Comprehensive Rape-Response Center Planned

A coalition of doctors, nurses, police and social workers are close to launching what would be one of the first comprehensive rape examination and treatment centers in Los Angeles.

To be located at Mission Community Hospital here--where a separate area in the emergency room already has been set aside--the level of services provided to rape victims would be unprecedented in the Valley. The center itself would be only the second established in the city, where 1,500 rapes are reported each year, about 500 of them in the Valley.

At its core would be a Sexual Assault Response Team (SART) that would be quickly deployed at the hospital to offer medical care, gather forensic evidence and expedite the issuance of arrest warrants. Its nurses, in particular, would be specially trained--not only to collect evidence but also to enhance their court testimony later.

“Training is critical,” said Thaine H. Allison Jr., a health economist hired by Mission Community Hospital to conduct a feasibility study.

“A nurse who has been asked to testify can say, ‘I’m a nurse, I did the swab.’ Or, she can say: ‘I’m a trained sexual assault nurse examiner. I’ve done 100 hours of training. I’ve conducted 50 rape exams. I have testified in court.’ It’s a whole different genre of credibility.”

Increasing rape convictions is a top aim of the program, whose concept isn’t new but was just introduced to Los Angeles last summer at the California Hospital Medical Center downtown.

Organizers, who have been meeting since fall, are currently seeking funds to purchase a colposcope--an intravaginal camera used to magnify and document the collection of evidence, including fibers, hairs and secretions. Doctors and law enforcers in Long Beach and Santa Monica, where similar programs have been operating for years, say the use of the colposcopes has increased their rape convictions by as much as 50%.

Another goal would be to limit the number of times a rape victim ust repeat her story. Victims are usually interviewed first by patrol officers and detectives, then by doctors or nurses, and yet again by prosecutors and crisis counselors. Mentally reliving a rape can retraumatize victims and retard emotional healing, experts say. SART would allow law enforcement and medical parties to gather information at once.

The team also would speed treatment. Rape victims can wait six hours or longer in emergency rooms while other patients with life-threatening injuries or illnesses are treated. Meanwhile, victims are advised not to use the bathroom, not to shower, not to eat and not to change their clothes, for fear of compromising evidence. The discomfort of waiting is sometimes compounded by doctors or nurses reluctant or unable to conduct detailed forensic rape examinations, which require about three hours.

And, there is the money factor.

*

Since 1987, the city of Los Angeles and Los Angeles County have reimbursed hospitals for only a third of the estimated $600 cost of a rape exam. The exam usually includes vaginal, anal and oral swabbings, exploration with a colposcope (if available), tests for pregnancy and sexually transmitted diseases including AIDS, fingernail and toenail scrapings, and pubic hair combings. If evidence of semen is found, slides must be made.

“That’s what it basically comes down to--money,” said Dr. Edward Lowder, an emergency room physician at Northridge Hospital Medical Center. Lowder is trained to conduct rape examinations for women and children, and has performed them at Northridge for three years. Valley police officers have taken to transporting rape victims to Northridge Hospital because they know Lowder is there, and they know a colposcope is available.

“A lot of physicians don’t want to do rape exams,” Lowder said. “They think they’ll have to go to court. And [the exam is] expensive in Los Angeles,” he added, noting that hospitals in Orange County are reimbursed at much higher rates than hospitals here.

If Lowder isn’t available, or if the emergency room at Northridge is packed with higher priority patients, Valley rape victims are sometimes driven by police to a rape treatment center in Santa Monica or to the SART at the California Hospital Medical Center, said Det. Mitch Robins, director of the major assault crimes unit at the Los Angeles Police Department’s Van Nuys Division.

Robins has been a member of the Valley SART coalition from the group’s beginning. “We need these services here in the Valley,” Robins said. “I handle nine to 12 rapes a month,” Robins said. “Sometimes, we have to take them over the hill to get immediate attention.”

Robins’ impatience to get the program started spilled over briefly at a SART organizational meeting earlier this month at Mission Community Hospital. As about six coalition members--including representatives from the hospital, the Northeast Valley Health Corporation, the IHM/Blythe Street Project and the Valley Trauma Center--discussed proposals and grant applications, Robins rolled his eyes.

“It’s nice to do RFPs [requests for proposals], but if money’s going to come from anywhere, it’ll be from places like Anheuser-Busch or Galpin Ford--from business.”

Linda Bear, a community activist and member of the Sherman Oaks Homeowners Assn. who is participating in the Valley SART coalition, has taken on responsibility for finding sponsors.

Allison, the health economist and Mission Hospital consultant, estimates that a program can be started with about $10,000. That money would be used to train a couple of nurses (at about $2,000 each) and to purchase equipment, including a used colposcope, (about $4,000).

“Before we got our colposcope, we found good evidence in maybe 10% to 15% of our rape cases,” said Beth Winokur, nursing director at Martin Luther Hospital in Anaheim, where most of the staff has received sexual assault examination training. The hospital handles nearly all rape cases reported in Orange County.

“Now,” Winokur said, “we find evidence in 75% to 90% of the cases.” She added that the hospital is fully reimbursed by municipalities for rape exams.

*

Winokur said the benefit of owning a colposcope is easy to measure: “A couple of years ago, we were examining a rape victim, and we pulled a fiber from behind [her] cervix that we never would have seen without the colposcope. This tiny fiber was from a rug in the van where the guy raped her.”

Magnified on a video screen, she continued, “it looked like a huge piece of yarn. To the naked eye, it was thinner than a thread.”

Nabbing sexual predators is part of SART’s goal. But providing sensitive and immediate care to women who have been violated physically and traumatized emotionally is critical, said Margaret Welch, a psychologist and director of Immaculate Heart of Mary/Blythe Street Project, a nonprofit community group in Panorama City.

“I was horrified when I found out there were so few services available,” said Welch, a member of the SART coalition. “There’s a huge problem just getting women to report rape--especially on Blythe Street, where they’re so afraid of getting themselves or their families in trouble. For the whole San Fernando Valley not to have a program that provides good, quick care, counseling, and follow-up to rape victims, that’s just unbelievable.”