State legislators seek to tackle shortage of nurses qualified to provide sexual assault exams

The Roanoke Times

RICHMOND — After a man raped her, Kayla Cotten didn’t know what to do.

She had been sleeping in her bed in Bedford County in July 2018 when a friend of her housemate crawled in beside and raped her.

“I was in shock,” Cotten, 22, recalled.

She was uncertain about reporting the attack. She talked to her brother, and he encouraged her to go to the hospital for help.

The Virginia General Assembly is considering a package of legislation tackling the shortage of qualified nurses and hospitals that provide sexual assault examinations as well as training. The problem is especially pronounced in rural Virginia, where victims of sexual assault may have to drive for hours to find a hospital that provides these services.

For Cotten, the nearest hospital with a sexual assault forensic nurse was in Lynchburg, about 40 minutes away. She met a nurse named Ginger, who was specifically trained and certified to care for sexual assault victims and to collect forensic evidence.

“The way she treated me that morning, she was one of the first people I interacted with,” said Cotten, who agreed to make her name public as an advocate for the legislation. “The way she treated me helped me decide to report.”

The nurse collected evidence, which was used to convict the man, who was sentenced to 20 years in prison, with 12 years suspended.

“That’s why it’s so important we have more funding and better access for people all around the state, and not just better access, but highly trained people like Ginger,” Cotten said.

The legislation is the result of a study conducted last year by the Virginia Joint Commission on Health Care.

“In the past, Virginia has not provided victims with the care and support they desperately need across the commonwealth,” said Del. Karrie Delaney, D-Fairfax, who introduced the 2019 legislation that led to the study.


It showed that sexual assault victims were sometimes traveling for hours to multiple hospitals before locating a sexual assault forensic nurse. Law enforcement brought victims to hospitals, only to be turned away because such nurses were not on staff.

Of Virginia’s 122 licensed hospitals, only 16 employ these nurses, according to a report. The Roanoke and New River valleys each have a hospital providing sexual assault forensic nurses, but there are none south of the New River Valley.

“Everyone in Virginia should have access to this type of service, not just a lucky few,” Sen. Creigh Deeds, D-Bath, said.


There were 5,726 sexual assaults reported in Virginia in 2017, although sexual assaults often go unreported.

There’s a tendency to treat sexual assault examinations as a criminal justice issue rather than health care issue. About 40% of sexual assault examinations are done anonymously, so there are no police reports, and assaults don’t end up in the court system.

The legislation introduced by Deeds, Delaney and Dels. Mike Mullin, D-Newport News and Tony Wilt, R-Rockingham, is based off recommendations from the report.

Proposals include establishing a sexual assault forensic examiner coordination program to work on recruiting more nurses as well as creating standardized training and guidelines for treatment of sexual assault victims. The proposed program would also train hospitals about how to transfer people so victims aren’t directed to multiple facilities that lack sexual assault examiners.

“There is an overwhelming gap in the provision and accessibility of specialized health care in the aftermath of trauma,” said Kristi VanAudenhove, executive director of the Virginia Sexual and Domestic Violence Action Alliance. “And particularly in many rural areas of Virginia this lack of accessibility often results in victims of sexual and intimate partner violence either having to travel great distances in order to receive appropriate care, or just not receiving necessary medical care at all.”

Another bill would expand access to the state crime victim compensation fund for sexual assault victims. Now, the fund only will cover the sexual assault examination — not other medical expenses — but only if the person reports the assault to police and cooperates with an investigation. The legislation also would ensure that a victim could get treatment without the possibility of an explanation of benefits being seen by other policy holders, which could include the offender.

None of the bills have passed the House of Delegates or Senate, but legislators are optimistic changes will come due to heightened attention on the issue.

“It’s so important that the state is working on this,” Cotten said. “Survivors fight so hard.”