While the Obama administration presses colleges and universities to respond more aggressively to sexual assaults, students who are attacked at Baltimore-area schools are unable to get rape kit exams on their campuses.
Instead, they must go to a hospital off-campus — an extra step that advocates for victims say deters at least some from reporting the crime.
The question whether schools should offer the exams is the subject of a national debate that is dividing school administrators, nurse examiners and advocates — with victims falling on both sides.
Nationwide, some colleges and universities have the kits and trained personnel to administer them, but it is unclear how many. No state requires its schools to make the exams available.
Officials at Baltimore-area campuses say costs, training and privacy concerns prevent them from offering the service.
"We're not meant to be experts, but to get [students] to experts," said Kathleen Anderson, dean of students at the University of Baltimore.
Pam Holtzinger, president of the Maryland-D.C. chapter of the International Association of Forensic Nurses, says if schools themselves employed staff trained to administer the exams, "I'm absolutely confident that [reports] would go up."
Nearly one woman in five in college is sexually assaulted, according to the Centers for Disease Control and Prevention. It is believed that a large majority of cases are not reported.
Baltimore-area schools reported at least 30 sexual assaults from 2007 to 2012. The University of Maryland, College Park reported 57 assaults during that time.
At present, an area student who wants a rape kit from a forensic nurse examiner or sexual assault nurse examiner must go to Greater Baltimore Medical Center or Mercy Medical Center. The nurse examiner addresses any trauma suffered by the victim and gathers evidence for law enforcement authorities.
The exam can take an hour or two. To be effective, it must be performed within 120 hours of the attack.
The White House released reports this year highlighting the problem of sexual assault on campus, and President Barack Obama has pushed colleges to bolster prevention programs, strengthen response plans and toughen disciplinary processes.
In Maryland, the Governor's Office of Crime Control and Prevention and the Maryland Coalition Against Sexual Assault are distributing booklets at 55 colleges and universities in the state with steps students should take to prevent sexual assault and to get help if it happens. Lisae Jordan, executive director of the coalition, describes the work as a response to the White House action.
Jordan said it's premature to say whether Maryland schools should offer rape kits, but called the idea "an important alternative to look at," and something the General Assembly should "absolutely examine."
Edward Parker, deputy director of the Office of Crime Control and Prevention, said the office is "willing to entertain anything that would help us deal with the problem."
If the growing focus on campus assaults leads more campuses to call for services, Jordan said, rape crisis centers might not be able to handle the demand.
"We're glad there's renewed attention," she said. "It's important to shine a light on the issue. But to have a response, [we] need more support."
A Baltimore woman who says she was sexually assaulted years ago on a campus in North Carolina believes that making rape kit exams available on campus would be "a great resource" for victims.
In her case, she said, she would have gone to the campus health center to report her assault, but the center did not have a nurse to administer the exam.
"I think there is a benefit to having that option and keeping your privacy for whatever reason," the woman said. The Baltimore Sun does not identify victims of sexual assault.
She said she asked for an exam at a hospital, but did not receive one. She said she was told by campus officials the next day that she "didn't have enough bruises" to go through with a report. She said no report was taken, and her assailants faced no repercussions.
The Oregon State University health center offers rape kit exams. Linda Reid, director of the sexual assault nurse examiner program there, said they should be an essential part of survivor care on campuses nationwide.
"Campus health services are uniquely qualified to address student needs because students are who we take care of," she said. "We're very good at making students feel very safe."
Another victim of a campus sexual assault said universities should not offer rape kit exams.
The woman was raped on the eve of her graduation in a rowhouse near Towson University. She was taken by ambulance to the Greater Baltimore Medical Center and given a rape kit exam.
"The knowledge [at a hospital] is going to be far more advanced" than at a campus health center, she said. "I think it's just scary for people to report. ... It doesn't have anything to do with where the rape center is — nobody's thinking about that."
The woman testified in court against the man who assaulted her. He was convicted and sentenced to 50 years in prison.
Debra Holbrook, director of forensic nursing at Mercy, believes that sexual assault nurse examiners are not needed on campuses if hospitals nearby provide the same service.
Holbrook, who sees about 750 sexual assault cases per year, has 31 forensic nurse examiners available to perform exams.
"I'm a firm believer in a designated center where it's done perfectly," she said. "[There's] less chance of dropping the ball."
Jeanne Lombardi, director of health services at Loyola University Maryland, believes most sexual assault victims would rather go off campus for an exam.
"It's kind of a more private area away from campus," she said. "It just makes more sense."
When a student at Loyola is assaulted, the school provides transportation to a hospital.
Lombardi said Loyola is not equipped to offer rape kit exams, and the training for sexual assault nurse examiners is intensive.
A certification course can be completed in a week. At Mercy, initial training costs about $250. Annual recertification is free.
Dennis O'Shea, a spokesman for the Johns Hopkins University, said the university directs assault victims to Mercy in part because it is open all hours. The Hopkins student health center is not.
Lisa Dever, head of the sex offense and child abuse unit at the Baltimore County state's attorney's office, said exams are "crucial" in the prosecution of rape cases.
"Lots of times there is no evidence," she said. In court, she said, the fact that a kit was done at all "certainly goes a long way."