Among the frustrations voiced by residents of Western North Carolina about operations at Mission Health hospitals since their acquisition by HCA, perhaps the most controversial issue is forensic testing of sexual assault victims.
In particular, access to sexual assault nurse examiners, or SANEs, has been called into question. Critics like REACH of Macon County say they have taken sexual assault victims to Angel Medical Center for forensic exams for many years, but those services are no longer available at Angel.
“Prior to Mission ever being involved with Angel, we had SANE nurses for at least the previous 10-12 years,” said REACH executive director Andrea Anderson. “Once Mission bought it, some of those SANE nurses that we had worked with previously were still at Angel. At that point we had SANE nurses still at Angel.”
“We do know that during 2015, we had SANE nurses still there, doing exams,” she said. “Granted, all these nurses had other jobs. There was a point a couple of years ago where we had none based out of Angel.
“I will say that when HCA purchased Mission, Angel did not have SANEs at that time,” Anderson said. “However, prior to the Mission merger we absolutely had SANEs at Angel.”
The official response from HCA/Mission offers a different take on the situation.
“There has been no change to the process as far as our forensic nurses since the acquisition,” said Mission spokeswoman Nancy Lindell. “Our SANE positions have always been at Mission Hospital. Mission Hospital has certified forensic nurses that are ready to dispatch to any regional locations as needed.”
Anderson said that while Mission has sent a SANE to Angel to perform an exam on request, that’s been the exception.
“The overwhelming majority of the time, if we have a victim of sexual assault, the victim needs to go to Mission or the justice center in Asheville to have a forensic exam,” Anderson said. “It’s not the best situation. It creates hardships for the victim.”
Anderson disputes Mission’s claim that it never had SANE nurses at its regional hospitals. She cites a 2016 Mission Health Nursing Annual Report, where there is an entry for a SANE at Highlands-Cashiers Hospital: “Katherine Hamby, BSN, RN, CCRN, SANE, Emergency Department Monica Crook, RN, CEN, Emergency Department.”
In a letter dated Oct. 11, 2017 to a U.S. House committee on drug pricing, then-Mission Health CEO Ron Paulus said, “Sexual Assault Nurse Examiners (SANE): Mission employs forensic nurse examiners that are specially trained, registered nurses who provide comprehensive care for victims of sexual assault, domestic violence, and child, elder, and dependent-adult abuse and neglect, and other violent crimes. Forensic nurses are also involved in community outreach and educational programs designed to raise public awareness of sexual assault, safe relationships, and recognizing and dealing with intimate partner violence. These nurses are on duty 24/7/365 and have a presence at each Emergency Department in Mission Health System. In 2016, operational costs of the SANE program were valued at just over $660,000.”
In response to N.C. Attorney General Josh Stein’s letter raising concerns with HCA, Greg Lowe, CEO of HCA Healthcare’s North Carolina division, said “a sexual assault survivor who comes to Angel Medical Center receives the same services now that were available prior to HCA’s acquisition of the Mission Health System.”
Having to go to Mission for a forensic exam makes an already traumatic situation even worse for sexual assault victims.
“Sometimes sexual assaults are so traumatic, victims may not come forward right away,” Anderson said. “It may take a day or two to get an exam. It’s a horrible experience. This just creates another barrier.”
In the 12-month period between July, 2018 and June 2019, REACH worked with a total of 149 sexual offense victims, 82 of them adults, according to Anderson. Of those, there were six forensic exams conducted for three unique clients.
Anderson met with representatives from Angel Hospital on March 6.
“They have reached out to us to work on some collaborative solutions going forward,” Anderson said.