Erlanger Health System worked behind the scenes for several months to expand its rape crisis services, believing it could centralize and improve the region's medical and forensic exams for rape victims.
However, the effort was quashed in early September and personnel hired to lead the effort were moved away from the project when hospital officials met with Hamilton County and rape crisis center leaders last month. Ultimately, some in Erlanger leadership positions lost faith in the project amid the then-looming ouster of hospital CEO Kevin Spiegel, who was championing the project, according to four sources with direct knowledge of the program.
"The person who loses the most by starting a fight with [The Partnership for Families, Children and Adults] is our patients," said a current Erlanger leader involved in the project who was not authorized to speak publicly.
Locally, sexual assault survivors seeking medical care go to emergency rooms and tell hospital staff what happened. They're treated and asked if they want to officially report the incident and whether they'll consent to a sexual assault exam, during which possible evidence would be collected. If the patient wants that, they're taken off-site to the Partnership. The center offers transportation or survivors may transport themselves.
There, survivors undergo the exam and receive other victim services such as counseling.
However, sexual assault survivors are often hesitant to report due to fear, trauma and embarrassment. Only 16% to 38% of rape survivors report the rape to law enforcement, and only 17% to 43% seek medical care after rape, according to an article in the New England Journal of Medicine. Of those who do report, the vast majority seek care in an emergency department.
"If a victim has to go from point A, in this case the emergency department, to point B, whether it's evidence collection or something else, oftentimes, they don't make it there. And they don't make it there because they expected to receive their care at point A, and they just had to say out loud to God knows how many people, 'I was sexually assaulted,'" said Jennifer Pierce-Weeks, CEO of the International Association for Forensic Nurses. The association provides certifications and technical assistance for sexual assault medical forensic exams.
What is Partnership’s Rape Crisis Center?
The Partnership for Families, Children and Adults serves the community through counseling, crisis intervention and prevention services. It has victim support services; deaf, deaf-blind and hard of hearing services; elder services; youth services; and family strengthening services.Its Rape Crisis Center provides forensic medical exams as part of a comprehensive service delivery to victims of sexual assault that includes: counseling, safety planning, court accompaniment; emotional support and follow up, according to a center spokesperson.
Those in support of the Erlanger project thought centralizing and expanding the services at the hospital would ease the process for victims. They believed having the entire process at one site would allow more people who had been victimized to report and seek treatment.
Research supports that incorporating evidence collection with the medical exam and treatment at one time in one location leads to better health outcomes and more successful prosecutions, but medical providers often are ill prepared when rape victims show up, Pierce-Weeks said.
"The evidence collection portion of that evaluation is really built into the entire exam and treatment of the person - it's not two separate things," she said, "which is why most of the time across the country, the emergency room is where the exam happens for adults."
Locally, forensic exams were done at the emergency department until the mid-1990s, when the Partnership formed its rape crisis center.
The goal of the Partnership's center was to provide a "one-stop shop for survivors of sexual assault," according to a statement from the organization. It also allowed for more private and concentrated care for victims and added experts who could testify in court, freeing up emergency room staff, according to the statement.
"Survivors were often subjected to long waits in the ER when they had just experienced the most fundamental intimate violation. Many felt shameful and re-traumatized when they would tell their story to law enforcement in a public setting and then had to tell their story multiple times to different medical personnel before they finally received the forensic medical exam," according to a statement from Partnership Chief Operating Officer Dr. Regina McDevitt.
Hospital decision-makers viewed Erlanger's recent effort to offer a full spectrum of rape crisis services as former CEO Spiegel's project. He was pushing for its implementation and had spoken with former Partnership personnel concerned about how rape evidence was handled at the center.
A former employee with the Partnership's rape crisis center approached Spiegel earlier this year after leaving the center due to concerns about victim privacy and the handling of evidence in the Desmond Logan rape case, among others. Notably, the employee was embarrassed and concerned when FBI agents came to ask about evidence in that case, according to one of the sources. It had been sitting for years in an unlocked locker left open because it was overflowing with evidence, the source said.
They approached Spiegel and recommended the hospital offer its own crisis services - believing it could better serve victims. The employee pitched the idea of the hospital serving as a hub for the region's rape victim services. Erlanger has more resources, could reach more victims and improve the current process, which is cumbersome for victims, by providing services at the emergency department - where most survivors already come for help - they told the Times Free Press.
Spiegel took on the project, contending that far too many local survivors fall through the cracks and rapes go unprosecuted due to the current setup. He declined to comment for this story.
At least one rape victim in the Logan case had raised similar concerns to the Times Free Press about her experience.
She wanted to report the incident in 2015 and believed she had done so, she told the Times Free Press in 2018. She had taken notes of her assault, outlined the incident and gone to the rape crisis center, she said.
However, after having told her story to the hospital and the Partnership, she didn't want to relive the experience for police. She believed she had already done enough to report the crime and didn't want to continue reliving the experience, she told the Times Free Press. In 2016, after a subsequent arrest, she mentioned the rape to her arresting officer. She learned it had not been officially reported because she had not continued assisting law enforcement. The arresting officer helped her file an official report. Logan has since admitted to the crime and is in federal prison.
The victim's experience was one of several that pushed the former Partnership employee to approach Erlanger about offering its own rape crisis services, according to a source.
However, some hospital leaders and other local officials questioned whether the public hospital should be getting involved with a system already in place.
Erlanger spokespeople did not directly address its effort to expand the hospital's rape crisis services to the Times Free Press. Instead, they provided the following statement.
"Like other area hospitals, Erlanger has worked very closely with the Partnership Rape Crisis Center with regards to the treatment of sexual assault victims presenting in our emergency rooms. We deeply appreciate and value what we consider a true team effort in the care and treatment of these patients," according to an official statement from Erlanger.
Some hospital officials saw it as unfair competition with a small nonprofit organization and were worried about appearances if Erlanger started applying for the same grants the Partnership was receiving. Questions also arose about chain of custody, the implementation of such a program and whether a second center overseeing rape victim services was necessary.
Partnership and county leaders learned of Erlanger's plan and held meetings to discuss the topic in late August or early September.
"My biggest concern is the competency level for the victims," Hamilton County Mayor Jim Coppinger, who was in the meeting, told the Times Free Press last week. "Not one time had I heard a single complaint about the services being provided by Partnership. This was something the former administration [at Erlanger] was trying to get involved in, but, you know, if someone is doing this service and providing it well, then I don't know why we would try to duplicate the service."
By then, Erlanger executives who questioned the project had learned Spiegel likely would be replaced in his leadership position. They met with the county and told the Partnership they were pulling the plug on the program and would continue its relationship with Partnership.
"It was causing problems with not only the Partnership, but it irritated a lot of people that Erlanger was going to take over this process that a lot of other agencies were involved in," a hospital executive said.
Added another, "[Erlanger] has worked for years with Partnership, and it's worked OK. The correct political phone calls were made, and what it sounds like is our elected officials may not have understood the scenario. There was sentiment that our community partners were treated with disrespect, and that's not what we're about at all."
The Erlanger leaders did not rule out the possibility of returning to the plan in the future. There are those who feel the victims would be better served if they received services directly at the hospital, but they said now wasn't the right time to move forward with the plan. They weren't opposed to continuing the relationship with Partnership, either, but want to improve the process to ensure more women who are victims of sexual assault are able to report the incidents and receive victim services.
"It's on our radar screen," one said. "With everyone focused on the news at Erlanger, we just figured it wasn't the right time. It got down a weird path and we weren't going to go down that path."
Contact Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.
Contact Mark Pace at mpace@timesfreepress.com or 423-757-6659. Follow him on Twitter @themarkpace and on Facebook at ChattanoogaOutdoorsTFP.