Specially trained health professionals provide compassionate care for patients who have experienced sexual assault. Evonne Garcia, RN, is a forensic nurse and certified sexual assault nurse examiner who has cared for thousands of patients and is now helping to train other specialized nurses. She joins us along with Taylor Tyson, an interpersonal violence prevention specialist and volunteer advocate for the Sexual Assault Resources Center in Bryan, Texas, to discuss why it is so important to seek medical care following sexual assault.
Lindsey Hendrix: Hi everyone. Welcome to the Vantage Point podcast. This is Lindsey Hendrix. April is sexual assault awareness month, so we’re sitting down with Evonne Garcia, a forensic nurse and certified adult and pediatric sexual assault nurse examiner. She’s with the College of Nursing. Also with us is Taylor Tyson. She’s an interpersonal violence prevention specialist in the Office of Health Promotion. Taylor’s also a volunteer advocate for the Sexual Assault Resources Center in Bryan-College Station. And she’s gonna help me co-host today. Welcome, Taylor.
Taylor Tyson: Hi! Nice to be here.
Lindsey Hendrix: And nice to have you with us, Evonne.
Evonne Garcia: Hi, thank you.
Lindsey Hendrix: First of all, what is forensic nursing?
Evonne Garcia: Forensic nursing is a specialty in nursing where we are trained to take care of patients who have been involved in violence, like interpersonal violence such as domestic violence, sexual assault, child abuse, elder abuse, traumatic injuries like gun shots, stabbings. So any patients in that regard where we can go in and take care of them as a patient but also collect evidence that we made need off of them.
Lindsey Hendrix: And you’ve been practicing as a forensic nurse for several years. Tell us a little bit about your experience.
Evonne Garcia: I’ve been a forensic nurse for 10 years. I’m originally from way deep south Texas. Edinburg, Texas. I started a program with the help of Doctor Mitchell, who’s also here at Texas A&M. I started a program down in the Rio Grande Valley for these kind of special population of patients. It was the only program there and I pretty much was running, doing, taking care of these patients 24/7 for about five years by myself. And then we had another nurse at that point. And finally this past July, I came to join Texas A&M University College of Nursing where I am a forensic program manager out of the forensic health care program, and I’m also the forensic coordinator of the HRSA grant that we just got. To where, my role is to help train and sustain forensic nurses throughout the state of Texas.
Lindsey Hendrix: So Texas A&M has the forensic nursing program. What is that and what are some of the goals?
Evonne Garcia: They do. They have a Master’s of Science and Nursing in forensics. So it’s a master’s program. The goal of that also is to, of course, higher level of education for these nurses who are wanting to go into forensics.
Taylor Tyson: So Evonne, sometimes we hear SANE and sometimes we hear forensic nurse. Can you talk to us a little bit about the difference between those two?
Evonne Garcia: Yes. SANE is a Sexual Assault Nurse Examiner. Those nurses are trained to take care of sexual assault patients. Forensic nurses are also SANEs, but are a little more trained to take care of the other variety of patients which are like child abuse, elder abuse, domestic violence, and so on.
Lindsey Hendrix: We hear about, in your field, a sexual assault evidence collection kit. Can you talk to us a little bit about what that is?
Evonne Garcia: Yes. That’s the, it’s a kit that’s, that’s what we use to collect evidence. So it contains swabs, envelopes, anything we would need to help us obtain the evidence from the person where we’re trying to pick up DNA evidence. So that’s the contents of the kit and then we would seal that kit and send it off to law enforcement or wherever it would need to come to it.
Lindsey Hendrix: And these kits are sometime referred to as rape kits but I know that’s not the preferred term, so can you explain to us why?
Evonne Garcia: Yes. We don’t like to call them rape kits ’cause in our, I guess our mentality is a rape kit is more like a black bag with rope and tape and stuff that someone would use to actually rape someone. So there’s a difference to us. A sexual assault evidence collection kit is what we use to collect evidence, not hurt the person.
Lindsey Hendrix: Right. So that’s a really important distinction.
Evonne Garcia: Yes.
Lindsey Hendrix: Why would someone come in for an evidence collection kit? What are the different reasons they might want that done?
Evonne Garcia: Well the evidence collection kit is, we usually have, we have a 96-hour window where we’re able to pick up DNA from the patient. So if they’ve been sexually assaulted and they come within those 96 hours we’re able to use the evidence collection kit to try and pick up DNA. Like so let’s say she said he was sucking me on my neck, we would swab that neck area and hopefully pick up that person’s DNA. After the 96 hours it’s a little harder to get the evidence, but we might still try, but it gets a little more difficult after that time frame and that’s why we have the 96-hour window.
Taylor Tyson: So you mentioned that evidence can be collected off of someone’s neck. So it wouldn’t necessarily have to be penetrative for there to be evidence that is collected, so what are some different things that y’all would look for in that kit to be able to gather evidence?
Evonne Garcia: So we could collect evidence, like I said, off of body fluid transfer so, like I said, sucking the neck, certain body parts. If they scratch the individual we could try and pick up DNA under the fingernails. So it’s just different areas and as we’re trained, we’re trained to think of those things as they’re telling us the history of the incident and what happened so we would know where to try and swab and pick up some of that.
Taylor Tyson: So that’s also a good reason why we shouldn’t call it a rape kit, because someone doesn’t necessarily have to be raped per se, the definition, to come in and have this evidence collection kit done. There’s a variety of other reasons they might want to come in and have this done.
Evonne Garcia: When we think sexual assault, I know a lot of people think it’s when the penis goes in the vagina and that’s sexual assault, but it could also happen in other areas. So it could happen in the mouth, it could happen, maybe attempted and not complete penetration, so we would still able to maybe see injury or maybe pick up DNA still in those kind of situations.
Lindsey Hendrix: So why would somebody go through this process? Why would somebody go in to have the sexual assault evidence collection kit done?
Evonne Garcia: Well primarily, the primary reason I would want someone to come in is to make sure they’re okay. Mentally, physically. That’s the first thing I would say. Come to the hospital, let’s check you out because a lot of stuff can happen during a sexual assault like hitting, strangulation, there’s a lot of reasons medically that we would want to see them. After all of that’s been cleared and they’re okay then we would move on to evidence collection and with evidence collection, finding DNA from another person helps their case if they wanted to pursue it with law enforcement so that they’ll have a stronger case to show this person’s DNA was on me.
Taylor Tyson: So we keep saying evidence, and I think a lot of people tie the word evidence to police. So if someone were to come in and have a kit done, does that automatically mean that they are having a report made to the police?
Evonne Garcia: No. There’s a law that if the person is 18 and older, they have the option to not report to police, but still come in and have evidence collection if they wanted to. How that works is they would come in, same process, tell us the story of what happened, we would collect the evidence, but that evidence instead of going to a police department, or getting reported anywhere, would be sent to a crime lab in Garland, Texas, and they’ll hold that evidence with an anonymous number on it, so it doesn’t even have their name on it, and they would hold that evidence for two years. If within those two years, the person decides to go ahead and come forward and contact police about the incident, then they would go back to that hospital, tell them they’re gonna do that, and then they would give ’em that unique identifier where they could recover that evidence from Garland and bring it back to the investigating agency.
Lindsey Hendrix: For people who might be minors and worried about their parents or somebody else in their family finding out that they were sexually assaulted, in some cases it could be a parent or somebody in the house who has done it, should people be concerned about their parents finding out?
Evonne Garcia: Minors have the right, also, to come in and get examined. They only thing with under 18 is, by law, we have to report to law enforcement if something happened to them. So that’s a, that’s a mandatory reporting that we have as registered nurses.
Lindsey Hendrix: We talk about rape, or sexual assault, happening by men to women most often. That’s what people think of. But it also happens across genders, whether you’re male or you’re gender non-conforming. Is the process different for these different populations?
Evonne Garcia: No. We take care of patients. I’ve had patients that are male-on-male, female-on-female, female-on-male. So there’s no specific type, you could say. And we treat them all the same. We’re gonna collect evidence in the same way. They’re our patient. I’ve even had to go as far as taking evidence from the suspect, so that person also we don’t treat them any different than any other patient. We’re still gonna worry about their medical care, their health, if they’re okay, and do what we need to do for them as a patient.
Taylor Tyson: When someone comes in to have a kit done, I think there’s usually kind of a fear of a cost associated when going to the hospital, what that might look like. Can you talk a little bit about that process and what is charged to the victim, survivor, patient?
Evonne Garcia: The actual evidence collection part, that is paid for by law enforcement or through a state, it’s the state attorney general funds that pay for that. So that part should never be charged to the patient. They may, if they go through an emergency room, they may get billed x-rays, medications, the physician visit, anything like that, but they’ll bill the insurance, they’ll bill Medicaid, and ultimately after that, then the state also has what they call Crime Victim’s compensation, which will also help pick up those charges that they have to be responsible for.
Lindsey Hendrix: So if somebody doesn’t have insurance they shouldn’t worry about having to pay exponential amounts for something like this?
Evonne Garcia: No, I would still go in and do what needs to be done and then figure that out later ’cause there are ways to help.
Taylor Tyson: And that’s also something that we are trained on as volunteer advocates, in the information that we take to the patient, victim, survivor in the hospital is information on follow-up resources, and one of those that specifically the Sexual Assault Resource Center here offers is helping folks navigate that process of applying for the funding and having reimbursements and things like that.
Evonne Garcia: ‘Cause Crime Victims also can help if it happened in their apartment and they’re not comfortable there anymore, they can help ’em relocate. If they damage their cell phone during the process, they can help them recover another cell phone. So there’s a lot of ways that the state can help with what happened to them as a victim of a crime.
Lindsey Hendrix: And there’s a lot psychological damage that can happen as a result of this, so what are some of the resources available to people in that area?
Evonne Garcia: Again, there’s Crime Victims can also help with counseling if they have to go to long-term, in-depth counseling, they can help with those. If, God-forbid, but let’s say a child witnessed it, they can also send the child to counseling. And like I said, there’s a lot of resources out there to help.
Lindsey Hendrix: And specifically for students at a university, are there services available to students that are easily accessible?
Taylor Tyson: Yeah. So on campus there is counseling that’s provided for students. There’s also the actual reporting process if students were to choose to go that route, the university can help with changing class schedules or parking locations, living arrangements, whatever that might look like if the person does not feel safe in the area that they’re in anymore. The Sexual Assault Resource Center also provides free counseling for folks who are victims, survivors, but also for secondary survivors so anybody who’s very close to someone who has experienced trauma, they can also go and have the counseling services provided for free there, as well.
Lindsey Hendrix: That’s awesome.
Taylor Tyson: So, I often get asked by students is there anything I need to know or need to tell a friend that they need to prepare for before going to have this kit done? I know earlier you had mentioned an hour time frame that is looked at for different parts of the kit. Can you talk to us a little bit about different things that someone could prepare for if going to have this kit collected?
Evonne Garcia: Yeah. Of course, first and foremost, you wanna always try and get them there as soon as possible. So, there’s really no preparation, just get to a facility that can take care of you and possibly collect evidence if needed. It doesn’t matter, I know a lot of people worry about well I already took a bath, I already ate, I already peed, I changed my clothes, it doesn’t matter. We can still, like I said, we have 96 hours. So if you took five baths within those 96 hours, we still will try and collect what we need to collect from whatever history you give us. But, if it’s something that just happened, I would say don’t, if possible, to try not to shower, try not to eat or drink anything, try to keep the same clothing you had on. So even if you’ve taken five baths within that 96 hours, you’d still wanna come in. Don’t let that be a reason to say no, I can’t go anymore, ’cause we’re still gonna do what we need to do. We’re trained to know exactly, from what you’ve done, what we still can do or can’t do as far as evidence collection. So if this happens to someone, or someone that, like a friend that you know, I would have them get to the hospital or the facility as soon as possible before they do eat or drink anything or take a shower, ’cause the sooner they get there, the more chance we have of collecting DNA in different areas.
Taylor Tyson: So after someone comes to the hospital to have an evidence kit done, about how long can they expect to be there? What does that timeline look like at the hospital?
Evonne Garcia: Once the sexual assault nurse examiner is with the patient, our exam can be anywhere from 45 minutes to three hours depending on the history of what happened, the evidence we need to collect. We do photographs, also, so if there’s no injury compared to bruising all over the body, of course that’s gonna take a lot longer ’cause we do take pictures and measure each injury that they have so it can be anywhere from I would say an hour to three hours with the patient. And again, we don’t like to rush. So we take our time with them, we let them talk to us as much as they need to, and of course we wanna make sure that we educate and we make sure they have a safe place to go before they leave.
Taylor Tyson: So what does the process for that kit look like once you’re completed?
Evonne Garcia: Once we’re done with the patient, then we seal the kit, and then we have law enforcement come, if law enforcement is involved, we have them come and pick up that evidence and then they’ll take that evidence to their evidence area in their police department and then from there I think they take it over to the crime lab. So I know there’s a law that they have to have taken it to the crime lab within 30 days, so that’s what’s supposed to be.
Taylor Tyson: So we’ve been hearing a lot in the news about the backlog of these evidence collection kits. Can you talk a little bit about that?
Evonne Garcia: The backlog is basically where either the police department has not sent those kits to the lab for processing, or the lab has not gotten to those kits. I think the lab now, with that law that came out that I was talking about, they’ve moved a little quicker on kit processing, and so I think that ones that have been coming out in the news is where they’re finding agencies that have not processed the kits for whatever reason.
Lindsey Hendrix: We say that you can go to a hospital to have this done, are there any other facilities that provide this service?
Evonne Garcia: Some areas do have community sexual assault nurse practices where they may have a small building that they use or some have children’s advocacy centers who also have a nurse inside the advocacy center who will see not so much the patients that it happened within 96 hours, but the children who, children sometimes won’t say anything til months to years later, so those are the ones that they’ll examine at the advocacy centers.
Lindsey Hendrix: For people who don’t live near a hospital or a healthcare facility, say they live in a small town or a rural outlying area, what recommendations do you have for them if this happens?
Evonne Garcia: There is a law that every emergency room has to have someone minimally trained to be able to do the evidence collection kit, so if they can just go to the nearest hospital and then either have that hospital do the exam or request to be sent to a hospital that has a program that’s specialized in sexual assault nurse examiners.
Lindsey Hendrix: With this minimum requirement that every emergency department has somebody who’s trained to do the collection kits, how is Texas A&M through the forensic nursing department addressing that need?
Evonne Garcia: That’s where that HRSA grant that I talked about earlier comes in. We have been granted, I think total three million over three years to get, to help train nurses. So we’re looking at the rural and underserved areas, and that’s where we’re reaching out to them to find nurses who are interested, who wanna do this, who were willing to come and train and then my job also is to sustain them so I’m helping through mentoring and checking on them or what do you need? ‘Cause, honestly, forensic nurses are very rare. There’s not a lot of ’em, there’s not very many that want to do it, so there is a lot of the gap in enough people. I know I can speak for myself when I started out there in the Rio Grande Valley, it was, like I said, it was just me and there was nobody available that I could ask questions to or ask for help or anything other than Doctor Stacey Mitchell who was in Houston, so it was pretty much through email or phone calls. But had I not even her support like that, I don’t know that I would have been able to sustain what I was trying to do down there just by myself. It gets really tough. So that’s part of, also, the grant is to make sure that we’re there for them to help them, to guide them, whatever they made need so that they do last more than a year or two years practicing.
Lindsey Hendrix: This training, then, is available to people who are already practicing nurses?
Evonne Garcia: To be trained as a sexual assault nurse examiner, you have to be a registered nurse for two years and then you can go through the training.
Lindsey Hendrix: Forensic nurses will probably have to deal with patients who are going through a lot of psychological problems. This is a big mental issue. How are nurses being prepared to handle that?
Evonne Garcia: I think it’s part of nursing in general. We encounter patients in any specialty who have, in an emergency room for example, you’re getting patients that experience a sudden, traumatic event or a sudden illness that they’re coming in for, so you have to really know how to speak with your patients, have the patience, deescalate sometimes when you have to, and just know that it’s not you, it’s what they’re going through, and knowing how to reroute them and kind of help them through and I guess it would be the same in surgery. They’re coming in for a major surgery and they’re scared, they may react, they may cuss at you, but it’s not you it’s just the fact of what they’re going through and they don’t, may be scared they don’t know how to deal with it, so it’s the same with our forensic patients. They just went through a traumatic event. They may be scared of a male, female. They might tell you to get hell out of the room, and that’s not, it’s not you or anything you did to them, it’s just the fact of what they just went through and it’s just learning how to calm them down and deescalate, and let them know they’re safe. I think that’s the biggest thing is they need to know that they’re safe and we’re here to help them, not to hurt them in any other way.
Lindsey Hendrix: And Taylor, from an advocate standpoint, what would you tell people out in the general population? Somebody who maybe has a friend who has fallen victim or comes across a stranger that they have witnessed being a victim of sexual assault. How do you prepare somebody in the community to deal with that?
Taylor Tyson: I think really talking about the empathy piece is important, and realizing that that person has experienced trauma and that everyone reacts differently. So I’ve been in the room with a victim survivor who has made jokes and has been laughing, and I’ve also been in the room with someone who could not stop crying. So, my job as an advocate in that space is to assist the nurse in that kit and making that person comfortable, and that person might have supports with them already and so sometimes that is me sitting with the support person and having that conversation with them about what next steps might look like and how they can support that person in the long-term. And sometimes people are there to have that kit done and don’t have anybody with them, and so I’ve been asked to stay through the whole process, and I’ve been asked to just give the resources and thank you and I can leave. So everything is different depending on the person, but really understanding that everyone reacts differently to this type of trauma, and it’s really important to believe that person and let them make the choices on what they want those next steps to be. Their support and their care long-term needs to be decided by them and them alone. So providing resources and providing that information for someone is really awesome, but also empowering them to make that decision for themselves.
Evonne Garcia: You don’t know how much the nurses love their advocates and appreciate them. ‘Cause they really are a help. Really, really. A big help.
Lindsey Hendrix: Are advocates available through the hospital or the health care facility?
Evonne Garcia: I’ve known them, where I’m from they were from the Rape Crisis Center, and they were trained through there and I think here it’s a SARC where they’re trained through and that’s how they do their training, and then we have a process where when we get a patient we’ll call them to come out to the hospital. So they’re kind of on-call with us.
Lindsey Hendrix: That’s fantastic. In the media on popular TV shows, crime shows, and movies, even in the news, we hear about rape or sexual assault being perpetrated by strangers. Is that always the case?
Evonne Garcia: No. I think the majority of the cases I’ve seen, I’ve seen about four to five thousand patients myself. Out of those patients, I would say 99.7% of them are someone they know. A family member, a teacher, a neighbor, karate instructor, so it’s always someone who’s kind of close to them, has access to them, has built trust with them, and that’s usually when they take advantage of the situation.
Lindsey Hendrix: And I would imagine, to an extent, that that would be so much more difficult to deal with.
Taylor Tyson: I think that’s also a large part of the reason why we see low reporting numbers is because folks think that if it was someone they know, someone they trusted, there’s a lot of self-blame. That I could’ve done something else, I could’ve done something differently, I should’ve done more, I could’ve. All those things that go through someone’s mind, and it’s not thought of the same way when it’s someone that they trusted, someone that they knew. And they might not report because of that.
Lindsey Hendrix: Let’s talk about, for a minute, the idea of consent. Because, I think especially people who are dating or they are married, this happens inside relationships. And so what are some things that could be crossing the line? This isn’t a consensual situation, maybe this is sexual assault.
Evonne Garcia: When the person says no, it’s no. It doesn’t matter they’ve been married 20 years and she’s always, or he has always done it, if it one night it comes down to they decide tonight I’m not gonna be with you and they say no and that person continues, then that is sexual assault.
Taylor Tyson: I think it’s important to remember that consent is ongoing, active, and can be taken back at any time. So, someone might consent to one thing and not consent to another. And even if someone’s been in a long, established relationship, even marriage, consent still has to be had every single time for every single sexual activity. And sometimes that sounds stuffy, but really that’s just checking in with your partner and making sure everybody’s okay and enjoying what’s going on. And I think a lot of the times, after that relationship has been ongoing or lasting, you start to pick up on that person’s nonverbals a little bit more, and so those nonverbals can be used more, but still consent has to be had every single time.
Lindsey Hendrix: I’m a mother of two young boys, and I have this concern in my mind about raising gentlemen. Do y’all have some advice for parents to prepare their children to be respectful and to avoid sexual assault situations?
Evonne Garcia: I’d have to say, and this is what I tell my parents that I have to talk to when they bring in their child to me, it’s never too early anymore to start talking about things with your child because you want them to know good touch from bad touch. You want them to know what’s okay and what’s not okay. And the truth of the matter is I hate social media. I mean it’s good for some things, but honestly, I’ve had 8-, 9-, 10-year-olds watching pornography.
Lindsey Hendrix: Oh my goodness.
Evonne Garcia: On phones, on tablets, on– One mom, she was so upset, she’s like I don’t even let her have a phone, I don’t, but she goes to school and everybody there has one and they’re showing things and they’re trying things and they’re experimenting and I mean, 10-year-olds doing things that you would never expect a 10-year-old to do. And so that’s why I say now, don’t wait. Start talking to your child. Start educating them. Keep them close to you. Keep that relationship open. ‘Cause even though you’re doing the right thing, you might be sheltering them at home as much as you can and being the perfect parent, but then they go to school and they’re exposed to so much, so you can’t keep them from everything. You have to talk to them, you have to show ’em what’s really out in the world.
Taylor Tyson: Helping them to set their own boundaries, too, when it comes to their body is really important. So things that they’re okay with, or allowing them to, if they’re not comfortable hugging someone then they don’t have to hug someone. So establishing those boundaries and being able to talk about their bodies I think is very important. Also being comfortable with you as they get older to talk about all of those things. Having conversations about consent and relationships and whatever that looks like as the ages come up. But helping them to establish those boundaries as they are young into adulthood I think is very, very important.
Lindsey Hendrix: Evonne, do you have any advice for other nurses who work in this field?
Evonne Garcia: I just want to say to any nurse or anybody working in the medical field, law enforcement, anything like that, always remember to take care of yourself. These jobs are hard to do, they’re not easy. And sometimes we don’t think about ourselves in that way. I’ll give you me as a prime example. I was always a happy, fun-loving, trusted everybody person, when I started this job, exactly this job, I was good, I shut myself off, I’d go home leave work at work and home at home, and without knowing it, it crept up on me. It does take a toll on you, no matter how much you try and shut it off, it does take a toll on you and you need to learn how to take care of you. You want to do the best for your patient, you wanna do the best, you know, law enforcement wants to do the best out there, doing what they do, but you always have to remember you and your family and take care of you first.
Lindsey Hendrix: Taylor, what are some resources available to members of the community with regard to sexual assault?
Taylor Tyson: I think it’s important for everybody to educate themselves on the topic and also, especially, to be able to support other people. So you can’t properly support someone if you don’t know a little bit about what they may be going through and what resources are available within the community to connect them to. So knowing about the Sexual Assault Resource Center, specifically here in Bryan College Station. Also Phoebe’s Home is a shelter and also does some other services for domestic dating violence victims or survivors. Specifically, the university has a number of resources. Everything from the Women’s Resource Center to the GLBT Resource Center. Counseling Center. Health Promotion does a variety of different workshops, programs, trainings for students, faculty, and staff to be educated on these topics. We have sexual assault awareness month and we will be doing a variety of different educational opportunities, events, programs, on and off campus with different partners throughout the month of April, so that’s another really great way for folks to show up for victims and survivors to get educated and to understand what the problem looks like.
Lindsey Hendrix: Thank you so much for that, Taylor. We’re gonna link to all of those resources in the show notes. And Evonne, what about for practicing healthcare professionals? What kind of resources are available for them?
Evonne Garcia: Well, of course, Texas A&M and the forensic healthcare program. I know there’s a hospital locally that has a program that sees sexual assault patients, and just like she said knowing your resources, who to call. If they’re practicing nurses that are out there in the field, they need to know the resources available to them in their area and what steps they need to take when they have that person that comes in and says this is what just happened to me.
Lindsey Hendrix: Is there anything else that y’all want people to know about this topic?
Taylor Tyson: I think it’s important for victim survivors to know that there are people out there who believe them and care for them and will support them. Like I mentioned before, there’s often a lot of barriers, self-blame, different things that people go through when it comes to these topics, but there are supports out there for you and there are people who care. And I think it’s important that as a community, we remember that it is most likely that we know someone that someone close to us has experienced this. To be compassionate, to show empathy, and just to be able to share that information with them and be supportive.
Evonne Garcia: I just say, speak up, you do have a voice and there are people here to take care of you.
Lindsey Hendrix: That is a great message to end this show on. Thank you both for being here. All of this information is incredibly valuable. I think a lot of people will really appreciate this, so. Thank you everybody for tuning in to the Vantage Point on Texas A&M Health Talk. We’ll talk to you next time.