Minutes

Sexual Assault Response Committee June 25, 2007

Roll Call of Members: Members present included: Regina Bernadin and Dawn Thompson [co-chairs of the SARC]; SARC committee members, one RTC Advisory Board member and Senior JMH administrative and nursing staff. [See sign up sheet, If your name is missing please let me know so I can revise the minutes]

Overview: The meeting focused upon a number of concerns voiced by SARC members regarding the delays in implementation of the SART Advocacy Policy by RTC as well as delays facing victims who arrive at RTC who do not receive an immediate medical triage for physical injuries and who wait for long periods of time for the forensic medical examiner.

Staff Report: Sharon Denaro gave a staff report which summarized some of the concerns:

  • Lack of nursing staff to provide emergency medical triage of victim when victims arrive at the RTC
  • Inconsistent Hotline response
  • Inadequate staffing [advocates/ social workers and nurses]
  • Long and time-consuming process for new hires
  • Lack of sufficient volunteer advocacy response
  • Long wait time for victim to see Forensic Examiner
  • Inconsistent or inaccurate communication between staff and victim
  • Lack of staff training has led to problems with police, victims and advocates.

Certification Risk: Felicia Adler, as a Board member of the Florida Council Against Sexual Violence reported that RTC is in danger of losing its certification from FCASV unless they can comply with certification standards.

RTC Advisory Board Concern. The RTC Advisory Board sent representation to the meeting who expressed deep concern that these problems have been allowed to develop and that the Board was not apprised of these matters by JMH administration. He stated that in his opinion, the RTC should exceed standards that have been established in smaller communities and that the RTC should have competent and appropriate staff responding to victims 24/7.

Senior JMH Administrators Give Assurances: Esther Eisler, head of the Ambulatory Care Center, where RTC is housed, also attended the meeting and gave the Committee assurances that JMH is committed to resolving the problems identified. To support this effort she announced that Cynthia Sinclair has been appointed RTC Director of Operations and is on site. Cynthia was appointed by Sandy Sears, and has the authority to make changes and cut through administrative layers. Members were encouraged to communicate future concerns to Cynthia.

Overview of Changes in SA Forensic Examiner [SAFE] staff: Esther also gave a brief review of the recent changes in the forensic staff. Nurse Practitioners [ARNP] have replaced on call doctors as forensic examiners in adult cases. The Committee was advised that ARNPs are more cost effective than doctors and are more willing to do these exams. Esther advised that she had checked models around the country and that this change was not inconsistent with e national models that utilize Sexual Assault Nurse Examiners [SANES] supervised by an ARNP or a doctor.

The problem at RTC has not been the shift to ARNP staff, but implementation. One ARNP was assigned to the RTC. She worked Monday-Friday. Evenings and weekends were covered by other ARNPs on call who worked the weekday shift for other departments in the hospital.

This plan faltered when the ARNP assigned to RTC went out on medical leave for several months. Her absence has caused a gap in services and has contributed to the long waits for the victims. Esther advised the committee that JMH intends to hire a total of 3 ARNPs who will be on staff at the RTC 24/7 Monday-Friday. Weekends will continue to be covered by the on call response ARNPs

The discussion was then opened to the SARC members attending who raised other concerns.

RTC Program Director has been limited by layers of administration. Committee members agreed that the lack of decisive action and progress has led to the perception by many in the community that JMH Administration has not supported the RTC as evidenced by the fact that they have not put appropriate resources into the program. Committee members were assured that Cynthia will have the authority to cut through the various chains of command [i.e. Nursing, Social Work, Health Education] to address all issues of concern.

RTC seems to operate like a JMH clinic not an emergency room. Adult rape victims are not given the same priority as patients in the emergency room despite the emergency nature of sexual assault. It was noted that frequently sexual assault victims are physically injured and that often those injuries are not immediately apparent [i.e. strangulation]. One research study done in Memphis, Tenn., reported that 40% of all sexual assault victims sustain injuries of varying degree (40% - mild to moderate injury; 10% - serious; 3% - life threatening].

It was suggested that RTC study the impact of returning the RTC to the OBGYN ER. MDPD reminded the Committee that they needed a private room to talk to the victim and expressed concern that this might not be possible in a busy ER. Others suggested an evaluation of the idea including the average time it takes to receive care in the ER. It was also mentioned that children and males are not seen in the OBGYN ER. Esther will explore this option and report to the committee.

RTC South: MDPD representatives advised that the current policy at Jackson South excludes all non-acute adult cases, and all adult Acute cases where police are not involved. It was noted that very few victims have been seen at Jackson South. Claudia Kitchens pointed out that the high number of undocumented immigrant victims living in South Dade are not apt to go to Jackson South if they need to report to police. In addition it was noted that there is a lack of outreach to these victims. This concern was echoed by others including Esther. Esther will investigate the program in the south and address the requirement of a police report.

There is some confusion as to the role of Advocates as opposed to Social Workers. Social workers provide clinical work, crisis counseling. The Social worker also does a psycho social with victim on the second victim visit. Advocates do not do crisis counseling. They make the victim comfortable, do follow up phone calls to make sure that the victim is receiving services and they fill out crimes compensation forms with the victims. The problem is that at present there is only one social worker working for RTC.

The current RTC staffing pattern is as follows:
[1] Social Work: crisis counseling
[2] VOCA advocates
Monday - Friday [one 8:00 - 4:30]
Monday - Friday [one 2:00 - 10:00]
Advocates can go with the victim to court and police. They cannot go to the scene.
[3] Social Worker
Adolfo [8:30 - 5:00 but he volunteers to stay later when it is needed]

Need for Better Hotline Procedures/Staffing/Training:

  • Weekdays 8:00 a.m. - 10:00 p.m. Medical Assistant [MA] answers the phone and transfers the call to Advocates and Social Workers. After 10:00 p.m., MA answers the phone. If MA cannot answer the call, the phone is transferred to Switchboard. Question?? Is Switchboard trained to talk to the victim? Is RTC staff trained to talk to victims? Certification requires all RCC staff to receive core competency before talking to victims. New procedures at RTC will have HOTLINE on every phone line to facilitate this requirement.
  • Hotline Script need work
  • Disabilities [Hotline must have TTD and TTY including a printout] Kelly Greene will meet with Cynthia to advise on requirements for victims with Disabilities.

Time for new hires must be shortened: Over the past year, all Human Resources were diverted to Jackson North. This situation has been resolved.

Need written forensic policies. Cynthia will develop an updated streamlined forensic policy to be shared with the SARC committee. The policy will address protocol for victims who do not want police involvement.
Need for Organization Chart: Committee members asked Esther to provide an Organizational Chart for RTC and their chains of command. Cynthia will develop the chart and provide it to the committee

Need for Statistics: Cynthia will provide statistics to ACTT who will publish report.

Next Meeting: July 27th at 9:30 at RTC