The study, which looked at six states — Florida, Massachusetts, Colorado, Nebraska, Wisconsin and Oregon — found that the supply of examiners in each was too small to cover the need for sexual assault exams, especially in rural areas.

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Wisconsin officials, for example, reported that nearly half of the state’s counties lacked a single examiner available for a patient who requested a rape kit. Nebraska struggled with the same imbalance.

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Turnover is also an issue, the authors wrote: Of 540 examiners trained in Wisconsin, only 42 were still on the job two years later.

Meanwhile, just one hospital in Colorado — Memorial Hospital in Colorado Springs — staffs examiners 24 hours a day, seven days a week. Some patients in the state must drive an hour to find such care, said GAO's Katherine Iritani, who led the study.

“If you’re in the mountains in the winter, and you’re told you have to go somewhere else, that can be a big barrier,” said Iritani. “Some victims never get tested.”

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Though the actual number of examiners in the U.S. is unclear, 227 programs in 49 states received government grants to train about 6,000 examiners in 2013, the most recent data show. (The Justice Department set aside more than $100 million to strengthen community responses to sexual assault.)

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The authors argue that more attention must be paid to rural communities, where rape investigations are more likely to end before they can begin.

Rape kits, as sexual assault exams are called, involve a medical professional meeting with a victim in an attack’s aftermath to swab for body fluids and document any injuries. They also provide emergency contraception and sexually transmitted infection testing.

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Advocates for victims of sexual assault say a speedy exam is necessary for the best shot at criminal charges that stick. They recommend medical centers provide at least one specially trained examiner on a round-the-clock basis. Experts say timeliness is crucial for evidence preservation — and a victim’s comfort, since they’re advised not to eat or drink between the time of the assault and examination.

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The GAO’s sample, of course, was comparatively small compared with the country’s pool of sexual assault examiners. The inspection of six states, though, hints at a broader problem, Iritani said.

Most states keep no data on their sexual assault examiners, she noted. Perhaps that’s why, despite federal grants reserved for their professional education, examiners who are available for patients often receive inconsistent training.

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The report’s authors argue that training for examiners in each state is limited and hospitals are sometimes reluctant to cover the cost of the programs. The pay for examiners, meanwhile, is often lower than typical Emergency Room staffer salaries. The hours also tend to be long and unpredictable — conditions that contribute to culture of burnout.

Nearly one in five women in the United States have been sexually assaulted, according to the latest DOJ statistics. While an estimated 32 percent of rapes lead to a police report, a slim 2 percent lead to a conviction.

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Colleen Gallopin, deputy executive director of the DC Forensic Nurse Examiners, which compiles rape kits for adults in the District, said her staff — a team of roughly 25 nurses — performed 410 exams from October 2014 to September 2015.

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The work is a non-stop endeavor. Some weeks bring up to 60 patients, who find the service through showing up at a hospital or calling their hotline.

Forensic nurses must be trained in both DNA collection and trauma sensitivity, Gallopin said. Botching a kit could mean compromising an investigation. Delaying a patient in a vulnerable emotional state could compel him or her to just go home.

“We don’t want to keep patients in the room, waiting for hours,” said Gallopin, who said members of her staff work all day and all night. “It’s in the interest of the community to preserve evidence and hold predators accountable.”

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Bridgette Stumpf, co-executive director of Network for Victim Recovery of DC, which pairs victims with advocates as they go through the criminal justice system, said how a victim is treated during a rape kit could also impact his or her criminal proceedings.

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Examiners learn in training to ask for consent before collecting a hair or photograph. They remain objective yet polite, acknowledging the patient is a human being and not a test subject.

"The way a survivor feels they are treated by the nurse," she said, "is going to have a huge impact on whether they decide to make a law enforcement report."