“Survivors shouldn’t be asked to have the courage to make that decision twice in one day.” That’s what an advocate said of sexual assault survivors who arrive at a hospital that lacks a sexual assault nurse examiner (SANE) and are told to go elsewhere. At Baptist Health in Louisville, that ’s exactly what happened in 2018. A survivor sought hospital care. The hospital had no SANE — a nurse specially trained in medical-forensic sexual assault care — and started calling around to find another hospital to send her. “It just felt really wrong,” Denise Carter, the nursing director, later told a reporter for Louisville Public Media. This is not an isolated incident. Kentucky’s SANE shortage means many survivors do not get the care they need after the worst experience of their lives. Survivors are often expected to travel many miles in the hope of receiving treatment and compassionate support, all while being unable to use the bathroom, shower, change clothes or eat. Many give up entirely and simply go home. This past December, the Kentucky Legislative Research Commission (LRC) reported that 100 of Kentucky’s 120 counties have no SANEs. Although the LRC reports that licensed SANEs have doubled since 2019, the access crisis still persists. Credentials and licensure don’t equal access. Thankfully, the legislature is responding. Current legislation would create a SANE coordinator to recruit nurses, facilitate training and build relationships with hospitals and rape crisis centers. It also establishes a public SANE registry. This is an encouraging step in the right direction. More infrastructure to support, coordinate and recruit SANEs is sorely needed. And yet even this doesn’t address a deeply flawed framework. A recent Cato Institute analysis — of which one of us is a co-author — examined SANE licensure requirements across the country. The analysis found that mandatory licensing or certification increases barriers to care, slows the profession’s development and exacerbates suffering. These regulations often subvert the needs of survivors and nurses and protect the interests of physicians and other practitioners. Kentucky is a case study in this failure. For nearly 30 years, Kentucky has required practicing registered nurses to obtain an additional state license before performing sexual assault forensic exams. The result is heartwrenching, raising the cost and burden of entering the field, driving burnout among those who qualify and concentrating the profession in urban areas where training and jobs are more available. The new SANEs coordinator will be recruiting and organizing nurses into the same restrictive system. Kentucky is one of only six states blocking registered nurses from performing full medical forensic exams. Forty-four other states rely on a multilayered system of voluntary certification, employer review, malpractice insurance, health system vetting and professional standards maintained by respected third-party organizations. Perversely, Kentucky makes it illegal for qualified and capable nurses to provide a full exam to sexual assault survivors without an additional state license. However, a physician with no SANE training at all can provide exams without restriction. A majority of both nurses and survivors are women, and a majority of physicians and assailants are men. The SANE licensure system not only reinforces barriers to access but maintains a deeply troubling form of gender injustice. The people often best suited and qualified to help assault survivors are the ones the state blocks. The licensure barrier also blocks one of the most important ways to address the shortage, especially for rural Kentuckians: tele-SANE, in which a remotely-located SANE guides a local nurse through the forensic exam. Under current Kentucky law, a local RN cannot conduct a full forensic exam, even with a trained SANE guiding the process remotely. A coordinator cannot connect survivors to care or nurses to survivors if the licensure laws forbid it. SANEs also collect and protect vital evidence and often provide testimony crucial for identifying perpetrators and bringing them to justice. Their work helps get assailants off the street and makes Kentucky safer. Lawmakers should be commended for finding ways to help survivors and bring attention to the often silent, shame-filled, and too-common experience of sexual assault.  They should go further and eliminate the SANE licensure requirement entirely. Many other reforms are necessary. But the first step is clear: Allow RNs to perform forensic exams under voluntary certification and other safeguards, as 44 other states already do. The Baptist Health nursing director was right. It feels wrong, and it is. Sexual assault survivors should not face extreme barriers to care in their time of need. Instead of a Band-Aid, Kentucky should fix the system itself. The next survivor who shows up at a Kentucky emergency room deserves it. The post Kentucky’s licensing rules block sexual assault survivors from accessing care appeared first on The Lexington Times. ...read more read less