Registered nurse Elizabeth Boothis was haunted by one rape victim: petite, late 20s, clad in jeans and a sweatshirt. Sitting alone, crying, nose running, with a hollow look on her face as she twirled the long blond hair coursing down her back, while waiting in the perpetually frenetic emergency room of MetroHealth Medical Center on Cleveland’s Near West Side.
Ms. Booth had just recently been hired. She watched from behind the nurses station as the young woman returned to be examined again and again. Each time, the charge nurse explained that she would have to wait. More severely injured patients were ahead of her.
In Cleveland’s only Level 1 trauma center, ER triage basically went like this: Life threatening. Everything else. Unless a rape victim had sustained injuries requiring emergency treatment, the person had to be, well, patient.
Growing increasingly agitated, the young woman began pacing the hallway, cursing under her breath. Finally, after five or six hours of stomping and fuming, she screamed, “Give me a break!” and stormed out of the ER.
That was in 2008, and it wasn’t the last time Booth would become upset by the look of hopelessness in the eyes of a rape victim forced to endure the humiliating experience of feeling as if no one cared.
In fact, Booth still shudders at how victims who chose to wait were finally treated. Since none of the hospital staff were trained in how to provide a thorough medical and forensic rape examination, someone would crack open a manual and read the directions for the procedure.
“There was no other area of medicine where that would be acceptable,” she says. “It just got to me, so I thought, ‘All right, I’ll do the training myself and see where it goes.’ ”
Just eight years later, the indefatigable Booth is the hospital’s sexual assault nurse examiner coordinator, working specifically with rape victims. She has trained 30 other nurses at Metro to become certified SANEs. The hospital is now a national training center for this growing specialty area of forensic nursing.
Booth’s pioneering efforts symbolize how Cleveland has become a national leader in new approaches to handling rape and sexual assault. Across the country, a growing number of cities are shifting their perceptions of sexual violence – taking more seriously crimes that many advocates have long thought were overlooked by police, prosecutors, and health-care professionals.
But few have pushed as far as Cleveland. Since 2009, the city has significantly accelerated its efforts to combine more-
aggressive methods to take sexual offenders off the streets with more compassionate ways to help survivors reclaim their lives.
The revamped mind-set has already achieved tangible results. A county task force investigating a backlog of more than 4,800 sexual assault cases has tallied a conviction rate of 90 percent, with 120 defendants sentenced so far. Authorities estimate they will hand down more than 1,000 indictments as they complete the project over the next few years.
Moreover, agencies responsible for law enforcement, prosecution, health care, and social wellness have begun to work together instead of operating independently – and sometimes in conflict with each other – as they pursue cases and deal with victims. Through the county’s Sexual Assault Response Team, for example, they meet regularly, train together, and collaborate closely to ease the far-reaching effects of these once-neglected offenses.
At MetroHealth, Booth no longer recoils at the treatment of victims, either. When a sexual assault victim arrives, the hospital’s ER nurses or social workers immediately contact the Cleveland Rape Crisis Center (CRCC) to send an advocate for the victim. The person assists and comforts the victim until the person can be treated in a private, separate area of the emergency department. Typical wait time: 30 minutes. No one waits longer than an hour. No one.
“Cleveland has been a really strong forerunner in these efforts, has accomplished some great things, and taken some important steps forward,” says Monika Johnson Hostler, president of the National Alliance to End Sexual Violence, based in Washington, D.C.
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Cleveland’s approach to sexual violence all changed on Halloween of 2009. That was the night local police arrested Anthony Sowell for what would become the most brutal serial rape and murder spree in the city’s modern history.
In the days following his arrest, crime scene investigators unearthed the bodies of 11 women the “Cleveland Strangler” had wrapped in plastic garbage bags and buried in his backyard or left in places within his house.
On the strength of an embarrassment of evidence, Mr. Sowell was convicted and sentenced to death on Aug. 12, 2011. His home on Cleveland’s east side, which had become known as the “house of horrors,” was razed on Dec. 6, 2011.
Deeply disturbed by the crimes, the major institutions that combat sexual violence began to implement fundamental changes. Two months after Sowell’s arrest, Cleveland Mayor Frank Jackson formed the Special Commission on Missing Persons and Sex Crimes Investigation. Issued on March 30, 2010, its report proposed 26 recommendations for handling these issues differently, including adding a countywide Missing Persons Bureau.
Later that year, one of the most visible demonstrations of the new approach occurred when the Cleveland Police Department refurbished the offices of its Sex Crimes and Special Victims Units, which have been combined into one department. The offices were painted with softer, warmer colors, and private rooms were added so that police would no longer have to interview victims in an open “bullpen.”
Capt. James McPike sits in a private office with a glass wall overlooking the cubicles. He remembers the old offices because he had a desk in the bullpen for six years before being transferred in 2008 to the Fourth District, where Sowell was later captured.
In 2012, the Cleveland Police Department named McPike head of the Special Victims Section, which includes both the Sex Crimes/Child Abuse and Domestic Violence units. Shortly after he took over, McPike initiated a program to have his detectives work directly with rape crisis center advocates assigned to victims from Day 1 of a case. They advise victims on counseling, health-care advocacy, and other services available through the center. They also guide them through the police interview and investigation and the justice system processes. Last year, Cleveland began funding one advocate to work with the Special Victims Unit full time.
“Our partnership with the Cleveland Police Department has never been as strong as it is now,” says Sondra Miller, CRCC’s president and chief executive officer. “The Sowell case moved us in that direction.”
Ms. Hostler of the National Alliance to End Sexual Violence considers Cleveland one of the five cornerstone rape crisis centers in the United States, along with Boston, Washington, Pittsburgh, and San Francisco. “Nationally, we need a lot of work to make all of our rape crisis centers the beacon of hope in their communities that Cleveland has accomplished,” she says.
McPike remembers how hard it used to be – the crush of caseloads, the emotionally wrenching nature of the crimes. He’d wake up at 3 a.m. worried about the interviews, trials, and other dimensions of cases he was handling. At the time, each detective in the Special Victims Unit was handling at least 30 open sexual assault and felony child abuse cases.
Now that he’s in charge, McPike says that he wants to be sure that victims are treated well and implement his goal of leading one of the best investigative units in the country.
“There’s a greater understanding in our profession that this is a unique crime that often takes place in private,” McPike says. “So, we take a more victim-centered approach, because they deserve to be treated with empathy and compassion.”
The Sowell case reinforced two lessons: First, sexual predators often attack people who live on the margins of society, because they are easier prey and are less likely to report their crimes or be believed if they do report them. Second, there are no strange stories.
“I tell police officers, ‘Please don’t judge what you are hearing, because sometimes the craziest story could be the truth,’ ” says McPike. If the first-
responding officers judge the victims, it causes the victims to have doubts, and then they become less likely to cooperate with the detectives’ investigation.
Booth concurs. In her job at Metro, both she and her SANE nurses interact with the police almost daily. Forced to meet in the hospital cafe because her office is stacked floor to ceiling with boxes of new clothes and toiletries donated for victims through a recent campaign, Booth says: “If the frontline person didn’t believe the survivor of a sexual assault, the patient would just take off before we could do our exam. Now that they’re being believed and treated well, they stay and complete the entire extensive and exhausting examination.”
Cooperative patients are more inclined to participate in the prosecution and testify in court, something Booth and her nurses do regularly themselves. Also, the victims’ healing process is improved, since they are more willing to seek counseling and discuss the assault with family members and friends who can support them.
The police interviews she hears today no longer lead with, What were you wearing? How much did you drink? Were you doing drugs? Instead, they focus immediately on the assault. Often officers will stay until the person’s SANE examination is finished so that they can take the person home or to a safe location.
As part of the changes under way, MetroHealth will soon be getting a new sexual assault examination center. Last year, Booth partook in a “shark tank”-style competition held by the hospital to fund innovative projects. For her presentation, she applied makeup and cried to depict a battered rape victim’s experience in the ER and underscore the critical need for a separate SANE unit. Out of 105 submissions, Booth’s was one of six approved for funding. She was awarded $100,000. She is waiting for her new unit to be built.
Ten years ago, approximately 200 such examination programs existed throughout the US, and now there are more than 600. More are needed. “If you divide that by 50 states, that’s a little more than 10 programs to cover an entire state,” Booth says. “So we are fortunate in Northeast Ohio to have four hospitals with established programs, but a lot of our rural areas still don’t have easy access.”
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Imani Capri knows the importance of having institutional support. She had been molested and raped by her stepfather starting at age 11. She escaped his clutches after college, but wrestled with the experience for several years. Then, in 2005, she decided to act. She decided to pursue prosecution.
“It may have taken me becoming a 25-year-old woman to fight for justice for that 11-year-old, but I did it,” Ms. Capri says. “He took a lot from me, but I didn’t let him take my voice.”
Capri found a sympathetic reception from the Cuyahoga County Prosecutor’s Office. Over the past decade, the office has been taking a more vigorous approach to prosecuting rape and sexual assault.
Capri’s first trial in April 2006 ended in a hung jury. She was devastated, but the prosecutor, who has since taken another job, told her they would pursue a second trial. “She said, ‘You’d better rest up, because I’m not letting this go,’ ” Capri recalls.
At the second trial in November 2007, her stepfather was found guilty and received a particularly heavy sentence: 20 years before eligibility for parole with five years of probation and registered sex-offender status.
The prosecutor’s office learned from the success of her case. They even invited Capri to speak to a group of more than 100 prosecutors, focusing on the compassionate manner in which the attorneys handled her investigations and trials.
“Being able to break my silence and pursue justice with their full support helped me heal and realize I could find a route to success again,” she says. “So compassion is way more powerful than they thought.”
In July 2011, the summer Sowell was sentenced, the prosecutor’s office launched a new initiative to test the backlog of sexual assault kits (SAKs) – the kits a medical examiner uses to collect key forensic evidence, such as DNA, in rape cases. According to McPike, DNA testing, which only became available in the mid-1990s, had been too expensive for the Cleveland Police Department’s Sex Crimes Unit, running in the range of $4,000 to $5,000 per kit.
By 2012, improved laboratory techniques had dropped costs to $433 per kit, so Ohio Attorney General Mike DeWine made testing a priority. He invested in robotic testing equipment and 10 new people for the laboratory of the Bureau of Criminal Investigations (BCI), the state’s official crime lab, to test the high volume of kits submitted from across Ohio. The result was a reduction in turnaround time of more than 100 days. Then, in January 2013, Cuyahoga County Prosecutor Timothy McGinty formed the SAK Task Force.
“The question was not just are you testing the kits, but are you pursuing the follow-up work needed to prosecute the cases?” says Richard Bell, assistant county prosecutor and criminal investigations division chief for Cuyahoga County. Prosecutors also realized BCI had such a high success rate of developing DNA profiles, which could be uploaded into a Federal Bureau of Investigation database shared with law enforcement agencies across the country, that they would need more investigators. Indeed, BCI’s 60 percent hit rate – the rate at which their evidence identified an offender on the FBI’s Combined DNA Index System (CODIS) – was higher than anywhere else in the US.
Because of the volume of SAKs – about 35 completed kits come from the BCI lab each week – Mr. Bell’s division now employs a crew of 25 investigators, six assistant prosecutors, two supervisors, and two paralegals. Four advocates are assigned to assist survivors through the justice process.
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At 9 a.m. on a Tuesday, SAK Task Force members assemble for their weekly meeting in a seventh-floor conference room in downtown Cleveland. Sizable north-facing windows frame vistas of Lake Erie, the Rock and Roll Hall of Fame and Museum, and FirstEnergy Field where the Cleveland Browns play – these days, not very well.
Roughly 20 of the task force investigators, prosecutors, advocates, and administrators sit around a long conference table or in chairs along the walls. Others sit at a smaller table in an adjoining section that also doubles as Bell’s office for the 2-1/2 days a week he is here. A large desk, credenza, and shelves are mostly empty because his main office is across the street in the County Prosecutor’s Office, but his children have given him several pictures to decorate the space.
Seated next to Bell, Mr. McGinty questions the team about several open cases, including one that is currently in court across the street. At the last minute, one of the three victims has decided not to testify. McGinty and the team decide they need her testimony to ensure they can put away a man accused of a series of vicious rapes who they believe is a severe threat to public safety.
Since this marks the first time in three years they must issue a warrant for a victim, they weigh the pros and cons for quite a while before the need to get this guy off the street wins out. Concerned for the difficult position of the victim, McGinty turns to Brett Kyker, Bell’s prosecutorial colleague who runs the daily operations.
“Make sure they include a statement in the warrant that she will never cross the threshold of a prison,” he says. “Police will pick her up at her house; she will testify as soon as she arrives in court, and the police will escort her home.”
Next on the agenda, Bell reviews year-end statistics for the task force that are projected on a screen at the front of the room. The percentage of offender DNA hits on CODIS hovers at 59 percent, still the highest of any city. They have completed 1,500 rape investigations each of the past two years, maintained a 90.5 percent conviction rate in 2015, and have reached an approximate halfway point with 438 indictments.
McGinty tells the team that he’s seen an increase in public confidence because of their successes and that will lead to an increase in reporting of rapes and sexual assaults. He’s proud of the collaborative efforts between different agencies.
After the meeting breaks up, Bell crosses to his office to convene with Mr. Kyker and Rachel Lovell, co-principal investigator at the Begun Center for Violence Prevention Research and Education at Case Western Reserve University (CWRU) in Cleveland. Ms. Lovell, who attends most of the weekly meetings, informs Bell and Kyker about the specific types of offender and victim characteristics they have coded in their research.
Last year, the task force partnered with social science researchers at CWRU and gave them $100,000 of federal funding they had received, along with 20 years of case files from the SAK initiative. This March, the one-year study will issue reports on details of the crimes with analysis of patterns and behaviors and what factors contributed to successful prosecutions. Other federal and local grants, totaling $3.5 million, are being used to underwrite the CWRU research and to process untested kits.
According to Bell, the task force has learned several key lessons. Brutal point No. 1: They have discovered 298 serial rapists who assaulted 902 victims. The DNA hits prove that these serial offenders are not locked into one type of victim or one method of operation, as was traditionally believed.
“If you’re a jerk enough to rape a stranger, you’re probably not compassionate or empathetic towards the women in your life, so you’re likely to assault an acquaintance,” Bell says. “Doesn’t seem like it should be, but that was an epiphany to prosecutors and police alike.”
Knowing this, investigators are now more diligent in searching for evidence of multiple rapes, which can strengthen the case against an offender on trial for raping an acquaintance and claiming it was consensual. The DNA trail has connected offenders to other crimes, too, from car theft to burglary.
As part of their efforts, task force members have also tallied just how costly sexual assault cases can be: So far, they’ve identified $220 million in outlays for the cases, ranging from hospital and counseling fees of victims to the expense of trials and out-of-pocket costs for victims who attend. Recent statistics indicate that the total costs of a rape typically reach at least $87,000.
Tracking those amounts is essential, Bell says, because it shows funders that their financial support contributes to prevent future rapes and other crimes those offenders are likely to commit, which saves money.
As they’ve learned more about sexual crimes and how to deal with them, Cleveland officials are increasingly being asked to speak across the country. “We’re trying to help other jurisdictions learn from our mistakes,” says Bell, who notes that task force members have talked to police departments in at least 20 cities. “We see the similarities in other places where kits weren’t tested or not enough detectives were put on cases to investigate and find the victims, so cases were regularly shut down when they should have been kept open.”
Standing nearby, with snow swirling in the gray lakefront skies behind her in the window of Bell’s office, Lovell reflects on the groundbreaking work being done in Cleveland. “There’s not a lot of research-based literature on sexual violence,” she says. “So, our ultimate goal is to change the ways we talk about rape, treat rape victims, and support them.”