The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

CHRISTUS ST MICHAEL HEALTH SYSTEM 2600 ST MICHAEL DR TEXARKANA, TX 75504 May 23, 2017
VIOLATION: QUALIFIED EMERGENCY SERVICES PERSONNEL Tag No: A1112
Based on review and interviews the facility failed to have nursing staff with specialized training to perform a Sexual Assault Examinations according to the facility's policy and procedures and The Texas Administrative Code TITLE 1, PART 3, CHAPTER 62, SUBCHAPTER A, RULE 62.5 in 2(#2 and 4) of 4(1-4) charts reviewed.


Review of the facility's policy and procedure "Management Of The Patient Of Suspected Sexual Assault/Abuse" last revised on 4/2003 stated that a patient that presents with a history of sexual assault would be seen by a "Level: Independent- RN/Sexual Assault Nurse Examiner.


Supportive Data: Any act of sexual contact or intimacy performed upon one person by another, and without mutual consent, or with an inability of the survivor to give consent due to age, mental or physical capacity. Factors of the offense of sexual assault which govern the medico-legal investigation are:
1. The patient is not old enough (either mentally or chronologically) to understand the nature of the act.
2. The offense was committed without consent.
3. Penetration, however slight, and by any means."



Review of patient #2's chart revealed the patient came to the ED for an alleged sexual assault on 1/17/17. Review of the chart revealed RN staff #10 performed a SANE exam on the patient and documented the exam. Staff #10 documented the evidence kit and released to the Texarkana Texas police department on 1/17/17 at 2036.


Review of patient #4's chart revealed the patient came to the ED for an alleged sexual assault on 1/16/17. Review of the chart revealed RN staff #10 performed a SANE exam on the patient and documented the exam. Staff #10 documented the evidence kit was released to the Texarkana Arkansas police department on 1/17/17 at 0019.



Staff #6 confirmed that staff #10 had done the didactic part of the SANE training but had not completed the clinical part of the training. Staff #6 and #4 confirmed staff #10 had not completed all of her training for SANE examinations during this time period.

There was no evidence that staff #10 was being proctored during these examinations by another SANE nurse.


Review of the Texas Administrative Code TITLE 1, PART 3, CHAPTER 62, SUBCHAPTER A, RULE 62.5
(a) To be eligible for an OAG SANE certification, an RN must:
(1) Hold a current and unencumbered license with the Texas BON;
(2) have a minimum of two years direct contact with patients as an RN within the last five years at the time the application for initial certification is submitted; and
(3) Have completed an OAG SANE Training Program, including training, clinical requirements for the appropriate OAG SANE certification, and courtroom observation requirements, as described on the OAG website.
(b) An applicant may request a waiver of training, clinical requirements, or courtroom observation requirements by providing documentation that the applicant completed the equivalent of the training or requirements. Requests may be approved on a case-by-case basis.
(c) An applicant who maintains a SANE certification other than an OAG SANE certification may be eligible for an OAG SANE certification. Requests may be approved on a case-by-case basis.


An interview was conducted with the ER Director staff #4 on 5/23/17. Staff #4 stated, "I just took over the SANE nurses so I am really not sure about the program. I only have one SANE nurse now and she works at the advocacy center during the week and is a charge nurse on the weekends. If she is not there to the exams the physician does the exams and the nurse does the evidence kit." Staff #4 reported that she was unsure if any of the nurses had SANE training or training in how to collect the evidence. Staff #4 was not aware of how to conduct a SANE exam or how to collect evidence, or release evidence of a potential raped victim.


An interview with staff #6 RN- House Supervisor stated that she has had SANE training and was certified. Staff #6 stated that she stopped doing the SANE exams a couple of years ago. Staff #6 stated she knew that the program had dwindled and the staff had not been properly instructed to collect evidence for a SANE exam. Staff #6 reported the physicians have been doing the exam but the nurses are completing the kits and holding on to the kits until the police department picked it up. Staff #6 confirmed the nurses performing the SANE exams did not have any formal training and was unsure what training they had to collect evidence for a sexual assault kit. Staff #6 stated staff #10 had been to the didactic part of the SANE training but was still working on her clinical training at this time.


An interview with ED RN staff #7 on 5/23/2017 revealed the nurse was not aware of how to conduct a SANE exam or how to collect evidence, or release evidence of a suspected sexually assaulted victim. There was no policy and procedure found on evidence chain of command. The facility was unable to provide any logs for forensic evidence chain of command. Staff #7 stated that if she had to use a sexual assault evidence kit she would just have to read the policy on how to collect the evidence.