Four years ago, Cait Hogan woke up in her bed on a Sunday morning after a night of drinking in the small college town of Athens, Ohio. Her entire body hurt. Her arms and legs were covered in blood. She realized she鈥檇 been raped.
鈥淚 didn鈥檛 really remember anything,鈥� says Hogan. 鈥淚 don鈥檛 remember when I first started remembering.鈥�
Later that day, Hogan, who was 24 at the time, called a friend to accompany her to the local hospital to get a rape kit completed.
Unfortunately the staff member who completed her kit at O鈥橞leness Hospital had only minimal training in the process. There were problems with the kit that led investigators to inaccurate conclusions. Police dropped Hogan鈥檚 case. For months, her attacker, a man she once considered a friend, was at large.
In small towns and rural areas, when a victim goes to the hospital to complete a rape kit, there鈥檚 no guarantee staff will have the expertise to complete it correctly. Though a rape kit is designed to be completed by a nurse with minimal or no training, funded by the Department of Justice, found that the chances of a getting a prosecution increase when a kit is completed by a nurse who has undergone a special 40-hour training, called Sexual Assault Nurse Examiner (or SANE) training.
Hospitals in larger cities, try to keep these trained nurses on staff around the clock. But in places like Athens, it鈥檚 not as common.
Collecting Good Evidence
After a person has been raped or sexually assaulted, they have a 72-hour window to complete a rape kit, also known as a sexual assault examination kit. Wait too long and the most useful DNA evidence is lost.
A rape kit is typically a cardboard box about the size of a lunch box. The contents are simple: papers with step-by-step instructions; a list of questions to ask the patient; bags to collect articles of clothing; and several cotton swabs for collecting DNA. The O鈥橞leness Hospital director of emergency services, Lianne Dickerson, says it鈥檚 just like CSI鈥攜ou鈥檙e looking for DNA evidence.
鈥淚f they can match that DNA we鈥檝e got a prosecution,鈥� says Dickerson.
Nurses completing rape kits use swabs and combs to collect forensic evidence. They also must ask survivors a series of questions, capturing information that can make or break a case. Dickerson says the training and experience that sexual assault nurse examiners have makes them better at this delicate task. Research shows they're more prepared to work with traumatized patients and provide emotionally sensitive care鈥攖hey even testify in court.
In the last three years, the O鈥橞leness hospital has increased the number of SANE trained nurses from just one or two to five--that's still not enough to cover 24 hours a day, seven days a week. The rest of staff are required to undergo a more basic four-hour training.
Dickerson says, larger cities have the resources to hire groups of these trained nurses, dedicated to completing sexual assault examinations.
鈥淚t鈥檚 one thing if you鈥檙e in a big city hospital,鈥� says Dickerson. 鈥淚t鈥檚 different when you鈥檙e in a small hospital.鈥�
When Hogan arrived atO鈥橞leness for her rape kit, she was taken immediately into triage and then to a private examination room. She remembers waiting there, until a staff member came in, placed a kit on the counter and told the nurse: 鈥淚t鈥檚 not hard, just follow the checklist.鈥� Hogan says it looked like no one knew what they were doing.
鈥淵ou go to the hospital, and these people who are supposed to be professionals and it鈥檚 like 鈥榦h you鈥檙e training?鈥� she says.
The nurse who signed off on Hogan鈥檚 rape kit was not a sexual assault nurse examiner. As she filled out a questionnaire on medical history she asked Hogan 鈥渉ad contraception been used?鈥�
鈥淓ssentially to clarify I said 鈥楲ike a condom?鈥� I didn鈥檛 know if they meant if I was on birth control currently,鈥� says Hogan.
The nurse wrote down that a condom had been used, despite the fact that moments before Hogan told her she had an allergy to latex. The nurse also mislabeled a DNA swab.
鈥淚 do feel strongly if at any point someone had known what they were doing, apparently it wouldn鈥檛 have weighted the whole case,鈥漵ays Hogan.
Lianne Dickerson from O鈥橞leness says every nurse who completes a rape kit at their hospital has undergone the required four-hour training.
After several months, the Athens police dropped Hogan鈥檚 case. The investigator said there was not enough evidence to pursue criminal charges. Hogan says she was told the mistaken idea that the attacker used a condom implied she had consented.
The Importance Of SANE Training
SANE training gives nurses the knowledge they need to avoid common mistakes like those that happened to Hogan鈥檚 kit. The training is important for giving victims a chance at justice, explains Alison Rerko, a SANE trained nurse who also works for the Ohio Alliance to End Sexual Violence.
鈥淲e know how to collect the evidence, we know how to document [it],鈥� she says.
In Ohio, the number of trained nurses have increased in the last few years. But they're still lagging in rural areas where just one may serve several counties.
鈥淚 think the challenge is a lot of hospitals don鈥檛 know how to set up a program,鈥� she says. 鈥淎nd then, is it cost effective to maintain?鈥�
Like many States, Ohio will reimburse hospitals for the cost of SANE training, but that training is often several hours away from rural hospitals, in larger urban areas. by the Government Accountability Office shows that the difficult nature of this work and its demanding hours leads to a high rate of burnout among SANE nurses. That can make it a challenge to keep these professionals on staff, even in a college town like Athens.
The GAO says other rural hospitals that operate on a tight budget may be reluctant to train nurses if they only treat a few sexual assault cases each year.
Delayed Justice
After police closed her case, Hogan contacted the county prosecutor. She knew her attacker was still out there and wouldn鈥檛 stop until she鈥檇 exhausted every option.
鈥淚 couldn鈥檛 be complicit in another woman鈥檚 rape,鈥� says Hogan. 鈥淚t was very much speaking for the next women.鈥�
Athens County Prosecutor, Keller Blackburn agreed to reopen the investigation. More evidence was collected, and it was discovered that the attacker, Dedrick Peterson, was a serial rapist. Blackburn says the police made a number of errors in their investigation, but it was the rape kit that led them to inaccurate conclusions. He says his office has dealt with this problem in the past, before the O'Bleness hospital managed to hire more SANE nurses.
鈥淚t鈥檚 caused us to have to resolve sexual assault cases either with lesser or non-sex offense, or reduced prison terms,鈥� he says.
Blackburn says the issues with the rape kit prevented them from winning a rape conviction in Hogan鈥檚 case, so they pursued a sexual battery charge instead. His office sought the testimonies of the three other women, and with the combined weight of their testimony he charged Peterson with three charges of sexual battery, 16 months after he sexually assaulted Hogan. On February 23, 2015, Peterson pled guilty and he was sent to prison for five years.
Conor Morris contributed additional reporting to this article.
This story was produced , a news collaborative focused on public health.
Correction: an earlier version of this story said Peterson was found guilty by a jury. The text has been updated to note he pled guilty without going to trial.
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