TRAVERSE CITY — Forensic nurses at Munson Medical Center are playing a key role in combating criminal sexual assault in northern Michigan.
Each year, they conduct 40 to 50 “SANE” exams to collect vital evidence using a process that protects confidentiality and aids law enforcement.
SANE stands for “sexual assault nurse exam,” sometimes called a rape kit exam.
Specially trained nurses follow a specific set of protocols to perform a medical evaluation in a private room at the emergency department. Usually lasting three to four hours, the exam includes taking blood and urine samples.
If the patient has injuries, the medical staff will document those and respond with appropriate treatment. In most cases, the SANE exam is an outpatient service. Cases with more serious injuries may require hospitalization.
No law enforcement personnel or non-clinical staff are allowed in the room during exams.
If medically warranted, patients can be offered prophylactic medications for HIV and other sexually transmitted infections, as well as contraceptives.
In addition to assessing and treating injuries, the SANE nurse on duty collects possible forensic evidence such as DNA swabs, fibers and hair samples. They also document the patient’s medical history and vital signs.
“We also look for anything abnormal, such as tissue injuries, bruising or blood in specific areas,” said Tori Sykes, director of nursing for emergency services and operations.
Specimens collected go into a SANE collection kit, which is sealed and labeled.
If the patient does not report the case to law enforcement, Munson will keep the evidence kit in a secure storage area for a year. In pediatric cases, evidence is kept until the patient reaches adulthood.
Patient autonomy
Patient autonomy and confidentiality are top priorities in SANE exams, according to Jennifer Standfest, chief nursing officer for Munson Healthcare.
At their own discretion, patients can decide to end the exam at any time without penalty or opposition. They can also decide whether or not to involve law enforcement, with the option of waiting to file a criminal complaint later if desired.
By state law, SANE nurses are “mandated reporters,” which means they must report cases of suspected sexual assault, though this can exclude the patient’s name, address and identifying information at patient request.
SANE exams are provided at no cost, as required by the U.S. Violence Against Women Act of 1994. Follow-up support is also available. Patients typically leave with a packet of detailed instructions and community resources.
Men, women and children can all be victims of sexual assault and Munson officials said they would all be treated with the same level of care during a SANE exam. Outside the Grand Traverse area, some but not all of Munson’s smaller clinics and hospitals also offer those services.
Essential empathy
Empathy, understanding and good listening skills are essential to every SANE exam, Sykes said.
“I think it’s really important to listen carefully to people when they’re going through something like that,” she added. “People may be in a very vulnerable situation. They may not want to tell family members or divulge something that can be very impactful to their life.
“When someone comes from a place that’s stressful and unsafe, we are the safe landing spot. They’re doing the right thing by coming here.”
Sykes said the SANE exam can be a deeply emotional experience for both the patient and the nursing staff involved.
That’s why Munson offers counseling services for its frontline staff, even those not working in the SANE exam field, Standfest said.
“We provide immediate debriefing and ongoing support tailored to the individual situation,” she explained. “In some cases, a much larger group is impacted by a traumatic experience and we provide services to them, as well.”
A monumental challenge
Michigan has the third-highest rate of forcible rape in the nation, according to 2023 FBI statistics. Only Alaska and Arkansas had higher per capita rates.
In raw numbers, Michigan officials reported a total of 6,196 rape cases in 2022, down from a high of 7,832 reports in 2018. Even with those high numbers, sexual assault still is the most under-reported crime in America, according to the National Sexual Violence Resource Center. Only 63 percent of those cases are reported to police.
Even more disturbing, less than 4 percent of reported rapes, sexual assaults, and child sex abuse allegations ever results in a sex crime conviction, according to a 2025 NBC News investigation of eight major cities.
Few convictions
Getting justice for sexual assault perpetrators is difficult. Ideally, it starts with a SANE exam and criminal complaint, then proceeds to the perpetrator’s arrest, prosecution and conviction.
Forensic evidence collected during a SANE exam is often the key to conviction in a court of law, officials said.
Researchers at the University of Massachusetts-Lowell conducted an in-depth study to determine why so few rape and sexual assault cases result in a conviction.
The most common reasons why rape cases languish in the legal system include:
— The death of a suspect or his arrest in another jurisdiction
— Lack of cooperation between law enforcement and local prosecutors, who may be reluctant to file charges
— High turnover among prosecutors and police assigned to sex crimes
— Long delays in the process due to budgetary and personnel restraints
— The overuse and misuse of case designations such as “inactive” and “exceptional clearance”
— Public attitudes about rape when drugs, alcohol or perceived “risky behavior” are involved
Victim attrition over time
“Victims may feel they’re not being treated with respect by police or prosecutors, or they might not have the resources to keep going back for interviews that require them to take time off from work, find child care, or something else,” said researcher Prof. April Pattavina.
“Cases often take years to prosecute, and sometimes victims don’t want to relive the assault over and over again, especially when they’ve moved on with their lives,” she added.
Nevertheless, public awareness of sexual assault crimes is much higher than it was 20 years ago, according to the National Sexual Violence Resource Center, thanks in part to national publicity campaigns and television programs like “Law & Order: Special Victims Unit.”
Munson officials urged all victims of sexual assault to get a SANE exam.
“We started doing the exams in the 1990s after a couple of our own nurses decided to launch the program locally,” Standfest said. “Now we have SANE-qualified nurses available in Traverse City 24 hours a day, either onsite or on call.”