Why It Matters
Kentucky’s regulatory framework for sexual assault nurse examiners is creating barriers that prevent survivors from accessing critical medical and forensic care when they need it most. The state’s mandatory licensing requirements for specialized nurses have contributed to a severe shortage that leaves 100 of Kentucky’s 120 counties without trained sexual assault nurse examiners (SANEs), forcing survivors to travel long distances or forgo treatment entirely. This access gap has direct consequences for both victim care and criminal investigations, as SANEs collect vital evidence and provide testimony essential to prosecuting perpetrators and protecting public safety.
What Happened
Kentucky faces a significant shortage of sexual assault nurse examiners despite the state doubling the number of licensed SANEs since 2019. The shortage became visible in 2018 when Baptist Health in Louisville lacked a SANE on staff and was forced to call other hospitals to transfer a survivor seeking emergency care. Nursing director Denise Carter described the situation as “really wrong,” highlighting the burden placed on survivors who must advocate for themselves during a medical crisis.
According to a December report from the Kentucky Legislative Research Commission, 100 of the state’s 120 counties have no SANEs available. This means survivors in the majority of Kentucky counties must either travel significant distances to receive specialized care or delay treatment. Survivors awaiting care are unable to use bathroom facilities, shower, change clothes, or eat—restrictions necessary to preserve forensic evidence.
In response, Kentucky’s legislature has introduced legislation to address the crisis through infrastructure and coordination improvements. The proposed bill would establish a SANE coordinator position tasked with recruiting nurses, facilitating training, and building relationships between hospitals and rape crisis centers. The legislation also calls for creating a public SANE registry to improve awareness of available services.
By the Numbers
- 100 of 120 Kentucky counties currently have no sexual assault nurse examiners
- Licensed SANEs in Kentucky have doubled since 2019
- One documented case in 2018 at Baptist Health in Louisville involving an unserved survivor
- Nearly 30 years of mandatory state licensing requirements for practicing registered nurses seeking SANE credentials
Zoom Out
Kentucky’s challenge reflects a national pattern identified in recent policy analysis. A Cato Institute examination of SANE licensure requirements across the country found that mandatory licensing and certification frameworks increase barriers to care, slow professional development, and ultimately exacerbate survivor suffering. The analysis concluded that these regulatory structures often prioritize the interests of physicians and other medical practitioners over the needs of survivors and nurses themselves.
The shortage of specialized sexual assault care providers is not unique to Kentucky. Many states face similar access gaps, particularly in rural regions where specialized medical services are scarce. The tension between professional credentialing standards and service accessibility has become a broader policy debate as states evaluate whether current licensing frameworks serve their intended protective function or inadvertently harm the populations they aim to serve.
SANE programs require nurses to complete specialized training in medical-forensic examination, evidence collection, and trauma-informed care. The clinical expertise is essential—SANEs perform examinations that protect evidence for legal proceedings while providing compassionate care to survivors. However, the regulatory pathway to becoming a SANE remains a point of contention among healthcare experts and patient advocates.
What’s Next
Kentucky’s legislature is expected to consider the proposed SANE coordinator legislation, which represents the state’s immediate response to the access crisis. If enacted, the coordinator position would begin recruitment and training efforts while establishing the public registry to increase awareness of existing SANE services.
Beyond the immediate legislative action, Kentucky will need to address the underlying regulatory framework that experts identify as a barrier to expanding the SANE workforce. This may involve examination of licensing requirements and potential alternative credentialing pathways that maintain clinical standards while reducing entry barriers for nurses seeking SANE training.
The Kentucky Legislative Research Commission’s December report suggests ongoing monitoring of SANE availability. The state will likely track whether coordinator efforts successfully increase the number of practicing examiners and whether access improves in underserved counties. Broader policy discussions may also emerge regarding how regulatory frameworks can be reformed to better align professional credentialing with patient access goals.