MUSC The Catalyst
MUSC arial view


MUSC Medical Links Charleston Links Archives Catalyst Advertisers Seminars and Events Research Studies Public Relations Research Grants Catalyst PDF File MUSC home page Community Happenings Campus News Applause

MUSC Medical Links Charleston Links Archives Catalyst Advertisers Seminars and Events Research
                          Studies Public Relations Research
                          Grants MUSC home page Community
                          Happenings Campus
                          News Applause


Nurses take cases from exam room to courtroom

By Allyson Bird
Of The Post and Courier staff

LeeAnn Blanche arrived at the emergency room around midnight, painfully aware of people staring at the stranger wearing a badge beside her. A blond nurse with a pixie haircut, Janet Ward, came out to get her, to photograph Blanche's bruises and to swab for DNA. Ward took notes as she asked Blanche for the details about what happened and asked her to change into a hospital gown.

Blanche sat naked beneath the thin fabric in the tight, windowless room. Ward pulled out a plastic speculum and — knowing how daunting it must look to a woman who's just been raped — she gave Blanche the usual speech: "Honey, don't worry. I'm not going to meander."

Blanche's 2010 case marked one of the first cases in the Lowcountry handled by the Sexual Assault Nurse Examiner program. The internationally recognized certification, shortened to SANE, restarted at MUSC two years ago.

Using a blue light and glasses, Janet Ward, a nurse with the Sexual Assault Nurse Examiners program at MUSC, can see bodily fluids on a sexual assault victim. She is specially trained to collect physical evidence from rape cases that can lead to convictions in court. Photo by Grace Beahm of The Post and Courier

Before that, in what SANE nurses call "the dark ages," one woman in North Charleston conducted all exams for the entire three-county area and beyond for more than a decade.

SANE works to take rape cases from the exam room to the courtroom by training nurses how to care specifically for sexual assault patients. Victim advocates and prosecutors help along the way to preserve the patient's dignity while also preserving evidence against the alleged attacker.

So far, two cases have gone to court, and both have ended in convictions and prison sentences.

Blanche spent about two hours in the cramped room at MUSC, as Ward collected evidence to send off in a cardboard box to the State Law Enforcement Division. At the end of the exam, Ward gave Blanche a round of antibiotics that made her retch.

Then the nurse gave her a hug and sent her home

The two women didn't see each other again for a year, until 34-year-old Michael Christopher Andes' trial. There, Ward testified about her exam, and Blanche testified about what happened some 20 hours earlier:

Blanche's roommate, a man she knew for five years and who outweighed her by 100 pounds, had forced his way into her bedroom and pulled off her pajama bottoms. Andes raped her and then sat on the side of her bed and urinated all over the room.

Blanche usually shared that room with her then-9-year-old daughter, but the girl stayed at her father's house that night.

Blanche took a hasty shower later that morning and then threw her daughter a 10th birthday party. Blanche had been out of work for a year and finally had the money to book a roller skating rink for the afternoon.

"I had to do that for her," she remembered

Afterward, she told her mother what happened and called Goose Creek police.

A Berkeley County jury late last year convicted Andes of first-degree criminal sexual conduct. He had been convicted previously of grand larceny, two counts of contributing to the delinquency of a minor and several counts of breaking into cars.

He is serving a 12-year prison sentence at Lieber Correctional Institution.

"It didn't matter to me, at the end of the day, if he went to jail," 32-year-old Blanche said at her Goose Creek home, months after the trial. "Did I want him to? Yes. What mattered was that they listened to me. It's down on record that he did what he did. He had to listen to that. His family had to listen to bits and pieces of it. That's what mattered to me."

Start to finish
What matters to Scarlett Wilson, the area's chief prosecutor, is getting those cases to that point — into the courtroom and on to conviction.

Rape cases are tough to try. Victims don't want to take the witness stand in a public courtroom, where defense attorneys will pepper them with questions about every detail of the attack and often dredge up their past mistakes.

To those victims, Wilson reasoned, the nurses and the hospitals represent "the system" at large. If their first experience with authorities only extends the trauma, they won't stick with the case.

"We had a couple of victims with particularly bad experiences who were good examples of why it was important," Wilson said.

She requested a meeting with MUSC almost immediately after becoming solicitor in 2007 and championed the SANE program until it officially launched three years later.

Now, there's a SANE nurse working at all times at MUSC, with two nurses devoted to the program full-time and another eight trained nurses on-call.

They pack work clothes and take separate cars to family outings. They panic when their cellphones lose reception. Some of the newer nurses stress about taking restroom breaks.

Sometimes, they treat two or three patients in a day, and sometimes a week goes by without a single sexual assault case. The nurses spend those slow days catching up on supplies, billing and the reams of paperwork required for every exam — to ensure both privacy and an airtight prosecution.

Even Blanche's experience in the cramped exam room less than two years ago now seems like the dark ages. MUSC recently dedicated a spacious room in its Clinical Sciences Building, with chairs, a privacy curtain and calming moss-green walls, specifically for SANE exams.

The patients can refuse photographs, swabs or any other part of the exam, said Kathy Gill-Hopple, the MUSC's forensic nursing coordinator.

"The point is to give them control back, and that starts right there," Gill-Hopple said.

Patients range from the college student with limited memory of the drunken night before to the elderly woman raped by the man who broke into her house. Women whose husbands forced them to have sex come in reluctantly, and men attacked in jail cells come in shackled.

Most often, the patient knows the alleged predator, said SANE nurse Nancy Hall. The commonality stops there.

"Every time you come in for an exam, you never know what you're going to get," Hall said.

A patient can seek an exam a full five days after an alleged attack and can wait as long as a year to file a report with law enforcement. A nurse gives the same weight to each patient, from the woman assaulted by a stranger in a parking lot to the prostitute whose customer held her captive.

"Our role is just for that right then, for her body and what she needs," Hall said. "If she never tells another soul the rest of her life, or if it goes all the way to prosecution, we are there to help her."

Proper treatment of rape cases not only means improved patient care but better evidence to take to trial. Getting rape kits completed early, before DNA evidence deteriorates, makes a good offense against a good defense attorney.
The two cases that have gone to trial since the program relaunched: Blanche's case against Andes, and a Colleton County case that ended in a 25-year prison sentence.

A hand to hold
Blanche spent two days testifying in the trial of her former roommate. Sometimes she wonders how she made it through those long hours on the witness stand while strangers listened to the details of the attack.

She recognizes how much harder that testimony, and the entire year leading up to it, would have been without the support she found through strangers with a group she'd never heard of before that night at the hospital.

The SANE process not only pages a nurse specifically trained to treat a rape patient but an advocate with People Against Rape. That volunteer comes to hold the patient's hand, to walk her back to her car after the exam and to guide her through the legal process over the months or years to come.

"I honestly do not know how well I would be right now if it was not for what they gave me," Blanche said.

Volunteers show up at the hospital but then spend the next month helping the patient cope, before referring her to a therapist, said People Against Rape executive director Melonea Marek. Then the advocates show up at court hearings, ready to hold a hand again.

Marek remembers when, more than 10 years ago, hospitals across the Lowcountry trained SANE nurses and then, because of funding, the programs slowly, quietly faded away.

She, like Wilson and the nurses, wants to see SANE programs at all local hospitals.

"If you break your arm, you can walk into any hospital and get service," Marek said. "It would seem to me that if you get raped, you could walk into any hospital and get service. There's no reason for that not to happen in this town."
Especially since, at one time, a patient could go nearly anywhere in this town for a rape exam.

The SANE program began in a few states nearly four decades ago, but those nurses lacked any network until the program became more widespread in the '90s. That's when Faye LeBoeuf joined the team of the first certified nurses in the Lowcountry.

Within a few years, though, all her colleagues gradually left the SANE program. At some hospitals, funding dried up; at others, nurses decided they couldn't handle the stress of such draining work at such unpredictable hours.

LeBoeuf remembers praying that her pager would stay silent on Christmas. She remembers spending an entire weekend in tears as she worked 10 back-to-back cases

Her four children ranged from age 3 to age 12 when she started. Her youngest was 17 when she stopped.
She missed swim meets, karate belt ceremonies.

"They knew Mom and the beeper," LeBoeuf said. "Plenty of times, I thought about stopping. But I couldn't do it to the women — or the men."

She stopped in 2010, when MUSC renewed its commitment to SANE in earnest. LeBoeuf still works as a certified nurse midwife for mostly low-income women at the MUSC's Women's Health outpost tucked away in a North Charleston strip mall.

She can't help but resent the people who call SANE a new program. "It started here," she said in an interview at her office.

People from Charleston, Berkeley and Dorchester counties, as well as people from as far away as Georgia, made their way to LeBoeuf, the only person for miles who could perform a proper SANE exam.

Years ahead
Staffed full time — by more than one person — the SANE program remains in its infancy.

Local nurses hope for grant money to purchase a $35,000 camera that will collect stronger evidence in sexual assault cases. They hope to add more members to their own ranks and at other hospitals in the area.

Patients who seek help anywhere but MUSC have to explain what happened at least one more time and then travel to SANE nurses downtown. Delays compromise evidence and also the patient's willingness to stick with the court process.

A sexual assault victim spends the rest of her life recovering from the attack, said Debbie Browning, nursing director at MUSC's Children's Hospital.

"If it happened at a gas station, she's going to think about it every time she drives past a gas station," Browning said.
For LeeAnn Blanche, her daughter's birthday reminds her of the attack. That's the part Blanche resents the most.

She avoids social gatherings that involve alcohol, remembering the stale beer on Andes' breath the night he raped her.
Sometimes she looks in the mirror and wonders how anyone can ever find her pretty.

But she hates the word "victim."

Blanche went back to work, kept up with her sexually transmitted disease testing and met with counselors and prosecutors regularly. She told her daughter the truth, because she wanted the girl to hear it from her and not from anyone else.

"I think when you use the word 'victim,' you're putting yourself into a category," Blanche said. "Yes, I am a victim of what happened, but that's not what I'm going to be the rest of my life. I don't want to use that as an excuse."

People ask her what happens after Andes' 12-year sentence ends. Blanche said she's content just knowing that she has 12 years to figure that out.

Editor's note: The article ran in the June 18 issue of the Post and Courier and is reprinted with permission.



Friday, July 13, 2012

The Catalyst Online is published weekly by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. The Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, Editorial copy can be submitted to The Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.