Nerone begins the process by interviewing the patient about the incident. The information will help her tailor the physical examination and, eventually, help make determination as to whether the physical evidence is consistent with the victim’s account. During the course of the exam, Nerone utilizes swabs, combs and a high-magnification camera that can document even small bruises or tears.

The exam itself, Nerone said, is relatively straightforward and simple. More difficult is correctly compiling the extensive documentation needed to ensure that the kit can pass muster as evidence in a criminal proceeding. One missed initial or misplaced swab can create an opening for a defense attorney to attack the credibility of the entire exam.

“It’s easy to get something thrown out of court if you’re not meticulous,” said Nerone.

Once the exam is complete, the kit is placed in a secure storage space. If the police have been notified, an officer will collect the kit and transport it to a state police crime lab for DNA analysis. If not, Nerone will keep the kit as long as there’s room in the safe, usually about 90 days, in case the victim decides to report the assault to authorities.

Senior Assistant District Attorney Katherine Van Loan heads up Carnright’s new Special Victims Unit. According to Van Loan, the forensic exams can yield smoking gun evidence, but only under limited circumstances. Van Loan, who has spent more than a decade prosecuting sex crimes, said only 30 to 40 percent of assaults are reported within the 96-hour time frame when useable DNA evidence is likely to be found in an exam. Of those, about 25 percent will come back with a positive hit linking the suspect to the victim. Confronted with DNA evidence, suspects can still fall back on a “consent defense,” arguing that the encounter was consensual. But in cases involving minors, where a consent defense is not an option, the DNA hit usually constitutes game, set and match for the prosecution.

“If we’re talking a about a child victim, direct DNA on a rape kit or a reverse rape kit, that’s it,” said Van Loan. “We usually get a plea.”

In the event that a case does go to trial, state police chemists will testify about any DNA and other lab tests. But it is up to Nerone to present the findings of her physical examination. Most critically, Nerone will be asked to answer with a simple yes or no (because hearsay rules bar her from repeating victims’ statements) whether the condition of the patient’s body comports with their account of the attack. In the case of the man accused of attempting to rape the 9-year-old, Nerone pointed to a discoloration on the hymenal ring that she said could have been caused by blunt force trauma. She also testified that attempted penetration of the vagina of a pre-pubescent girl would cause extreme pain, corroborating the victim’s testimony in which she rated the pain during the alleged assault as an eight on a scale of one to 10. But, on cross examination, Nerone conceded that the discoloration could have been caused by other factors and that she cannot say for with certainty that the exam turned up unassailable evidence of attempted penetration. The defendant in the case would later be acquitted of sex crimes charges in the case, a circumstance Nerone described as “frustrating.”

But, for Van Loan, who prosecuted the case, Nerone’s impartiality, both during the examination and on the witness stand, and her ability to stick to the facts are her greatest asset. Other SANE nurses, Van Loan said, might be moved to “stretch” their testimony out of sympathy for a victim. That’s a mistake in a proceeding where defense attorneys are prepared to seize any thread of inconsistency to unravel expert testimony.

“She’ll tell you what she can tell you and she’ll tell you what she can’t tell you,” said Van Loan. “That’s why she’s so credible.”

The emotional strain of dealing impartially with victims of sexual assault is one reason why Nerone is currently the only certified forensic nurse working with the SANE program in Ulster County. The work can be literally stomach-turning, even for veteran ER nurses. Nerone recalls one former colleague who would be struck by crippling migraines every time she had to do an exam. The low pay and need to be on call around the clock deter others. Nurses who can handle the exam may be unwilling or unable to handle the demands of the legal system.

“We had one nurse who took the training and did a few exams,” recalls Van Loan. “But when she had to testify, it turned out she was not comfortable saying the word ‘vagina’ in public, and that’s a problem when you’re a SANE nurse.”

When Nerone began working with the SANE program back in 1997 there were three nurse examiners. At the program’s peak, there were 10. Now, as the only one left, Nerone is essentially on call all day every day. She has had to run out on her kids’ concerts and family evenings out. The last time she went to a conference, she had to get on the phone to walk a colleague through a sexual assault exam step by step. Nerone said she sticks with the job because she finds it interesting and out of a sense of dedication to victims whose only chance at justice may lay bundled in a meticulously documented, expertly administered examination.

“If someone in my family was abused, I would want someone who had an interest in taking care of them,” said Nerone. “Not someone who drew the short straw.”