The Archuleta County Board of Health (BoH) heard and discussed a proposal for a forensic nurse examiner program at its July 18 meeting.
Faith Koehler presented to the board, stating that she is a sexual assault nurse examiner with experience in forensic nursing who recently moved into the community and who, after speaking with community partners, had become interested in establishing a forensic nursing program in the community.
She explained that forensic nursing covers overlaps between the legal and medical systems and involves treatment or assessment of injuries or conditions connected to a crime.
Koehler stated that this can involve treating sexual assault victims, but can also cover those suffering from domestic violence, human trafficking, elder abuse and neglect, or child abuse and neglect.
A medical forensic exam, Koehler indicated, involves both providing treatment or making referrals for injuries or trauma the victim has suffered and collecting evidence for criminal investigation, such as DNA.
She stated that forensic nurse exams have a well-documented positive impact on the outcomes for the victim of the crime and for the success of prosecuting cases in the legal system.
Koehler explained that local domestic violence prevention nonprofit Rise Above Violence, the Archuleta County Public Health Department (ACPHD) and the Archuleta County Department of Human Services (DHS) would “love to see” increased access to forensic nurse examination in the community.
She stated that there is a forensic nurse examiner program in Durango, but there are currently not any similar programs available in Archuleta County.
Koehler indicated that she has investigated a variety of options for creating such a program and wanted to see if the BoH might be interested in the ACPHD hosting such a program or in having the health department partner with other organizations to help patients acquire sexually transmitted infection (STI) prophylactics and schedule follow-up appointments.
She added that the program could potentially also use space at the ACPHD.
BoH member Jennifer Cox commented that she was a “resounding yes” for having the program and feels it is needed in the community.
BoH member Stacey Foss stated that the issues would be the logistics of the program and the amount of need for it, but added that she feels having the program located at the ACPHD would be valuable as it would provide a centralized location to offer services.
Koehler commented that she agrees that the program should be centralized.
She added that, currently, she is considering applying for the grant funding for the program through Rise and potentially having the ACPHD house it, but stated that she also plans to speak with Aspire, which could potentially host the program as well.
Koehler commented that a partnership with Aspire could also be valuable in securing necessary supplies for the program.
ACPHD Director Ashley Wilson stated that she and Koehler had discussed the proposal and that one of the core issues that would need to be addressed would be how to support a paid coordinator for the program, which she commented would be valuable for the program’s success.
She added that the ACPHD has space and most of the equipment that would be necessary for the program and could acquire the rest relatively easily.
“I just think we need to have a place people can go,” Wilson said. “And while I know that the emergency room is ideal if they need additional imaging, it’s not always the most trauma-informed environment for the initial exam and so … that is also another reason why the public health space could be a great place for the initial exam, because we have the ability to limit the craziness of what’s happening.”
BoH member and Archuleta County Commissioner Warren Brown commented that much of the imaging can be done after the initial exam.
Wilson stated that she would support facilitating the program in whatever way is necessary, whether through partnering with other local organizations or housing the program and hiring staff to coordinate it.
She added that the department has a nurse who is completing their sexual assault examiner certification and that the opportunity to receive examiner certification is also available to other nurses.
Wilson noted that she wanted to determine if the board would be willing to host and hire staff for the program.
Brown commented that he believes the service is “critical.”
“I think, out of all the services that we provide, this is right on the top,” he said.
Cox and Foss also expressed support for the program, with Foss adding that the program would match the priorities the BoH has discussed.
Wilson explained that the ACPHD is part of a program that allows it to obtain “highly discounted items for sexual health” that would allow it to provide STI prophylactics and other items at a reduced cost.
Cox asked how the program in Durango operates.
Koehler explained that the program is run through CommonSpirit Mercy Hospital and is supported with grant funding that pays for staff, a coordinator and continuing education.
She added that medical care can be billed to insurance and that there are various streams of funding that reimburse patients to ensure the costs do not come out of their pockets.
The data collection for criminal investigations is supported and paid for by an agreement with law enforcement, Koehler stated.
In response to a question from Cox, Koehler stated that she understands the program is working well.
She added that she is planning on creating a “call schedule” for the program, which she stated is working well in Durango.
Koehler stated that having a call schedule for patients to be treated or make an appointment would diminish the need for them to visit the emergency room, which she commented can be “scary and dark.”
She added that, once the details of the program are solidified, she would start doing outreach for it to ensure community members are aware of it.
Koehler stated that there would be a 24/7 number available for those needing assistance to call.
Wilson noted that the health department has a similar system where after-hours calls are redirected to her.
BoH member and Archuleta County Commissioner Veronica Medina commented that she agrees with the rest of the BoH that the proposal is a “fabulous idea and something our county definitely needs.”
She added that her concerns about space and funding had already been discussed and it appears the ACPHD would have space.
She then asked Wilson if the program would require office or storage space in addition to space to perform examinations.
Wilson replied that the department has exam and storage space available and that, if the coordinator for the program is a nurse for the clinic in addition to their coordination work, they would already have office space.
She added that, if the coordinator position is separate, it would likely have limited hours and could be a remote position that would not require space in the ACPHD offices.
Wilson commented that she hopes that a coordinator would also serve as a clinic nurse, although she added that this would only be true if the program is completely operated by the ACPHD.
If it is administered through an agreement with other organizations, Wilson stated, the ACPHD would only have to provide examination and supply storage space.
“Thank you. I like the idea,” Medina said.
The discussion concluded with the board thanking Koehler for her presentation and Brown expressing hope that the board would communicate with Koehler again soon.
josh@pagosasun.com
