The Forensic Nurse

Police in Hollywood Florida today announced that Ottis Toole who had long been the primary suspect in the murder of Adam Walsh. John Walsh the boy’s father came to nation attention back in 1981 as he pleaded and worked with police to find his son.

Fisherman discovered the decapitated head of Adam walsh in a river over 120 miles away from where the boy was abducted. The remains of his body have still not been found to this day.

Police were riduculed for their repeated bungling of the case and the case evidence. The bloodstained carpeting found in Toole’s car that would have provided DNA evidence to tie him to the case was lost.

Following his son’s death, John walsh became obsessed with finding his son’s murderer and helping to be sure that other children and families didnt have to endure what he had gone through. 

He gained national attention when he starred in the America’s Most Wanted television show in the 1980s’. After serveral years of hosting the show and testifying to congress, the Adam Walsh Child Protecion Act was passed.

A 21 year old man in austrailia is claiming that he is innocent of commiting unlawful sexual acts with a 10 year old minor female because the acts were consentual on both of their parts.

The Man, Brodie James Watson  is charged with four counts of sexual penetration of a child under 13, six counts of indecent dealing , and one count of possessing an article with intent to injure.

The defense attorney for mr. Watson, Andrew Parker has asked the local magistrate if Watson could live with a relative if he stipulated not to go near the girl or her mother.

The magistrate has denied the request, stating that the acts commited were serious enough that mr. Watson should remain in custody.

Mr Watson stated during the proceeding: “Can we just sort it out right here and right now … because … I am innocent … it was consensual” The magistrate informed him that  “It can’t be consensual if she’s a 10 year-old girl.”

Its quite disturbing that someone is incapable of being able to see that it would ever be acceptable to engage in such acts with an elementry school aged child. Most children of this age can barely decide what to have for breakfast, let alone be able to give an informed consent to engage in sexual acts. We have an age of consent for a reason.

The Georgia Death Investigation Act (O.C.G.A. 45-16-20) requires that the coroner or county medical examiner of the county where the body is found or the death occurs be notified and that a medical examiner’s inquiry be made in all deaths that occur in this state that meet the following criteria:

1. As a result of violence;
2. By suicide or casualty;
3. Suddenly when in apparent good health;
4. When unattended by a physician; no person shall be deemed to have died unattended when the death occurred while the person was a patient of a hospice licensed under Article 9 of Chapter 7 of Title 31 of the Georgia Code.
5. In any suspicious or unusual manner, with particular attention to those persons 16 years of age and under;
6. After birth but before seven years of age if the death is unexpected or unexplained;
7. As a result of an execution carried out pursuant to the imposition of the death penalty under Article 2 of Chapter 10 of Title 17;
8. When an inmate of a state hospital or a state, county, or city penal institution; or

9. After having been admitted to a hospital in an unconscious state and without regaining consciousness within 24 hours of admission.

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.

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/

On Friday July 29, 1994, 7-year old Megan Nicole Kanka disappeared. She was promised to see a puppy, her neighbor, Jesse Timmendequas, lured her into his home where he raped, strangled and suffocated her. Her body was stuffed into a plastic toy chest and dumped in a nearby park.

Jesse Timmendequas a two time registered sex offender lived in a home nearby with two other sex offenders that he had met in prison.

Officially Megans Law is known as the Sexual Offender (Jacob Wetterling) Act of 1994 . This law mandates that persons convicted of sex crimes against children to notify local law enforcement of any change of address or employment after release from custody (prison, psychiatric facility). The notification requirement may be imposed for a fixed period of time - usually at least ten years - or permanently. 

The Adam Walsh Child Protection and Safety Act supplements Megan’s Law with new registration requirements and a “three-tier” system for classifying sex offenders according to their risk to the community. This teiring system helps to classify better those who may be more likely to repeat offend.

The use of digital forensic photography is steadily gaining in popularity almost everywhere, but one item that is almost universally raised is the authenticity of these photographs.

Digital Photographs are much easier to manipulate or alter than a traditional photograph. I’m sure that just about everyone reading this has seen some kind of ‘photoshop’ doctor’d image. From the supermodel airbrushing, or cellulite adding for shock value, to the bin laden doing various activities, the use of digital photograph editing is widespread.  (Browse thru your local supermarket checkout tabloids if you would like some fresh examples.)

But not all altering of digital photographs is necessarily harmful, at least in intent. Take for example, the straightening or cropping of a photograph to help highlight that perfect shot, or the masks and filters that take the annoying red eye out of a photograph caused by the lense flash.

These are often innocent “enhancements” to photographs to make the captured subject more pronounced, or centered into the picture. But be careful treading into this arena if these photographs are going to be used in a criminal or forensic proceeding.  

Image Enhancements

Any process intended to improve the visual appearance of the image falls under the category of an image enhancement. That includes contrast, brightness, color adjustments, color rebalancing, cropping, bluring, dodging and burning.

Unless the photograph is admitted and agreed to by the stipulation of both parties, the party attempting to admit the photograph into evidence must be prepared to offer testimony that the photograph is an accurate representation. Or more to the point, be prepared to testify in court that the image being submitted into evidence is accurate and unaltered in any way.

Federal Rules of Evidence, Article X (Contents of Writings, Recordings, and Photographs), Rule 101 defines writings and recordings to include magnetic, mechanical or electronic recordings. Rule 101 states that if data are stored in a computer or similar device, any printout or other output readable by sight, shown to reflect data accurately, is an “original.” A “duplicate” is defined as a counterpart produced by the same impression as the original…by mechanical or electronic re-recording … or by other equivalent techniques which accurately reproduces the original. Rule 103 (Admissibility of Duplicates) states a duplicate is admissible to the same extent as an original unless a genuine question is raised as to the authenticity of the original or in the circumstances it would be unfair to admit the duplicate in lieu of the original. This means a photograph can be stored digitally in a computer, that a digital photograph stored in a computer is considered an original, and that any exact copy of the digital photograph is admissible as evidence.

In part Two, we will discuss the proper chain of custody for digital evidence

The US Supreme court has ruled today that child rapists cannot be put to death. In essense stating that capital punishment is reserved only for murders.

The case is based on Lousiana man Patrick Kennedy, who was sentanced to death for the rape of his 8 year old step-daughter.  The case drew national attention due to the unusual sentancing. Kennedy if put to death would have been the first time in 44 years for a criminal to be put to death in a case when the victim was not also killed.

Justice Anthony Kennedy wrote in the majority opinion that “evolving standards of decency” in the United States forbid capital punishment for any crime other than murder. Execution of Patrick Kennedy, the justices ruled, would be unconstitutional.

Statistics from the NCVC:

For additional information, please contact:

National Sexual Violence Resource Center

123 North Enola Drive

Enola, Pennsylvania  17025
877-739-3895 (tollfree)

717-909-0710 (phone)

717-909-0714 (fax)

717-909-0715 (TTY)

www.nsvrc.org

National Alliance to End Sexual Violence
(202) 289-3903
www.naesv.org

National Center for Victims of Crime
2000 M Street NW, Suite 480
Washington, DC 20036
Phone: (202) 467-8700
Our helpline is staffed Monday through Friday 8:30am to 8:30pm EST:
Toll-free: 1-800-FYI-CALL (1-800-394-2255)
Fax: (202) 467-8701
TTY/TDD: 1-800-211-799�
Email: gethelp@ncvc.org
www.ncvc.org

Rape, Abuse, and Incest National Network (RAINN)
National Sexual Assault Hotline
2000 L Street, NW, Suite 406
Washington,DC 20036
(202) 544-1034
(800) 656-HOPE (4613)
info@rainn.org
www.rainn.org

supported increases to the VOCA cap, pressure from the White House and continued

Grants to Encourage Arrest.