Once or twice a week, Alejandra Casarrubias answers the call to meet a sexual assault survivor and carefully collects forensic evidence that can be used in court.
A soft-spoken woman with a friendly and competent manner, she first listens to survivors’ accounts of their assaults while sitting in one of the interview rooms at the Family Advocacy Center in Downtown Albuquerque.
The rooms are comfortably furnished; snacks, cold and hot drinks and supplies of new, donated clothing and hygiene kits are on hand.
The rooms where she conducts exams have adjoining bathrooms where survivors can shower after the physical evidence – DNA samples, photographs of injuries, clothing – has been collected.
She has examined women, men and transgender people. The youngest was 3 years old, the oldest 86.
Casarrubias is one of about 70 nurses currently doing this work after being trained by the New Mexico Coalition of Sexual Assault Programs to become a sexual assault nurse examiner, or SANE.
The majority of those nurses work at one of the 10 centers the coalition has established in New Mexico since 2004. A small number work for Para Los Niños, a University of New Mexico program that provides medical evaluations for children and adolescents who have been sexually abused and sexually assaulted.
Connie Monahan, state coordinator for the coalition programs, estimates that the nurses handle roughly 1,200 cases a year, about 500 of those in Albuquerque.
At present, Monahan said she believes the number of SANEs is adequate to meet demand for their services, except in sparsely populated areas of the state. Albuquerque, for example, has 17 trained nurses, while the center in Carlsbad has only one.
“We will always have an ongoing need for new SANEs,” she said. “I’d estimate 15 to 20 a year. Our need is greater in rural and smaller communities in New Mexico.”
The nurses do this specialized work in addition to their primary jobs, be it in a hospital, hospice, psychiatric clinic or at a school. Casarrubias’ day job is at the Casa de Salud clinic in the South Valley.
SANEs are on call for 12-hour shifts, during which they must respond instantly, day or night, when summoned to the center to conduct an exam.
Monahan said the SANE burnout rate is high because of the demands of being on call and the emotional toll of the work itself.
“It’s incredibly challenging listening to narratives over and over again,” she said.
The coalition runs two to three training courses annually and has trained 350 nurses in 15 years. The 64-hour course includes instruction on the paperwork required for legal purposes, specialized medical equipment and examination techniques. Nurses must also perform five exams under supervision.
Most of the nurses do the work for less than three years.
Casarrubias is unusual, having been a SANE since 2011. She became a nurse after working for organizations that helped crime survivors and domestic violence victims.
“It’s not hard on me personally, because I believe it’s very rewarding,” she said. “I believe they (the patients) need somebody, and I’m there when they need me the most. I like helping people in crisis.”
It can take several hours to examine a patient from head to toe, photographing and documenting bruises, abrasions, bite marks and taking genital swabs. The goal is to gather evidence that supports the patient’s narrative of the assault, Monahan said.
Crime lab requirements mean forensic exams must be performed within five days of an assault, or within three days for children ages 12 and under.
Individuals don’t have to report an assault to police to have the exam, and there is no charge for the service.
If a survivor hasn’t filed a police report, the evidence is sealed in an envelope, often called a “rape kit,” to avoid contamination. The kit is stored securely at the SANE center for a year. If the individual decides to file a report within that time, the kit is delivered to law enforcement for investigation, Casarrubias said.
However, Albuquerque Police Department has a backlog of more than 4,000 untested rape kits. Last week, Mayor Tim Keller and Albuquerque SANE announced the Sexual Assault Information Line. Survivors can call 1-866-613-SAIL (7245), or email KitInfor@abqsane.org, to learn the status of their case.
Monahan said the coalition encourages nurses to take the exams to be certified by the International Association of Forensic Nurses. She believes having the certification strengthens a nurse’s testimony if a case goes to court. However, Monahan said only about 10 percent of the New Mexico SANEs’ caseload ever becomes part of legal proceedings.
It costs between $275 and $425 to take the test, depending on whether a nurse is an association member. In 2017, 60 percent of those who took the test passed. Association records show that New Mexico has 16 certified nurses, but executive director Jennifer Pierce-Weeks said certification is not required to practice as a SANE.
People who have been sexually assaulted can call the SANE center at 505-883-8720 or the Rape Crisis Center of Central New Mexico’s 24-hour hotline at 505-266-7711.
If an exam is requested, a dispatcher will contact a nurse and a Rape Crisis Center victim advocate. The advocate helps with referrals for counseling services and can accompany the individual to court. SANEs can also conduct exams at local hospitals or at the Metropolitan Detention Center.
Valerie Sanchez, the Rape Crisis Center’s director of crisis service and community education, said the hotline receives about 2,000 calls annually, and the center sends advocates to help about 600 people. She said some callers just need to talk and get emotional support.