One morning a few years ago, Julie walked into Baylor Medical Center at Garland. It was 3:50 am. She had been sexually assaulted. Eventually, Julie (not her real name) was led to an exam room where, she assumed, a doctor or nurse would collect physical evidence with something called a rape kit. This is standard procedure. Instead, the nurse who came to see her had surprising news.
“She explained to me that they don’t have the means to provide care for me there, that they would have to transport me to Parkland,” says Julie, now 29. Only Parkland, she was told, had rape kits and the staff trained to use them.
Garland Police filed a report, and she was taken by ambulance to Parkland. Records show she arrived at 6:23 am and was triaged to the Obstetrics & Gynecology Intermediate Care Center (ICC), where female sexual assault victims are seen. The victim advocate from the hospital’s Victim Intervention Program/Rape Crisis Center (VIP) was kind and compassionate, Julie says, but she waited several hours for a doctor to see her.
One of the staff told her, “You have to understand we only have one doctor available to do this exam, and she is tending to other patients. She will see you in between patients.” In a final insult, Julie says the doctor who performed the exam said to the attending nurse, “Why do all the girls these days shave down there?”
She was finally discharged at 12:26 pm, more than eight hours after going to Baylor and six hours after arriving at Parkland—“probably the worst six hours of my life,” she says.
Julie’s story is not uncommon. Until last year, as per an agreement made with the Dallas County District Attorney’s Office in the 1970s, only Parkland could gather forensic evidence in rape cases, regardless of where the assault took place or where the victim lived. Victims sometimes forewent rape kits altogether rather than go to a county hospital and experience long waits and sometimes insensitive treatment.
But the system began to change last March. Thanks to a rape survivor named Courtney Underwood, as well as a $2 million grant from the W.W. Caruth Jr. Foundation, Texas Health Presbyterian Hospital Dallas opened its Sexual Assault Nurse Examiner (SANE) program. Incredibly, for the first time, sexual assault victims could choose where to go to have evidence collected. Underwood was also responsible for the launch of the Dallas Area Rape Crisis Center (DARCC), the city’s first independent rape crisis center, which opened a few months earlier.
Mere months after Presbyterian launched its SANE program, Dallas Police Chief David Brown announced a 25 percent increase in rape cases. The number, initially alarming, is actually a good thing. Brown at the time didn’t make the connection, but the increase in rape numbers means the new system is working. In other words: now that SANE and DARCC are in place, there is an increase in reporting rather than occurrence of the crime.
It all makes so much sense, and yet it took Underwood nearly 10 years of pleading with city and county officials to make it happen. In a county now barreling toward a population of 3 million, why did Dallas labor for so long with just one hospital serving victims?
A little background: Underwood—28 years old and vice president of asset management for her and her mom’s company, Underwood Financial—was raped by her pastor when she was 15. But she didn’t tell her mom until she was an SMU undergrad. Soon after, she launched her crusade when she discovered that, had she chosen to report her rape, she would have had no choice in hospitals. Between 2001 and 2004, she educated herself about Dallas’ sexual assault response process, even training and volunteering as a victim advocate at Parkland. She was astounded at the wait times victims faced there. So Underwood began knocking on doors, soliciting support for bringing a SANE program to Dallas.
“I met with the president of Presbyterian. I met with the mayor at the time. I met with the district attorney,” Underwood says. “I actually cornered [then DA] Bill Hill at a Republican campaign party so that I could talk to him, and he was really nice. His response was, ‘Wow, I didn’t know that. You’re right.’ ”
But that’s what everyone said to Underwood. And then they wouldn’t return her calls. (Hill did not return calls for this story.) Nearby communities such as Fort Worth, Plano, and Kaufman have had SANE programs in place for several years. But Annette Burrhus-Clay, executive director of the Texas Association Against Sexual Assault (TAASA), the state’s largest sexual assault advocacy group, says she had long heard from concerned Dallas citizens who told her the district attorney didn’t want a SANE program. In Texas, while SANEs require 180 hours of training, doctors are still “seen as having more expertise,” Burrhus-Clay says. But, she adds, “In our experience the SANEs develop more of a specialty because they perform the exams more often. They tend to be more sensitive to victims and better at testifying on the stand.”
Beyond the lack of a SANE program, it also concerned Burrhus-Clay that a city the size of Dallas had no independent rape crisis center. Underwood was making the same recommendations, with few results. She attributes the resistance to the fact that the current system had been in place for so long with few people challenging it—largely because it centered on “such a taboo subject as sexual assault.” Parkland officials say there was no need for change because their system isn’t broken.
“Forensic collection is straightforward, but you have to be very exact in order to have an absolutely perfect collection of evidence,” says Linda Licata, the hospital’s director of nursing and advanced practice for Women’s Health Specialty Services. “When you start diluting who is going to do the collection of evidence, you run the risk of not achieving excellence.”
Here is how Parkland and Presbyterian differ in their processes:
At Parkland, as in the case of Julie, women are seen in the Obstetrics & Gynecology Intermediate Care Center. A victim advocate from the Victim Intervention Program/Rape Crisis Center (VIP) is dispatched, and the medical school faculty OB/GYN physician on duty performs the forensic exam. Men are treated and examined in the ER. Both men and women can receive counseling support through the VIP center.
At Presbyterian, certified nurse examiners perform the exams. DARCC and Victims Outreach provide victim advocates and counseling services. Another difference: Presbyterian will soon begin construction of its Sexual Assault Forensic Exam suites, rooms that will be used only for victims of sexual assault, both men and women. Since the SANE program is new, Dallas police refer only those who live in, or are assaulted in, the city’s Northeast Division. But if a victim elsewhere requests Presbyterian, police will honor that wish.
“We’ve actually treated patients who have come in from McKinney, Kaufman, Ennis, Richardson, Garland. So we’ve serviced quite a few, even one from Fort Worth,” says Loren Larkin, Presbyterian’s SANE program coordinator and the Emergency Department educator. “This is word of mouth because we have done very little advertising.” SANE gathered evidence in 55 cases last year.
Even Parkland’s Licata would have to agree that indicates there was a need for another hospital to provide rape kits, right? “We’ve been the only source for the sexual assault victims for a long time, and we’ve not exceeded our capacity,” Licata says. “We can continue to meet the needs.”
Underwood’s efforts to change the system finally gathered steam in 2005 when Dallas businessman and civic leader Charles Terrell heard her concerns. Terrell was then co-founding Safer Dallas Better Dallas, and he brought Underwood onto the nonprofit’s steering committee. Underwood was trying to lead this charge by herself, Terrell says, so “it wasn’t a priority with anybody. Making her part of Safer Dallas made it a priority.”
In 2008, he arranged for Underwood to make her pitch to newly elected District Attorney Craig Watkins. “We thought, Wow, that really makes no sense. Why is there only one place that you can have this service?” Watkins says. “Based upon our own due diligence there was no answer that made sense, so we fully backed what she was doing. A lot of folks want to say we’ve always done it this way. That’s not good enough.”
With Watkins onboard, a year later, Presbyterian had committed to housing the program, and the W.W. Caruth Jr. and the Meadows foundations stepped in to fund the launch of both SANE and the crisis center. Their impact is still being felt. But they have already done wonders for one rape survivor.
“Going through this really long journey and finally getting the rape crisis center open and the SANE program started, I could finally see why that happened to me,” Underwood says. “And I don’t actually regret what happened, because all of these women’s lives are being changed.”
Beatriz Terrazas was part of a team in 1994 at the Dallas Morning News that won the Pulitzer Prize for a project on violence against women.