This story discusses sexual assault. Reader discretion advised. Resources are available online here, or call the 24-hour crisis hotline at 1-800-656-4673.
Megan Allen works in a medical system that she says has repeatedly failed survivors of sexual violence.
“All we can do is be the best we can be in that moment, and make sure that we can be strong and be there for those patients in that moment,” Allen, a sexual assault nurse examiner and emergency department manager at Pikeville Medical Center, said.
Her hospital is more than 90 miles away from the next nearest hospital certified to have a nurse trained to conduct sexual assault exams available 24 hours a day. It’s a highly specialized credential that requires a week of classroom learning, meetings with local advocates and prosecutors, knowledge of criminal proceedings and more.
While Allen said all emergency room nurses should be able to collect a Sexual Assault Forensic Exam, or SAFE, kit, she said having a nurse on staff who isn’t just reading instructions off the box is crucial. Caring for a survivor in what may be the most emotionally and physically devastating moments of their life takes time and expertise.
“You have somebody's leg lacerated in one room, somebody having a heart attack in another room and somebody dying from sepsis in the next, and you're trying to take care of a sexual assault patient, let alone a pediatric sexual assault patient,” Allen said. “I can't imagine not having that resource [of a sexual assault nurse examiner].”
In Kentucky, one in four Kentucky counties have no sexual assault nurse examiners, or SANEs, and another quarter have just one or two, according to June data from the Kentucky Board of Nursing. All Kentucky hospitals are required to perform sexual assault exams on those who come through the door requesting one, but only 25 hospitals have the state’s SANE-ready designation, meaning they have a sexual assault nurse examiner on-call 24 hours a day.
Still, it’s a remarkable increase from 2017, when only seven hospitals in Kentucky held the designation. The total number of SANEs in Kentucky too has increased significantly, doubling since 2019.
However, outside the state’s golden triangle, SANE-ready hospitals are few and far between. There are none west of Owensboro and hospitals in Pikeville and London are the only SANE-ready hospitals in southeastern Kentucky.
Aside from the extensive certification process, becoming a SANE is emotionally grueling work. Allen said she understands why many nurses are hesitant to begin the process. Becoming a sexual assault nurse examiner often doesn’t come with more money, and it means taking on a whole new workload. And with few SANEs to go around in some parts of the state, it's not surprising there aren’t more SANE-ready hospitals.
Allen said the designation is important because survivors deserve to know a qualified provider will be ready for them at any time of the day or night.
“These people don't need to question, ‘Is there going to be somebody there that can take care of me for this reason,’” Allen said. “That needs to be like an automatic, ‘Yes, there's someone here, there's someone that cares, or someone that wants to take care of you for that reason.’”
The state legislature has also acknowledged it is vitally important to make sure nurse examiners are available in every part of the state. Over the last several years, Rep. Rebecca Raymer, a Republican from Morgantown, has championed laws that requires all emergency medical staff be trained up on sexual assault response. She also passed a law going into effect this month requiring the state to hire a statewide coordinator.
Jenna Cassady, the chief policy officer with the Kentucky Association of Sexual Assault Programs, said she’s seen some providers and nurses struggle to figure out how to get started and navigate the numerous laws, regulations and trainings required for forensic examiners. She said in many communities it’s come down to one or two SANEs who have championed and developed their local program alone.
“We need a singular coordinator for that role, so that it's consistent across the state, so that hospitals aren't wondering where are these SANEs, and how do we have a relationship with them to support survivors who present at the hospital asking for sexual assault forensic exams,” Cassady said.
Melissa Gilpin, herself a long-time SANE out of Bowling Green, began at the board of nursing on July 1 as their first statewide coordinator.
Jill Brummett, the forensic nurse manager at St. Elizabeth Healthcare in northern Kentucky, said part of the calculus is convincing hospitals it's worth the time and effort to establish a team of SANEs, especially in rural areas where cases may be less common. Her program, started two decades ago, began as a sexual assault-specific program, but now also conducts other forsensic exams, including domestic violence.
“The program itself is not really a money maker for the hospital, which is why a lot of hospitals don't support it like the way they should,” Brummett said. “I know we're not making any money for you, but we're making a difference in even just one person's life.”
Brummett described how, early in her career as an ER nurse, she would have to read the instructions on the side of the SAFE kit before administering the exam. She said the program has come far in providing the best in trauma-informed care. Getting the SANE-ready certification may seem difficult, but it makes all the difference for patients and their future ability to get justice and begin healing.
“They don't come in Monday through Friday, 8 a.m. to 4 o'clock. They come all hours of the days, the nights, so having that nurse there and being able to go provide that care, that trauma-informed care, to that patient. It’s very, very impactful for them,” Brummett said.
Lisa Smith, a SANE in south central Clinton County, said she is always working on her fellow nurses, convincing them to go through the process and gain the special designation. Neighboring Cumberland and Monroe counties hold no certified SANEs, but her rural county now has four and she’s seen more nurses take up the work nearby.
“When they found out we were SANE-certified, then they were bringing them here, which, that's what they're supposed to do, instead of going further off,” Smith said. “We've been blessed with the support we have.”
She said she encourages others to get the certification, to make sure this is a service their community is prepared to provide. Smith is in the process of getting her pediatric SANE certification, so children who need an exam have a qualified provider close to home.
“I want to make sure that if it's my family, that they get the proper care and they get the proper support, and when they go to court, that it's properly documented, it's done right,” Smith said. “I want good help. I want people to know.”
Lotus Children's Advocacy & Sexual Violence Resource Center serves the far western Purchase region of the state, providing resources and advocacy for survivors. Ivette Cope, the director of advocacy and crisis response, said many nurses in her region understand the importance of collecting forensic evidence, but don’t always appreciate the value of the extra SANE training.
In western Kentucky, two hospitals that once held the SANE-ready designation have since dropped out. Cope said every hospital in their region has a SANE on staff, with 11 active nurses at five regional hospitals, but none currently have a SANE on-call throughout the day yet. In the meantime, Cope said there will always be a need for specialized care, but hospital staff need to be trained and prepared to provide that care in the meantime.
“Anybody that works at a hospital setting is absolutely capable of doing a SAFE kit. They are still nurses, they still provide trauma-informed care, they still take care of victims,” Cope said.
New training for all emergency room staff, mandated in 2025’s House Bill 219, is coming out this month. Cassady, with the Kentucky Association of Sexual Assault Programs, said the training can’t take the plan of a SANE, but it can make sure that every person who interacts with a survivor knows how they need to be treated in the emergency room.
Billing staff need to know that no survivor should pay for the cost of their exam. Intake staff need to know that hospitals aren’t allowed to turn a survivor away, even with no SANE on call.
“We would hope to have those frontline workers who might first encounter a patient asking for a sexual assault forensic exam understand we have to offer this care under Kentucky law,” Cassady said.
Allen, at Pikeville Medical Center, said it’s incredibly difficult as a stranger in the hustle and bustle of an emergency room to create the kind of space where a survivor can feel safe. She said much of her and her team’s work is to break through embarrassment and stigma.
“To be a positive influence and to be a positive experience in that kind of darkness, it's definitely a specialty that's needed throughout [Kentucky],” Allen said. “I don't think any facility should ever be without it.”
