skip navigation
Implementing SANE Programs in Rural Communities: The West Virginia Regional Mobile SANE Project
Publication Date:  June 2008
Printer-Friendly Option
About This E-Pub Message From the Director Acknowledgments About the Author Related Links
minus icon
minus icon
minus icon
minus icon
Developing a Contractual Agreement With Hospitals
minus icon
Office of Justice Programs Seal   Office for Victims of Crime, Putting Victims First

Developing a Contractual Agreement With Hospitals

Hospital Issues

Issues that hospitals need to resolve before initiating a project of this type may vary from one region to the next. They will depend on factors such as differences in size and financial capacity; whether the hospitals are networked with each other or have experience working together; how much they compete with one another; and the extent to which they are willing to collaborate.

Resolving Issues Among Hospitals

Numerous aspects of project implementation depended on the hospitals signing a contractual agreement. Until the hospitals had formally committed to the project, the service area could not be defined. Before they were willing to sign an agreement, however, the hospitals first had to resolve many issues. Among them were the following:

  • How much would each hospital contribute to the project? In a concession by the smaller hospitals, the hospitals agreed to contribute to the project equally, rather than in proportion to their size, number of SANEs, or financial capacity. Although the smaller hospitals historically treated smaller numbers of sexual assault victims, each hospital would be paying for the same services to be available 24/7.

  • How would hiring and payroll for nurses be handled? To standardize the way SANEs were paid, it was decided that the host hospital would hire all SANEs on a temporary part-time basis. The three smaller hospitals agreed to this stipulation, although they were concerned about being able to retain the SANEs who worked for them outside of the project if the larger hospital offered more competitive wages. Fortunately, this arrangement has not led to significant problems in nurse retention for the smaller hospitals.

  • How would patient privacy issues be addressed? About the time the project was taking shape, the medical field was struggling to figure out how to implement the Health Insurance Portability Act of 1996 (HIPAA). Because SANEs would be shared across hospitals, the hospitals grappled with the issue of how HIPAA might affect their service provision and recordkeeping. They concluded that potential privacy problems would be addressed by having the host hospital serve as the employer of all of the SANEs and the keeper of all records for the project.

  • What was the liability risk posed to the hospitals by using SANEs? Although FRIS’s research indicated that no SANE had been the defendant in a civil action as a result of conducting a forensic examination, liability was of paramount concern to the hospitals during the project participants’ initial conversations. FRIS emphasized that the SANEs were collecting evidence, not performing medical examinations. It also asked the hospitals to assess their liability without trained medical personnel collecting the evidence. In the end, hospitals concluded that project implementation would neither increase nor decrease their liability.

  • Who would cover the costs of providing the required SANE orientation? The host hospital required that all SANEs it hired go through its orientation, complete with a physical examination and background check. It sought to have the project cover the costs of this 2-day program, with SANEs to be paid on the same scale as its own nurses. The smaller hospitals initially rejected this stipulation, but ultimately agreed to share these costs. In turn, the host hospital covers the costs of quarterly SANE meetings (which amounts to, primarily, paying SANEs’ salaries while they attend these meetings).