Your evidence can make or break a conviction
When Trudy A. Meehan, RN, CHE, director of emergency services at East Jefferson General Hospital in Metairie, LA, was subpoenaed to testify in a rape case, she was grateful for a longtime habit of sealing pieces of evidence with tape she had initialed. When the defense attorney asked Meehan if she had collected a certain item, she confidently answered "yes." He asked how she was so sure. "I politely showed him my initials on the tape that had secured the specimen container," she says. "It was the most priceless look of amazement I had ever seen. He promptly indicated he had no further questions for me."
Practices such as this one can make or break a conviction case for a victim of sexual assault, according to new research. Two studies have demonstrated a close link between documentation of traumatic injuries and eventual convictions.1,2
"Forensic evidence is very important to a sexual assault case and has made the difference achieving a conviction in many a case," emphasizes Diane DeHart, PA, coordinator of the sexual assault nurse examiner (SANE) program at Harborview Center for Sexual Assault and Traumatic Stress in Seattle.
If a SANE team isn’t available, you should ask request training in collection of forensic evidence, says Valerie Sievers, MSN, RN, CNS, CEN, SANE-A, clinical forensic nurse specialist and SANE Coordinator at Colorado Coalition Against Sexual Assault in Denver. "The Joint Commission [on Accreditation of Healthcare Organizations] mandates that emergency departments and ambulatory care centers provide education to staff who will respond to victims of interpersonal violence," she underscores.
DeHart says that many SANE programs provide training programs for ED nurses. She suggests sending one or two ED nurses to a training course, who in turn can return to their ED and function as a resource or trainer for the nursing staff. She also recommends making an appointment to tour your state crime lab, if you are regularly involved in forensic evidence collection. "Most labs give such tours to people involved in this process," she says. "Seeing what happens to the evidence and learning why certain techniques of collection are important can be a great help."
Training is important because ED nurses may be the first health care providers to have contact with a patient, so what they observe and record is invaluable. Here are items to consider:
• What the patient tells you. DeHart says to include details in the history such as the type of physical contact that occurred, whether ejaculation occurred, and whether a condom was worn. "All of this information will give clues as to where potential DNA might be located and lead to collection of valuable evidence," she says. Use the patient’s exact words, and describe the patient’s appearance, she advises. "You are painting a picture of how that patient appeared to you, what she said, and what the assailant said," she says.
• Appearance of an unconscious patient. Start the evidence collection process immediately if you suspect sexual assault, says DeHart. She gives the example of an unconscious trauma victim with clothing partially removed. In this case, place the clothing in a paper bag and label it, DeHart says. "Thus, clothing that might contain valuable forensic evidence is saved rather than discarded," she explains.
Here are effective ways to collect forensic evidence in your ED:
• Consider every item as potential evidence. Even such items as tree bark, leaves, and dirt can assist forensic experts in determining the location of a crime scene, stresses Meehan. "Assume everything you can possibly collect is potential evidence," she says. "Let the people at the forensic laboratory exclude it."
• Work closely with SANEs. An ED nurse once stopped DeHart in the hall to explain that an obtunded patient needed to be catheterized for a toxicology specimen, and the nurse was concerned that evidence might be lost. "This was excellent information to have and resulted in us doing the procedure together," says DeHart. "I gathered the vulvar swabs for evidence prior to the application of Betadine solution for the catheterization."
• Follow instructions in the evidence collection kit. If you don’t routinely perform rape examinations, Meehan recommends pulling out the directions of the rape kit,’ rather than risk improperly performing the exam. "Share with the patient that you are following the directions exactly to ensure that all evidence is properly collected," she says. It also will make the patient’s case stronger in court if you can testify that you followed the printed guidelines, says Meehan. "Make note of this, since by the time the case comes to trial you will not recall," she adds. "Your documentation will aid in supporting that you gathered the evidence properly."
• Provide privacy during the examination. You must ensure privacy for the victim and obtain consent before any collection or examination, stresses Sievers. "This exam is not a spectator sport, and there is no legal reason for an audience of people to be present during collection of evidence," she says.
1. Gray-Eurom K, Seaberg DC, Wears RL. The prosecution of sexual assault cases: Correlation with forensic evidence. Ann Emerg Med 2002; 39:39-46.
2. McGregor MJ, Du Mont J, Myhr TL. Sexual assault forensic medical examination: is evidence related to successful prosecution? Ann Emerg Med 2002; 39:639-647.
For more information about forensic evidence, contact:
• Diane DeHart, PA, Coordinator, SANE Program, Harborview Center for Sexual Assault and Traumatic Stress, Harborview Medical Center, 1401 E. Jefferson, Suite 400, Seattle, WA 98122. Telephone: (206) 521-1800. Fax: (206) 521-1814. E-mail: firstname.lastname@example.org.
• Trudy A. Meehan, RN, CHE, Director, Emergency Services, East Jefferson General Hospital, 4200 Houma Blvd., Metairie, LA 70006. Telephone: (504) 454-4018. Fax: (504) 456-5428. E-mail: email@example.com.
• Valerie Sievers, MSN, RN, CNS, CEN, SANE-A, Clinical Forensic Nurse Specialist, Colorado Coalition Against Sexual Assault, P.O. Box 300398, Denver, CO 80203-0398. Telephone: (303) 576-7674. E-mail: firstname.lastname@example.org.