Wednesday, Oct. 31, 2007 | 7:35 a.m.
Clark County's decision to suspend a popular program at the Children's Advocacy Center stemmed from concerns about clerical staff 's assisting nurses in examinations of children for sexual abuse, sources say.
The county has officially cited undisclosed personnel reasons for its suspension of the medical component of the Sexual Abuse Investigative Team that operates out of the center next to Clark County Family Court.
But sources familiar with the reasons for suspending the program, who spoke to the Sun on condition of anonymity, said worries arose when county clerical staffers expressed concerns about the propriety of their role in the exams. The county abruptly ended the exams Oct. 4 and transferred the case load to Sunrise Children's Hospital.
The doctor and two nurse practitioners who performed and signed off on the exams said the county did not consult them before closing the service.
Advocates of the program have criticized the county for its haste and its failure to provide more information about the reasons behind the decision.
The program's collaborating physician, Dr. John Martin, said his main concern is the children involved.
"The whole idea of SAINT (the investigative team) is to provide them with a child-friendly environment," he said.
The examination area allows children to play with stuffed animals and video games and is painted with murals. It is intended to be a more relaxing, less intimidating atmosphere for exams than a hospital emergency area.
Christine Skorupski, a spokeswoman with the county's Family Services Department, would say only that the decision was tied to a specific personnel matter that the county is investigating.
"We will be reinstating the medical exams, hopefully later this year," she said. "We're in contract negotiations with some new medical providers. We also may add a medical director."
Clark County Commission Chairman Rory Reid said the program's suspension arose from concerns over how the exams were being conducted.
Family Services Director Tom Morton was concerned, Reid said, "that people were doing it that might not have had the proper training."
A physician and two nurse practitioners provided the service on a part-time contract ual basis. The nurse practitioners, however, often relied on county clerical staff, such as office assistants, to aid in the exams.
Phyllis Suiter, one of the nurse practitioners, said county clerical employees began assisting in the exams about 21/2 years ago, after the county removed a federally funded social worker therapist who had helped with the tests.
The clerical workers sometimes held hands with the children during exams and, on rare occasions, squirted water through a syringe into the child's genital area to help the nurse with the exam, Suiter said.
Earlier this year, Suiter said the county told the SAINT medical team that clerical employees could no longer assist in the exams because it was not part of their job.
So the nurses began relying on volunteers, including a retired registered nurse, throughout the spring and summer, Suiter said. During a short period in late summer, a county therapist intern assisted in the exams, but left abruptly to return to school, Suiter said.
When that happened, Suiter said, the county hired one of the part-time clerical workers who had previously helped with the exams to fill the intern's part-time exam assistant position.
The clerical worker had been a certified nurse assistant in another state and was attempting to gain certification in Nevada, Suiter said.
That clerical worker assisted with four exams on a day in early October before Family Services officials decided she could no longer participate because she was not yet certified in Nevada, Suiter said. The staffer was transferred back to a part-time clerical position at the Children's Advocacy Center and the medical program was suspended.
Sources familiar with the decision said that immediate supervisors at Family Services knew about the clerical staff's intimate involvement in the exams for several months, but that higher-level managers learned of it only recently when the issue was mentioned as part of a labor issue.
Suiter, a faculty member at the University of Nevada School of Medicine, said she thinks the reason the county took action was concern over possible lawsuits by suspected perpetrators.
But sources familiar with the program's suspension said that was not a significant factor in the decision.
Dr. Andrew Eisen, former director of pediatric residency at the University of Nevada School of Medicine and now an associate dean at Touro University, said that in general, it is not inappropriate for non medical personnel to assist in such exams if the person had training in patient privacy and taken precautions to prevent the spread of infectious diseases.
Suiter said the clerical staff never received formal training in precautions, but wore gloves and washed their hands before and after assisting in the exams. Another source said that children being examined were asked whether they wanted a parent present, and that 95 percent of the time, a parent was in the exam room.
Sunrise Children's Hospital, which is handling the exams for now, already examines children in its pediatric emergency room when sexual abuse is suspected.
The county is considering contracting with Children's Healthcare Network, a local group of pediatricians, to conduct the exams at the Children's Advocacy Center, Skorupski said.
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