Forensics Talk

Missing Toddler’s Body Found in Septic Tank

From MSNBC

Updated: 7:36 p.m. ET Jan 27, 2007

   Remains of 3-year-old missing since Wednesday discovered near his home

    

KALISPELL, Mont. - The body of a 3-year-old boy was found in a septic tank less than 10 feet from the house where he was reported missing, Flathead County Sheriff Mike Meehan said Saturday.

The body of Loic J.M. Rogers was found late Friday, and an autopsy showed that he drowned, Meehan said.

It was unclear how the boy got into the septic tank, and the manhole-sized lid was closed. Meehan said investigators do not believe he could have climbed into the tank and put the lid back on himself, but declined to speculate how Loic may have gotten inside. An investigation is continuing.

Full Article

Hospital Liable For Covering Up Child's Injury

By Dick Dahl Staff writer

© 2007, Lawyers USA

       An Oklahoma jury ordered a university hospital to pay $18 million to parents who were investigated for abusing their 9-month-old son after a CAT-scan showed the boy had a fractured skull.

The injuries had actually occurred when a nurse at the hospital accidentally bumped the infant's head on a nightstand, but she failed to report the incident and the parents became the prime suspects.

Although this suit was filed as a straight medical negligence case, the last-minute evidence of the hospital's alleged cover-up prompted a $9 million punitive damage award, according to the plaintiffs' attorney, Gerald Durbin.

  The Accident:
Full Article

 

Question and Answer With Attorney Jim Cooney on Duke Case

From:
ABC11tv.com
Eyewitness News Forum

   By Gary L. Wright

McClatchy Newspapers

(MCT)

CHARLOTTE, N.C. - Charlotte lawyer Jim Cooney is handling the highest-profile case of his career: defending one of three Duke lacrosse players charged with sexually assaulting an exotic dancer hired to perform as a stripper at a team party last March.

The three men - David Evans, Collin Finnerty and Reade Seligmann - are white. The woman is black.

Cooney, for the first time since being hired to defend Seligmann, talked in depth about the controversial case that has fueled racial tensions in Durham, led to the suspension of Duke's lacrosse program and left Durham County District Attorney Mike Nifong facing ethics charges.

How have these three men been affected by the publicity and the sexual assault allegations?

The best way to answer this question is to ask everyone who may be reading this to imagine how they would feel if their picture - or a picture of their sons or daughters - appeared on the cover of Newsweek accused of a crime as heinous and vile as rape. Then I would ask everyone to consider that if the district attorney had succeeded in convicting these young men of all of the crimes with which they had been charged, none of these young men would have been released from prison until they were well into their 50s. They literally would have never seen their parents alive again outside a prison visiting room. It does not take much imagination to understand the daily pain that these young men and their families go through each day these cases are permitted to continue.

Durham County District Attorney Mike Nifong has been accused of withholding evidence favorable to the defendants. The DA eventually dropped the rape charges after the victim changed her story. He now faces ethics charges levied by the N.C. State Bar. What is happening in this case?

I think my answer to this question is better left until the resolution of these cases. Moreover, Mr. Nifong is now the subject of ethics charges by the State Bar, and I think it is important to accord him something that was not given to these young men - due process and a fair trial.

Do you think we'll ever know what happened during the team party on March 13, 2006?

I feel very confident that we know what happened. I am also confident that there are certain people who will never believe the facts of this case because it does not fit their view of the case or their personal agendas. The simple truth, as the facts show, is that there was no rape, no sex offense and no kidnapping.

What do you believe happened inside that house?

There is little question that this was a party in which a number of young men were engaging in conduct - drinking, watching strippers - that is offensive and about which they should have known better. This said, nothing that occurred at that party justifies either jailing these young men for 30 years or the national condemnation and death threats that they received.

Have you met or interviewed the woman who accused your client and the other Duke lacrosse players of sexually attacking her?

No. If this case goes to trial, however, I anticipate getting a chance to do so when she is under oath in a court of law.

Do you think the news media played a role in the players being charged?

I think the media played a pivotal role in these cases, both in leading the "charge" against the players, and then in the re-evaluation of the cases in light of the objective evidence. There is little question that, fueled by the district attorney's comments and focused on the theme of "privileged white males vs. poor black female," a feeding frenzy developed among the media with one commentator after another competing to outdo each other in their condemnation of the defendants.

The feeding frenzy led to an atmosphere of outrage that not only demanded indictments_regardless of the evidence - but was directly responsible for street protests in Durham and in front of Dave Evans' house and the mob that confronted Reade Seligmann at his court appearance, a mob that shouted out death threats. As objective evidence emerged, however, and as the evidence was analyzed and re-analyzed on the Internet and in the "blogosphere," something fairly rare occurred - many parts of the media began to re-examine their initial views on what happened.

The DA has taken himself off the case and asked the N.C. Attorney General's Office to take over the prosecution. What do you hope will happen now?

My hope is that all of the charges will be dismissed against all of these young men. My belief is that the prosecutors now reviewing the case will do so professionally and honestly, and will review all of the objective evidence in order to decide whether this case should continue.

What do you make of the tensions of race and gender that this case has exposed in Durham?

I think many of these tensions pre-existed this case. Perhaps one of the great tragedies of this case is that the African American community in Durham has historically been one of the most vibrant, prosperous and successful communities in this state, even during the height of segregation. The success and resiliency of that community has been lost in the media frenzy surrounding this case. Regrettably, these cases were hijacked by individuals who had an agenda that had nothing to do with Durham, these defendants or justice. I fear that this case has widened the race and gender tensions that existed before, and so polarized people that any attempt to relieve those tensions has been set back by years.

Rape is often a difficult crime to prosecute. Will this case change how prosecutors deal with rape cases?

I can't speak for how prosecutors will view rape cases. I do fear that many legitimate victims of rape will not come forward after these cases because their real claims will be met with skepticism. There was a long struggle in this country to force the justice system to take rape cases seriously and treat real victims of rape with the dignity and justice that they deserve. I fear that these efforts have been set back by decades because of this case and the way in which it was handled and prosecuted.

Why do you think this case attracted so much attention?

I think there were really three factors. The first was that this case was a "perfect storm" of race, class and gender issues - it appeared to appeal to our worst thoughts about male athletes and underprivileged women of color. Second, the district attorney was so adamant and certain in his public statements that these crimes occurred - and that they were racially motivated - that even casual viewers could not help but be outraged by it. The third was that a number of constituencies - both the media and individuals with various race, gender and class agendas _then seized upon the case for their own purposes. This created a Pandora's box that, once opened, could not be shut.
Posted: 1/28/07 7:50 AM

Point of View

     I couldn't agree more! I too am afraid that this case has set back victim's rights. One of the things that has concerned me so much about this case, aside from the apparent injustice against innocent young men, is that it is hurting the true victims of rape.

     Because of my criticisms of this case, those reading my blog may be under the mistaken impression that I am overly critical of rape victims in general. Not so. In fact, nothing could be further from the truth. I wouldn't be working in this field if I felt that way. It is for all true victims, both of rape and of injustice, that I speak out.

     I admit though that I can be quite critical of those who would deliberately file false charges, thereby hurting the credibility of all the true rape victims. I'm afraid that the notoriety of this case is going to cause true rape victims, in the near future, to be reluctant to come forward, for fear of not being believed.

   And it is the Cash Michael's, Victoria Peterson's, Wendy Murphy's, and yes, the Jesse Jackson's of this world who apparently fail to see that by enabling any false accuser - black or white - by means of their extremely vocal or high profile status,  in order to push their own particular agenda, they are spitting in the face of all those truly in need.

  The above named people may be well known but they are not the ones sitting in that exam room, holding the hands of a softly sobbing woman, as she reveals the raw anger, pain, and degradation she feels at the ultimate violation of her person. They are not the ones looking into her eyes, hearing her voice, or seeing the despair on her face as she recounts moment by horrible moment an assault that took away far more than just her dignity.

     They were not there with me when I examined a young man who had been savagely raped, beaten, stabbed and left for dead. They were not there when I had my arm around his mother, as she cried standing next to him. They were not there when he later died of his wounds.

   We nurses are the ones who are up close and personal with men and women, black and white, young and old, who may be going through the greatest emotional crisis of their life.

   While most physical wounds may heal, emotional scars can be with you forever. We are the ones who are there for them in their moment of crisis, examining and treating them, listening to them, and giving them the emotional support they need. We are the ones who assist them with that first step on the road to recovery.

     We are also the ones who have developed a pretty good sense of who is being true and who is being false. No FNE/SANE I know supports the fallacy that there are no false accusers. We know better.

   When the very professionals who are used to working in this field, look at this case, start to question things and say, Hold on, something's just not right here - you know you have a problem.

     We know that within any particular group of people, you are always going to find a very small percentage who are just completely dishonest, vengeful people who care nothing for the pain they cause others.

     People who would think nothing of spewing lies against innocents for their own personal gain. People without a conscience. People with personality disorders who are so completely self absorbed, they have absolutely no insight into their own behavior, and could care less about any pain and destruction it may cause.

     This kind of person should not have their status elevated because it happens to fit into someone else's agenda, search for publicity, or a race for TV ratings; but rather, should be exposed for the dishonest, vengeful person they are.

   Steps should be taken early on to prohibit this type of behavior, so that it does not endanger the chance of true rape victims to seek justice for what was done to them; or cause irreparable harm to innocent men - also victims -  who may be imprisoned as a result of false allegations, or inadequate, sloppy, or dishonest investigations.

     In the search for truth, and to protect the rights of both the accuser and the accused, no stone should be left unturned. No fact or evidence should be ignored or hidden.

     No agenda driven activism or media outlet should be employed so as to paint a picture which distorts the true reality of the facts as they are known at that time.

     To do so, is to make a mockery of our constitution, and to re-victimize true victims all over again.

`Truth Test' To Uncover False Rape Allegations

The(London) Independent
Oct 31, 2000

       A "LIE-DETECTOR" test to help uncover false allegations of rape is being developed by the police and criminologists.

Between 10 and 41 per cent of allegations of rape are made up by the "victim", according to previous research. In the new test, a claimant's statement is analysed and points are given from a list of set clues - people who have made up a rape allegation get a low score, while genuine complaints get a high score.

Using this technique in two studies, police officers and researchers had a success rate of between 72 and 100 per cent in identifying genuine rape victims from liars. All the cases were real- life examples selected because of the existence of strong evidence, such as closed-circuit television footage, to prove the defendants' guilt or innocence.

The two pieces of research indicate that police officers who rely on their detective skills and intuition when examining a statement by an alleged rape victim are no better than a member of the public at identifying a genuine complainant from a false one.

‘Mean Girls’ Trend Points To Deeper Problem

Psychologists, educators disturbed by lack of adult guidance for teens

By Alex Johnson and Chris Jansing

MSNBC

Updated: 7:32 p.m. ET Jan 18, 2007

       Even the officer leading the police investigation admits that the video of three New York girls beating up a classmate — widely available for a time on MySpace.com — is hard to take.

“Every time I watch it — the second time you watch it, the third time — it’s not any easier than the first time,” Suffolk County Lt. Robert Edwards said Thursday in an interview with MSNBC’s Chris Jansing. “It’s pretty traumatic and kind of graphic.”

But you need to watch it. Psychologists and educators say it points to a disturbing trend that is being left unchecked by parents and school officials: the eagerness of American girls to seek approbation by flaunting increasingly outrageous behavior.

Full Article

Pregnant Girls Gone Wild?

Associated Press
Updated: 3:25 p.m. ET Jan 18, 2007

Police: 3 teens whack group home director with frying pan, flee in minivan

   AMERICAN FORK, Utah - Three pregnant teens living in a group home whacked the director in the head with a frying pan, tied her up and then fled in a stolen minivan, police said.

The director, who was tied up with power cords Tuesday, eventually broke free and called police, police Sgt. Shauna Greening said. She also freed another pregnant teen tied up in the attack, she said.

Authorities believed the teens — two 15-year-olds and one 16-year-old — left the state and a search was under way. Police said the teens also stole the director's purse, checkbook, credit cards, cell phone and video camera.

Full Article

Police Say Man Rapes Wife, Films It

Suspect Faces Life In Prison If Convicted

Associated Press

Updated: 11:57 p.m. ET Jan 16, 2007

     ORLANDO, Fla. - A 30-year-old man kidnapped, raped and tortured his wife, then hung her from a tree to film a two-hour bondage pornography video, authorities said Tuesday.

The man was charged with aggravated assault and battery, sexual battery, kidnapping, and false imprisonment. He was being held in the Brevard County jail on Tuesday in lieu of $3 million bail.

“I don’t know how to even explain it,” sheriff’s deputy Marlon Buggs said, adding, “the victim will be mentally scarred. He humiliated her.”

The Associated Press does not identify victims of sexual assault. The man was not identified in an effort to protect his wife’s identity.

Full Article

Evidence Lacking To Support Many Off-Label Uses Of Atypical Antipsychotics

     Main Category: Psychology / Psychiatry News
Article Date: 18 Jan 2007 - 0:00 PST

   

Some newer antipsychotic medications approved to treat schizophrenia and bipolar disorder are being prescribed to millions of Americans for depression, dementia, and other psychiatric disorders without strong evidence that such off-label uses are effective, according to a new analysis by HHS' Agency for Healthcare Research and Quality.

The federally funded comparative effectiveness review of these drugs -- called atypical antipsychotics -- identified the medications' potential for serious side effects while pointing to an "urgent need" for more research into new treatments for the growing population of dementia patients who display severe agitation.

"This report emphasizes the importance of understanding the risks and benefits of different medicines," said AHRQ Director Carolyn M. Clancy, M.D. "Caution is necessary in the off-label use of atypical antipsychotics, especially when used in the elderly and when the evidence for effectiveness is not good."

Atypical antipsychotics are second-generation medicines designed to cause fewer neurological complications than conventional antipsychotics. They include aripiprazole (sold as Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). Each is approved by the Food and Drug Administration to treat schizophrenia and bipolar disorder, and risperidone is also approved to treat irritability in children ages 5 to 16 who have autism.

Some studies suggest that atypical antipsychotics may help patients with mental health conditions for which there are no FDA-approved alternatives. Risperidone and quetiapine, for example, help certain patients with obsessive- compulsive disorder when used in conjunction with antidepressants. Risperidone and olanzapine improve sleep problems, depression, and other symptoms in men with combat-related post-traumatic stress disorder when used to augment therapy with antidepressants or other psychotropic medications.

Overall, however, researchers found that much of the scientific evidence for off-label use of antipsychotics was of insufficient quality because studies were too small or lacked scientific rigor.

Review authors evaluating the potential benefits and risks of the medications also found strong evidence that atypical antipsychotics can increase chances of adverse events. Some of the drugs increase risks of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems.

The new review was produced by AHRQ's Effective Health Care program. It was authored by AHRQ's Southern California/RAND Evidence-based Practice Center. The center examined 84 published studies on atypical antipsychotics and summarized evidence about several conditions:

Dementia:

One analysis showed a small benefit for risperidone and aripiprazole in the treatment of agitation and psychosis. Another suggested olanzapine may help treat psychosis. But a large clinical trial that explored whether risperidone, olanzapine, and quetiapine controlled behavioral disturbances in Alzheimer's patients concluded that the risks of adverse events offset the potential benefits. Overall, analyses identified potential harms as a small increase in the risk of death and increased chances of stroke, neurological problems (such as tremors or muscle contractions), and weight gain.

Depression:

For patients who don't benefit from selective serotonin reuptake inhibitors (SSRIs), the supplemental use of atypical antipsychotics was not helpful, according to research. No studies showed the drugs provided a clear benefit for patients with major depressive disorder with psychotic features. Evidence is conflicting for bipolar depression.

Obsessive-Compulsive Disorder:

Atypical antipsychotics significantly helped patients who don't respond adequately to SSRI therapy, studies showed. Overall, patients taking the drugs were about 2.7 times as likely to improve as patients taking placebo. The chances of benefiting were best for risperidone and quetiapine.

Post-Traumatic Stress Disorder:

Studies of men with combat-related PTSD showed risperidone and olanzapine, when used with antidepressants or other psychotropic medications, improved sleep quality, anxiety, and other symptoms. Studies were inconclusive when measuring benefits for women.

Personality Disorders:

For patients with borderline personality disorder, one study suggested olanzapine was more effective than placebo but showed little benefit when used to augment talk therapy. All studies of olanzapine were very small, however, and patients experienced significant weight gain. Two other small trials suggested risperidone may benefit patients with schizotypal personality disorder, and aripiprazole may help patients with borderline personality disorder.

Tourette's Syndrome:

Risperidone is more effective than placebo, according to a small body of research. The benefits of ziprasidone are uncertain.

Off-label prescribing is a common but relatively understudied practice in health care. A 2001 AHRQ-funded study concluded that about 21 percent of prescribed drug use was for conditions not indicated on the label. Cardiac medications and anticonvulsants were the drugs most commonly used off label. Most off-label use occurs without scientific support, the study said.

The report released today, Efficacy and Comparative Effectiveness of Off- Label Use of Atypical Antipsychotics, is the newest analysis from AHRQ's Effective Health Care program. That program represents the first federal effort to compare alternative treatments for significant health conditions and make the findings public. The program is intended to help patients, doctors, nurses, and others choose the most effective treatments. Information on the program, including full reports, can be found at http://www.effectivehealthcare.ahrq.gov.

Agency for Healthcare Research and Quality
http://www.effectivehealthcare.ahrq.gov

Long-Term Narcotics Use For Back Pain May Be Ineffective And Lead To Abuse

Main Category: Pain / Anesthetics News
Article Date: 20 Jan 2007 - 1:00 PST

 

     Narcotic drugs (opioids) are commonly prescribed for short-term relief of chronic back pain, but their effectiveness long-term has been questioned in a review article by researchers at Yale School of Medicine, who also found that behaviors consistent with opioid abuse was reported in 24 percent of cases.

"Patients with chronic back pain commonly request pain medication, and opioid medications are used despite the concerns clinicians have with patients developing an addiction to these medications," said first author Bridget Martell, M.D., assistant clinical professor of general internal medicine at Yale School of Medicine. "Our findings suggest that clinicians should consider other treatments with similar benefits but fewer long-term adverse effects."

Published in the January 16 Annals of Internal Medicine, Martell and co-authors conducted a systematic literature review and meta-analysis that addressed the prevalence and effectiveness of opioid prescriptions for patients with chronic back pain, and the incidence of substance abuse disorders among patients receiving opioid medications for chronic back pain.

The study populations consisted of non-obstetric patients over age 18 with non-malignant chronic back pain lasting for at least three months. The research focused on efficacy of oral, transdermal, or topical opioids, where there was no pre-existing diagnosis of opioid dependence. According to the report, opioids may be effective for the short-term (less than four months) treatment of chronic low back pain, but long-term effectiveness was not conclusive.

"Our results also demonstrate that the quality of the literature on these topics is generally weak and more studies need to be done before firm conclusions can be made," said Martell.

###

In addition to Martell and corresponding author David Fiellin, M.D., associate professor of general internal medicine at Yale, other authors on the study included Patrick G. O'Connor, M.D., Robert D. Kerns, William C. Becker, M.D., Knashawn H. Morales and Thomas R. Kosten, M.D.

Citation: Annals of Internal Medicine, Vol. 146, No. 2 (January 16, 2007)

Yale News Releases are available via the World Wide Web at http://www.yale.edu/opa

For further information please go to:
Yale University

Don't give tots or babies cold medicines, CDC warns

    

By Daniel Yee

The Associated Press

Tucson, Arizona | Published: 01.12.2007

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ATLANTA — More than 1,500 toddlers and babies wound up in emergency rooms over a two-year period and three died because of bad reactions to cold or cough medicine, federal health officials reported Thursday.

   The U.S. Centers for Disease Control and Prevention warned parents not to give common over-the-counter cold remedies to children under 2 years old without consulting a doctor.

   The deaths of three infants 6 months or younger in 2005 led to an investigation that showed the children all had high levels of the nasal decongestant pseudoephedrine, up to 14 times the amount recommended for children ages 2 to 12. The study found 1,519 ER cases from 2004 and 2005 involving young children and cold medicine.

The CDC said it's not known how much cold or cough medicine can cause illness or death in children under 2 years old, but there are no approved dosing recommendations by the U.S. Food and Drug Administration for that age group.
Full Article

   

DNA Reverses 12th Case in Texas County

                

                  'Exoneration Tally an 'International Embarrassment'


     DALLAS (Jan. 19) - In a case that has renewed questions about the quality of Texas justice, a man who spent 10 years behind bars for the rape of a boy has become the 12th person in Dallas County to be cleared by DNA evidence.

That is more DNA exonerations than in all of California, and more than in Florida, too. In fact, Dallas County alone has more such cases than all but three states - a situation one Texas lawmaker calls an "international embarrassment."

James Waller, 50, was exonerated by a judge earlier this week and received an apology from the district attorney's office after a new type of DNA testing on hair and semen showed he was not the rapist who attacked a 12-year-old a boy living in Waller's apartment building in 1983. The boy had been the chief witness against him.
Full Article

'Perfect Storm' Comment Response.

 Kathleen,

Your descriptions of bi-polar disorder and histrionic personality disorder appear to be accurate. But, you do not appear qualified to or have sufficient information to make any statements, however tentative or qualified, regarding the accuser's mental condition or whether that condition may have had any impact on her behavior the night of the alleged events.

Your biography shows no experience directly treating individuals specifically for psychiatric disabilities and you do not appear to have any formal training in psychology, psychiatry or psychopharmacology.

Psychiatric disabilities are notoriously difficult to diagnose, including most especially bi-bolar disorder. I worked with five experienced psychiatrists before I was accurately diagnosed and treated for BP-II. None of the doctors made mistakes. The disease is just very difficult to diagnose. Of course, my case, like the accuser's, is unique.

In addition to the problems of diagnosis, patient responses to psychotropic medication are unpredictable and vary widely from one patient to another. The variety of positive responses, side effects and discontinuation symptoms to the same medication are numerous.

In this instance, we do not know the full panoply of mental disorders she may suffer from. We do not know the precise dosage or the length of time she was on depakote or seroquel (or any other medication) and we have no precise information regarding whether or when she discontinued any of her medications.

While your intentions are obviously good and I applaud your sympathy towards people who suffer from psychiatric disorders, given the continuing stigma associated with these disorders, it would be best not to suggest soemthing might be a "perfect storm" when it is frankly quite impossible for you or anyone else (other than perhaps medical personnel who have treated her) to have sufficient enough nformation to do so.

Posted by: Tom D. | January 15, 2007 at 07:28 PM

Tom D.

     Thank you for your response and I respect your opinion. I probably should have included my professional experience in the post.

First off, I am not a psychiatric nurse. When choosing among the various areas in which to work, I was always more interested in trauma and critical care. Those are the areas I concentrated on before moving into home health care.

    Prior to our psychiatric nursing training, we were required to take psychology courses at our local college. Psychiatric training was a requirement in nursing school.

    As nurses, we are all taught to care for the whole person, to incorporate all the psycho-social and physical issues into our care of the patient.

   My initial psychiatric nursing training was taken at the old Phipps Clinic, Johns Hopkins Hospital in Baltimore.

   That was followed by more training at Crownsville State and Sheppard Pratt Hospitals.

While I didn't go into the Psychiatric nursing field, nevertheless, I still received a certain amount of psych experience. All nurses do, no matter where we work.

   That's because we deal with the general public and our patients would come in with a variety of mental health issues.

   Also, we are all given in services, at various times throughout our careers, to help keep us abreast of new developments and learn about new medicines and treatments.

  At one point in my career, I decided to go on my hospital float pool in order to have more time flexibility. During that period, I often floated to our Psychiatric unit.

  Ten years of home health care, visiting patients in their own homes, also gave me experience, as we had many patients who had psycho-social, as well as physical health issues. It was an excellent learning experience.

   If you'll look on my biography again, you'll see Nurse Consultant listed. Prior to deciding to go independent, I worked as a nurse consultant, auditing state residential facilities for developmentally disabled adults.

   My job was to ensure that the facilities were in compliance with state regulations, oversee the care of the residents to ensure that the standard of care was being followed, investigate and testify regarding suspicious injuries, and educate staff on health care, medication administration, and correct documentation.

  Many of the residents had psycho-social issues, a psychiatric diagnosis, and were on a variety of psychotropic medications.

   As it was my job to monitor their care, as well as the safety of the staff, I was required to have an in-depth knowledge about a variety of illnesses such as schizophrenia, bipolar, conduct & other personality disorders, as well as the meds each person was on.

   We had a few residents who could, and did, become aggressive or violent.

  One held a staff member against a wall once, with a pair of scissors to his neck, and I had to not only talk him out of it, but get him to agree to go with the police to the hospital - all done by phone, since I was sitting at home an hour away. If I remember right, I think it was around 11pm. I can definitely say that was probably one of my more stressful days.

    There was always something going on, some incident occurring somewhere. It was not all covered by phone though. I oversaw multiple facilities and I was down at one or another almost everyday, checking the residents on site to make sure they were being well cared for and there were no problems.

   I was also at the state hospital, to discuss discharge plans with the nurse, and to evaluate new residents coming into the programs.

    If a resident was admitted to the hospital in the middle of the night, I was right there, following them to the hospital.

    Trust me, I was in almost daily contact with their treating physicians and psychiatrists. I had to be and I learned a lot.

     It was excellent learning experience. One I don't think I'll ever forget!

Duke Lacrosse Accuser 's Psychiatric History - A 'Perfect Storm'?

   

        I was not surprised to hear the Revelation on CBS' 60 Minutes last night that the accuser in the Duke lacrosse case has a long psychiatric history (bi-polar) and has been on Seroquel and Depakote.

       From the beginning, in my posts and via private communications, I questioned whether this woman was on any psychotropic medications and whether or not she was having episodes of delusions.

     First of all, I'd like to clarify that I do not believe that just because someone has a history of psychiatric illness, any complaint they might make of sexual assault should just be tossed out the window.

     Just because someone has a mental illness doesn't mean they can't be raped. Sexual assault can happen to anyone of any race, age, occupation, or mental condition.

      However, I also believe that any complaint of sexual assault should be thoroughly investigated, prior to charging a suspect(s). That should include investigating the back ground of the accuser as well, especially if they have an illness which might cause them to have personality or conduct disorders, delusions, or hallucinations.

    While I agree that there is still too much stigma attached to mental illness, and complaints should not be ignored on that basis alone, we have to be realistic too.

     We need to realize that sometimes the accuser's reality may not be the same as everyone else's. I believe to ignore that possibility is to commit a grave injustice against anyone who might be charged with such a crime.

     A Victim Would Never Lie!

 I have read and heard this phrase so many times in the last 10 months. People have been shouting this from their soapboxes left and right - as if this one statement is enough to assure everyone within hearing distance that the three Duke lacrosse players are guilty.

    Why would a victim lie?, they ask. So these boys have to be guilty. Absolutely. No question about it, right?

   Wrong.

     On the surface, that statement is correct. No true victim would lie. However, not all accusers are true victims - and people need to realize that.

      Most women wouldn't lie. Unfortunately, there is a small segment of the population who, for whatever reason - vindictiveness, guilt, regret, fear of their parents finding out what they've been up to - attempt to manipulate the system outright by making false accusations.

     Then there are others who may suffer from various mental illnesses, such as schizophrenia, bi-polar disorder, histrionic personality or Munchhausen's Syndrome which may hinder rational behavior. 

       The detectives in our area take a dim view of false accusers.

     Of my own patients alone, I have had one arrested right there at the hospital, as she walked out of the SANE exam room.

     A second one, who they believed had staged the crime scene, was for possible arrest.

    And a third was going to be arrested as well, except that I asked if the police could get her to mental health services instead.

      My impression at the time was that she was totally out of touch with reality. She actually believed what she was saying. I didn't think it was right to arrest someone who was that delusional. 

     Persons like Victoria Peterson and Wendy Murphy should not stand there and try to tell everyone that no accuser would ever make a false claim. Experienced SANE / FNE's know better.

   Bi-Polar Disorder

        Bi-polar disorder is an illness involving extreme mood changes, beyond the normal ups and downs of life. It's characterized by cycles of deep depression and feelings of worthlessness.

      It's followed by periods of extreme manic behavior such as euphoria or extreme irritability, flights of fancy, grandiose ideas, lack of sleep, excessive buying sprees, increased aggressiveness, or a sex drive that's in overdrive.

      It often shows up in late teens or early twenty's. That person's history may also show ADHD throughout childhood and / or Opposition Deviance Disorder as they grow older.

      Quite often you will see a mixture of both manic and depressive symptoms. Some people may only have one, or few, episodes in their life; others may have frequent episodes, with moods quickly changing within a matter of hours, days, or weeks. This is known as rapid cycling.

      Persons who go untreated have trouble throughout their entire lives. They have trouble with school, work, and inter- personal relationships. They often drop out of school, get fired or quit jobs frequently; have failed marriages, abuse drugs / alcohol, end up in bankruptcy, and get into trouble with the law.

     Without treatment, the manic-depressive episodes can become more severe, ultimately leading to psychosis - a break with reality, and even suicide.

     The current treatment of choice is Lithium, a mood stabilizer, along with an anti-depressant. Anti-depressants alone are not recommended for bi-polar because they can cause the person to go into extreme manic episodes.

       Lithium has to be monitored very carefully. The risk of Lithium toxicity is high and it can be fatal. A Lithium level should be drawn every 3 months. Dehydration and salt removal from the body must be avoided since salt deficiency can result in lithium toxicity. Excessive alcohol intake must be avoided as well because it also can increase the loss of salt and water from the body.

      Other current treatments include a drug cocktail mix of Seroquel and Depakote. The Depakote is used in place of the Lithium. Normally used as an anti-convulsant, it has been found to be a good mood stabilizer, with reduced side effects. 

     The Seroquel is an anti-psychotic drug, used to keep the extreme manic episodes at bay. Depakote and Seroquel must also be monitored closely. Seroquel can cause memory loss and altered mental status.

     Caution must also be used when combining Seroquel with muscle relaxers, or drinking alcohol, as the sedative effects are increased.

       Histrionic Personality Disorder

       Histrionic Personality Disorder is a "chronic, often life-long pattern of maladaptive behavior, characterized by excessive emotional expression and attention-seeking behavior...  Individuals with HPD tend to be flirtatious, demanding of attention, seductive, but emotionally shallow."
   
     The person with this disorder is usually immature. He or she is dependent on others, is self-centered, and often vain. The person's behavior is intended to gain attention.
   
     "They are prone to impulsive and dramatic displays of emotion and are easily influenced by others. HPD individuals find it difficult to delay gratification, and are often crushed by what they perceive as rejection."

     "These individuals display overly dramatic and attention seeking behaviours. They are shallow of emotions, self-centered and they can be inappropriately sexually provocative. "

     This type of person must be the center of attention at all times - even going to extreme measures to get it. This type of behavior applies to women, while anti-social disorder applies to men.

       Characteristics includes immaturity, sexually provocative behavior, theatrical type behavior, exaggerated statements (and symptoms). Their behavior is easily suggestible by other people or circumstances.

     When they don't get their own way, or feel rejected by others, they may throw temper tantrums or plan revenge. They are often involved in drug / alcohol abuse.

     This type of disorder belongs to the DSM III -R group cluster of personality disorders, Cluster B:  disorders characterized by dramatic, emotional or erratic behaviors. 
                                                 antisocial 
                                                 borderline 
                                                 histrionic 
                                                 narcissistic


        It has been stated that the Duke lacrosse accuser has a history of bi-polar disorder. What is known of her long-term behavior would certainly indicate it. However, I am also including some information on histrionic personality disorder.
 
        Quite often, you will find persons suffering from a combination of different personality disorders. I can't help but question, given the accuser's exaggerated, rapidly changing, and hysterical type behavior, and statements, both during and after the party, whether she also suffers from histrionic personality disorder.

      In fact, when you look at her known history and occupation, as well as her behavior and statements after the party, they appear to show almost classic symptoms for this disorder.

     I began to get suspicious when I first read of Gottlieb reporting first that she screamed at the sight of a white man (sorry, but I had to laugh at that one), then that the speculum exam took an excessively long time due to "extreme pain". There usually isn't any "extreme pain" involved with inserting a speculum.

     Our patients don't go screaming at the sight of a white man - or any man for that matter. They are usually just the opposite - either very subdued or talking, relaxing, or sleeping in the family room.

      Often they arrive with male friends or family members. Until our exam room got relocated, we had to walk every patient through the ED to get to the bathroom.

     The ED is filled with men. Police, detectives, nurses, technicians, patients, security guards coming, going, and standing around all over the place. Not once has a single patient of mine ever shown any discomfort or fear at the sight of these men. Never.

     These two statements flew up the first red flags. Others included the accuser stating that she and Kim Roberts went screaming into the night. Then Kim reported that the accuser suddenly started screaming and yelling out at the boys while they were in the bathroom.

     My first thought at that was that the accuser was ticked off at someone big time. Not afraid. Ticked off!

      Why? I believe the answer lies in later statements that implied the players rejected her. Histrionic personality types can't handle any type of rejection.

       One day later, the accuser was at UNC, once again with extreme symptoms, trying to get some Percocet. Two days later, Sgt. Gottlieb supposedly observed the accuser, at her home, in anguish. The poor woman could barely walk or sit. Once again, I felt that those were exaggerated symptoms.

   There seems to be a pattern here.

      Persons with bi-polar disorder often have co-morbid personalty disorders. According to an article on Medscape Today, "The incidence of comorbid personality disorder ranges from 45 to 65%, with borderline personality as the most prevalent, followed by histrionic personality disorder."

    "Personality disorder traits predict poorer medication compliance among bipolar adults, and the social support that buffers against relapse is lacking.^[15] Bipolar patients with personality disorders also spend more days in the hospital in a given year,^[16] are less likely to achieve symptomatic recovery,^[17] have more severe mood disorder symptoms, and function at a lower level than those without personality disorders. "  Many are also involved in drug / alcohol abuse and drug-seeking behaviors.

     When you look at the accuser's behaviors and statements in this context, everything  seems to make sense: the erratic behavior, the stumbling around, yelling from the bathroom, banging on the door to get back in, then passing out on the steps; jumping at the suggestion of rape given by the nurse, changing her mind twice, followed by the refusal to speak to the police officer, the exaggerated complaints at the hospitals and in the interview with Gottlieb; pole dancing while at the same time claiming back injuries, changing her stories multiple, multiple times, not getting anything straight, poor relationships, impulsive behaviors, even her poor (sexually provocative) career choices ...

        According to pharmaceutical literature, the Seroquel / Depakote combination is used specifically to prevent extreme manic episodes. When viewing her behavior, it appears she may have been off her medicine.

       If extreme manic behavior is not treated, it often will progress to psychosis, including delusions. I cannot help but question if that is what happened in March, 2006.

     It seems to me, there are indicators that both of these disorders, as well as drug seeking behavior, and alcohol abuse, may have all combined together to create a 'Perfect Storm'. 

     A storm which has raised racial tensions across the country, hurt innocent people, ruined careers, and tarnished the name of a renown university.

      It's a storm that needs to end.   

   

    

   

 

    

 

 

 

 

 

    

 

Forensic Talk Postings Irresponsible?

Comment by Dermite:

   Kathleen,

   I respect your efforts to shed light on and apply reason to the Duke lacrosse case; however, I am disappointed by what I perceive as a lapse in judgment in several of your recent blog posts. In this pair of posts about the SANE nurse, you’ve crossed the line from analyst to gossip-monger.

The accuser may be full of it and case may go nowhere; but where do you get off dragging someone through the mud who by all accounts was just doing her job? You took a small amount of information and made some huge leaps in your assumptions. From the details of protocol at a hospital where you don’t work, to what the law says in a state where you don’t practice, to the extent and suitability of the nurse’s education and experience, you’ve made a bunch of guesses with very little backing them up. You said, "I'm hoping the information, or my interpretation, is incorrect." But from that point on you treated your interpretation as a certainty. That’s pretty irresponsible.

 

Finally, have you read what KC Johnson wrote in response? He uses your post as an excuse to make a completely unfounded attack on the nurse, accusing her of ideological bias. The statements he has published in a public forum are a profound disservice to women’s health and you should respond. He says that an article written by Levicy “is not exactly mainstream on issues of gender.” It is despicable to deride a healthcare provider for urging colleagues and patients to be open and unashamed when talking about health issues.

Posted by: Dermite | January 13, 2007 at 01:57 PM

My Response:

Dermite:
Thank you for your comments.

   While I certainly respect your opinion, I wholeheartedly disagree that I was "dragging someone through the mud".

If you have read my blog posts, then you'll recall that I've written that I have nothing but the highest regard for my colleagues and that is true.

   I've also written that in no way do I mean any disrespect towards Ms. Levicy.

However, there are certain aspects of this case which I have questioned from the beginning.

  First and foremost, was the first nurse asking if the accuser had been raped.

I certainly respect that nurse as well but that doesn't mean I have to agree with what was done. In fact, as I've written, I strongly disagree.

   The second was not doing the toxicology tests in the SANE exam.

I realize that the guidelines discourage testing. However, in a case where a patient states they combined alcohol and Flexeril, I would have felt the testing was appropriate - for the safety of the patient alone, if for no other reason.

Appropriate medical care takes priority over the SANE exam. I would not have felt comfortable letting such a patient leave without making sure she was safe to do so.

   In fact, it was not doing the testing that first made me question how much nursing experience Ms. Levicy actually had.

  The third was the report from Gottlieb that the speculum exam took an extremely long time. Hmmm.

The fourth was the report, again from Gottlieb, that Ms. Levicy told him a week later that the accuser's injuries were "consistent with sexual assault".

And of course, there is the "diffuse vaginal edema" issue.

   I not only questioned it myself, but discussed it with several other medical professionals.

   I wanted to make sure I wasn't mistaken, as I'm certainly not a person who thinks I know it all.

   Everyone I spoke to, all with many years of experience, agreed with me.

   In that particular situation, you had a resident overseeing a SANE nurse in training. 

   I feel, as does everyone I spoke to, that there should have been an experienced SANE nurse supervising that exam.

  That's not trying to sling mud, Dermite, that's just being honest.

We all make mistakes, especially when we are first training. That's why we need supervisors and preceptors - especially in nursing.

In this case, you have three young men who may be facing 20 - 30 years in prison, based partly on the impressions of a resident and a nurse in training.

What if an honest mistake was made?

I do not need to work on that unit in order to know what the standard protocols are, Dermite. We're all trained pretty much the same way.

In fact, one of the reasons I have tried to be very specific, in my writing regarding all the different aspects of the SANE exam (aside from educating the public), is to show that our training and exams are pretty standard in all states.

   As far as the nurse's experience as an RN, the information is available on the NC Board of Nursing website. It states the initial RN license was given in 8/05. That's why I wrote that I hope that either the information presented, or my interpretation, was incorrect. I really didn't want that to be true.

   However, upon further research, it was noted that she was practicing in a non nursing capacity, for planned parenthood, in 2003. The job description appeared to be secretarial. It was also noted that she was certified as an EMT. EMT's are great - but it's not nursing, and shouldn't be confused with nursing.

   I checked the requirements for our state, and it stated that EMT's have to take extra training in order to get a position as a health technician.

   In the nursing field, seven months experience is almost nothing.  I don't think you'll find too many nurses who will disagree with that.

  As far as attacking Levicy's health article, it appears that it was a non-professional article, written to educate the lay public on female health issues. And that's a good thing.

  While a person's attempt at educating the public shouldn't be attacked, and I commend her for trying, I also believe that particular subject should maybe have been written about by a more experienced medical professional.

   Irresponsibility

   I do not see how you feel that stating this information is being irresponsible.

Is it that I'm publicly stating I question certain things regarding that exam or that I'm openly questioning a person's experience?

   What do you think is going to happen in court?

Are you saying I should show my loyalty to my colleagues by being silent?

   Are you saying, I can openly question anything I like but not another nurse, is that it?

Well, normally I wouldn't. But this is a very unusual case.

  In this particular case, you have three young men being accused of something that, at this point, appears highly improbable.

   In this case, you have three young men who may go to prison for decades.

I knew I would be sticking my neck out by posting the info and asking the questions I did, since FNE's are usually used by the prosecution.

I certainly didn't relish the thought of making enemies among law enforcement professionals, for whom I also have the highest degree of respect.

But I thought, if I don't speak up, if I don't ask the questions that need to be asked, if I don't point out to the general public, important things that should be pointed out (from a medical stand point), who is going to?

I felt it was right to let people see things from a different point of view than just what the media was filling their heads with.

Whether people agree or disagree, it's OK. It doesn't matter to me. What matters is that they get enough credible information to enable them to think a bit, broaden their views a bit, and start asking questions - not just blindly believe what the media is telling them.

   I'm sorry you feel the way you do, Dermite, and I certainly respect your opinions, but I felt it was the just thing to do.

 

 

 

 

 

Posted by: Kathleen | January 13, 2007 at 06:07 PM

 

Duke Lacrosse Accuser Changes her Story - Again ... and Again ... and Again!

       

                                             

     The latest news is that the accuser in the Duke Lacrosse case has changed her story yet again - for the umteenth time.

Johnsville Blogspot has plenty of links and comments. I read the report, showing Inv. Wilson's notes taken during a second interview with the accuser on Dec. 21.

    It was the most ridiculous thing I've ever read!

   I swear, it's almost as if the accuser is all but begging for this dying horse to be put out of it's misery. I mean she can't come out and say to the world, I lied - about everything - all along.  No, can't do that.

   So, it appears one has to do what any decent con would do to get out of trouble - lie again. Only this time, the lies have to be so outrageous as to leave no doubt in anyone's mind that this woman is seriously delusional. Who's going to arrest a nutcase?

   But does it magically go away? No, it doesn't. Instead, she's got her knight in shining Armour determined to carry forth, determined to fight for her honor. Except of course, in this case, there doesn't appear to be any honor worth defending.

   There is no honor in lying. There is no honor in destroying innocent people's lives. There is no honor in enraging people's emotions and inciting community hatred to the point where death threats are made. There is no honor in betraying, and making a mockery of, a criminal justice system that most Americans count as a source of great pride.

   It's not perfect, but it's ours and we're darned proud of it. At least, until something like the Duke case comes along and does nothing but hold us all up to ridicule and contempt. Then it makes us feel ashamed. Ashamed that many of our fellow Americans would just sit back and allow this travesty of justice. Some actually even promoting it!

  Most of us happily live our lives in relative anonymity. We go along, doing our daily tasks, working, going to school, and taking care of our families. Most of us are law abiding citizens who don't expect to end up on the nightly news.

   Unfortunately, all that is changing now. In a heart beat, our faces could be flashed across the screens for all the world to see. Actual innocence or guilt doesn't seem to matter anymore, as facts are twisted, or disappear entirely, in order to promote one's agenda.

   Careers can be ruined, lives changed forever, exorbitant financial costs endured; innocent people can be publicly humiliated, pointed at, stalked, or even threatened.

   All because some people apparently don't know the meaning of the word, honor.