Governor Jim Doyle, along with the Department of Administration and the Department of Health Services leaders announced the hospital assessment proposal on January 14. The announcement met with approval from WHA, the Wisconsin Manufacturers and Commerce and Democratic Legislative Leaders. The plan will allow the state to capture $300 million in additional federal Medicaid funding each year. The additional dollars will enable the state to significantly increase Medicaid reimbursement rates to Wisconsin hospitals for the first time in over a decade, and fund statewide insurance coverage for low income, uninsured childless adults—a component of BadgerCare Plus.

In a prepared statement following the announcement, Wisconsin Hospital Association President Steve Brenton applauded Governor Doyle’s announcement.

"The hospital assessment initiative will bring more federal dollars back to Wisconsin, improve Medicaid payments to hospitals and provide funding for essential health care programs during one of the most challenging times in Wisconsin history," according to Brenton.

Hospitals have not received an increase in Medicaid reimbursement in more than a decade. As a result, hospitals are paid less than half of what it costs to serve Medicaid patients. That has fueled a $600+ million annual shortfall between what it costs to treat patients and what the Medicaid program pays hospitals. Those losses are being passed on to everyone else. The hospital assessment and the matching federal dollars will result in higher payments that will reduce that burden.

Brenton said that "Governor Doyle is taking an important step forward with this proposal. It will bring Wisconsin’s fair share of federal health care dollars back to the state and use them to better fund necessary health services for hundreds of thousands of patients and families. The Wisconsin Hospital Association is committed to working with the Doyle Administration and the Legislature to advance this important initiative."

In a recent survey of WHA members, Wisconsin hospitals indicated that they have been hit hard by the recent economic downturn with both charity care and bad debt increasing by 20 percent over the past year, and these numbers continue to get worse.

"These extremely challenging economic times are resulting in higher levels of charity care, skyrocketing bad debt and greater Medicaid utilization at Wisconsin hospitals," said WHA Executive Vice President Eric Borgerding. "The recession is straining the health care safety net. The assessment is coming at the right time and will help preserve access to vital health care services for our most vulnerable patients."

WHA hopes for quick passage of the assessment when the Legislature convenes in late January through February. The proposal could be introduced as separate legislation or folded into a comprehensive economic stimulus legislation being developed by Governor Doyle and legislative leaders.

The revised hospital assessment has broad support, applauded by health care, business and labor organizations alike. In addition to WHA, the Wisconsin Manufacturers & Commerce (WMC) hailed the proposal.

"WMC looks forward to working with Governor Doyle to help pass the hospital assessment to help balance the state budget, reduce health care costs for employers and attract new federal funds to our state," said James A. Buchen, vice president of government relations for WMC.

WMC’s Buchen said his organization will lobby for its passage. The Wisconsin Primary Health Care Association, the Wisconsin Association of Health Plans and the Wisconsin Federation of Nurses & Health Professionals all issued statements endorsing the proposal.

Colorado Considers Medicaid Provider Assessment

While 22 states now have a hospital assessment program in place, more are in the planning stages. Last week, Colorado Governor Bill Ritter announced his intent to pursue a hospital assessment that has the backing of the Colorado Hospital Association.

In his State of the State speech, Governor Ritter said hospitals would pay a fee based on their patient revenue. The revenue would then be used to leverage matching federal dollars that would be used to "reduce underpayments to hospitals, which would stabilize their rates and provide coverage to our most vulnerable populations."

Ritter added, "During these difficult economic times, when more and more families are struggling to access health care, our provider fee partnership with the hospitals is a bright light that will not only help the uninsured, but slow the escalating cost of health care for struggling businesses as well."

Over 375 health care practitioners gathered on January 15 in Wisconsin Dells to launch the Wisconsin Pressure Ulcer Reduction and Prevention Project. The Project denotes the first multi-setting clinical collaborative in Wisconsin with representatives from 23 hospitals, 85 nursing homes, two assisted living facilities, and eight home health/hospice organizations.

"The interest and participation in this project is phenomenal. The breadth and variety of organizations that are now working together to tackle a long-standing, challenging health risk through this project again demonstrates the commitment of Wisconsin’s health care system to provide the best care possible to citizens of this state," according to Dana Richardson, WHA vice president of quality initiatives.

The goal of the project is to reduce the prevalence of pressure ulcers within participating health care organizations by 50 percent in one year. The current pressure ulcer prevalence rate in Wisconsin nursing homes is 6.7 percent.

Barbara Braden, author of the "Braden Scale for Predicting Pressure Sore Risk," presented the keynote address. The Braden Scale is a clinically-validated tool that allows nurses and other health care providers to reliably score a patient/client’s level of risk for developing pressure ulcers.

The project will focus on two key themes: consistent assessment and implementation of evidence-based practices, and the creation of an environment for cross-setting participants to begin and sustain mutually beneficial ongoing communication. This will be accomplished through standardized data collection to monitor improvement, use of an evidence-based risk assessment and pressure ulcer staging scale, and implementation of a variety of interventions known to prevent pressure ulcers and reduce the severity of those that do occur.

The Wisconsin Pressure Ulcer Reduction and Prevention Project is jointly sponsored by MetaStar, Wisconsin’s Quality Improvement Organization, with funding from the Center for Medicare and Medicaid Services, and the Wisconsin Pressure Ulcer Coalition (WPUC). The WPUC was formed in December 2007 and is comprised of several Wisconsin stakeholder groups including the Wisconsin Hospital Association, Rural Wisconsin Health Cooperative, Wisconsin Division of Quality Assurance, MetaStar, Wisconsin Homes and Services for the Aging, Wisconsin Health Care Association, Wisconsin Assisted Living Association and HOPE of Wisconsin.

For more information about this project, contact Dana Richardson at drichardson@wha.org or 608-274-1820.

The November elections brought in a new President and new majority in Congress, both of whom are ready to tackle major health care and hospital issues. By attending WHA’s Annual Advocacy Day event on April 1 in Madison, you’ll hear about these issues firsthand from keynote speaker Rick Pollack, executive vice president of the American Hospital Association. From reforming health care to electronic medical records, you won’t want to miss his presentation so you can be informed and aware of national matters. At the state level, attendees will hear important insights on state issues from luncheon keynote speaker Governor Jim Doyle (invited).

Advocacy Day 2009 will also include the always-popular state legislative panel discussion (extended by 15 minutes) and a legislative issues briefing by members of the WHA government affairs team. Using the information from this briefing, attendees will then head to the State Capitol just two blocks away to meet personally with their state legislators or their staff members.

These face-to-face legislative visits are the most important aspect of WHA Advocacy Day. Having hundreds of hospital employees, trustees and volunteers take what they’ve learned during the day and put that into action by meeting with their legislators in the afternoon is essential to having the voice of hospitals heard. WHA schedules all visits and provides a legislative issues briefing beforehand.

Mark your calendars and plan to join 600 of your peers from across the state in Madison at Advocacy Day 2009 on April 1. A complete program and registration form are available online at www.wha.org.

This week the House Appropriations Committee, chaired by Wisconsin Congressman David Obey, unveiled the "American Recovery and Reinvestment Bill of 2009," an $825 billion stimulus package targeting health care, energy, transportation and education investments among other provisions.

The proposal is said to provide $275 billion in economic recovery tax cuts and $550 billion in targeted priority investments. Among those priority investments important to health care are:

• $87 billion for a temporary increase in the Federal Medical Assistance Matching Rate for states (Medicaid Matching Rate);
• $20 billion for health information technology;
• $600 million to address primary care workforce shortages, including doctors and nurses; and
• $30 billion to extend COBRA to the unemployed.

"Congressman Obey’s notable efforts will help save essential health care services from being at risk during this difficult economic downturn," WHA President Steve Brenton said. "And the prospects for federal help with purchasing and implementing digitalized health records is a key health reform outcome."

Also unveiled this week and expected to be considered next week are additional stimulus proposals from the House Ways and Means Committee. Included in this plan are incentives for purchasers of tax-exempt hospital bonds.

The bills are expected to be considered as one package on the House floor the week of January 26.

For decades, WHA has produced a newsletter on Fridays and printed and mailed hundreds of copies. After convening a workgroup and reviewing our communications vehicles, the decision was made to begin to reduce the Association’s dependence on paper and send more communications to members electronically.

Each WHA member hospital and system CEO will continue to receive the Friday Packet that will include a hard copy of the newsletter. However, all other recipients of the newsletter will receive WHA communications, including the Friday newsletter, "The Valued Voice," by email only starting February 6.

If you are currently receiving a hard copy ONLY of The Valued Voice by mail and wish to receive it by email starting February 6, contact Tammy Hribar at thribar@wha.org, or 608-274-1820. The Friday Packet is also available 24/7 from the WHA Web site at www.wha.org. The current issue is on the home page of the Web site, and past issues can be found in Publications & Archive.

One of the most significant plusses associated with the "fine tuned" Hospital Assessment initiative is the fact that, if enacted, the new Childless Adults Medicaid waiver will be able to be implemented statewide. And that wouldn’t be happening in the midst of an incredibly difficult state budget cycle without funding from the assessment.

The Childless Adults waiver has been strongly supported by WHA since it was unveiled by Doyle Administration officials a couple of years ago. The targeted population is employed, low-income adults who have been without health insurance for at least one year. Many of these patients use the hospital ED as their primary gateway to health care services, a situation that may begin to change once the program is fully implemented.

Milwaukee County hospitals are well aware of the importance of providing some level of coverage to this vulnerable population as that county has actually had a locally-supported program for years—the General Assistance Medical Program (GAMP), which is funded and sustained by support from county and state tax dollars and by local hospitals. Milwaukee County will be first in line for Childless Adults implementation due to this history, but statewide implementation can now also be a reality. That means that thousands of Wisconsin’s most vulnerable citizens will soon have basic health coverage—made possible in an economic downturn that may well worsen the coverage crisis for newly-unemployed or underemployed workers and their families.

As has been mentioned previously, the hospital assessment represents a win–win–win–win for Wisconsin. First it’s a "win" for Wisconsin hospitals, especially those disproportionately burdened by serving large Medicaid patient populations. Next it’s a "win" for Wisconsin employers who have financed a growing "hidden tax" via cost shifting that should modestly decrease once this plan is in place. It’s also a "win" for the State of Wisconsin that gains much needed revenue to continue funding important health care programs during a time of economic turmoil. And finally, it’s a "win" for as many as 40,000 uninsured citizens who may soon have coverage for essential health services.

Steve Brenton
President

Early Bird Registration: Register by January 23 to Qualify
The American Club Room Reservation Cut-Off: February 20

More information and registration form can be found at www.wha.org or contact Lisa Geishirt at 608-274-1820 or lgeishirt@wha.org.

The health care workforce shortage is an ongoing concern in Wisconsin hospitals. With hospitals reporting significant vacancy rates in their workforce as long-time employees retire, the WHA Employee Pride Program assumes even more importance as a tool to attract new workers and reward existing workers in the field of health care.

The Wisconsin Health Care Employee Pride Program is based on the fact that the decision to work in health care is often made for personal and compelling reasons. The decision to stay in health care is often tied to the same reasons, along with the desire to help others live healthier lives. The Pride Program gives employees the opportunity to share why they love their career of service to others, while giving the Association a moment to honor their contributions to their hospital, community and profession.

Last year, 76 hospital employees were honored at the Pride recognition dinner and award ceremony. This year we hope to recognize even more employees and to publicize their essays more widely in an effort to interest others in joining the health care workforce.

A designated leader from administration, human resources, public relations or patient care from WHA member hospitals is asked to coordinate the program. Employees are encouraged to submit to the hospital a one-page essay, poem or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital. That employee will be honored at a reception and dinner May 7 at the Kalahari Resort in Wisconsin Dells.

The Wisconsin Hospital Association, along with the Wisconsin Society of Healthcare Human Resources Administration and the Wisconsin Organization of Nurse Executives, is proud to sponsor the Wisconsin Health Care Employee Pride Program.

Pride Program materials are included in this week’s packet. In addition, these materials are available on WHA’s Web site at www.wha.org/workforce/pride_2009.aspx. Don’t miss this opportunity to participate in the 2009 Pride Program. For more information contact Shannon Nelson at snelson@wha.org or Mary Kay Grasmick at mgrasmick@wha.org, or call 608-274-1820.

The Medicare Payment Advisory Commission late last week recommended that Congress provide hospitals with a full Medicare payment update for fiscal year 2010 inpatient and outpatient services, based on the rate of change in the market-basket index, concurrent with implementation of a quality incentive program. MedPAC also recommended reducing indirect medical education payments by one percentage point, and using the estimated $1 billion in savings to help fund the quality incentive program.

"While we appreciate MedPAC’s recommendation for a full market basket update for FY 2010, we are concerned about the one percent cut in payments for indirect medical education (IME)," said George Quinn WHA Senior Vice President. "IME payments represent the Medicare Program’s share of the cost of training high-quality physicians. If we continue to reduce resources for these programs, we cannot expect to have an adequate supply of physicians in the future."

MedPAC also recommended freezing Medicare payments for skilled nursing facilities, inpatient rehabilitation facilities and home health agencies in 2010. MedPAC recommended providing long-term care hospitals with a full market basket update minus an adjustment for productivity growth, for an estimated update of 1.6 percent.

The Wisconsin Organization of Nurse Executives (W-ONE) hosted newly elected State Representative Sandy Pasch (D-Whitefish Bay) at their recent Board meeting. As a nurse-legislator, the W-ONE Board wanted to meet with Rep. Pasch and discuss important nursing issues on the horizon.

By training, Rep. Pasch is a mental health nurse who received her Master’s of Science in psychiatric nursing from the University of Rochester and a Master’s degree in bioethics from the Medical College of Wisconsin. She is also a former assistant professor of nursing.

"I decided to run for office because as a nurse we become advocates," said Pasch. "That’s what we do…[and being a legislator] is the ultimate advocacy role."

When asked what her number one priority would be, Rep. Pasch responded "mental health parity in Wisconsin." As a mental health nurse, she has decades of experience and commends the mental health parity law at the federal level but feels there’s more that needs to be done to bring that about in Wisconsin.

Rep. Pasch discussed her feelings that the nursing shortage is a result of many things, including an aging faculty and failure to keep nurses in nursing. To try and understand the full breadth of the nursing workforce in Wisconsin, Rep. Pasch indicates she will team with Sen. Judy Robson on ways for the State to collect this data. This is something both WONE and the Wisconsin Hospital Association have previously advocated.

In discussing issues that may be on the horizon, Rep. Pasch said that the use of mandatory overtime "should be rare and not a staffing policy." The WONE Board agreed and went on to provide Pasch with insight into how their facilities staff, indicating mandatory overtime is not used as a staffing policy and is infrequently employed.

After further discussion and noting that mandatory nurse overtime is infrequently used and something that would actually cost hospitals more (i.e., mandatory overtime = higher staffing costs), Wausau Aspirus Chief Nursing Officer Tim Gengler, RN, posed the question: "Do we need this legislation at all?"

Pasch responded, "I would hope not, but it is something we may need to look at."

Froedtert Chief Nursing Officer Pamela Maxson-Cooper indicated nurse staffing is "always about patient care," to which Rep. Pasch responded, "That’s my bottom line."

On the hospital assessment, Rep. Pasch said it is something she supports and believes will move quickly.

W-ONE Board members indicated they would like to forward Rep. Pasch information on important issues and would be happy to help provide research on evidence-based solutions to policy and staffing issues facing nurses.

Rep. Pasch responded that she is "always amazed when I hear a panel of ‘experts’ who have no health care experience…so, I welcome your input."

On September 26, 2008, CMS approved DNV Healthcare, Inc. (DNVHC) by granting it deeming authority for hospitals to become the first new hospital accreditation organization in more than 30 years. Any hospital accredited by DNVHC after that date is deemed to be in compliance with the Medicare Conditions of Participation (CoP).

On January 20, WHA is offering two ways to learn more about this new accreditation option. For those looking for a brief overview, a 90-minute audio conference January 20 will introduce the new DNVHC accreditation program. The National Integrated Accreditation for Healthcare Organizations, or NIAHO, standards integrate requirements based on the CMS Conditions of Participation with the internationally recognized ISA 9001 Standards for the formation and implementation of the Quality Management System.

For those looking for more in-depth information on NIAHO, WHA is offering a four-part audio conference series that begins on January 20. Participants have the ability to participate in any of the four sessions, or take advantage of a discount on the registration fee by registering for all four parts. The series will focus on the NIAHO requirements versus the Conditions of Participation, how NIAHO integrates the ISO 9001 as its infrastructure, the actual survey process and results to date, as well as the current climate and DNVHC’s capabilities.

WHA’s annual one-day conference for executive assistants and other administrative support staff from hospitals will be held March 13 at the Tundra Lodge Resort in Green Bay. Clint Maun, a nationally-recognized health care consultant will facilitate this conference. This conference will provide insightful tips and proven methods so participants will be able to communicate more effectively with others and incorporate the concept of "customer" in their daily interactions.

This program is designed for executive and administrative assistants, business office managers, and other support staff in hospitals and other health care settings. A brochure and registration form is included in this week’s packet. Please pass it on to the valued administrative support service professionals in departments throughout your organization.

In part one of our two-part series we gave a brief overview of heliport liability coverage. This article focuses on the exposures that may need to be evaluated as your facility considers the need for a separate heliport liability policy.

Aviation-related activities: Coverage provided for injury to a third-party or their property from the operation of a helicopter in and out of a hospital’s helipad; for example, damage caused to a vehicle from debris.

Non-owned aircraft liability: Coverage for health care facilities who bill patients for use of the helicopter. The hospital may assume liability as a patient transport service and any damage in route may be the responsibility of the hospital. This coverage may be endorsed onto a helipad liability policy or purchased as a separate policy.

Ground hangar keepers liability: Coverage as a result of a helicopter remaining at the hospital or base location overnight. This provides coverage for aircrafts that are not owned by the hospital but may be held liable while the helicopter is in their custody.

Products and completed operations coverage: If fueling or maintenance of the aircraft is performed at your facility, this coverage protects the hospital from "indirect" or "contingent" liability.

For more information regarding heliport liability, contact Matt Wahoske, FinCor Solutions, at mwahoske@fincorsolutions.com or at 608-469-8590.

ThedaCare has been named a national finalist for the 2008 Foster G. McGaw Prize—one of health care’s most prestigious honors for excellence in community service.

The Foster G. McGaw Prize, first awarded in 1986, recognizes health care organizations that demonstrate commitment to community service through a range of programs that demonstrate a passion and continuous commitment to making communities healthier and more vital. The prize inspires hospitals, health systems and communities to assess and implement programs that improve their communities.

"We see our role in improving community health as that of a convener and facilitator," said Dean Gruner, MD, ThedaCare president and CEO. "We know that systemic health issues in our community cannot be solved by our health care system alone. Because we need all sectors of the community to be part of the solution, we’ve developed a unique process that convenes leaders, fosters collective understanding, and leverages community assets. The result has been truly innovative, effective solutions to some of our community’s most significant health concerns."

The Foster G. McGaw Prize is sponsored by the American Hospital Association (AHA), Baxter International Foundation and Cardinal Health Foundation.

The Upland Hills Health housekeeping staff has started using a new "green" waxing system on the floors, reducing the amount of chemicals used on the floors and harmful fumes from those chemicals.

The new system by 3M, called Easy Shine Applicator, uses less VOCs, or volatile organic compounds, than other waxing systems, including the previous system used at Upland Hills Health. VOCs can contribute to respiratory irritation, headaches and other illnesses.

According to Gail Riechling, housekeeping supervisor, the system applies only the amount of wax that’s needed to the floor, cutting back on chemical use. Staff members wear a backpack-type device that keeps the chemicals contained. This reduces the amount of fumes that staff, patients, visitors and residents are exposed to. The floors are then buffed with an environmentally-friendly reusable micro-fiber mop.

The move to the new waxing system adds to the environmental efforts currently at work at Upland Hills Health. Half of Upland Hills Health’s cleaning chemicals are now green-seal approved, including the vacuum cleaners, which have the Rug Institute green-seal approval. Styrofoam use has recently been virtually eliminated and more recycling bins are showing up all over the hospital.

Marissa and Thomas (not their real names) seemed to be a simple Columbia St. Mary’s Blanket of Love (BOL) success story. They were both regular participants in the BOL prenatal and parenting education program. The program is coordinated by a CSM parish nurse and held in a community church in the central city to provide a setting of hospitality and welcoming to young African American families. The program often struggled to get men involved but Thomas seemed to look forward to coming. He was always friendly and energetic and the participants appreciated his sense of humor. Marissa and Thomas took advantage of the education and advice given by the women who are BOL staff and mentors. A healthy baby boy was born and they were overjoyed.

They weren’t done with BOL, however. They continued to be regular participants in the parenting education program. It wasn’t easy to go through the challenges of growing along with the new baby, but they dealt with the challenges together. It seemed to be a "Readers Digest" kind of success story. Until one night; Thomas was the victim of the violence that has plagued Milwaukee. He was shot and killed.

The Blanket of Love became something entirely different for Marissa. She had always enjoyed the friendship of the group through the many months of prenatal care and training. But at the time of Thomas’ death, she came to depend on the BOL community for ongoing support. Grieving is a difficult task at any time, but when a baby is involved and a family is ripped apart, it is even harder. Her BOL friends and staff now take the time to be sure that she is adjusting and grieving as well as being a good parent. All are committed to help her be the best parent she can be in keeping with the plans that she and Thomas once held together.

Wellness. Disease prevention. Good nutrition. Exercise. It’s hard to open a newspaper or magazine or to turn on a radio or TV without hearing something about these topics. We all understand their importance. But incorporating such strategies into one’s daily life? That’s the challenge, especially when most people are at work at least eight hours per day.

Work. . . what about bringing health and wellness to the workplace? Nearly six years ago, St. Croix Regional Medical Center (SCRMC) and the Polk Co. Public Health Department conducted a survey of area employees and employers to determine the level of interest in a company-based wellness initiative. This survey initiated projects and discussion, which resulted in a brief specific to Polk County worksites. Wisconsin Governor Doyle’s office initiated the Healthy Wisconsin 2010 Initiative, whose idea was to go into communities, schools, and worksites to improve wellness.

The St. Croix Falls-based Straus Knitting Mills, Inc. agreed to participate as the pilot company for the new Polk County Worksite Wellness Coalition. Funding from a Healthier Wisconsin Worksite Project mini-grant was received through the efforts of Janel Hemmesch of Polk County Public Health and Kathy Weeks, SCRMC Valley Occupational Health Coordinator.

Together, Straus staff, Hemmesch, and Weeks used the state’s new Worksite Wellness Resource Kit, which was specifically designed to help companies’ staff implement strategies proven to be effective. The kit provides important help to implement a broad range of strategies and programming, some of which require little or no resources while others require considerably more. "The kit provides proven steps for improving the health of employees, regardless of the size of the worksite and available resources," explained Sandy Hinrichs, human resources director at Straus.

Straus management developed a wellness policy, set aside money for the effort in their budget, and set up a worksite wellness committee. All employees learned about steps they could take to motivate them to improve their diet and exercise habits. "One of the ideas we had, something we’d never thought of, was to put healthier food choices in our vending machines," said Hinrichs. "It was simple, low cost, and a very beneficial idea." Together with SCRMC and Polk Co., Straus employees were also given health screenings. This was followed by on-site appointments with Wanda Brown, Nurse Practitioner, and Dietitian Janel Hemmesch to discuss test results, and more importantly, steps individuals could take to address any problem areas or concerns. In addition, Straus purchased and trained staff to use an automated electronic defibrillator (AED), one with which area emergency personnel are familiar. Life Link III provided training on site and were instrumental in helping to make a purchase decision thus saving Straus on cost replacement of pads should they need to use their new AED.

The coalition is now approaching other organizations in the community to utilize this worksite kit and area resources, thus improving worksite wellness and the company’s bottom line. Quarterly meetings are taking place to help companies implement such strategies. "Our goal," Weeks explained, "is to work together as a greater community to assess businesses and help them help their employees make healthier personal choices. We stress to all in the workplace that the benefits are many, and include healthier employees and families, less absenteeism due to illness, and lower health insurance premiums for both employers and employees."

Being a Sexual Assault Nurse Examiner (SANE) is not the job Sue Robertson envisioned for herself as she launched her nursing career. She’s glad she didn’t come to that work early on. Robertson sees horrifying things when the victims of sexual assault come into the Emergency Center at St. Vincent Hospital and carries their sad stories with her long after the perpetrators have been brought to justice.

But Robertson, Team Leader of the SANE Program at St. Vincent Hospital, and her 11 colleagues are united in their goal: "We do it so we can make this community safer," she said. "As hard as it is to do what we’re doing, you think about the outcome. We want to make those perpetrators responsible for what they did."

To that end, the SANE staff greets each sexual assault victim, male or female, infant to the elderly, with gentle words and compassionate care, even while they perform medical examinations, take photographs of wounds, collect samples of hair and bodily fluids and repair injuries.

The SANE Program started at St. Vincent in 1992 and, at police and community request, became a 24-hour, seven-day-a-week service in 2004. Most years it has witnessed some 200 victim exams annually. In fiscal year 2007-08, the number dipped to 167, but Robertson noted that the numbers already seem on the upswing again in July 2008. In the year that ended on June 30, 2007,

St. Vincent’s costs were $83,359 in uncompensated care for SANE, much of that in on-call staff time expenditures, education costs and other unfunded program costs.

Victims were evenly divided in 2007—84 adults, 83 children. Robertson said the youngest child her staff has treated was three months old; the oldest adults have been in their 70s and 80s. Last year, nine males seen in the Emergency Center were victims of sexual assault.

Sadly, she noted, "Only one in 10 sexual assaults is reported. Imagine how many we could be seeing. We’re just touching the surface."

St. Vincent is the regional center for SANE care. In Green Bay, Bellin, St. Mary’s and Aurora BayCare hospitals transfer sexual assault victims who come to their facilities to St. Vincent after making sure they are medically cleared. Smaller hospitals in the region do the same. That’s because St. Vincent has the only nurses trained to do the very skilled and technical exams and collect the forensic evidence in a manner that will hold up in court proceedings. "It costs over $5,000 to train a nurse," Robertson explained. "The typical exam takes an average of four hours, but it can take as long as eight hours depending on the severity of the assault and injuries."

The SANE staff is also trained to present their findings in court if necessary, but increasingly those sexual assault cases are being settled before they get to trial. "We probably go to court 15 times a year," Robertson said. The forensic evidence the SANE staff has provided is powerful, especially the photos, she added. "It is so much clearer for the jury. They make a big impact." Oftentimes, cases settle without going to court "because we collect such good DNA. That way, the victim doesn’t have to go through the whole court process."

In May, St. Vincent opened a new SANE examination room built just for that purpose and about three times the size of the room previously used for sexual assault exams. This one "is not hospital-like," Robertson said. "It is a warm environment for patients and for staff."

Robertson was named the recipient of the Wisconsin Coalition Against Sexual Assault’s 2008 "Voices of Courage" Award for Health and Human Services. She asked that the recipient name be changed to represent the SANE program, not just her.

A SANE staff member is always on call to assure coverage at all hours of the day and night should a sexual assault victim need the compassionate care they can provide. "It’s not an easy job to do—you have to have a passion for it," Robertson said. "But we want to make things safer for everybody, including these victims."

2006 had been a particularly difficult year in terms of the impact of domestic violence in Sheboygan County. Two domestic abuse homicides and another incident where police intervention prevented a third, had heightened awareness of the dangers inherent to abusive relationships.

Since 1998, St. Nicholas Hospital has donated the free use of two homes to Safe Harbor, a domestic violence shelter, located in the City of Sheboygan. The two homes are used as transitional living for women in Sheboygan County who have left an abusive relationship and want to become independent.

In order to qualify to live in the two homes, the women must have an income and need to have at least one child. The women who reside in the homes can live there for two years. To help them become more independent, their rent is based on 30 percent of their income. Safe Harbor also helps the women become self-sufficient by providing them with resources such as support groups, meetings with a care manager, and help with goal setting. Some of the women who have lived in the homes have learned to become independent and have gone on to purchase their own homes.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Top of page