Sexual Assault Nurse Examiner (SANE)

A SANE, or Sexual Assault Nurse Examiner, is a forensic nurse who conducts sexual assault and abuse exams. These nurses often testify as expert witnesses during sex crimes trials, but their testimony can be problematic for a variety of reasons. If you are facing a sexual assault, continuous sexual abuse, or indecency charge, you should understand how this testimony may be used in the prosecution against you and potentially at your trial.

Tarrant County

In Tarrant County, most child sexual assault exams or “Rape Kits” are performed at Cook Children Hospital or John Peter Smith Hospital.

Cook Children

The SANEs at Cook Children are a part of the “Cook Children’s Child Advocacy Resources and Evaluation” (CARE) team intended to provide medical and forensic evaluations for alleged victims of physical abuse, neglect and drug exposure, sexual abuse screening examinations and preventative education for victims of child maltreatment.

A CARE team examination of alleged child victims of abuse are usually conducted pursuant to a referral from Child Protective Services (CPS), law enforcement agencies, or a medical provider.

John Peter Smith

The JPS is part of the Tarrant County Sexual Assault Response Team and provides care for adolescents and adult alleged victims of sexual assault. The JPS SANE Team provides this service for more than 50 police jurisdictions in seven Texas counties including: Tarrant, Wise, Parker Johnson, Hood, Erath and Somervell.


To complete the SANE training, an individual must first be a registered nurse. It is preferred that trainees have at least two years of experience working in areas that require advanced assessment skills, such as critical care or emergency room settings.

To become certified in Texas, an individual must complete a SANE training course that has been approved by the Office of the Attorney General (OAG). The certification also requires 16 hours of in-person courtroom observation. The OAG recommends that the observation should be of cases related to sexual assault or cases that involve expert testimony, but it is not a requirement.


A SANE certification is a credential that allows registered nurses to conduct sexual assault exams. The training should equip nurses with the following skills:

  • Respond to the needs of patients requiring care because of alleged sexual assault or abuse; crisis intervention
  • Conduct a sexual assault medical forensic exam
  • Document the findings of the forensic exam for use in prosecution
  • Participate in judicial proceedings, including testifying

There is currently no law in Texas requiring nurses to have a SANE certification to conduct these exams, but many jurisdictions, hospitals, and other healthcare centers require the certification anyway.

Effects on Prosecution

Research suggests that SANEs play an important role in the prosecution of sex crimes and abuse cases. When SANE nurses are involved in a case, alleged victims may be more likely to participate in the prosecution, and police may be more likely to file charges. Cases involving SANE nurses also have higher conviction rates and longer sentences on average. As a practical matter, if an adult or child are identified as a possible victim, then law enforcement and advocacy centers almost always route the alleged victim to have an exam.

In many cases, SANE expert testimony is instrumental in obtaining a conviction for someone accused of sexual assault or continuous sexual abuse. The admissibility of this expert testimony is being litigated through the country. A 2000 case in Virginia, the Commonwealth V. Johnson, set the precedent to accept forensic nursing as expert evidence in court. During this case, the judge ruled that Suzanne Brown, a forensic nurse and SANE, was an expert witness and allowed her to testify. SANEs are typically called in by the prosecution. Expertise is not the end of the challenge to this expert testimony. As Judge Cochran recognized in 2014, the Sixth Amendment confrontation implications are ” an important constitutional issue, and [the Court’s] decision to refuse appellant’s petition should not be read to foreclose consideration of this same issue in a different case.” Herrera v. State, 424 S.W.3d 52, 54 (Tex. Crim. App. 2014).

Standards for Expert Testimony

Scientific evidence can be very compelling to the jury and can sway the trial’s outcome. Because expert testimony has so much power, the United States Supreme Court has put standards in place for how district courts should decide whether or not to allow expert witnesses and scientific evidence at trial.

During the case of Daubert V. Merrell Dow Pharmaceuticals, Inc., the Supreme Court established that a trial court should act as a gatekeeper for expert witnesses. Scientific evidence can be complex and difficult for the layperson to understand, so it is very easy for jury members to be swayed by pseudoscience or false information. It is the trial court’s responsibility to ensure that the evidence the expert witness presents is reliable and relevant. It is a defense lawyer’s responsibility to challenge faulty or unreliable expert opinion or testimony.

Problems With Expert Witness Testimony

Although expert witnesses can provide valuable information during trials, their testimony can also be problematic. Appearing in court as an expert witness can require a tremendous amount of preparation. It can take hours for the witness to gather all of the information needed and to figure out the best way to present it. These witnesses should have knowledge and experience in their field beyond what the layperson has, but they have to present the information in a way that is accessible and easy-to-understand for everyone else in the courtroom. This can be a very difficult task for forensic nurses who already work demanding, high-stress jobs. Unfortunately, these demands may result in less reliable testimony, but the patina of expertise often blinds the jury to these deficiencies.

Witnesses sometimes feel obligated to promote the side of the party who called them in. When it comes to SANE witnesses, this is most often the prosecution. Expert witnesses can be paid for appearing in court, but lawyers are ethically prohibited from paying their witnesses based on the content of their testimony. Expert witnesses should remain impartial, but this is much easier said than done. Everyone has beliefs and biases, and it’s difficult for anyone not to let their own personal bias and prejudice affect their testimony. This is especially true in sexual assault and abuse cases, which can be very upsetting and emotional. Indeed, expert witnesses engaged in child advocacy, like a SANE, feel compelled to seek a conviction, viewing it as a service to the alleged victim.

Another problem that affects many expert witnesses is a lack of understanding of legal courtroom proceedings. SANEs must complete 16 hours of courtroom observation to get their certification, but they aren’t required to observe cases that involve expert testimony. When an individual is unsure of the proceedings, they may feel anxious or confused, which may affect their testimony. This often leads to a witness becoming defensive and difficult during cross-examination. Controlling a difficult witness is a skill that a lawyer can only acquire through experience and specific training.

Expert witnesses are an important part of many trials, but their testimony is not a perfect source of information, far from it. SANE witnesses are usually called in by the prosecution, so if you have been accused of sexual assault or indecency, it’s essential that you work with an experienced criminal defense attorney from the very beginning of your case. A seasoned lawyer should be able to assess your case from both sides and anticipate the steps the prosecution will take.

If a case is likely to include this kind of testimony, your attorney should be filing a pretrial objection and requesting the trial court conduct an evidentiary hearing (Daubert Hearing) outside the presence of the jury to evaluate the admissibility of the testimony.


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