Moose Lake Star Gazette - Serving Carlton and Pine Counties Since 1895

By Emilee Franklin
Moose Lake Star-Gazette 

SANE program offers quality care to victims


SANE exams are free for victims. If victims receive the forensic evidence collection but do not know if they want to pursue a legal case, WINDOW and the county is able to hold the evidence for a period of time while the victim is deciding on their next option.

In the past year since WINDOW launched its Sexual Assault Nurse Examiner (SANE) program in April 2016, they have responded to 23 sexual assault victims.

Eleven of these assaults were in Pine County, nine were in Carlton County and three were in Kanabec County. SANEs are fully trained registered nurses (RNs) or nurse practitioners who choose to receive extra training in order to be eligible become a SANE, and perform examinations. SANE-trained employees must complete at least 40 hours of training before starting, and continue to take training sessions. These training sessions are provided free through WINDOW. They receive specific training in the areas of sexual assault, forensic evidence collection, injury assessment and trauma-informed care. After training, these nurses will be trained and ready to conduct exams on individuals who have been sexually assaulted.

Why are SANE exams better?

One of the main reasons for SANE examination is they are victim-centered. The nurses who treat victims have some idea of what the victims may be going through, questions they might have, and have training on how to better care for these patients. In areas that do not have SANE nurses, victims may be put into a situation with doctors or nurses who may not be able to give them the best treatment. According to WINDOW, once a rape kit is opened the provider is not allowed to leave the room, for fear of contamination.

In a busy emergency room without SANE, this could take away a central provider for 2-3 hours or more. If this provider is not used to giving care to someone who has experienced such a traumatic event, and is thinking of other patients, they may rush, or not treat the victims as they should.

SANE exams are free for victims, and the county in which the assault occurred is billed. The nurses do not pressure victims to file a criminal case, or pressure victims to have any part of the exam that they do not want to have. If victims receive the forensic evidence collection but do not know if they want to pursue a legal case, WINDOW and the county is able to hold the evidence for a period of time in a locked evidence fridge with no pressure while the victim is deciding on their next option.

SANES on call

WINDOW currently has 12 nurses that provide on-call coverage of area hospitals: FirstLight Health System of Mora, Pine City and Hinckley; Essential Health-Sandstone; Community Memorial of Cloquet and Mercy Hospital of Moose Lake. WINDOW currently has two SANE nurses on call for the tri-county area between 4 p.m. on Friday and 8 a.m. on Monday morning. SANE nurses make $200 for each weekend they are on call, and are required to be sober and within an hour of the location. If a SANE nurse receives a patient, they will make an extra $350 for their time. WINDOW hopes to add more SANE-trained nurses in the future to ensure more 24/7/365 care, rather than weekends only.

"We're doing the week-long training in July. We are looking for RNs to attend and commit to six months (renewable thereafter). No charge for nurses who choose to commit in our participating hospitals," said Lisa Lilja, the director of WINDOW.

When the on-call nurse is paged, they usually respond within 30-60 minutes. The SANE or other medical personnel (ex-emergency department physicians or nurses) will first assess the victim's need for emergency medical care to ensure that serious injuries are treated. After the victim's condition is stabilized, and it is determined that immediate medical care is not required, the SANE can begin the examination.


WINDOW's SANE program can provide services to adolescents and adults. They are able to do an exam on someone of ages 12 and up. For victims under age 12, those cases must be referred to either the Twin Cities' Midwest Children's Resource Center (MCRC) or Duluth for an exam done by a pediatric SANE.

"If we are called in on those cases, we will provide advocacy to the child/parents and can go with them to the exam if that is what they would like for us to do, said LoAnn Westerman, WINDOW's program manager.

"In Pine County, when either Child Protective Services (CPS) or law enforcement is doing a forensic interview, they will call us, and we will provide an advocate at the interview to meet with the parent/guardian etc., while the interview is taking place.

"This allows us to explain the process to the parents, discuss Orders for Protection, Harassment Restraining Orders, and reparations and do any paperwork that may be needed."

As far as plans for pediatric services in the future, "I would love nothing more than to have that service available in our area," said Westerman She is currently researching information on how to develop and support such a program within the area. For the time being, referrals are made to MCRC and Duluth for the forensic exams.


Because of their position, SANEs must be prepared to testify in a criminal or civil trial as a fact or expert witness when necessary. Prosecutors have found SANEs to be credible witnesses in court as a result of their extensive experience and expertise in conducting evidentiary exams.

The director of a Wisconsin SANE program reported that during a 3.5 year period, they had a 100 percent conviction rate in cases where a SANE testified at trial. With the growth of SANE programs throughout the country, court systems are processing greater numbers of cases of sexual assault in which the victim has undergone a forensic exam.

As more of these cases go to trial and result in increased numbers of convictions, state and federal appellate courts are reviewing constitutional and evidentiary challenges by defendants. To date, these courts have rejected all defense challenges to convictions based on SANE testimony.


WINDOW was able to start this program through a grant through Blue Cross Blue Shield of Minnesota Foundation's Healthy Communities: Health Equity in Action fund. The Foundation offers a total of $1 million in grants each year for community-based projects addressing one of the social or economic determinants of health including community safety, education, employment, family and social support, or income.

WINDOW applied and received a two-year, start-up grant in 2016 for the SANE program, and has applied for another two-year grant to help fund the program going forward. The foundation provides grants up to $100,000 per year for a total of two years.

According to the Minnesota Forensic Nurses organization, only 31 out of the 87 counties in Minnesota have SANE programs. Pine, Kanabec and Carlton joined this group this past April. Other counties currently served include Hennepin, Dakota, Rice, Ramsey, Washington, Anoka, Mille Lacs, Sherburne, Wright, Scott, Carver, Itasca, St. Louis, Olmstead, Mower, Beltrami, Cass, Hubbard, Clearwater, Red Lake, Blue Earth, Steele, Kandiyohi, Stearns, Benton, Wright, Pipestone and Chisago.

History of SANE

The SANE program began in the early 1970s. According to the Office of Victims of Crime (OVC), it was developed when nurses saw that victims of sexual assault were not receiving as quality care as other patients in the emergency room (ER), or at all. These patients had specific concerns such as contracting a sexually transmitted disease (STD) or becoming pregnant, that were not able to be addressed in the best ways.

The first SANE programs were established in Memphis, Tennessee, in 1976, followed by Minneapolis in 1977. In 1991, there were 20 known SANE programs in the United States. From that time, SANE has grown to an estimated 800-plus programs across the country. According to the International Association of Forensic Nurses, there are currently 3,700 members who practice forensic nursing in 24 countries.


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