Marshfield Medical Center-Marshfield transferring sexual assault examination services to Weston center

MARSHFIELD, Wis. (WSAW) - People who have been sexually assaulted and want to get a forensic exam in and around Marshfield will now have to travel to Weston to receive care within the Marshfield Clinic Health System. Last week Marshfield Medical Center-Marshfield notified staff that the program is being eliminated due to “business reasons.”

Marshfield Clinic declined an interview but told 7 Investigates the Sexual Assault Nurse Examiners, or SANE, program in Marshfield will be “consolidated” with Marshfield Medical Center-Weston. “There will be no interruption in service for patients,” a spokesperson said in an email.

“The goal of consolidation is to create additional training opportunities for S.A.N.E. specialists and a more sustainable program,” Marshfield Clinic’s spokesperson continued in the email. “The low volume in Marshfield – around three patients per month – limits the amount of clinical training and experience available to and required of nurses in the program. These nurses will have the opportunity to complete their training in Weston. Additionally, consolidated volumes will help the SANE nurses maintain their specialized skills over time. Maintaining these skills assures the highest quality of care for our patients.”

Several staff members who spoke with 7 Investigates had a different perspective. Carmen Vazquez was a SANE specialist at MMC-Marshfield until she was notified last week.

“I got a phone call from the coordinator, and she pretty much was like, you know, effective immediately our program in Marshfield is no more and anybody that will present to the emergency department will have to go to Weston, to the sister campus.”

She said the call came in Tuesday last week. She received an email that Friday walking her through her employment separation steps. This Tuesday, she received a letter in the mail dated Nov. 17 stating: “As you are aware, your secondary position as a casual Forensic Nurse Examiner in the SANE Program at the Marshfield Medical Center is being eliminated for business reasons and will end as of November 17, 2022.” It goes on to speak about how she can apply to any available forensic nursing positions within the health system should she be interested in continuing to provide those services.

When 7 Investigates pressed on what Marshfield Clinic referred to as misinformation as to whether the SANE program was being eliminated at MMC-Marshfield and instead calling it a consolidation, speaking to the letter Vazquez received, the spokesperson said they cannot comment on specific employees. He noted there is certain legal terminology that human resources use when documenting administrative changes.

Vazquez, who is an independent nurse when she is not performing these exams, said the timing of this was odd and unexpected, as the program was just about to grow by four in a matter of days.

“We were just getting them off of orientation to do their own exams, and this happens.”

One of those nurses in training, who did not want us to use her name for fear of retribution, was about to complete her last step: a mock exam before she would be able to perform exams without another nurse’s supervision. The exam was scheduled for Nov. 16; on Nov. 15 she was told she did not need to come in due to the program being eliminated. If she and the other four nurses in training had completed their last few steps, it would have grown the team from two nurses to six.

“When we have a death due to domestic violence in the community, it raises the hair on the back of my neck,” she noted about the timing of this news with a recent murder-suicide case in Marshfield. “This is not living up to Marshfield Clinic’s mission and vision,” she added.

Another former SANE specialist, who also did not want to be identified for fear of retribution, said she recently resigned from the position because there was a lack of education, meetings, and hands-on training for the role.

“There wasn’t enough ongoing training. It would all be on your own time,” she said. “You need to keep up your skills because you’re an expert witness. I didn’t want someone not to get the justice they deserved because I did something wrong.”

She had been with the program for a few years and said they went from having 10 people on the team to just a couple after the COVID-19 pandemic; the program coordinator was among the people who left.

Another now-former SANE specialist at MMC-Marshfield who did not want to be named echoed the frustration of a lack of training.

“Ongoing training is not really happening at Marshfield Clinic. They wanted us to go to a training and take vacation (time) for that. We want to stay up on the latest information and training, but you can’t expect people to fit that into their off time.”

In response to 7 Investigates asking about what these employees said about a lack of paid ongoing training time, a Marshfield Clinic spokesperson said, “Any employee work that is done is always paid, including during orientation.” While these employees noted a lack of available training opportunities, the spokesperson pointed to, “Low patient volumes did not allow nurses to maintain their comfort level with the complex protocols and exams that are necessary for any SANE program.”

All of the employees that spoke with 7 Investigates stated this change, causing patients to travel even further than they already have, is not in the best interest of patients; especially as these are among the most vulnerable patients they serve.

“Is a program being cut because of funding? You know, are you really taking an assault patient and abuse patients and thinking of them as money,” Vazquez questioned.

SANE Programs funded through state grants

The Wisconsin SAFE Fund, a state grant program, reimburses health care providers for the cost of a forensic medical exam for sexual assault victims. It includes covering the cost of things like testing, collection of samples and patient medical history, the physical examination, photographs taken for evidence, along with the cost for the use of the medical facility for the examination. It does not cover follow-up treatment or evaluations.

The Wisconsin Department of Justice will directly pay the provider two-thirds of the amount billed for eligible services, up to a maximum of $1,347.52 for each examination in 2022, the DOJ website states. The maximum amount will be adjusted each year for inflation as defined in state statutes.

“The health care provider may not bill the victim or the family of the victim for the cost of a SANE exam,” the website states with emphasis.

Nurses told 7 Investigates, typically, there would be someone who signed up to be on call over the weekend: between 3:30 p.m. Friday through 3 p.m. on Sunday. During that time, they said they would be paid $3.25 an hour to be on call without getting called in. They would be paid time and a half if they are called in while on call.

During the week, there are no nurses on call, instead, a mass page goes out to the specialists in the program with the goal of having someone available to respond within 30 minutes. Nurses who are working a regular 12-hour shift at that time could be moved from their regular duties to perform the examination if there was enough staff available to cover their duties.

Several nurses noted that because the exam can last as little as two hours to as long as 12 hours, with an average of 4-6 hours, many staff are hesitant to perform those duties if they are coming off or about to go on a regular 12-hour shift. Though, they noted they would if no one else was available.

“SANE nurses are casual positions (i.e., called in when the service is needed),” Marshfield Clinic’s spokesperson said in an email. “Consolidating the programs result in a more sustainable call schedule for the SANE nurses. In recent months, Marshfield frequently referred patients needing this valuable service to Weston due to availability of SANE nurses.”

Nurses, advocates, and officers who work directly in or with the SANE program acknowledged, at times, patients would need to receive services at the Weston center due to the availability of nurses, however, they said it was not the norm. They also noted, again, the staffing levels for that program were about to triple in size in a matter of days.

Since the majority of the costs are covered through grants, the employees and agencies that touch the SANE program were confused about why this of all programs was cut in Marshfield.

“Much tougher decisions”

Marshfield Clinic staff told 7 Investigates they have noticed changes within their departments over the last few months. One employee who did not want to be named for fear of retaliation said there is an idea board in their ward with thoughts about how they can cut expenses, like reducing the use of medical products where they can or finding efficiencies.

Several employees said they have been asked to take on more duties and patients as they watch entire departments eliminated and providers quit as they are asked to see more patients in a day.

An internal memo 7 Investigates obtained in September sent on behalf of the chief operating officer to system leaders noted the health system is losing millions of dollars in a matter of a month.

“In the month of August, the Health System lost $25 million, and without the positive factors we shared this morning, we’d have lost $114 million year to date,” it states.

It goes on to talk about how teams across the system have come up with ideas to cut expenses and increase access to care.

“We’re seeing some success, but we are not moving fast enough. In fact, if we keep going at the current pace, we will be forced to make much tougher decisions.”

7 Investigates reached out to Marshfield Clinic about the memo when it announced discussions of a possible merger with Essentia. They declined an interview and a spokesperson said there are daily challenges to the health care industry as a whole with staff shortages and rising costs across the country.

’I’m not going to do it. It took everything in me to come here in the first place.’

“It really seemed like there were some great things happening, and then we receive this news that services were discontinued. So, that really took me off guard,” Renee Schulz, Executive Director of the Personal Development Center Inc., also known as the Orenda Center, said.

The organization is a victim services center for individuals and families, serving Wood and Clark counties. It interacts with MMC-Marshfield’s SANE Program regularly, as trained volunteers are there for patients as they go through the exam process, and connect them with whatever services are needed.

“We have been actively working to bring our sexual assault response team back together,” Schulz said of a county-based team of advocates, law enforcement, district attorneys, and SANE specialists. “And really improve that coordination and that communication between all of us.”

Members of that team recognize each step in the process for a victim to disclose and report is momentous and difficult, so adding one more hurdle, especially for people who may have already traveled many miles just to get to Marshfield for care, could silence them.

“When someone is in trauma, there’s, there’s a lot of emotion that goes along with it and, you know, always questioning if they’re doing the right thing,” Schulz explained. “And you just never know, at what point it’s just going to be too much for them.”

“To be told that, you know, ‘sorry, you drove 45 minutes to come here in the first place, took everything you had,’” Vazquez mocked. “‘If you choose to get that care, you’ll have to go another 45 minutes.’ Almost always, they won’t take that up. They’ll just be like, ‘I’m not gonna do it. It took everything in me to come here in the first place.’”

“(It’s) a really hard, sensitive issue to be able to disclose to, you know, essentially strangers at that point in time. So they’re talking to law enforcement about and they’re talking to medical staff about it and it’s hard to tell people about a very private thing that has happened,” Lt. Travis Esser with the Marshfield Police Department said.

While victims have complete control throughout the process as to what they consent to have done or collected, not going through the exam and gathering evidence in a timely manner, if at all, makes holding the perpetrators accountable that much more difficult.

“We will interview a suspect, and many times they will deny that it happened, or there will be a discrepancy over consent. And so, the physical evidence obviously allows us to be able to say that this actually did happen,” Esser stated.

“It’s unfortunate, it really is unfortunate when we have this medical facility here, where we should be able to address those needs, locally and, and really work hard to provide the best practice services that we can. And now we have to leave our community,” Schulz concluded.

Complicating care services

Oftentimes, SANE exams are needed in the middle of the night. Schulz said the Orenda Center has a local team of volunteers to be ready to respond as quickly as possible, but that can become more complicated if that volunteer has to travel nearly an hour away. She said this change could cause them to have to hire staff to dedicate to traveling and possibly transporting patients who need it, which is also more costly for an organization on a limited budget.

However, Schulz affirmed they will meet the needs of victims regardless of this change and the challenges it brings.

The Orenda Center’s equivalent in Marathon County, the Women’s Community, has grave concerns. Executive Director, Jane Graham Jennings said SANE programs are important for supporting trauma victims. She believes people underestimate how important it is to have people who can provide trauma-informed care during an extremely invasive process, to have these services to keep perpetrators from offending again, and to provide expert testimony and evidence.

She says she is concerned, not only about how this change is not victim-centered but that it could cause an influx of potential victims to the Wausau area; that is if those victims decide to make the drive.

A mix of staff and volunteers respond to both Marshfield Clinic and Aspirus SANE programs in the Wausau area when victims go through exams. Graham-Jennings said they coordinate with programs similar to theirs, especially for counties that do not have SANE programs locally. She explained they will likely establish a protocol with the Orenda Center similar to how they handle victims coming from Langlade County, who come to the Wausau area for exams. While they always try to connect that person to the local services, including local advocates from the beginning, they make sure an advocate is there no matter where that advocate may be from.

A true community service

All of the nurses 7 Investigates spoke with mentioned they joined the SANE Program because they want to serve women, children, and underserved populations, and the agencies connecting with their work sang their praises, echoing the same sentiment.

One nurse, who did not want to be named, switch careers after being a school nurse for more than a decade.

“I saw the horrible things kids come to school with,” she said, mentioning kids who experience domestic violence, drugs, and sexual assault within their homes.

One instance that she said “hits me to the core” while she worked at an area school was when she cared for an eighth grader who had been raped by her father and whose mother was addicted to drugs. The student had already had a sexual assault kit collected a year prior; the nurse was frustrated.

“What are we doing? And she’s supposed to just sit in school?”

When she saw the opportunity to join the SANE team, she jumped at it. She said there are not enough resources for victims of sexual assault or domestic violence. Now, she said, not having the SANE Program available in Marshfield is just one less resource in an underserved, rural area.

Those who have been sexually assaulted can still receive services, but again, will not be able to be performed at MMC-Marshfield, but are encouraged to contact the Orenda Center. Phone: (715)384-2971; Toll-Free Phone: (844)210-8899; 24-Hour Crisis Line: (715)384-2971.

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