The Los Angeles Daily News recently reported that the LAPD is a backlog of more than 7,000 rape kits waiting for processing by the LAPD DNA lab.  Some of these cases are nearing the ten year mark, at which time they become inadmissible as evidence due to the statute of limitations law in california with regard to evidence testing. In California, if the kit is tested within two years of the sample collection date, then there is no statute of limitations for it.

The main reason that these kits haven’t been tested yet, is simply manpower and funding. In just five years the demand for kits to be tested has doubled.  According to the article. “In about 2000, the department ordered analysts to keep every shred of cell evidence in rape cases, just in case they might need to test it. Before the change, rape kits were regularly purged from the property division, with the permission of an investigating officer.”

The City of Los Angeles recently approved the hiring of 16 addtional criminalists, but these positions have yet to be funded.

The IAFN, has  just announced two new regional chapters were formed. One in Northwest Florida, and the other in Illinois.

 These two new chapters do not currently have established websites that we have found, but once they do, we will be sure to update everyone with the proper information.

If you would like information about the Northwest Florida chapter, contact Lynda Tiefel.  Information about the Illinois chapter, contact Patricia Metzler.

Often I hear the question, “how do I become a forensic nurse?”. There are many sexual assault centers around the country, and even around the world. But not all of them offer the same standards of care.

Lets say you wanted to remodel your basement. You could open the phone book and find a wide array of contractors who would happily come and try to meet your needs. Some of them are licensed, bonded, and insured….and others…..well they try their best.

When it comes to sexual assault victims services you may find yourself in a similar situation. Depending on where you live, there may be a full service facility with fully trained and certified SANE’s, counciling services, advocates and more. 

It is also quite possible that you have no formalized services at all. in several areas (counties, cities, etc) of the country do not recognize SANE expertise. A lot of this has to do with the expierence that local district attorneys and law enforcement have had with others who may or may not have had any formalized training at all.

Although the IAFN has served as an example of standards of care, there is no regulating body that makes sure these standards are taught and  mandated for nursing sexual assault practice. Forensic Nursing is now recognized by the ANA as a specific dicipline these days, but the formalized standards of care vary greatly from facility to facility. 

There are many facilities that allow nurses without any forensic nursing credientials or formalized training to practice as a sexual assault nurse.  This variance in education and training often leads to botched cases, misleading or inaccurate collection of data, and is detremental to the SANE cause. 

Part of what makes a forensic nurse such a valuable tool for law enforcement, district attorneys, and their patients is adhering to a standard of care. Allowing nurses to practice as a SANE, without giving them the tools they need to succeed is harmful to SANEs everywhere, and worse yet to the patient.

Failure to properly follow a standard of care, and the established rules of evidence collection could very easily lead to the rapist going free or even the wrong person being arrested. Rape and Sexual Assault touches lives forever.

Over the last few years more and more convictions are being overturned because of faulty evidence collection or DNA. We owe it to our patients, and we owe it to the accused to make sure that we get it right.

The laboratory system consists of eight regional laboratories. The laboratory locations are listed below. Please note that not all services are provided by each of our laboratories. Therefore, refer to each laboratory before submitting evidence. If a service is not available at a regional laboratory, evidence may be delivered to that laboratory for transfer to the appropriate laboratory, or mail directly to….

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It may sound like a simple question, “Does mandatory reporting help?”, but it’s one that can be a much more difficult than most health care providers think under the surface.

As a health care provider, you can provide documenation of current injuries, and in many cases in past injuries as well. As a Forensic Nurse, you have the training to collect evidence that may be used in trial to prove the types of offenses that happened. Your medical charting of events can provide a detailed interpretation of facts and injuries than the victim himself/herself would have been able to provide on their own.

Obviously, by reporting that an event of domestic violence or sexual violence against a patient has occurred brings the situation out into the open where other agencies like law enforcement, DFACS, counciling services, and others can offer help and support to the victim, and even counciling to the perpetrator.

What if the patient doesnt want to report?

Informed consent is one of the principle foundations of modern medicine. This empowerment of patients to make informed decisions over their treatments and what happens to their bodies.  For a victim of sexual assult, or domestic violence, this control has been taken away from them. As a mandatory reporter, you are again taking away any sense of control away from the victim. They have no choice in the matter, since you are obligated to notify proper authorities.

The knowledge of confidentiality and essense of trust can be critical components in getting any successful intervention of a sexual assult or domestic violence. Mandatory reporting may directly affect that relationship though, since in effect a mandatory reporter must violate that patient confidentiality to inform proper authorities. Here is an excerpt from a battered woman focus group

“What made it difficult for me to confide was the fact that I feared for my life, you know. And I knew that if I was to tell them what actually happened, that they would call the police and I would have to file a report and they couldn’t guarantee me that they would be there 24 hours to protect me from this maniac. So, therefore, I wasn’t taking that chance on my life. … What would make it easier for me would be….to be my choice….[I] f this happened to me but I don’t want the police involved, can you please treat me and keep my confidentiality? There’s supposed to be a law that they keep confidentiality between the patient and the physician.”

Because of this violation of trust, some will argue that in order to get an accurate story from a patient that you should not tell the person that you are a mandatory reporter until after they have given their recount of events. Others will say that is ethically wrong, and that you should tell that person up front about your reporting status and in effect, give them the choice of reporting what actually happened, or just receiving their medical care and moving on.

Mandatory reporting laws were developed to provide a safety outlet for individuals who may be too afraid or unable to seek help (children, elderly, controlled spouse ,etc). The question that many of these victims ask is that “what are you going to do to protect me?”. Law enforcement can’t be in a home 24 hours a day. So what happens when the victim goes home, and the victimizer gets released from custody in a few hours or days? Is that person(s) safer now?

“Abused women hare had their autonomy taken away by their abusive partners. Forcing me to report her abuse again takes that autonomy and control away from her. She is a better judge than I of the consequences to her of reporting.” - PhysicianSurvey Statement

Right or wrong, mandatory laws exist for many health care providers.  What do you think ?? 

Addtional Resources:

http://www.endabuse.org/

The Georgia Bureau of Investigation  has published a document for the requirements needed to submit evidence collection kits for processing.

 http://www.ganet.org/gbi/labmanual.html 

Law enforcement agencies (local, state and federal)
Judicial systems
Medicolegal community
Other government laboratories
Regulatory and public service governmental agencies
Non-law enforcement security departments (for criminal cases only)

HOURS OF OPERATION

Laboratory hours are from 8:00 a.m. to 4:30 p.m., Monday through Friday.

Evidence receiving hours are from 8:00 a.m. to 3:30 p.m. , Monday through Friday .

The Crime Laboratory observes the State of Georgia official holiday schedule.

A gang rape is when a group of two or more attackers sexually assault one or more victims. This type of group rape is sometimes referred to as a “gang bang” or “running a train”. Approximately 10-20% of all sexual assualts are gang rapes. The word tournante is a French adjective meaning “turning” and is used as a slang term to mean a gang rape. According to the testimony of numerous victims, young Muslim women who stray from traditional conduct in the immigrant neighborhoods, such as behaving and dressing like a westerner, or wanting to live as Europeans or refusing to wear the traditional clothing, have been considered by some to be “fair game” for tournantes.

According to Samira Bellil in a CNN interview, there was a trial in Lille regarding a 13-year-old girl who had been allegedly gang-raped by 80 men.

Samira was first gang-raped when she was 14, by a gang led by someone she knew. They beat her viciously and raped her all night. A month later, one of the most violent attackers in the gang followed her and dragged her off a train by her hair, while other passengers looked the other way. She was then brutally gang-raped by the gang members again.

She did not report her rapes until two friends told her that the same gang had raped them too. The typical scenario that takes place is that the targeted young woman is drawn or lured into a secluded area where she is brutalized and repeatedly raped by groups of men who take turns raping her. The victim is usually insulted for behaving in a Westernized manner. Typically the girls are often released afterwards, but rapes are often unreported for fear of reprisals against their families. In nearly every case on record the young victim who does report the crimes committed on them says that days later they would again be caught by the gang and gang-raped again.

These types of attacks can also be further categorized into sub categories like: opportunistic rape, street gang rape, male rape, aquaintance rape.

Opportunistic Rape: The most common scenario is during a burglary or robbery. During the process of committing the robbery the attacker(s) may be startled or interupted by a female who happened upon them. Rather than fleeing the scene they may linger and decide to “take advantage” of the situation by raping her. Often these types of attacks are not especially violent, but may escalate into a violent situtation due to the impulsive nature. Because the attackers were suprized by the person being there, they typically have not planned out what or how to deal with the person. They may use improvised restraining devices or no restraints at all, and simply threaten or imply violence if the victim does not comply.

This type of impromtu sexual assault is usually short in duration. If they were there to commit a robbery in the first place, they may still be trying to get away with the stolen goods. A condom is rarely used since the rape was not premeditated and opportunistic. Ejaculation may or may not occur. Recent SANE-SART statistics on ejaculation sites.

Street Gang Rape: This type of rape is almost completely intracial. Rarely does it cross racial boundaries. Increasingly this type of sexual assault is used as part of the gang initiation process. Sometimes it may involve a younger member of a sister gang who is also being initiated, sometimes it may be a random target chosen off the streets, and in other cases, it may involve a same sex target of a rival gang. This is meant to humiliate and degrade the rival while proving that the attacking gang is stronger.

In many cases there are many levels of insult and intimidation. Forced oral (fellatio) and anal sex are common. Urination  on the victim, especially by later members of the “train procession” as a way to further degrade the victim may occur. With each “round” the levels of degredation, torture, and acts tend to escalate.

 Male Rape: Males who are sexually assualted typically are lower reporters than female victims. Depending on the study used, most statisitics show about 5-10% of victims are male. One study indicated that approximately 36% of male prisoners are sexually assualted by more than one perpetrator. Usually the first time prisoner, illegal immigrants, or phyiscally handicapped (weaker and more vulnerable targets) are the ones targeted for repeated assaults. The majority of these rapes are done by heterosexual males, much like the rival gang rapes listed above.  Violence is much more likely on male on male rapes, as well are the demanding of multiple physical acts. Weapons are also more common method to enduce coersion.
Gang Acquaintance Rapes:  In most instances in a gang aquaintance rape the victim has been carefully selected and includes some group collaberation and forethought before the attack occurs. The victim may have one or more of the following characteristics:

• New student, or new to the area with few friends
• unpopular
• unattractive
• overweight
• already had sex with one of the group members
• intoxicated
• drug use
• low self esteem, may be easily lured / flattered by attention before an assault
• Sorority sister

College campuses are a common location for such incidents. Often at parties or on the way home from a group date. While most acquaintance rapes involve one perpetrator and one victim, the campus gang rape is far too prevelant.

Incoming freshmen females are the most targeted for gang rape. They are usually more naive, tend to be more vulnerable, have fewer friends, and be more willing to be lured into a position of isolation. The first few weeks of the new school semester are the most vulnerable times for gang rape for incoming freshmen.

These types of gang rapes are often planned well in advance and can endure for hours as each group member has their turn. The use of alcohol and other narcotics to subdue the victim. It is not all that uncommon for their to be multiple spectators to the events, and even video taping of the assault. In most cases there is limited to no physical injury to the victim, except for any genital injuries as the result of repeated intercourse.

When and if defendants are ever charged in such cases, they most often don’t deny that sex occured, but that the victim was consentual, or that “she never said no or stop”.

The IAFN, has selected Atlanta GA for its 2009 Annual Scientific Assembly. This event is held each year around the country to help spread the word about forensic nursing and give participants and exhibitors the opportunity to network and learn more about the latest trends and best practices for Forensic Nursing.

This four day event will be held on October 21-24, 2009.

For Hotel information in the area or flight arrangements: http://www.findnearbyhotels.com/DESTINATIONS/Atlanta_GA_US/

The Northside Hospital - Forsyth, Sexual Assualt Nurse Examiner program is proud to announce that they have become the only SANE  program in the state of Georgia to use employ the use of SDFI technology.  

Secure Digital Forensic Imaging technology offers digital imaging clarity that is on the cutting edge. This technology is also fully compliant with federal rules of evidence, ensuring that the images stored will be admissible in court if necessary.

Master of Science in Nursing
Certificate in Forensic Nursing

Offered at the Prince William Campus

Point of Contact

Michele Davidson, PhD, CNM, CFN, RN
Telephone: (703) 993-1924
mdavidso@gmu.edu
Fax: (703) 993-3612

This certificate program offers formal study in theory and practice in applied forensic science and nursing for nurses with a bachelor’s degree in nursing or individuals in another discipline with a baccalaureate degree from an accredited institution.

Program Requirements

Students applying to the certificate program must be enrolled in graduate degree status or hold a bachelor’s degree. Application is made through the Admissions Office of the University. A requirement for the certificate is 15 credits of graduate course work in which a 3.00 GPA is earned.

Program of Study

The program for the certificate consists of 15 credits in forensic science.  Students who already hold certification as a Sexual Assault Nurse Examiner (SANE) or non-nurses are exempt from NURS 734 and will be required to take GCH 602 in place of NURS 734.    

Practice Opportunities

The GMU forensic program focuses on the application of forensics from a social science perspective and prepares graduates to work with clients in a variety of practice settings. Graduates of the GMU forensic nursing program will provide services to victims of violence and abuse including, but not limited to, sexual assault, child abuse, elder abuse, homicide, and drug or alcohol abuse. Forensic nurses work in a variety of public health and public safety settings, as well as in the private sector.  The scope of practice is broad and can include product tampering, environmental hazards, medicolegal death investigation, sexual assault examination, and epidemiological issues.  Clinical roles include emergency and trauma care, corrections, nurse investigator/evidence collection, psychiatric mental health, sexual assault nurse examiner, and nurse coroner positions. The legal nurse consultant is another role that specializes in forensic practice and providing expertise in legal matters. Forensic practitioners often care for living clients and train other nurses to appropriately assess and care for these victims.  As a member of an interdisciplinary team, the forensic nurse possesses expertise in normal anatomy and physiology, assessment skills, determination of causative factors of injuries, and use of therapeutic communication. The GMU forensics program is sound in terms of theory, clinical decision-making skills, and field experiences.  The program is comprised of an interdisciplinary faculty that possesses expertise in nursing, criminal justice, death investigation, and forensic science. Many of the faculty members are nationally recognized experts within the various fields of the forensic specialties.

• Required courses (15)
  • NURS 733 (3:3:0)
    Introduction to Forensic ScienceÂ
    This course focuses on the introductory concepts of forensic science and examines its impact on society. 
  • NURS 734 (3:3:0)
    Interpersonal Violence & Sexual Assault ExaminationÂ
    This course focuses on the incidence and consequences of interpersonal violence and examines the role of the sexual assault nurse examiner when caring for victims of violence. (Must be a nurse with a valid nursing license to take this course).
  • NURS 735 (3:3:0)
    Crime Lab and Crimes Scene Investigation
    This course focuses on the components of the crime lab and the role of the forensic scientist in crime scene investigation.
  • NURS 736 (3:3:0)
    Psychological and Legal Aspects of Forensics
    This course focuses on the psychological and legal aspects of forensic science.
  • NURS 737 (3:3:0)
    Investigation of Injury and Death
    Explores the role of the forensic scientist in death investigation. Examines death, manners of death, and causes of death along with the death certification process. The role of the medical office professional and autopsy procedures will be reviewed.  DNA evidence and the Federal Bureau of Investigation’s Combined DNA Index System (CODIS) will be analyzed. 

Explanation of Credit Hours

Course titles are followed by numbers in parentheses (0:0:0), separated by colons. The numbers have the following significance:

• First Number: credits for the course
• Second Number: hours of lecture or seminar per week for the course
• Third Number: hours of laboratory for the course

For independent study, readings, topics, or similar courses, individual instructors set hours.