It takes a certain kind of person to be able to do what Debbie Mulcahy does.

Mulcahy, a registered nurse at Kalispell Regional Medical Center, is the lead Sexual Assault Nurse Examiner at the hospital. She sees many of the roughly 60 sexual violence cases reported in the area every year.

“A Sexual Assault Nurse Examiner, or SANE, is a specialized nurse who has extra forensic training, and who collects evidence for law enforcement,” she said. “A patient can have evidence collected for up to five days after the incident, but obviously the sooner the better.”

Mulcahy and Mary Mae Stubbs, the hospital’s director of emergency services, along with several nurses in various stages of training, handle the difficult job of sexual assault and rape cases.

Of the 60 or so cases the SANE nurses see each year, two-thirds are under the age of 18.

“The cases come in spurts. We’ve seen two this week already,” Mulcahy said. “Everything comes through the emergency room. We see more sexual trauma around holidays and in summer, just like with other types of trauma. There is some correlation there.”

To become a certified SANE nurse, an applicant must go through a 40-hour course to be able to treat adults and adolescents. The training is more than just collecting forensic evidence for potential criminal charges and prosecution. It is also the sensitivity to deal with a person (woman, child or man) who has been through a deeply traumatic experience.

Another 40 hours of training is dedicated to dealing with children.

“Most children we see, it almost always was someone they know,” Mulcahy said. “Stranger danger usually isn’t the case. Most adults and adolescent cases are at least acquaintances or friends of friends.”

For the overwhelming majority of sexual violence cases the nurses see in the emergency room, it is perpetrated by a family member, friend of the family or at least someone the victim knows. A stranger assaulting or raping someone is the rare and terrifying exception.

Stubbs said one in four women will be assaulted in their lives and men have rates of about one in six.

The SANE program at Kalispell Regional is one of only a few in the region. The extensive training and the nature of the work can be difficult to get more than a handful of trained nurses in places such as Missoula and Billings.

“Some nurses just can’t do this,” Stubbs said. “But I don’t know if I could work in a place that did not have a program like this.”

A patient might come in the morning after being assaulted and the SANE nurses, who are on call 24/7 to handle cases, would do the exam and collect evidence. The term “rape kit” is a colloquial term for the sexual assault evidence kit. Most registered nurses in the country are familiar with how the kit works, but sexual assault nurse examiners collect possible DNA evidence from an assailant while helping the victim deal with the trauma.

“The whole goal of the SANE program is to give dignity and respect back to the person,” Stubbs said. “Without the SANE program, the person comes into the ER like every other person and has to wait in the waiting room with everybody else.”

Under the examiner program, the victim is taken back to a private examination room to collect the evidence.

Travis Ahner, a Flathead County deputy attorney, works closely with the nurses to use that evidence to prosecute the perpetrators.

“They are extremely helpful in exploring issues and finding evidence,” he said. “But even when they don’t find evidence it is helpful.”

Particularly in pediatric cases, a child cannot or would not go to the emergency room to report an incident. Many of those cases are reported months or weeks after an incident, and physical evidence is no longer there.

“It is often late disclosure for them,” Mulcahy said. “Generally we don’t do acute exams on children.”

Ahner said the nurse examiners serve other valuable purposes in addition to collecting evidence, DNA or otherwise.

“They aren’t just for particular cases, but for answering questions of a general nature,” he said. “They are open to discussing what they do and they work with defense attorneys as well. They educate attorneys on what is important and what isn’t.”

The nurses can deal with subpoenas or even be called to trial, but it’s just a step on the way to justice for victims.

When victims come into the emergency room, they do not have to talk to police officers that night. Those examinations are typically free if someone talks to law enforcement.

The new plan to expand the emergency services wing of Kalispell Regional includes several isolated rooms away from the hustle and bustle of the nurses station. These are for sexual assault victims, and include a shower and an interview room, along with an incinerator to destroy the clothes.

Stubbs feels that compared with the 300 or so cases reported each year in Missoula, the Flathead Valley could be under-reporting. Although Missoula is a college town, which almost always raises the rates of sexual assault, the number should be closer to 100. This gap might be attributed to a reluctance to find blame.

“I don’t think I’ve ever done an exam where they didn’t say ‘I shouldn’t have done that, I shouldn’t have gone to that bar, I should have done this,’” Stubbs said. “It’s never their fault, but they always feel like it is.”

More than 90 percent of all cases involving adolescents and adults also involve alcohol. Consent must be expressly given. If a person is too intoxicated to speak clearly or stand up, or is under the Montana age of consent (16), that person is unable to give consent, even if they say yes.

Victims do have resources in town besides the hospital. The Abbie Shelter and Violence Free Crisis Line, at 752-7273, is a valuable resource for those dealing with domestic or sexual violence in the Flathead.