Hospitals Turn Away Rape Victims, Blame State Rules

A new series of stringent, time-consuming procedures for examining rape victims has prompted more than a dozen privately owned hospitals in Los Angeles and Orange counties to stop admitting sexually abused women and children and has forced police to scramble to find emergency rooms willing to take them.

The hospitals, which are scattered throughout both counties, include some of the busiest and most prominent in the region.

Although officials said they are working on ways to ease the crisis, the dearth of examination facilities is so acute in some areas that police have reported delays of as long as eight hours, first to find a hospital and then to wait for medical personnel to see the victim. One examination lasted almost 10 hours, according to a counselor at an Orange County rape crisis center.

“It’s putting a hardship on the officer and more so on the victim,” Los Angeles Police Detective Steve Laird said. “We had just gotten to a point where these victims were treated nicely. . . . Now they are becoming victims of this as well. It’s destroying all the advancements we have made in the care . . . of these victims.”

But the situation is not as acute in Orange County as it is in Los Angeles. Hospital and law enforcement officials said the number of rapes that occur in Orange County are just a fraction of those occurring in Los Angeles.

Aside from county-run emergency rooms, where victims still are examined, a Times survey of more than 40 area hospitals showed that about one-third of the privately owned facilities are turning victims away. Several other hospitals said they were likely to begin referring them elsewhere within the next few weeks.

Many hospitals that refuse to perform the rape examinations said they will, however, treat victims for other injuries suffered in the attack before directing the victims elsewhere.

In Orange County for example, two hospitals, La Habra Community and La Palma Intercommunity, have stopped examining for rape, specifically where collection of physical evidence was necessary.

“We aren’t equipped to do evidentiary exams. Those (victims) are referred to St. Jude (Hospital),” said Jan Henderson of La Habra Community Hospital.

At La Palma Intercommunity, spokeswoman Ingrid Humphrey said the emergency room there once conducted the exams, but now: “We don’t have the demand. It did not warrant the additional staffing and equipment.”

Victims are referred to Anaheim Memorial or Martin Luther hospitals, both located in Anaheim, Humphrey said.

In Inglewood, both Daniel Freeman Memorial Hospital and Centinela Hospital Medical Center are not examining for rape. The South Bay area’s Little Company of Mary, Bay Harbor and Torrance Memorial hospitals no longer provide the service.

Nor does the San Fernando Valley’s busy Northridge Hospital or Holy Cross Hospital. In Culver City, Brotman Medical Center refers patients elsewhere. So does Los Angeles’ Beverly Hills Medical Center. The city’s Queen of Angels Medical Center will begin referring victims within a month.

“Victims are being denied care by a large number of hospitals” in (Los Angeles) city and county, said Gail Abarbanel, director of Santa Monica Hospital Rape Treatment Center.

“After being raped, they have to drive 50 miles. That’s not OK for people who are that traumatized. There are horror stories.”

Suzanne Hard, Laguna Beach Community Clinic director, said: “It’s like the system is set up so that no prosecution will occur. All these things are set up so that they seem to block what the victim wants and needs.”

In addition, the new rules have intimidated some physicians.

“There is a fear among physicians who conduct these exams that this means they could be tied up in court for two to three days verifying the evidence,” said Jonnie L. Wesley, coordinator for Orange County’s Central Assault Network, which is made up of private, nonprofit organizations.

Although the situation is not nearly as acute in Orange County, the new rules have caused some examinations to take longer. In one case, the exam lasted almost 10 hours, Wesley said.

In one case, a victim who was accompanied by a volunteer simply lost all patience during the examination.

‘Get Me Out of Here’

“By the fifth hour, she had just lost it. She was being poked and prodded, and from her perspective nobody was trying to expedite the exam to get her out of there,” Wesley said. “She said, ‘OK, that’s it, just get me out of here! I don’t want to carry this any further’.”

The woman remained, however, and completed the examination, but only with gentle persuasion on the part of the volunteer, Wesley added.

For law enforcement officials in Orange County, the changes have brought no significant impact. Some cities have not reported any rapes since the changes went into effect, police spokesmen said.

There are 5,000 adult sexual assaults in Los Angeles County each year, officials said. By contrast, there were 599 rapes reported in Orange County last year, according to FBI and sheriff’s figures.

Changes in Procedures

In effect statewide since July 1, the changes in procedure were instituted by California’s Office of Criminal Justice Planning to make examination and reporting procedures more uniform. Officials said they drafted the changes at the request of state legislators who thought that sexual abuse cases would fare better in court if improvements were made in the way evidence is collected.

Often, prosecutors cannot obtain a conviction without the kind of medical evidence obtained in such examinations; officials will not even seek a criminal complaint unless the victim agrees to be examined.

And law enforcement officials conceded that the new guidelines are necessary to build better criminal cases against defendants.

“Rape cases are not the easiest cases to put on in court,” said Sgt. Don Blankenship, president of the Santa Ana Police Benevolent Assn. “Unless you’ve got something nailed shut, there can be problems, and you have to really have your story and evidence together, and all the questions asked.”

Blankenship said the previous routine took as little as one hour. But the time spent waiting in an emergency hospital room “was nothing. Because you get wrapped up with the victim helping them. The time spent is one of the most important things you’re going to do for that victim.”

The new procedures, called protocols, are characterized by state officials as refinements of existing exam requirements. Until the new protocols went into effect, most hospitals with emergency rooms were required to perform the exams. But the new rules permit them to drop them. And many have done just that.

Although some hospitals said they have discontinued the service because the new protocols are too complicated, some state officials suggested that the real reason is that medical centers are losing money on the examinations.

“It appears that the protocols are being used . . . and I think that’s really unfortunate,” said G. Albert Howenstein, executive director of the criminal justice planning office. Some hospitals that have begun turning away rape victims said they have always lost money on the examinations, and with the changes their losses would be greater.

Scant Pay for Hospitals

“The decision has been made by a whole lot of hospitals to centralize these activities in a much smaller number of them,” said David Langness, spokesman for the Hospital Council of Southern California. “The hospitals get paid literally nothing, and it takes four or five hours of intensive work to do these (examinations).”

California law requires that local law enforcement jurisdictions pay for the examinations, but few jurisdictions pay enough to cover anything close to the actual cost, which can run up to $450. At UCI Medical Center in Orange, for example, examinations cost about $360. But Santa Ana reimburses just $240 of that cost, according to Elaine Beno, a medical center spokeswoman.

Despite the deficit, Beno said, “We will continue to do rape exams.”

Most police officials conceded that what their jurisdictions pay hospitals covers very little of actual costs.

“The (hospitals) that are forced into doing it are doing it,” said physician Lou Acosta, emergency room chief at Beverly Hills Medical Center. “The hospitals that are not forced into doing it are keeping out because the losses are tremendous.”

Los Angeles Police Officer Bill Collins, who acts as a liaison between local hospitals and police, called it a “case of the cities not paying the hospitals an adequate amount of money.”

Trying for Settlement

Collins said hospital and city officials have been meeting over the reimbursement issue. “We expect to resolve it fairly soon and get things back to a reasonable situation. . . . We have been doing everything we can to get the hospitals to come back into the fold.”

Similar talks are also under way in other jurisdictions.

The new requirements call for more specific reporting by emergency room nurses and doctors and more precise methods of gathering evidence. The reporting forms have been expanded from two pages to five, and additional procedures are performed on sexual secretions taken from the victims.

Where the old rules required physicians to take a sample of sexual secretions, the new procedures specify that three swabs must be taken. Moreover, the collections now must be air-dried for an hour, a process that preserves the evidence for longer periods of time.

In some cases, participating hospitals will be required to buy more equipment and have workers undergo additional training to comply with the changes.

Hospitals Have an Out

But most importantly, the law gives hospitals that are unable or unwilling to comply with the new standards a way out: They can refer patients to other hospitals. The rules require only that Los Angeles County have eight hospitals that will treat the victims.

Times staff writers Nancy Wride, Marilyn Garateix and Hugo Martin contributed to this story.