By Kimberly Sherman

In most career settings, there is at least one stand-out employee: one who treats work as a life calling rather than simply a job, and whose effervescent dedication helps to spur a radical change.

Meet Angie Graziano.

Ask Graziano what she does in her free time, and she charmingly stumbles over her words. She’s a single mother who likes to read, go to the movies, spend time with friends, and, um …

Ask her what she does at work, and after the disclaimer, “I’ve always been driven,” Graziano shares a captivating dissertation about her biggest career achievement, the development of the SART (sexual assault response team) program for Tulare Regional Medical Center.

Graziano, now the director of the Medical Services unit, recalls her introduction to the world of nursing, the precursor to her dedication to improving the lot of sexual assault victims. Her tone is modest and void of any puffery.

“I always wanted to be a nurse, but it was derailed when got into the milk industry as a lab tech for Los Angeles County,” said Graziano. “But I always felt my calling was in the nursing industry. I love children and the elderly.”

Ten years into her job, performing microbiology testing for all the milk in Tulare, tragedy struck. Graziano’s 18-month-old toddler was stricken with viral meningitis and became comatose for well over a week. Staying with her daughter day and night, Graziano found solace in a nurse who spent extra time consoling Graziano, offered words of encouragement despite doctors’ grievous concerns, and helped her understand her daughter’s condition.

Miraculously, after a three-week stint in the hospital, Graziano’s daughter emerged unscathed, dodging obstacles such as speech, bone, and neurological complications that the doctors had warned might plague her.

One year later, Graziano chased her nagging dreams by enrolling in the College of the Sequoias. “I graduated from the nursing program in 1988 and came to the hospital in 1989,” she said. Tulare Regional Medical Center has been her sole employer since her graduation.

Grass-roots Efforts Realized

Graziano, interested in dealing with patients in crisis, attended a seminar in 1990 designed to bring the special needs of sexual assault victims to light. With the success of the San Luis Obispo SART (Sexual Assault Response Team) program as a model and some tips for starting a local team, Graziano came home, vigor renewed. “I decided we could launch a program like that in our community to make a difference in assault victims and to inform the community,” she said. “Rape affects both children and adults, the rich and the poor. There are no barriers as to who it affects, and there were no local programs that took care of the victim from beginning to end.”

Graziano targeted the fragmented relationship between law enforcement, nursing services, and the district attorney’s office. She started her grass-roots effort by forming a partnership with “Rape Crisis” through Tulare County Human Services and garnering support from community services such as the victim witness program, each of whom would be a part of the sexual response assault team.

Along with training on how to take evidence with a rape kit, conduct a detailed interview, and take proper photographs, nurses involved in the program rode with police and sheriff’s officers and spent quality time with the district attorney and local gynecologist to fully understand anatomy and injury. “We spent a lot of time perfecting our abilities in order to qualify as expert witnesses in the courtroom,” she said.

In 1991, a year after campaigning and tying up partnerships with all the necessary agencies, the SART program was put into practice at Tulare Regional Medical Center—the first such team in the San Joaquin Valley.

A Much Needed Change

Typical protocol for the fragile rape or molest victim prior to the inception of the SART program was no different from that for a patient sick with the flu. “They had to compete for hospital services just like any other patient in the ER,” said Graziano. “Their information was taken in front of other people. A nurse would come in and get an assessment, followed by the doctor, then the police were called in. That victim had to try and tell a horrid story three to four times, and evidence was collected in spurts.”

Understandably, sexual assault victims often left the hospital without services rendered, harboring evidence and feelings of guilt, the potential for apprehending a violent suspect compromised or lost. Viable evidence of rape decreases significantly after three days, and the lack of physical evidence makes for a difficult prosecution.

Getting to court with an interview chain-of-command and evidence intact was key for a

successful prosecution. Providing enough emotional support to allow the victim to work through the crisis and face the perpetrator in court was the goal.

With the SART system in place, a nurse was on-call twenty-four hours a day to help rape or molest victims. The patient was secured outside of the emergency room setting and escorted into a private room with the freedom to move about during the two- to three-hour process.

With all pieces of the puzzle, in the forms of each agency, in place, law enforcement officials and a nurse took care to interview the victim one time only. A new set of clothing was provided (the old clothing collected as evidence) and a rape crisis advocate filled the role of emotional support. This freed the nurse to focus on treating any physical injury, administering medications—prophylactic antibiotics, a morning after pill if there was a chance of pregnancy—and helping with a hot shower.

“We had an array of patients, including men, those infected with HIV, gang rape victims, and those given roofies (the date rape drug),” said Graziano. “ The youngest victim was 7 months and the oldest was 64, but the majority of victims were 16 to 24 years old.”

Reaching a New Level of Care

Although the SART program at Tulare Regional Medical Center disbanded in December of 2000, Graziano is exuberant about the level of care that has superseded her grass-roots efforts begun ten years earlier.

“The level of expertise required to handle these cases has brought nursing into the level of forensics,” she said proudly. “Now, law enforcement officers take the victim to a designated hospital and a forensic team of nurses in Fresno are dispatched out to handle these exams.” Child victims are taken to Fresno for specialized care.

In 2006, Graziano was certified as a Palliative Care Trainer by the End-of-Life Nursing Education Consortium (ELNEC). She has since turned her skill and enthusiasm to a new program and facet of care.

“Our hospital is the first in our region to embark on improving the quality of advance care planning. All too often we find families and patients having to make difficult choices at the end of life rather than making these choices with loved ones in advance based on their values and healthcare goals,” she said. “The goal of advance care planning and advance directives is to ensure and respect patients’ wishes at the end of life. This program, too, will make such a difference in our communities.”

In recognition of her dedication and the milestones in the quality of nursing care that Graziano has achieved over the past 20 years, the humble nurse determined to provide the best in care for her patients has received a slew of awards.

Of her work with the SART program, Graziano summarized her intensive efforts: “We educated hospitals and law enforcement, strengthened prosecution, and helped victims become survivors.”

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