Health Professional Exams of Suspected Child Victims

The SANE Model (Sexual Assault Nurse Examiner)

Beatrice C. Yorker, R.N., J.D.

One of the promising new models for expanding the availability of specialized health professionals trained to examine alleged sexual assault victims has been the SANE nurse model. SANE nurses follow guidelines established by the International Association of Forensic Nurses. For more information, visit the International Association of Forensic Nurses website (http://www.forensicnurse.org).

SANE nurses have reported generally positive experiences with the courts in being recognized as experts in conducting health care exams related to sexual assault and testifying as expert witnesses. Below is an article that describes more about this promising field:

Yorker, B.C. & Kelley, S.J. (2000) Excerpts from an unpublished manuscript to be submitted to Child Abuse and Neglect.

Acceptance of non-physician providers of forensic medical examinations varies. The rapid growth of nurse practitioners (NPs) and physician assistants (PAs) is a byproduct of the unmet consumer demand for primary health care during the 1960's (Hirsch, 1991). Government reports conclude that the continued success of NPs and PAs not only has a positive impact on patient outcomes, but patient satisfaction is also improved (Safriet, 1992). Concerns regarding the use of non-physicians include competition and scope of practice. Even in collaborative physician extender relationships, physicians may be vicariously liable for the practice of an employee, independently liable for poor protocols and inadequate supervision of mid-level providers in their practice, or liable for aiding and abetting the unauthorized practice of medicine if a provider exceeds his or her scope of practice (Sermchief v. Gonzales, 1983). Currently, the vast majority of states authorize independent practice and prescriptive authority for nurse practitioners and some mid-level providers such as physician assistants or nurse midwives are regulated under medical practice acts (Inglis & Kjervik, 1993). The courts have clearly interpreted state legislative intent to recognize the "existence of overlapping functions between physicians and registered nurses (RNs) and to permit additional sharing of functions within organized health systems" and are suspect of any attempt to restrict trade (Fein v. Permanente Medical Group, 1985).

The legal community needs to be aware that an increasing number of non-physicians are being qualified in court as able "to exercise that degree of skill practiced by the average prudent practitioner in the same or similar circumstances" (Avret v. McCormick, 1980; Fein v. Permanente Medical Group, 1985; Hirsch, 1991). The 1994 statewide survey of prosecutors and judges showed that judges are less likely to view non-physicians as qualified to testify in child abuse cases than do prosecutors (Doss, 1994). Although the current survey was limited to prosecutors, it also has implications for judges who conduct child abuse cases.