Victims of sexual assault, domestic violence and rape in Baldwin County cannot receive care from a nurse trained to collect evidence, making it nearly impossible to get a rape kit in one of the fastest-growing areas of Alabama.

One woman from Fairhope told AL.com that she waited for hours in a Baldwin County emergency room to get a rape kit this summer.

A nurse eventually checked her blood pressure and told her that she would need to drive across the Bay to Mobile if she wanted to get evidence collected.

“Realistically, I’m not gonna do that. I’ve already sat here five hours,” she told AL.com. “I’m gonna go over there and sit there for five more hours?” AL.com typically does not identity victims of sexual assault and is withholding the woman’s name.

There are no sexual assault nurse examiners, nurses specially trained to perform rape kits and collect evidence, working in Baldwin County, the fastest growing county in Alabama since 2010 and now the fourth most populous in the state.

Instead, victims of sexual assault are often told to travel to Pensacola or Mobile for treatment, sometimes left to drive themselves after suffering a traumatic assault.

Kathryn Loveless, a sexual assault nurse examiner (SANE) in Mobile, said such barriers dissuade victims from reporting and getting treatment.

“Making the journey from Baldwin County (to Mobile) is typically what’s going to dissuade somebody,” Loveless told AL.com. “To make that extra effort, especially when you’re bringing in other circumstances of transportation, getting all the way from wherever they present to across the bay over here, and then having to wait to see a physician to call the SANE nurse, which we typically get there in about an hour. It’s a day trip.”

Robert Wilters, the district attorney in Baldwin County, said when victims are dissuaded from reporting assaults and getting rape kits, his office cannot prosecute the perpetrators.

“If they don’t go, we’ve got no way to prosecute somebody,” he said. “We don’t have any evidence, we don’t have a report, we have nothing.”

It’s a problem some prosecutors, nurses and other medical professionals have been working to address for years in Baldwin County.

Nurses needed

Nursing shortages affect hospitals across the country — but it’s even more pronounced with sexual assault nurse examiners, who require over 300 hours of specialized training to be certified by the International Association of Forensic Nurses. This training includes how to collect evidence that will hold up in court, treating victims of sexual assault with empathy and testifying in court.

Only 17-20% of American hospitals employ a sexual assault nurse examiner, according to 2022 data from the International Association of Forensic Nurses.

The problem is most common in rural areas, which have few hospitals or other health care services. In Alabama, 51 of the 67 counties do not have a sexual assault nurse examiner on staff, according to the Commission for Forensic Nursing Certification, which publishes a list of all SANE-certified nurses across the country.

Most sexual assault nurse examiners are concentrated in metro areas and cities.

A handful of counties in Alabama, including Baldwin, are served by rape crisis lines, which usually provide advice and advocacy to victims of sexual assault. But when asked by AL.com about how they handle victims of sexual assault who call and need a rape kit, an operator in Baldwin County said they direct callers to their local emergency room.

“We don’t provide medical services. We provide support services and advocacy,” the operator said. “Then we’re not in control after that.”

Yet in Baldwin County — home to over 246,000 people — no hospital employs one of the specially trained nurses.

‘Disappointed in humanity’

Any nurse can perform a rape kit.

“But there’s so many factors with collecting evidence and storing evidence and how you do that. In every one of those situations, we want to make sure it’s done correctly,” said Kenny Breal, president of North Baldwin Infirmary hospital in Bay Minette.

In a best-case scenario, victims who seek treatment at a Baldwin County medical facility will successfully make it to a hospital that employs a sexual assault nurse examiner, such as USA Children’s & Women’s Hospital in Mobile. But according to Breal, that’s not always possible.

Survivors of sexual assault display willpower by going to a hospital, rape crisis center or police station in the first place, Loveless said. But once barriers are added to receive care or report an incident, it starts getting more difficult for victims to follow through.

“Sometimes they’re like, ‘You know what, I just want to go home, take a shower, and I want to go get in my bed,’” she told AL.com.

The woman from Fairhope who told AL.com about being unable to get a rape kit in Baldwin County said the experience discouraged her from reporting her assault. She decided not to pursue a police investigation.

“It just feels like I’m helpless to do anything else, just kind of powerless,” she said. “I’m just disappointed in humanity.”

Supporting assault victims

Studies show that sex crimes are underreported in the U.S. One in six women and one in 33 men will experience an attempted or completed rape in their lifetime, according to the Rape, Abuse & Incest National Network.

In 2016, the Department of Justice estimated that nearly 80% of rapes and sexual assaults go unreported. That statistic could be even more staggering in areas where rape kits are inaccessible, such as Baldwin County, Loveless said.

When contacted by AL.com, a handful of police departments in Baldwin County said they did not believe their ability to investigate sexual assault was impacted by the lack of care options for victims.

In Gulf Shores, a popular vacation town along the Gulf Coast, Det. Carl Wittstruck said that until being contacted by AL.com he was unaware of the shortage of sexual assault nurse examiners. He said it’s possible that the inability to get a rape kit makes sexual assault underreported in the city.

“That sort of occurrence here in Gulf Shores is very infrequent,” Wittstruck told AL.com. “Maybe because of the shortage, you say, of nurses, we haven’t seen that or experienced that.”

Loveless believes that a contributing factor to the limited access to rape kits is the lack of awareness about the prevalence of sexual assault.

“If you have a dedicated SANE program, and you put a lot of money towards educating these nurses, you have to admit that rape and sexual assault happens where you live,” she said. “It’s just not being reported.”

Breal said that when he became president at North Baldwin Infirmary a few years ago, Wilters reached out to discuss developing a local SANE program.

“I committed to him that I would start looking into what it would take to have a program here in Baldwin County,” Breal said.

Since he took office in 2017, Wilters said he quickly realized this was a need in Baldwin County — but he wasn’t the first.

In 2012, AL.com published an article about an effort by the Baldwin County Sexual Assault Response Team and Lighthouse of Baldwin County to conduct SANE training and have three SANE rooms in all Baldwin County hospitals within the year. Over a decade later, that was never achieved.

According to Wilters, the onset of the COVID-19 pandemic derailed any efforts to establish a SANE program in the county, but he and Breal said this is a serious problem. Although no plans have been announced, Wilters said he expects to see headway within a year.

“It’s not going to be easy for a rape victim. It never is,” Wilters said. “But we can make it a little bit easier.”