In the latest installment of our occasional conversations with Fort Worth leaders, Cindy Burnette, director of the Sexual Assault Nurse Examiner program at Texas Health Resources, discusses what the SANE program is and how it can help people who’ve been sexually assaulted. 

This conversation has been edited for length and clarity. For a longer version, please listen to the audio file attached to this article.

Alexis Allison: Cindy, you are a sexual assault nurse examiner. Can you tell us what that means?

Cindy Burnette: A sexual assault nurse examiner is a nurse who has her registered nursing license, but then we’ve had extra training. We’ve had extra training in the areas of sexual assault, the different laws that we have to work under, and then we also learn special training, like women’s exams. Most of your bedside nurses don’t do those — those are done by a physician. But we do those ourselves for victims. And then we also learn about collecting evidence, how to collect it, the best way to get it. The last thing is courtroom training — more so we know that etiquette of court and things like that. Sometimes it takes up to two years actually to get all of those things done to get somebody certified here in Texas.

Allison: You’re also the director of the SANE program at Texas Health Resources. Can you tell us what the program is and does?

How does Texas law define sexual assault?

In a nutshell, penetration without consent. For specifics, read the law here.

Burnette: A SANE program is a group of nurses that are certified to treat victims of sexual assault, both medically as well as collecting evidence so that when they come to a hospital, they get that specialized treatment.

Our program here at Texas Health is a little different. Texas Health just realized a few years ago that they were losing — I say “losing” victims, but that’s exactly what was happening. (Survivors) were going to other hospitals that did not employ sexual assault nurse examiners, and they treat them medically and say, “Hey, we need to transfer you to one of the hospitals that does.” What we were realizing is that person never showed up to our facility. They would leave whatever hospital they were at. They’ve already been through a very traumatic experience, you know, and had to tell everybody what happened during that experience, that it was just too much for them to start over again.

We decided to make our program a mobile program. Tarrant County is huge. So if a victim comes in at Arlington Memorial, our nurses are going to go to them. In Tarrant County, we go to Texas Health Arlington Memorial, and Texas Health HEB, Texas Health Azle, Texas Health Alliance, Texas Health Fort Worth downtown and also Texas Health Southwest. We actually respond to six different hospitals in Tarrant County. 

Allison: Can you talk about what the process would look like for someone who has been sexually assaulted or maybe they know someone who has been?

Burnette: We would love everybody to get medical care. A lot of people don’t realize that they need it. Sadly, some people may go through a sexual assault and don’t think that they’re really hurt. But we always recommend that everybody get that medical care. 

And so what happens is, they would just (go to) the emergency department. In the emergency department, we’ve trained our staff at the Texas Health hospitals to limit what they talk about (regarding) the assault. What we want them to do is assess: Are you medically hurt somewhere that we need to treat? From that point, they call our sexual assault program, and we immediately dispatch a specially trained nurse to that hospital. 

We’re going to come in and take over care, just because we’re trained to use a very trauma-informed approach — we can speak with them, not only competently, culturally — but we also know the laws. So we can actually sit down and talk with them about what their options are, and whether they want to call the police or don’t call the police. We get the privilege of having that one-on-one patient relationship. And a lot of times, they’ll tell us a lot more than what they’ll tell the physicians. 

And then at that point, when I give them back to the emergency room physician, I can make recommendations as far as getting the appropriate sexually transmitted infection medications, pregnancy prophylaxis and even HIV prophylaxis medication if they need it.

Allison: Can you talk about the recommended timeline for this (process)?

Burnette: It’s never too late to go be checked. Under the law for evidence collection, it’s 120 hours. So, five days. Most people think, “Oh, if it’s not the first 24 hours, they can’t do anything for me.” But that’s really not true. A lot of people think, “Well, I bathed, I showered, I did ABC.” But that really doesn’t matter. We’ve really learned over the years (about) places evidence can be stored on the body, because that’s basically our crime scene. Especially for women in the vaginal cavity, we just know DNA can last a long time there.

Allison: There might be some people who are concerned about going to the ER because of the cost — what would you tell people about cost?

Burnette: Texas has really done a lot of great things for sexual assault survivors over the past few years. And one of those things is that they are not billed for the sexual assault forensic exam. The Crime Victims’ Compensation Program automatically pays for forensics costs of the hospital. 

(Survivors) are also eligible to get their medical portion paid for. Crime Victims Compensation also tells them they have the right for that to be paid for as well. And there’s a little more process to it. There’s an application that has to be completed. What we actually do at Texas Health is we sit down with (survivors) and help them complete that application. So any sexual assault survivor that comes to Texas Health should not ever receive a bill of any kind.

Allison: Correct me if I’m wrong, but a person who comes to get this exam doesn’t have to submit a police report if they’re not ready. Can you talk a little bit about that?

Burnette: Sure. Anybody that is over the age of 18 and doesn’t have any kind of mental disabilities, they really have options about what happens, you know, I know that everybody thinks that it’s a crime that needs to be reported. You have the option to report to the law enforcement agency that has jurisdiction over the crime. But you also have the option of what we call a “non-report exam.” 

People ask me all the time, “Why would you not report this?” But you have to stop and think that, maybe (the survivor) was assaulted by a family member, maybe they were assaulted by a boss. Maybe they’re untrusting with the police; we see that a lot as well. 

What we’re going to do is go through the whole exam and collect the evidence as well. When you report to the police, that evidence collection kit is then handed over to law enforcement, and they take it to a crime lab to be processed for DNA. And if they’re not reporting, it is anonymously sent to the Texas Department of Public Safety warehouse. They’re given a unique identifier, and that kit is now stored for five years. At any point in those five years, if (the survivors) decide they want to report the crime to law enforcement, they can fill out the proper paperwork, and then they can send it to the DPS warehouse, and that warehouse will then give law enforcement the kit. 

Allison: Thank you for sharing that process. Can you just briefly tell us what the actual exam involves, so that if someone wanted to come in and get one, they would know what to expect?

Burnette: Sure. A lot of people think it’s this horrible thing, and it’s really not. At Texas Health, they come in, they see our medical team, just to make sure that there’s no emergent medical needs that need to be addressed. But then once the SANE gets there, we’re going to sit down and talk to them, we’re going to talk about their medical history, and then we’re going to talk about what happened during the assault. It’s very important for us to know exactly what happened. If they were hit, if they were kicked, because that tells me where on their body to collect evidence from. 

So we’re going to look at their body from head to toe — even if they said nothing happened. Sometimes that adrenaline’s going and you don’t realize that you’re injured. 

And then we’re going to do a female examination on them, just like you would go for your yearly Pap smear. While they’re there, we always call in the crisis center. And for Tarrant County, it’s The Women’s Center of Tarrant County. We always make sure that they have an advocate at the bedside, that is also there for emotional support, and any kind of resources that they may need. 

Then, before they leave, we also want to make sure that we do individualized discharge planning with them, and really kind of crisis intervention. I want to make sure they’re going back home to a safe place, especially if they were assaulted by somebody that they know or maybe even a spouse. And if that’s not a safe place for them, at that point, we work on getting them to a safe place.

Allison: April is sexual assault awareness month and April 27 is Denim Day. Can you tell what that means?

Burnette: Denim Day is an action and awareness event where they encourage people to work to wear their denim or their blue jeans to really combat what we call “victim blaming” and educate others on sexual violence. I think that sexual assault is the one thing that we still blame on the victim: What were you wearing? What were you drinking? Why did you do that? Whereas we don’t do that with other crimes. 

(Denim Day) came about several years ago. There was a young lady from Italy, and she had been assaulted (by a driving instructor). They went to court, prosecuted the crime, the whole thing. Well, he got his conviction overturned by the Supreme Court under the point that this young lady had very tight jeans on. The judge ruled that there was no way that the person that did the assault could have removed those jeans without the victim’s help. So the judge actually overturned his conviction based on what this young lady was wearing. So Denim Day came about as a way to bring awareness about how we often blame the victim for what happened to them, rather than the assailant that did the crime in the first place.

Allison: Thank you so much, Cindy. Is there anything else you’d like to share?

Burnette: I just want to always encourage people to go get that medical care. To know that, especially at Texas Health, we’re there to provide that specialist care even if they don’t feel like they’re hurt, or maybe they don’t know what they want to do. To go in, let our team sit down with you and talk to you about your rights, and then we’ll help you make the decision that’s best (for you).

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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