Rape is a notoriously difficult crime to prosecute. Of every 100 rapes nationwide, 46 are reported, 12 lead to arrests and three result in prison sentences.
To improve those odds, advocates are encouraging more nurses to receive the training to give a forensic examination that can be key to securing a conviction. Prosecutions are difficult when a victim fails to get a prompt examination. And with TV crime dramas such as "CSI" raising expectations among juries, prosecutors and victims' advocates view the forensic exam as more essential than ever.
"Juries now expect science," said Scott D. Shellenberger, the Baltimore County state's attorney.
Statewide, there are just 165 registered nurses — out of nearly 50,000 — who are certified to perform the two-hour exam, offered free to any rape victim who wants one in at least one hospital in each county under a program launched in 1999. With more classes being offered this year, advocates hope to fill vacant positions throughout Maryland.
These forensic nurse examiners are responsible not only for rape victims' medical care but the foundation of their legal case, said Linda Kelly, who manages Greater Baltimore Medical Center's sexual assault forensic examination program for victims in Baltimore County.
The statewide rape exam system means victims can go by ambulance, police escort or on their own to a hospital. They should go without delay. Evidence can be destroyed when a victim waits and uses the bathroom, showers or even brushes her teeth.
Nurses know they need to find evidence if a case has any chance, so they gently persuade victims to get the exam. They label rape kits as "Jane Doe" for three months or longer so victims can decide later if they want to pursue their cases, though few do. The state Department of Health and Mental Hygiene pays the costs of all exams, which this fiscal year is expected to exceed $1.4 million.
State health data shows that more than 3,300 exams are completed annually in the state, but crime data shows a little over one-third of that number were reported to police in 2010. About 11 percent lead to an arrest.
In Baltimore City, the state's attorney's office reported that in the six months ending Jan. 31, charges were brought in 109 rape and sexual assault cases and 63 led to convictions, with sentences ranging from 9.6 to 16.6 years.
To learn how to properly perform the exams, about 20 registered nurses recently began 40 hours of classwork at GBMC. They came from Maryland, Virginia, South Carolina and Massachusetts. A military nurse came from Japan.
They would spend the week learning about anatomy, victim and suspect exams, trauma, sexually transmitted diseases and pregnancy. They also would be taught about evidence collection and preservation, courts and the law, testifying, suspect profiling, domestic violence and referrals to other victim services. Before being certified, they need to get clinical experience and to pass several tests. They also must be recertified annually.
Once certified, the nurses can apply to any hospital with a program and become part of an on-call schedule that runs every day and night of the year. They're paid about $3 an hour when they're on call. Most have full-time nursing jobs elsewhere.
Katherine Norelli, a 27-year-old cardiac surgical intensive care nurse from the University of Maryland Medical Center, has wanted to be a forensic nurse examiner since she was in school and toured a program. She'll soon enter GBMC's rotation.
"It's such a critical time in someone's life," she said. "They need someone caring, compassionate and who know what she's doing. …The evidence collected is so important. If you don't collect all the evidence, or you miss something or don't take the right photo, the case can be blown."
It's not the life-or-death pressure she faces in the ICU, Norelli said, but she considers rape "life changing." She's hoping she can bring all of her skills, and maybe her youth, into service for the women who come to GBMC — often from area schools. GBMC saw about 150 cases last year, and about 60 percent of the victims are ages 13-34. One-third of victims say alcohol was involved and more than half know the alleged attacker.
The demographics and needs are different in each county, said Debra S. Holbrook, who runs Mercy Medical Center's program in Baltimore, the state's oldest at 18 years and the largest with about 30 nurses and 60 rape cases a month.
At Mercy, forensic nurses also see domestic violence cases. Nurses at Mercy and elsewhere also travel to victims if their injuries are too serious for them to be moved.
But Holbrook said most victims don't have obvious physical injuries, which can make juries skeptical. Nurses such as Holbrook and Kelly often serve as expert witnesses to explain the facts. Other nurses rarely testify, or learn the outcome of cases, but they still must be prepared.
That means mock trials during training. It also means thorough, by-the-book exams. Nurses have to ensure that photos are taken, swabs are done, clothes are collected and the evidence is kept safe and unadulterated until it's sent to the police crime labs, Holbrook said.
"You've got one moment in time, and it's not a team sport. No one is looking over your shoulder or helping," she said.