If you survive a rape in Multnomah County but aren't critically injured, your options for hospital treatment are so limited that experts and advocates say the system discriminates against you.

Victims who need emergency treatment for external injuries must be admitted at any of the county's seven hospitals. And those willing to report the rape to police are offered a rape kit (consisting of a medical exam, sexually transmitted disease prophylaxis, emergency contraception, and collection of evidence is collected).

But if they're not critically injured, women are advised by emergency rooms across the county to go to Oregon Health & Science University, which has the county's only hospital with specialized personnel called "sexual assault nurse examiners," or SANEs.

Told to drive to another hospital, many women decide not to put themselves through the ordeal of admission twice, and go home without proper treatment, says Erin Ellis, executive director of the Sexual Assault Resource Center in Portland.

Melissa, a case worker at the Portland Women's Crisis Line, says that leaves already-traumatized women wondering on the spot, "How many places do I have to go to tell that this terrible thing happened to me?"

Their answer all too often, says the case worker, is "I'm exhausted, I don't want to do this again."

Elaine Walters, SANE coordinator for the state Attorney General's Office, says the local system is broken and is hosting a regional conference Wednesday, Aug. 23, to find ways to better meet victims' needs.

The county is in this spot because OHSU took the lead about 15 years ago in providing care for rape victims. Local law enforcement responded by giving OHSU an exclusive contract to administer rape kits.

That contract is no longer in force, but in the four years the state's SANE program has existed, no other hospital has picked up any responsibility from OHSU.

There are seven SANEs at OHSU and two at the student medical center of Portland State University, but frontline rape responders say the two PSU nurses are virtual unknowns to them. That leaves seven nurses on Pill Hill to care for most county rape cases.

Other Oregon counties do things differently. In Washington County, for example, there are 13 SANEs in three hospitals: Providence St. Vincent, Tuality Hillsboro, and Tuality Forest Grove. Sgt. Tom Hunt of the Portland Police sexual assault detail says the system in Multnomah County remains geared toward OHSU because other hospitals lack evidence lockers and trained staff to preserve the results of the rape kits.

But that wouldn't be so hard to change. Planned Parenthood nurse Barb Kane, who is going through the 60-hour SANE training so she can offer rape services at her Northeast Portland clinic, says the training goes into great detail about evidence preservation.

Legacy spokeswoman Lisa Wood says her hospital and others agreed to keep sending noncritical rape victims to OHSU after the university hospital decided to keep taking them because it had the expertise. None of the hospitals tracks how often that happens.

Erin Ellis says other hospitals have declined to participate in the past because a lot of bills for sexual-assault cases remained unpaid and had to be sent to a collections agency. And Allie Draper, a nurse who co-chairs the SANE program at publicly funded OHSU, says, "Certain hospitals are meant to make money, [and] sexual-assault care is a community service."

To illustrate the magnitude of rape, consider these numbers: Local law enforcement responds to about 450 sexual-assault calls a year. The Portland Women's Crisis Line, the main helpline for victims in the county, gets about twice as many calls—900—from women who don't want to report to the police. And other state estimates of rape make even those figures seem low.

There is a glimmer of hope: A state task force is working on a bill for the 2007 Legislature that would allow women to get a rape kit at any hospital without having to report to police. The change would not force hospitals to take patients. But Chanda Evans, director of the Portland Women's Crisis Line, says not having to face police right after an attack would help victims.

"The increase in numbers," Evans says, "would force hospitals to face the fact that they can't turn anybody away."

Rape victims can call the Portland Women's Crisis Line, (503) 235-5333 or (888) 235-5333; and the Sexual Assault Resource Center, (503) 640-5311.