Written by Rebecca Hierholzer, MD, MBA, FACEP
While I was on staff at North Kansas City Hospital, two nurses Tammi and Cheri, had taken the SANE (Sexual Assault Nurse Examiner) training at another facility and wanted to start a program at North Kansas City Hospital. Upon speaking with the ED nursing director they were told they needed a physician to work with the program and were told to contact me. Once they explained what SANE was, I agreed to be the medical director. Cheri was the SANE educator for Missouri Coalition Against Sexual Assault (MoCASA) and I helped her in the training of additional nurses so that the program was fully staffed.
Shortly after the program started we were contacted by a women’s group that wanted to donate a colposcope to our program. We were told that we could not accept the gift just for our program and that we would have to share it with another department. We were discouraged but decided at that time to start our own nonprofit so that any donations to us would be ours alone. I contacted a friend who was an attorney who gave us examples of other organizations Bylaws and Articles of Incorporation. Tammi, Cheri and I worked on completing those documents but still did not have a name for the organization. There was MOCSA (Metropolitan Organization to Counter Sexual Assault) as well as MoCASA which were both advocacy groups.
We met with Linda Netzel, who at that time was a DNA analyst at the Kansas City Police Department Crime Lab and she is now director. We wanted a name that was different as our organization was based on forensic science. We finally came up with the name Collection of Victim Evidence Regarding Sexual Assault (COVERSA). Our documents were completed and submitted and approved by the State of Missouri on August 10, 2000. We then tackled the nonprofit application with the IRS. COVERSA was approved (43-1918057) within 3 months after our application and was retroactive to our incorporation date.
We found a house next to the hospital to use as our office but needed permission from North Kansas City as it was zoned residential. We presented our information and were allowed to use the house as our office. The North Kansas City Police Department was supportive and arranged to have several vendors with colposcopes for us to examine. We picked the one that we liked and they donated it to us. The North Kansas City Fire Department put in a wheelchair ramp so that it was handicap accessible. We had several North Kansas City garage sales to raise funds. I know that some people in the community believed we would not survive when we first started, but I knew that this service was needed in the community. The nurses who worked with me from the start said someone started a fire within me and it was still burning.
At the end of 2000, I left North Kansas City Hospital and went to work at Providence Emergency Department. I wrote a contract and presented it to the administrative office so that COVERSA could start providing services. They were not interested. I called a neighboring hospital that had been sending us patients for exams and asked if they would be interested in a contract. I was in the middle of Price Chopper doing grocery shopping when I received a call that they wanted to talk, the next day we met and contract negotiations started and were signed by the CEO.
I put together a business plan which is still being used today. Initially we saw patients in the Emergency Department but it was difficult. So the hospital provided an office and exam room in the building across the street from the ED. Our colposcope and exam table were moved from our office into the exam room and other office furniture was donated. We had memorandums of understanding with several hospitals as the only hospitals at the time with SANE programs were St. Lukes Hospital and Truman Medical Center.
We started to get very busy and ended up with a second exam room. Another used exam table was donated and a company painted it for us as a donation and my mother helped me recover the table pads with new vinyl. At this time we needed a full time program director and North Kansas City Hospital agreed to pay their salary.
I continued to help with SANE trainings at least twice a year. Due to comments from nurses who attended the classes, we started having a practice exam, called MegaSane, with volunteers who were given a scenario to use and were moulaged with bruises to look like real victims of sexual assault.
Although we were busy we found that several patients who were referred to us never arrived. We had a meeting with all the nurses and decided that we needed to expand our services where our patients lived. Our first hospital was Centerpoint Medical Center. Contracts were signed and I applied to the medical staff and the nurses soon followed. We were concerned that our numbers at North Kansas City Hospital would decline (which they didn’t) and underestimated what happened at Centerpoint. It was almost like “build a baseball field” and they will come. Other hospitals became aware that we were at Centerpoint and began calling.
COVERSA now supplies SANE services to Excelsior Springs Hospital, Liberty Hospital, North Kansas City Hospital, Centerpoint Medical Center, Ray County Hospital, Lafayette Regional Medical Center, St. Joseph Hospital, Lees Summit Hospital, Belton Regional Hospital, Cass County Medical Center and Western Missouri Medical Center in Warrensburg, Olathe Medical Center and Overland Park Medical Center in Kansas. Research Medical Center wanted assistance in starting their program but eventually COVERSA took over the program. I am on staff at all those hospitals so that COVERSA nurses can credential through Human Resources to be allowed to come on site.
We started merchandising items as fundraising and sold items at local SANE trainings and at IAFN (International Association of Forensic Nurses) meetings. Our space at the hospital was not sufficient for all our items and we found a great place for our new office in the West Bottoms. As our state reimbursement for exams was reduced North Kansas City Hospital no longer paid for our program director. By that time we had a fully functional board, nurses agreed to a reduced reimbursement, the program director declined her reimbursement for a few months, and we were able to get our finances stabilized. Once stabilized the nurses and program director reimbursements were returned to prior level.
It was at this time that I realized the nurses who provide services for COVERSA are really invested in their practice and wanted COVERSA to continue to survive. COVERSA had been supplying services at several hospitals that valued our services and agreed to new contracts. North Kansas City Hospital converted the building where our office space was and now our office and exam room has been moved to a remodeled space in the lower level of the hospital where there is a nice waiting room, exam room and a conference room. Instead of having our patients walk across the street from the ED they can take the elevator. Other larger hospitals here in Kansas City have given us space in their EDs. At the smaller hospitals without extra space we utilize locked rolling carts. Any rooms where exams are done are only accessed by COVERSA Staff or Security as any evidence has to be maintained behind two locks to maintain chain of custody.
COVERSA has participated in the training of nurses to become SANE for years. We progressed from MegaSANE to a different type of training. We now include hands on pelvic exam competency and techniques in dealing with male victims with medical models. The event is “SANEAPALOOZA.” The concept was presented in a poster contest at the International Association of Forensic Nurses (IAFN) Annual Meeting in Puerto Rico in 2012 and won. Follow up results have been published in the IAFN Journal of Forensic Nursing.
As COVERSA has grown, pagers, which were originally used to contact COVERSA that an exam was need, are no longer used. COVERSA now has 855-717-1136 which is toll free for our contracted hospitals outside the Kansas City Service area and is answered by a live operator. Due to our large service area, there are two nurses on call and a backup nurse for the third.
Prior Program Directors were all SANE nurses. COVERSA’s program director is no longer a nurse but an office administrator who has grant writing experience. Nurses who have been with the organization for many year now act as Nurse Managers. As all physicians are aware medical practices are electronic and COVERSA received a grant to make our documents electronic. COVERSA has 16 years of paper records that are being scanned and all will be uploaded to HIPPA compliant cloud.
Current SANE training is 40 hours of instruction with 8 hours of hands on training via SANEAPALOOZA. It is difficult for nurses to take that much time off. COVERSA is in the process of putting SANE training on line and once a nurse completes 14 modules, they can schedule three days to come to Kansas City for an expanded and continuing didactic SANEAPALOOZA. COVERSA works closely with the UMKC School of Nursing and Health Studies where SANEAPALOOZA takes place. COVERSA also works closely with Metropolitan Organization to Counter Sexual Assault to provide advocacy as our nurses need to remain unbiased. In our history, COVERSA has taken two murderers off the streets of Missouri. One case was in Cass County and DNA recovered after the sexual assault matched unknown DNA from a recent murder. As in most sexual assaults, victims know their assaulter.
The other case was in Liberty, Mo. That DNA was also matched to unknown DNA in a previous murder. This patient could identify her assaulter as well. One other case recovered DNA in Independence, Mo. and the case was not being heard but those same assailants went to Johnson County, Kansas where they perpetrated another sexual crime.
I was CEO, as well as Medical Director and I felt I needed a business education. I did go back to school and received my Masters of Business Administration in Health Care in 2005. I was recognized as Emergency Physician of the Year by the Missouri Emergency Nurses Association in 2010, Non-Profit Connect “Rising Star” in 2014, and Metropolitan Medical Society Award for Community Service in 2016. I have also published a short chapter in the ACEP (American College of Emergency Physicians) Publication: Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient, 2013.
The media has talked about the “ME Too” and “Times UP” movement and producers, actors and now Dr. Larry Nassar have been charged and sentenced. Sexual harassment and sexual assault are within all levels of society and sexual predators come from all economic groups. April is Sexual Assault Awareness month and it is time to remember that people need to be believed and the correct word to hear is “Yes.”
Hospitals are continuing to call us about expanding. Our current problem is that we don’t have enough SANE nurses. We are looking for those nurses who are truly interested in forensic nursing and realize the practice isn’t like the television show CSI. It is real life and real victims of sexual assault. The assaults occur at all hours of the day and night, weekday and weekend. If nurses see this article and are interested, please do not hesitate to contact COVERSA.
There are even bigger things to happen in the future that we are working on and can’t comment about now. Keep checking on COVERSA.ORG and Facebook.
1317 W. 13th Terrace, Level 3A
Kansas City, Missouri 64102
Rebecca Hierholzer, MD, MBA, FACEP
Cell Phone: 816-590-8353