Note: For a background investigation on the following story, see “Rape Crisis Failure: How the Children’s Advocacy Center Betrayed a Victim at Her Most Vulnerable,” from July.
A FlaglerLive Investigation Follow-Up
It was a big production in late July with big-name invites including State Attorney R.J. Larizza and Flagler County Sheriff Jim Manfre. The Children’s Advocacy Center’s open house on July 23 was celebrating the opening of a new rape-crisis clinic in Bunnell.
The fanfare was intentional. The center had been embarrassed months before by a scandalous failure. In June, following an alleged rape in Flagler Beach, a Flagler Beach detective tried for hours to secure a forensic nurse examiner to conduct the required exam on the victim at a private facility in Bunnell. The center was supposed to have such a nurse on call, ready to respond. It did not. Instead, it gave the detective the run-around for several hours, and finally told the detective that it would not send a nurse. The victim, the center said, could be examined by local hospital staff—an unacceptable arrangement for many victims, whose trauma can be compounded in the glare and bustle of an emergency room.
The detective finally took the victim to St. Johns County, where she was properly examined.
Children Advocacy Center Breakdowns
It wasn’t the first case of such a failure on the part of the advocacy center, a $3.9 million non-profit based in Daytona Beach that for almost a decade had provided such services, without a hitch. The center’s commitment to provide rape-crisis services to victims collapsed last year when the center’s contract for those services went awry. Flagler and Volusia sheriff’s deputies and other local police agencies found themselves having at times to transport rape victims as far away as Seminole County to conduct proper exams, jeopardizing the integrity of the prosecution’s cases and further traumatizing victims.
The center claimed it was doing its best in a poorly-funded arrangement, and that it wasn’t even required by law, as hospitals are, to provide that service, even though it had done so for years, even though Flagler County government for years has annually contributed $50,000 to the center, and even though the center’s own mission statement leaves no doubt about its responsibilities: “The Children’s Advocacy Center is committed to providing quality forensic, therapeutic and prevention services to all child abuse and sexual assault victims in a gentle and professional manner.” The center emphasizes that mission when it makes emotional appeals for money to donors, who respond in kind.
The center has over the past year made a distinction between its responsibilities to children and to adults: it’s focused on children, not adults, and therefore should not be expected to provide rape-crisis services to adult victims.
Because of history and available funding, the distinction has not been convincing to law enforcement officials. Larizza and Manfre took a hard line against the center’s conduct. Reggie Williams, the relatively new head of the Children’s Advocacy Council (he’d been a district chief for the Department of Children and Families previously), took responsibility for the center’s publicized failure in the Flagler Beach rape case, saying he had no excuses to offer. And in July, though he wasn’t there himself, he publicized the opening of the rape crisis center’s larger facilities in Bunnell, inviting the public to visit and pledging that the center would be there to stay.
It turned out to be more smoke and mirrors.
Two Advocacy Center Ultimatums
On Dec. 4, Williams told Larizza, Manfre, Volusia County Sheriff Ben Johnson and Daytona Beach Police Chief Mike Chitwood that the Children’s Advocacy Center was getting out of the business of independently providing forensic examinations at CAC sites such as the Bunnell facility.
“Effective January 1, 2014, forensic examinations will not be performed any longer at CAC sites and law enforcement will be instructed to take all victims to hospital emergency rooms for forensic examinations,” Williams wrote the four law enforcement chiefs. CAC would then provide a nurse examiner “should one be available,” Williams wrote. (Such nurse examiners are known by their acronym, SANE, which stands for Sexual Assault Nurse Examiner.)
And effective June 30, Williams warned, “if a resolution is not reached with hospitals to share the cost of providing SANE nurse examiner services, this service will be terminated by the CAC and hospitals will be solely responsible for providing these services as outlined in Florida statute.”
Larizza was livid, and like others who’d been invited—and had responded—to the open house in July, he felt manipulated. He’d believed the CAC’s pledge in July that it was there to stay.
“That’s what we were told,” Larizza said in an interview Thursday. “And the next thing I know, we get this letter that says we can’t do it anymore. It makes you pause and wonder what’s really going on.”
Larizza’s answer—co-signed by Manfre, Johnson and Chitwood—was a furious and unequivocal rejection of Williams’s ultimatum.
“I was extremely disturbed to read your letter of December 4, 2013,” Larizza wrote on Dec. 17. “Most particularly in view of the wholly inadequate advance notice of such a significant decision, and the substantial negative impacts it will have on sexual assault victims –as well as the efforts of law enforcement to bring perpetrators to justice. Your letter has been reviewed by the undersigned law enforcement officials from Volusia and Flagler counties. We are all in unanimous agreement that the proposed changes as outlined in your correspondence are totally unacceptable.”
“Lack of Professional Courtesy”
Larizza was not happy with the fact that Williams gave his office less than 30 days’ notice that all CAC sites would be closed to forensic exams. “This decision appears to have been made unilaterally, without any input or request for assistance from the State Attorney’s Office or the various law enforcement agencies that depend upon your agency to meet the critical needs of adult and child victims of sexual assault and violence,” Larizza wrote. “Moreover, you failed to indicate in your letter whether you had contacted any hospitals In Volusia and Flagler counties to ensure that the proposed transition from your examination sites to alternative sites occurs with the least amount of disruption or emotional trauma to our victims.” (Williams had been in contact with some of the hospitals, but no conclusive arrangement had been reached.)
Williams’s manner, Larizza wrote, “demonstrates poor planning and a total lack of professional courtesy.” The contradictions between the CAC’s pledges on one hand and its ultimatum on the other were especially galling to Larizza: “Your extremely short notice flies in the face of a year of ongoing meetings between your agency, the State Attorney’s Office, the Volusia County Sheriff’s Office, the Domestic Abuse Council and various medical professionals to address and resolve any and all issues regarding the mandated services the CAC had agreed to provide to adult and child sexual assault victims,” he wrote. “It should be noted that during these ongoing meetings, neither you nor anyone from your staff ever mentioned that you would shut down your examination sites due to funding or any other issues. To the contrary, you consistently represented that additional medical professionals were being trained to ensure that when requested, a SANE nurse would be available to respond and perform the necessary medical examination at CAC examination facilities.”
That, in fact, was precisely one of the emphases of the open house in July, when SANE nurses were introduced to the public, among them Terri Augspurger, contracted by CAC to coordinate the SANE nurse examiners work from the forensic perspective. In an interview on Thursday, Augspurger said the CAC’s position is not unique. “This is not an isolated problem to Volusia and Flagler. People are struggling all over the state,” she said.
Augspurger said that after the open house in July, it became apparent that costs were outrunning revenue, and that the facilities CAC was providing were not always equipped to handle biohazard issues, nor were they funded well enough to account for all the needs—which makes using hospitals more logical.
The costs of running the system, according to Williams, are not keeping up with revenue. But the costs are relatively minimal, compared to the CAC’s $4 million budget—and most of those costs are offset by a $500-per-exam reimbursement from the state. Williams says that CAC would be running a $38,000 deficit if it were to maintain the service through June 30, and that the average of seven exams per month, which generate $3,500, are not enough to cover costs. “A minimum of eight exams per month is needed to cover on-call costs,” he states.
On-call nurses are paid just $2 an hour. That works out to $17,500 to cover all on-call costs for an entire year—a cost CAC would easily be able to cover on its own. Out of the $500 per exam, $300 goes to the nurse conducting the exam. The rest goes to CAC, netting $16,800. Augspurger is paid $25 an hour, for 15 top 20 hours of work a week, for her coordination services. The center must also pay for supplies. Based only on what the state reimburses, CAC unquestionably faces a shortfall. But the shortfall is modest—and compared to CAC’s overall operations, it is insignificant.
But even Augspurger conceded that 24-hour coverage with five SANE nurses is not possible, and there isn’t enough money to provide more. None of the five is in Flagler County (three are in St. Johns, including Augspurger.)
That lack of coverage was particularly alarming to Larizza and the police chiefs, who seized on Williams’s words that SANE nurses would be provided only if available.
“This is an unacceptable arrangement,” Larizza wrote. “Given your vague and equivocal representation that SANE nurse examiners might (or, one can assume, might not) be provided, how then can law enforcement be expected to carry out its sexual assault investigations when it is in doubt as to whether your staff will respond when requested to perform a medical examination. It is my understanding that the CAC was the recipient of grant funds for the provision of SANE nurses and examinations as part of your services to Volusia and Flagler Counties. Accordingly, you are obligated and expected to comply with the grant or other funding requirements and provide the services as previously agreed upon and mandated, at the very least until expiration of the particular funding agreement.”
Larizza, reiterating the State Attorney’s Offfice’s expectations that CAC will provide forensic services in accordance with previous pledges and expectations, concluded: “As you know, the collection of evidence of sexual assault through medical examination is extremely time-sensitive and very traumatic for the victim who s undergoing the exam process. Your ambiguous representation regarding the provision of SANE nurse examiners puts the investigation and prosecution of sexual offenders at risk and will inevitably further traumatize sexual assault victims going through the process.”
“A Clerical Error Was Made”
Larizza’s letter led to a meeting of the CAC board of directors, and a response—not from Williams, but from Joanne Pinkston-McDuffie, who chairs the board, and who gave a bizarre explanation for Williams’s letter to Larizza: The letter, she claimed was supposed to be sent to hospital administrators and merely copied to Larizza. “Unfortunately, a clerical error was made,” Pinkston-McDuffie claimed, “giving you the impression that we wanted you to address this matter when the intent was to inform you of our continuing efforts to get cooperation from the three primary hospital administrators.”
Pinkston-McDuffie was, of course, being disingenuous: Williams’s letter was clearly addressed to Larizza and copied to law enforcement chiefs, with no mention of hospital administrators even in the cc line. And if it had been intended for hospital administrators, Larizza and the chiefs would have been equally, if not more, infuriated for being faced with what still amounted to an ultimatum, without being directly included in the discussion, or given prior warning. As with the fallout from the CAC’s failure last June, however, the CAC was looking for cover.
The claim of a clerical error was reminiscent of another error during the CAC’s catastrophic response to the Flagler Beach detective’s call for a SANE nurse, when the person on CAC’s rape-crisis hotline seemed ignorant of the meaning of “sexual assault,” asking the detective if it was the same as a rape.
And the substance of Pinkston-McDuffie’s letter was not different from Williams’s: it merely extended the ultimatum by 60 days. It did not address Larizza’s concerns about a lack of proper communications, or about the chasm between the CAC’s previous pledges and its latest stance. Rather, the letter focused on the CAC’s desire to shift the responsibility for forensic exams to hospitals, and Williams’s attempts since July—at the very time when CAC was boasting of its new center in Bunnell—to execute that shift. Pinkston-McDuffie’s timeline, therefore, implicitly concedes that July’s open house was for show: CAC was actively working to pull out of the business even then, except when children are concerned.
“The primary reason for moving adult forensic examination services to the hospital is that this procedure is a medical procedure and the CAC is not equipped to handle acute medical incidents,” Pinkston-McDuffie wrote Larizza in one of the letter’s straw men: the police chiefs have never claimed that CAC’s service was to supplant immediate attention in an ER in cases of acute medical needs, just as SANE nurses are trained to detect such needs even when they may not be obvious—as, for example, when a victim has been strangled, but the consequences of the strangling may not immediately be apparent except to a trained examiner. In such cases, hospital care takes precedence over a forensic exam. But one does not exclude the other, nor negate the need for a discreet facility where forensic exams can be provided.
Hospitals generally do not provide such facilities.
Playing Word Games
Pinkston-McDuffie also defended Williams’s pledge to provide a SANE nurse “if one is available,” saying that CAC has lost three such nurses since September 2013. “We are not pleased with this outcome,” the chairman wrote. “Any assistance you can provide to encourage other SANEs to contract with our agency is appreciated.” Yet Williams himself had spoken in summer of CAC providing training for SANE certification, so that the pool of such nurses would grow, and would eventually include nurses who live in Flagler. As it turns out, CAC held just one such training session in Daytona Beach, and no other.
Finally, Pinkston-McDuffie emphasized that CAC’s role is “on recovery, not evidence collection,” relying—with remarkable insensitivity to the purpose of forensic examinations—on the wording of the contract with CAC to beg off the broader responsibility of providing SANE nurses. But that is a misreading of SANE nurses’ work, which Augspurger, the SANE nurse coordinator, describes as a painstaking process that can take up to five hours, that includes a head-to-toe exam, and intensive evidence collection, down to documented evidence through pictures. The presence of an advocate focuses on recovery. But the SANE nurse’s work is precise, clinical and evidence-based.
Pinkston-McDuffie ended her response with a proposal to establish a task force to look into the same issues Williams raised in his letter. The ultimatum was extended 60 days.
Such a task force was established, and meetings carried out, Larizza said Thursday. “I think we got it figured out as far as what we’re going to do, but until I confirm it with the sheriffs I can’t give you specifics,” he said. “All the options are open. The ultimate concern is one, the victims that come into these examinations are treated with dignity and respect and they don’t have to be transported hours away from the jurisdiction to get an examination, so we want to make sure that where these exams take place, that it’s an environment that’s private and that’s conducive to us to conduct the examination and investigation.” Secondly, the examinations must be conducted with the care and precision that helps lead to successful prosecutions, Larizza said.
“The hospitals have been extremely helpful and cooperative, they understand the significance and the importance of this,” Larizza said. But it’s not yet clear where and how the SANE examinations will be provided, and with what certainty.
“I’m optimistic we’re going to make it work,” Larizza said. “We’re not going to have adult or children victims of sexual assaults not getting the exams or the interviews because there’s an issue about money, because this is too important not to.”