Nursing program to help sex assault victims at Winnipeg's HSC without staff for 40 hours over weekend

A sexual assault nursing program at Winnipeg's Health Sciences Centre meant to support victims around the clock is running without staff for 40 hours starting Friday, leaving advocates worried that survivors may be turned away.

The sexual assault nurse examiner (SANE) program is made up of specialized forensic nurses who collect evidence that can be used in sexual assault investigations, but they mainly work on a casual basis and often have jobs in other areas of the health system.

It's running with on-call staff at the HSC this weekend. The forensic nurses will be available to give advice and direction only by phone. 

"When we see large gaps in our schedule, it's very concerning," Heather Didora, a nurse in the sexual assault nurse examiner program, told CBC on Friday.

"We're not necessarily encountering anything new. We're just not having any communication or any change in course to what we've been advocating and what Shared Health seems to be implementing."

In April of last year, the province announced $640,000 annually to support the SANE program and hire permanent positions. Five of seven new permanent forensic nurse examiner positions have now been filled, Shared Health previously said.

When those positions were first posted, they were listed as Nurse 3 positions, which have the ability to move between facilities to meet patients, and must go through an interview process to be hired.

Those job postings were later revised as Nurse 2 positions, which are restricted to working at one facility, and jobs are allocated based on seniority within Shared Health, and not necessarily based on experience as a forensic nurse.

Didora says Shared Health has deviated from what was proposed and approved by the provincial government.

"You have non-forensically trained nurses that have applied and accepted these positions, and are, at best, six months out from independently doing exams," she said.

"HSC is supposed to be the centre of excellence… If we don't have experienced forensic nurses in these positions, then how can that be?"

Didora is among five pre-existing and forensically-trained nurses in the SANE program that would be ready to walk into a Nurse 3 position if they were posted immediately, she said. She did not apply for a Nurse 2 position because she felt it would not benefit patients of the program.

Two nurses began training on Monday, according to Didora, and the remaining three will receive their training in April — an entire year after the funding was announced.

Didora is concerned about victims of sexual assault being sent home without receiving adequate care. Recently, staff had to turn away four victims in one weekend and asked them to come back once staff was available.

"And we know two of those didn't, and two of those were homeless, very vulnerable women," she said, adding that one of them was threatened with death by her partner.

Nurses in the SANE program are cutting into their personal lives to ensure the program is reachable by phone over the weekend, she said.

"It's hard enough to make that decision to come and see us initially, and then when [victims are] turned away, we know that a lot of them just don't simply return," she said.

Misleading statistic from Shared Health

Between April 1, 2022, and Jan. 24, 2023, 764 patients presented to the program, according to Shared Health. In 14 of those cases, a forensic nurse wasn't available to provide the care needed. 

Shared Health previously said nine were able to be examined later the same day, one patient had to return the next day, and four ended up declining an exam.

But Didora says Shared Health has not provided an accurate statistic, which most likely represents the number of people who said they had been sexually-assaulted for their entrance complaint as they were triaged to the emergency department.

"Not all patients are being triaged with an entrance complaint of domestic violence or sexual assault. It can come out later on in their medical process," she said.

Nobody in Manitoba should accept that survivors would be treated this way by their government.- Manitoba NDP health critic Uzoma Asagwara

In a statement to CBC, a Shared Health spokesperson confirmed that their statistic came from an electronic search of people who sought care specifically for sexual assault.

While the SANE program aims to provide 24/7 care, its staffing model can leave shifts unfilled, the statement said. In such cases, victims may choose to wait or could be asked to return at a later time.

Shared Health says it deeply regrets the unfilled shifts, but called it a motivator towards more secure staffing.

"This is a situation that should never, ever happen," Manitoba NDP health critic Uzoma Asagwara told CBC.

"Survivors should never be in a position where they may not be able to access the essential healthcare they need," said Asagwara, calling it "abysmal."

Asagwara says the province has set the SANE program back, despite nurses' advocacy on how to strengthen it.

The situation shows the province's failure to listen to nurses, they said.

"Nobody in Manitoba should accept that survivors would be treated this way by their government."

Kemlin Nembhard, executive director of the Women's Health Clinic, calls the situation "appalling," and says it perpetuates trauma on people that have already endured violence.

The gaps in care for the SANE program may also allow perpetrators of sexual violence to slip under the radar, she said.

"You're basically giving a free pass to perpetrators, because the longer you wait to collect that information, the less likely it is that it'll be usable."

Didora says the window to collect evidence from younger patients is more narrow than with adults, which is troubling, since nurses are being told to send patients home and have them come back once staff is available.

"Then we have to make that decision [of] whether or not it's worth doing the evidence collection at that point, which can affect a judicial process."