Horizon makes sweeping changes to sexual assault services after victim turned away from ER

The Horizon Health Network has announced dramatic changes to its sexual assault nurse examiner program, including plans to increase staffing, develop a provincial education strategy, form a provincial governance committee, and a rebranding as forensic nurse examiner services.

The changes, which will cost  about $1.16 million, come following an internal review of the program, triggered last month after CBC News reported that a Fredericton sexual assault victim who went to the local emergency department to get a rape kit performed was turned away.

The woman, 26, whom CBC is not naming, said she went to the Dr. Everett Chalmers Regional Hospital to get a sexual assault forensic exam but was told no one trained to perform the exam was available on staff or on call until the next day.

She was instructed to go home overnight, not shower or change, and to use the bathroom as little as possible to help preserve any evidence.

The case made national headlines and grabbed the attention of Prime Minister Justin Trudeau, who described it as "horrific." Premier Blaine Higgs described the incident as "unacceptable" and "reflective of a process guided by very poor decision-making and a lack of compassion."

We certainly recognize that Horizon has work to do to rebuild the trust of individuals and communities.- Margaret Melanson, interim president and CEO of Horizon

Horizon released the results of its review of the sexual assault nurse eaminer program, formerly known as SANE, on Wednesday.

"We certainly recognize that Horizon has work to do to rebuild the trust of individuals and communities," interim president and CEO Margaret Melanson told reporters. "That will be part of the work that we will undertake in the months ahead."

The changes to the program, now known as forensic nurse examiner services, or FNE, will help ensure "consistent access and improved care for survivors of sexual assault and intimate partner violence," according to Horizon.

They will "help ensure safe, compassionate and quality personalized care for survivors of sexual assault and intimate partner violence, regardless of gender, can be provided and that resources are available in the right place at the right time at each of Horizon's five FNE sites," Melanson said in a statement. 

The plan calls for Horizon to add full-time forensic nurse examiners, who will be dedicated to the program, instead of relying largely on full-time nurses being on-call on top of their regular duties, said Greg Doiron, vice-president of clinical operations, who led the review.

This will guarantee coverage for 16 hours per day in Moncton, Saint John and Fredericton, and eight hours per day in the Upper River Valley and Miramichi, he said.

The breakdown of the additional full-time nursing needs is:

• Moncton area — 2.8 registered nurses, Class A, full-time equivalents
• Saint John area — 1.8 RNCAs FTEs
• Fredericton area — 1.8 RNCAs FTEs
• Miramichi area — 0.4 RNCAs FTEs
• Upper River Valley — 0.4 RNCAs FTEs

Horizon also hopes to add or increase forensic nurse examiner co-ordinators in all five areas, said Doiron.

He acknowledged the program will face the same recruitment challenges faced by the rest of the health-care system, however, and will look first at drawing from the existing pool of nurses who work for the program on-call.

"We are realistic that while we are starting our efforts to recruit right away, we may not be able to get to 100 per cent of those positions staffed right away. So we are making contingencies from an on-call perspective to maintain that balance during that transition."

At least four sexual assault nurse examiners resigned from the understaffed program in the wake of the premier's comments, which one nurse described as a "slap in the face."

Horizon hopes they will consider signing up again and that other nurses will "show an interest," based on the investment and development of the program, said Melanson.

And while Fredericton sexual assault nurse examiner Janet Matheson has said the job isn't for everyone because it requires extensive training, continuous education, and is difficult emotionally, Doiron contends there's "growing interest."

"I believe that these investments will solidify this," he said.

"This is a program that people have been attracted to for years, and not for the money but for the purpose —  to be able to help victims in their time of need. What this is going to do is give them an opportunity to do exactly that, and do it in a manner that can be sustainable for our patients, but also for them."

Committee will establish, ensure standards

To help make training more accessible and efficient, Horizon plans to streamline its education strategy with technological solutions.

A provincial committee, composed of leaders and experts from Horizon, Vitalité and the Department of Health, will establish, review and endorse quality standards for New Brunswick, and monitor performance measures, said Doiron.

The governance committee will "ensure that patients or victims requiring the care of our forensic nurse examiners get the same standard of service regardless of where they live in New Brunswick."

The committee will also recommend further changes to better meet the needs of patients, he said.

New name an 'appropriate modernization'

The program will be renamed to better reflect the specialized diverse training and skill sets required for the role today compared to when the sexual assault nurse examiner program began in New Brunswick in 2006, said Doiron.

This idea came from the examiners themselves, who felt sexual assault examiner was too narrow a definition for the broad services they provide, he said.

Forensic nurse examiners provide specialized nursing services and trauma-informed care to victims of sexual violence, intimate partner violence, and any maltreated individual, including men, women, teens, children, seniors and members of the LGBTQ community.

In addition, FNEs are trained in conducting a medical forensic exam, including evidence collection, providing courtroom testimony and showing compassion and sensitivity toward survivors.

"This is an appropriate modernization."

Province will 'hopefully' help with funding

The extra $1.16 million annually for staffing will be added to Horizon's regional health and business plan, in collaboration with the provincial government, said Melanson.

Horizon will cover the costs until the end of this fiscal year, but it won't be taking funding away from anything else, she insisted.

"This will be net new funding that the health authority will be investing, and as noted, this is being done in discussion with government to be added to our regional health and business plan for the fiscal year of 22-23 where government will hopefully be assisting us with the ongoing funding."

In an emailed statement, the Department of Health said only that it has been working with both Horizon and Vitalité Health Network on this "important program and it will continue to support the delivery of this critical service."

Horizon continues to work closely with the government and Vitalité to finalize and enact the program changes "as quickly as possible," said Melanson.

"We look forward to sharing progress on these efforts as we move forward" in the coming months, she said.