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GREENSBORO - A startling number of rape cases never see a prosecutor's desk, much less a courtroom.

Police, health care workers and victims' advocates say a host of problems can derail investigations - sometimes even before they really start.

Victims decline to cooperate with investigators. Evidence is scant. Going to trial can take too long.

The result is that fewer than half of rape victims report the crime, according to a 2007 study by the national Bureau of Justice Statistics, and a tiny fraction of those cases end up in court.

A new federal law, which went into effect Jan. 1, seeks to change all that. Previously, health care providers were required to contact police when patients arrived reporting sexual assault.

Under the new law, women may now seek medical treatment for rape but are not obligated to immediately report the crime to police.

While it sounds counterproductive to increase the number of rape investigations and prosecutions, victim advocates say separating medical care from reporting the crime is an improvement.

"If (rape victims) get treatment and care, they're far more likely to go ahead and speak to law enforcement and possibly move forward with prosecution," said Catherine Rossi, head of forensic nursing at Moses Cone Health System.

Nationally, the number of reported rapes has declined, according to federal crime-reporting studies.

But in Greensboro, rape reports have increased in three of the past four years from 90 in 2006 to 118 in 2008.

More surprising is the outcome of those accusations. Of the 400 rapes reported to Greensboro police between Jan. 1, 2005 and Dec. 31, 2008, 68 resulted in a warrant or an arrest.

What happens in the rest of the cases?

In 20 percent, police cannot prove that a crime occurred, so the investigation stops.

In another 22 percent, cases are "exceptionally cleared." That means that, while police are able to determine that a rape occurred and have identified a suspect, something beyond their control ends the investigation.

In 24 percent, cases grind to a halt when detectives go as far as they can with the evidence they have, but can't determine who to charge with a crime. These cases can be reopened if more evidence comes to light.

In the remaining cases, prosecutors decline to move forward and, in a handful of cases, women refuse to cooperate with detectives.

Police who work rape cases said they hope the numbers are going up because of the strength of outreach and support programs that encourage rape victims to report the crime.

"Any time we have a change, we ask, 'Are more women reporting?'" said Cpl. Cheryl Cundiff, the police department's head sexual assault investigator.

For instance, Cundiff said the department has seen a steady increase in the number of women reporting domestic rape - rape by a husband or boyfriend.

But Cundiff said the rising numbers might be a consequence of the city's growing nightlife.

"Alcohol plays a lot of roles with this, too," Cundiff said. "You've got more bars in Greensboro, more women going out."

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 Several Greensboro-area law enforcement agencies and prosecutors partner with medical professionals in the Sexual Assault Response Team, which meets bimonthly.

"They all get to sit at the same table and talk about all the rapes that are happening," said Rossi, the Moses Cone head of forensic nursing. "Greensboro is the leader in the state. We've been doing it consistently, and consistently well, longer than anybody."

Rossi coordinates the Sexual Assault Nurse Examiner program for Moses Cone and is president of the North Carolina chapter of the International Association of Forensic Nurses. She sees both sides of a rape investigation and knows it's difficult for both victims and detectives.

Without evidence of a crime, police are limited in what they can do for victims. After all, sometimes the evidence left by a rape may not look different from evidence of consensual sex.

"Just because you can't prove it doesn't mean it didn't happen," Rossi said. "It may only take a slap to the face. You don't always have these violent injuries. ... Proving harm is very difficult."

The investigation is also made more difficult because there is a short window of time - no more than 72 hours - in which to collect evidence before a woman's body cleans and heals itself.

Sonya Desai works for Family Service of the Piedmont and with the Greensboro Police Department as a victim witness advocate. Her clients are victims of rape and sexual assault, and her job is to guide them through care, counseling and the criminal investigation.

Desai said a number of women simply run out of patience for what can be a long and personally difficult process, especially when it comes to having to retell the painful experience repeatedly.

"I never ask what happened," Desai said. "Every time she has to retell her story, that's revictimizing her again."

And many victims don't feel like the benefit they get from following through to prosecution is worth the effort and pain, said Monika Johnson Hostler, executive director of the North Carolina Coalition Against Sex Assault.

Statewide, only 1 to 3 percent of cases result in prosecution, Hostler said.

"Reporting to law enforcement doesn't give them any sense of closure or validation," she said.

But victim advocates hope that women who take advantage of anonymous rape kits will be able to revisit their decision not to report and the end result will be more justice for rape victims.

"My primary goal is to make sure my patient is taken care of," Rossi said. "If I can at least offer to preserve the evidence, six months later it's there and it's not lost."

Contact Sonja Elmquist at 373-7090 or sonja.elmquist@news-record.com