much smaller number of them,” said David Langness, spokesman for the Hospital Council of Southern California. “The hospitals get paid literally nothing and it takes four or five hours of intensive work to do these (examinations).”

California law requires that local law enforcement jurisdictions pay for the examinations, but few jurisdictions pay enough to cover anything close to the actual cost. The cost can run as high as $450, but Inglewood, for example, pays $50 and the City of Los Angeles less than $20.

“That’s hardly enough to open the electric doors to a hospital,” said Laird of the Police Department.

“The (hospitals) that are forced into doing it are doing it,” said physician Lou Acosta, emergency room chief at Beverly Hills Medical Center. “The hospitals that are not forced into doing it are keeping out because the losses are tremendous.” Los Angeles Police Officer Bill Collins, who acts as a liaison between local hospitals and police, called it a “case of the cities not paying the hospitals an adequate amount of money.”

Trying for Settlement

Collins said hospital and city officials have been meeting over the reimbursement issue. “We expect to resolve it fairly soon and get things back to a reasonable situation. . . . We have been doing everything we can to get the hospitals to come back into the fold,” he added.

Similar negotiations also are under way in other jurisdictions.

In San Diego, one of the three hospitals under contract with the San Diego Police Department to perform the rape examinations has decided to drop out, in part because the new procedures take too much time.

Clairemont Community Hospital, which has been under contract with the city for seven years, has notified the Police Department that Thursday will be the last day it will perform the examinations, said Sherry Price, Clairemont’s nursing supervisor.

Price said one of the reasons for pulling out of the contract is that the new protocol takes 2 1/2 to 3 hours to complete, compared to an hour under the former method.

“Although we would like to give these patients the amount of time they need, the amount of time is incredible that our nursing and physician staff has to give to detail these cases,” said Price.

The remaining two hospitals on the contract are Sharp Cabrillo Hospital and San Diego Physicians & Surgeons Hospital. Administrators at both say they will continue to perform the new protocol.

“It is time-consuming,” said Diane Larson, a Sharp Cabrillo spokeswoman. “We’re thinking, it’s necessary, somebody has to do it. It’s certainly not a happy situation, but we feel it is necessary and we’re going to continue doing it.”

No Long Waits--Yet

San Diego police spokesman Lt. Lou Scanlon said the department didn’t anticipate any inordinate waits for examinations, even with the loss of one hospital, but he acknowledged that the situation is not likely to improve.

“It would obviously be more convenient for us and for the victims if there were more hospitals that would perform this service,” he said.

An administrator at Children’s Hospital reported no problem with the protocol in examining children who were sexually abused, and Palomar Memorial Hospital officials say they have been able to accommodate the 109 rape victims since Jan. 8 who were referred under contract from the Escondido Police Department.

The new requirements call for more specific reporting by emergency-room nurses and doctors and more precise methods of gathering evidence. The reporting forms have been expanded from two pages to five and additional procedures are now performed on sexual secretions taken from the victims.

Where the old regulations required physicians to take a sample of sexual secretions, the new procedures specify that three swabs must be taken. Moreover, the collections now must be air-dried for an hour, a process that preserves the evidence for longer periods of time, officials said.

In some cases, participating hospitals will be required to buy additional equipment and have workers undergo additional training to comply with the changes.

Hospitals Have an Out

But most importantly, the law gives hospitals that are unable or unwilling to comply with the new standards a way out: they can refer patients to other hospitals. The regulations require only that Los Angeles County have eight hospitals that will treat the victims.

And, whatever the reason, many hospitals have elected to refer rape victims elsewhere.

“We’ve got an emergency situation,” said Acosta, one of the physicians who has been involved in talks with city officials. “I don’t know where this is going to end.”

At Cedars Sinai Medical Center, where “our obligation to the community” means that victims are still welcomed, emergency-room personnel have reported a “significant increase” in business in recent weeks. At the Santa Monica Rape Treatment Center, the number of exams suddenly doubled from two to four each day.

“There are 5,000 adult sexual assaults in Los Angeles County each year,” said Abarbanel of the rape treatment center. “Even to have eight hospitals do it is wholly inadequate. There’s too many victims; the geographic spread is too great.”

8 Hours for Exam

A few weeks ago, Abarbanel said, one woman went to Inglewood police after she was abducted and repeatedly raped over two days.

“It took them eight hours to get her an exam,” Abarbanel said. “She was finally taken to Martin Luther King Jr. Hospital and left there, far away from where she could have gotten care.

“I can’t think of any other kind of patient who is being turned away from emergency departments,” Abarbanel said. “To be singled out and denied treatment is beginning again this whole process of attaching stigma to rape.”

Although the situation is not nearly as acute in Orange County, the new rules have caused some examinations to take longer. In one case, the exam lasted almost 10 hours, said Jonnie L. Wesley, coordinator for Orange County’s Central Assault Network, composed of private, nonprofit organizations.

“There is also a fear among physicians who conduct these exams, that this means they could be tied up in court for two to three days verifying the evidence,” Wesley said.

For law enforcement officials in Orange County, where there are considerably fewer reported rapes than in Los Angeles County, the changes have brought no significant impact. Some cities have not reported any rapes since the changes went into effect, police spokesmen said.

And, according to a brief survey of Orange County hospitals, only two, La Habra Community and La Palma Intercommunity, have stopped accepting rape victims.

Times staff writers Ralph Frammolino, Marilyn Garateix and Hugo Martin contributed to this story.