Like other assault victims, sexual assault victims must decide whether they want to involve the police.
As long as the victim is 18 or older and the attack did not involve a weapon, the victim can choose to receive medical treatment only. In that case, the emergency room staff will not summon the police, said Gail Perkins, coordinator of Mary Washington Hospital's SANE, or Sexual Assault Nurse Examiner program.
If the police are notified and they believe that a rape has occurred, they will ask a SANE nurse to gather evidence through a forensic exam.
The SANE nurses do the exam if the victim has arrived at the ER within 72 hours of the attack.
After 72 hours, "there is no evidence to collect," Perkins said.
The nurses prefer that victims not eat, drink, shower, urinate or brush their teeth before going to the hospital. The SANE exam usually takes three to five hours.
"If they haven't showered, we have a real good chance of getting good evidence," Perkins said.
Seven specially trained nurses constitute the SANE team. Team members report that the exam can be stressful, both for them and for the victim. One SANE nurse resigned after treating an elderly victim who had been viciously beaten and raped.
Perkins said she has a hard time dealing with the cases involving children.
"I feel like their innocence has been lost, stolen from them," Perkins said.
Mary Washington receives a reimbursement of $750 per exam from the state, but the hospital estimates that each exam costs about $2,000, including lab tests, medicines and nursing coverage.
"It is a community service," Perkins said.
The nurses work in partnership with the Rappahannock Council against Sexual Assault. One of its volunteers is also summoned to the ER when an assault victim shows up. RCASA workers help victims with the emotional aspects of the attack.
Or as Lisa Biever, executive director of RCASA, has said: "SANE does the neck down. RCASA does the neck up."