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.   

 

The Duke Lacrosse Had Only Seven Months Experience? Part II

                                                          Modified 1/09/07 7:06pm
     A few days ago, I took an informal poll from among the various professional list servs to which I belong.

   I asked for their personal feelings as to how much clinical time and experience (in their prosective fields) should be obtained before a person should be able to testify as an expert.

   I specifically asked if they would consider someone who is but a few months out of school to be experienced enough.

   Among the professionals who responded are nurses, criminal investigators, forensic scientists, private detectives, insurance investigators, fraud investigators, an arson investigator, and attorneys.

 

         Since that first post, I have received more responses:

      From Joyce, a Legal Nurse Consultant:

     "We try to match our TE's to the case.  Examples - BSN:BSN, MD:MD  OBGYN:OBGYN  ADN:ADN and years of experience is the same. Then we look at the level of the area they are working and match up  Level III nursery nurse with a Level III nursery nurse, with the same degree and years of experience. And is [sic] is going to depend on what the issue is or what scope of practice was not followed.  The text book may say one thing but in reality treatment can not be text book every time."

   From Kelly, a Latent Fingerprint expert:

   "A related aspect to the expert question is a problem that "experts" from the greatest majority of LE agencies encounter. The question "Do you perform the duties of **** 100 percent of the time" arises, sometimes in court and sometimes in questionnaires for training.

   The question infers that if a person is not 100 % dedicated a singular task he could not be considered an expert. Consider that the overwhelming majority of agencies are small to medium.  In these departments it is necessary that employees mult-task. Our rural locations makes using larger department's impossible. Besides they have more than enough work to do and we should be able to do our own cases. 

   I may be in charge CID, take my turn working crime scenes, testify as a latent examiner,and make coffee. No, I do not function 100% of the time as a latent examiner, but I do 100% of the latent examinations. Does the fact that I make coffee make me less of an examiner? So in your research I feel that the question on the "expert" question should be one of training and education, not if the department is from a large city or not. Time to make more coffee. "

   From John, Private Investiagtor:

   "From my point view, the question may answer it self.  There are many Private Investigators that might think of themselves as experts in their chosen profession but the product may not say that.  At least we are all smart enough to ask questions to help get us to expert level."

   From Paul, Forensic Consultant:

   "Ultimately, it is the role of the judge to determine if an individual meets the standard the judge sets for that courtroom. It also will vary by the field...a brand new PhD who just determined a new way to approach a problem. who has here to fore never been in a courtroom nor conducted a forensic examination may be qualified as an expert; a general practitioner may wait many years to build the bona fides for another court to grant expert status.

   I had four years experience when I first testified as a latent print examiner; it was my first latent case to go to trial, and I was qualified handily. Another court, another resume, may have been a very different story."

      Mark, Forensic Scientist: "This is indeed the 100,000 dollar question (or should I say "million dollar" question)... To me expertise relies on knowledge, skills and abilities.  The forensic sciences seem to take the approach that there is a magic number...two years. This is regardless of whether you are a DNA analyst or a fingerprint technician.  Obviously this approach isan oversimplification but it is, at the very least, a standard.

I think it may also be illustrative to give a "qualitative" range for expertise.  For instance, expertise should be more substantive than a few seminar courses but should be less than 30 years.

The problem with putting a "time" metric on training and experience is that different people will have different training and different case experiences during training.  There is also a quality component to
training...this can vary as well.

No doubt that you followed the message thread regarding "science v.s technician" on the Forensic-science list serv on yahoo recently.
Unfortunately the whole topic got off track and became an attack on my credentials which I found both amusing and libelous at the same time because numerous unsubstantiated inferrences were made.  However I think the discussion makes a great point for the differences (and misunderstandings) of the "specialist expert" vs. the "generalist expert".

I think a valid legal bright line exists by using the layman as a standard.  If a person has knowledge, skills and experience that is greater than that of the average layman of average intelligence and means, then I think that constitutes expertise.  However this knowedge and experience base must be useful for the trier of fact.  Having said that, the usefulness mustbe on the side of truth seeking, not winning a case.

In some ways I see the judge as rightfully having the duty to determine who is an expert.  There is a moral and ethical duty for experts to know the limits and bounds of where there expertise begins and ends.  I think this aspect has room for improvement with many
experts.

That's my 2 cents worth ... I personally think that some areas of forensic science require more time to learn than other areas.  Fingerprint identification is not rocket science, however DNA analysis approaches a type of rocket science level of understanding."

   Chris, adoption expert: " I think better than 10 years experience.

I am an expert in adoption and heir research and I have been called as an expert witness several times each time I was asked my experience history."

   Willie, Legal Investigator:  "No, 6 months would not qualify as an expert in any field."

   Richard, Legal Investigator: "The answer to your question is very simple the longer the history of the person the better the expert witness will be.  An example very simple to explain is your character witness must have a strong history of knowledge to be considered an expert."

   Ed, Pathologist: "In pathology I qualified with no experience beyond training. I have qualified ever since, now up to 44 years later. No one has any value without ability to qualify. One would not be employable and be able to accumulate experience without beginning"

   To the question posted, regarding if only a few months experience was enough to qualify a person, Lee, a criminal investigator, answered, " Absolutely NOT! "

   Kathy, Legal Nurse Consultant: "My gut feeling is about 10 years of experience for most standard of care nursing experts and physician experts. Having said that, I do know of an ICU nurse who is an excellent expert with 8 years of adult ICU experience. However, she has been in that specialty for the entire time and speaks as to the standard of care in regards to cases only in that area."

   Susanna, Consultant Expert:  "I have referred testifying experts for many years and, regardless of statutes, I think this is what the market bears:

All expert need to be clinically active.

I only refer a nursing expert with a BSN if  he or she has a certification in their area of expertise and >10 years of experience.

Thus, the majority of nursing experts I refer have advanced degrees, specialty certifications and > 10 yr experience.

 

The same holds true for physicians.  I do not have attorneys who want an expert MD who is not board certified or who has less than 10 yrs post residency."

   Lori, Medical legal Consultant:  "I think ideally, 5 years plus is needed to be an expert in any given field.  I do think some will be considered experts after three years, depending on prior experience.  For new grads, I can't go less than 5 years."

   Dan, Office Manager of a Legal Nurse Consulting firm: " am not a medical professional, but you did not specify that I needed to be. I have twenty-five years in the service industry and eleven in business management.

   In my opinion an expert should be out of the training phase of their career ie; apprentice, journeyman, internships etc.. and have at least ten years of on the job training. Because the term "expert" implies a high proficiency at a particular endeavor as well as just being qualified to perform the work.

   I think you need to have "seen it all" or at least most of it, a couple of times. I also think there should be...especially in the medical profession, exceptions that require more time than that as some fields of endeavor are extremely technical and diverse as far as the different situations that occur. It may also be worthwhile to note that some fields, like nursing are significantly compartmentalized and should require a certain amount of expertise in that particular area, I don't know that it would require ten years though, maybe four?"

   Ruth, RN: "I have been a testifying expert for almost 18 yrs. I have been an RN fo 38 years.I have no advanced degree but what I do have is experience and conviction in what I testify to."

   Beth, Legal Nurse Consultant: " We use the basic rule of at least three consecutive years of practice in the field (with ongoing current clinical practice in the field - nursing experts), MD's too must be current and clinically active - I always feel the more the better - I think it would take at least that long to hold yourself out as an expert, and I always look for ongoing CEU?ME's/ lecturing/presentation/publication experience in that field, but that being said - I think active clinical practice is always the most important aspect."

   Bill, Private Investigator: " Kathy you have an awesome Blog   (Thank You, Bill !)

I believe the two most abused words in the judicial system are 'forensic and 'expert.' Last year I heard a Child expert testify on behalf of the prosecution. She must have used the word "forensic" 30 times in her testimony. Such as, "And then I conducted a forensic interview." YUK! During the break after the jurors and 'expert' left the courtroom, the old judge threw his pen down on his bench/desk and stated "If I hear the word 'forensic' one more time...." Bottom line is, it has now become an abused buzz word or cliché.

 

Regarding 'experts." I am a court qualified 'expert' in many areas. But I refuse to testify as an expert. While the court can qualify a witness as an expert if they have enough of either of the following.

 

1. Experience

2. Training, and/ or

3. Education.

 

Too many do not have the actual 'experience.' Especially regarding use of force experts. Most of them have never unfortunately been placed in a situation to use force. But now their experts? But then again, their paid to give that opinion."

  Sue, Defense Investigator:  "Since I am a member of some of the forensic groups and I've already read this inquiry, I understand what you are looking for. However, with this group it is usually quite different.

   As the private investigator working for the defendant, we are the ones who interviewed the witnesses, took the pictures, measured the distances, transported exhibits from Point A to Point B, etc.

Usually when we testify it is to lay a foundation for the admission of the pictures, the diagrams, the measurements, etc. as well as the occasional need to impeach a witness. It doesn't matter whether it is our very first case or not.

Here in CA, for instance, I am licensed by the State who says I am
experienced enough and possess the necessary requisites to become licensed. No county prosecutor can undermine the authority of the State very successfully. Unless the investigator witness comes off sounding like a babbling idiot, the prosecutor demeans the strength of his own case if he attacks too aggressively."

   Joe, RN, Forensic - Psychiatric Nurse: " Six months of training and doing the job is probably sufficent. "

  Nancy, RN, Forensic- Psychiatric Nurse, immediately responded back to Joe:  "No it's not. It does not make you an expert. I am sorry I beg to differ."

    I beg to differ with Joe too.  A few months nursing experience does not make one an expert at all. How can it? We were all "babies" at that point!

   Just to clarify my position, I'm not saying that a nurse has to have five years, or whatever amount, experience as a SANE nurse in order to qualify as an expert.

   What I'm saying is that, in my opinion, any nurse who should decide to take the SANE / FNE training course and go into forensic nursing, should first have several years [preferably at least ten] experience in the ED, Trauma, or Maternal-Child Health fields before venturing forth into this highly specialized area of nursing.

   Most certainly, I do not feel that any SANE nurse still in training should be doing an exam without supervision by another experienced SANE nurse. Even after finishing our training, we still don't know everything.

   After months of clinical experience, I was still going into the office, asking my superior, to come double check me, to make sure that my impression of what I was seeing was correct. A prime example, was when I first found extreme redness and abrasions on a patient, months after I had started working. This was the first time I had seen this and needed to be sure that these types of symptoms were indicative of sexual assault. Turned out, I was glad she was right next door.

   She took one look and let me know that, no, those symptoms are often caused by vaginal infections, rather than sexual assault. Since vaginal infections can be present for a long time before the woman is aware, they can do more damage to the tissues.

   What you will see then is extreme redness and swelling, all the way around - sometimes to be the point of the tissue being almost excoriated -  many abrasions, and a deep, cherry red looking cervix. There will also usually be excessive vaginal drainage. If she had not double checked me, I might have come to the wrong conclusion.  These are the types of things you can only learn through time and experience.

   One other thing I'd like to note, is that nurses cannot determine causation. Only a physician can do that. We can give our opinion as to whether the injuries are "consistent with" sexual assault but we can't determine what caused the injuries.

  That point was stressed during the Kobe Bryant case when Dr. Michael Baden, was released by the prosecution for providing evidence that undermined the accuser's allegations.

   As Dr. Baden stated, " Usually, a physician can't tell consensual from non-consensual. They can tell whether there's been intercourse or not intercourse, but not whether it's consensual because one can have bruises and certain injuries from consensual sex and one can have no injuries from non-consensual sex."

Well, common sense causes me to ask: If one can't determine causation with regards to actual outer visual injuries like redness, tears, and abrasions, how could one determine what actually caused "diffuse edema of the inner vaginal walls"?

 



   
   

 

                                                      
         

Duke Lacrosse Nurse had Only Seven Months Experience?

 

                            

     Comment from Kethra:

 

 

 

Modified 1/8/07 4am

Correction: Title changed. Intended to read, "had" seven months experience.

 

     Ms. Levicy indicated in 2003 she was going to enroll in an NP program. If she indeed did that, she could be in her clincals and thus doing SANE by virtue of the NP (shudders).

If not, as it now appears, Duke allowed a nurse who is barely off Graduate Nurse probation do a SANE exam, I would have to call into question the competency of the Nurse Manager for Duke ED. I would feel that way even if Ms. Levicy was in NP clinicals given her extreme lack of experience.

Excellent post!

     Thank you for your comments Kethra! I have read your excellent posts as well.

     I double checked the educational and clinical requirements for NP programs at various universities. U of. MD. has an excellerated program for those who hold a BS degree in fields other than nursing:

   "MS Accelerated – Clinical Nurse Leader

The CNL is a generalist clinician with education at the master's degree level. This pre-licensure program will allow individuals with degrees from other disciplines to earn a Master of Science degree in nursing by building on the foundation of their bachelor's degree.

   A second bachelor’s degree will not be awarded. Upon completion of the program, students will be eligible to sit for the national licensing exam (NCLEX) to earn RN licensure."

   Most of the others I found required a BSN first; many required prior clinical nursing experience.

   I find it hard to believe that they would allow someone to go from not being a nurse at all to being a nurse practitioner. No offense intended to anyone, but to allow someone to diagnose and prescribe medicines, who had no prior clinical nursing experience, is just mind boggling - and very disturbing! I agree with you, Kethra. I shudder at the thought!

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     The book learning, even advanced degrees, are great. But as Kethra and I, and millions of other nurses know, there is far more to nursing than what comes out of a book. Theory must be put into practice and that practice must be continuous over a lengthy period of time in order for everything to come together.

    I still remember what it was like when I was fresh out of nursing school. There was no way, at seven months, that I would have considered myself an "expert" in any type of nursing. I was still following the other nurses around, asking a million questions.

   Oh sure, the day to day  routines, such as changing dressings, handing out medicines and charting, were easy enough to learn. But it was the ability to translate what we had learned in school, to apply the theory to the actual picture of what was going on with that patient, that took time to develop. 

   It took time, and additional hands on learning, to realize that something that seemed so straight forward in school really wasn't when it involved different types of patients, of different ages, and in different physical conditions.

   It takes time to develop the ability to make snap decisions needed in emergency situations. It takes time to learn about things like the bio-mechanics of trauma and patterns of injury. It takes time and skill to recognize personality disorders and manipulative and attention seeking behaviors that some patients will exhibit.

   You can't just learn about these things in a book. You have to see and experience them first hand in order to apply the knowledge that was obtained in school.

   Nursing school is just the beginning. It can take years to learn the rest.

    Privately, I offer both forensic and legal nurse consulting services. Many forensic nurses are also legal nurse consultants. I've belonged to various LNC professional groups for several years now. Often, a nurse, maybe a year or two out of school, will express interest in becoming an LNC.

   That person has always been told, by the majority of group members, to wait until he/she has gained more experience. That person has always been told that you usually need a good 10 years of solid nursing experience before considering legal nurse consulting.

   Why? Well because the primary job of an LNC is to be able to review medical records to determine if there has been any deviation from the standard of care (SOC) provided to a patient.

   The LNC also must be able to educate attorneys on a wide variety of things, such as medical terminology, anatomy & physiology, the pathophysiology of a particular disease process as it relates to their clients; to usual nursing practice and procedures, to management and staffing issues. Often, the LNC is retained to testify as an expert in court.

   In order to fulfill all the requirements of the LNC position, one must have a strong clinical background which can only be obtained through years of hands on practice.

  It's the same for nurses who train as FNE's in our state. That person is required to have a strong clinical background, backed up by several years of recent experience, before being qualified to take the SANE training course and obtain their certification.

   Sure, they can collect the evidence competently. Technicians do that out in the field. That's the easy part. The hard part, the part that requires the nurse to interpret what she's seeing, must be based on clinical expertise. As I said before, most of the FNE's I know have years of experience under their belts.

   This information on forensic nursing is from my other website, www.HarfordMedlegal.com:

   "The definition of forensic nursing is the application of nursing science to public or legal proceedings; the appreciation of forensic aspects of health care combined with the bio-psychosocial education and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity, and traumatic accidents." [Lynch 1989]

      Forensic nurses are registered nurses with advanced, specialized training in forensic sciences and the law. Forensic nurses apply this knowledge in the care and treatment of victims of abuse, the collection of evidence, and provision of testimony for criminal investigations.

    To quote Dr. Mary Dudley, Chief Medical Examiner for the Sedgwick County Regional Forensic Science Center in Wichita, Kansas [from whom I took my death investigation training], "The forensic nurse must obtain specialized knowledge of trauma, forensic psychology, criminalistics, forensic science, and legal issues for expert testimony." (Forensic Nursing, Mary H. Dudley, M.D., M.S.N., R.N.)

   There is no way I would have even considered becoming a SANE nurse with only a few months nursing experience, much less walk into court to testify as an "expert". I'm glad that my own state has the high standards and stiff requirements that it does for our own FNE's.

   Since I'm always interested in other professional opinions, I questioned several of my colleagues, both within the forensics field and out, as to their opinions of an RN with only seven months experience providing SANE exams. Their reactions mirrored my own. Mouths flew open, "You're kidding!" 

 No, unfortunately, I'm not.

Daubert Requirements

     Rule 702. Testimony by experts

If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence of to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise, if (1) the testimony is sufficiently based upon reliable facts or data. (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case.

    How does one maintain they have "specialized knowledge" when they haven't even finished their training yet? 

   I know what SANE "in training" means. It can mean anything from still trying to get their initial GYN training exams done, as well as the other training requirements, to having completed less than three SANE exams.

    It means you have almost zilch experience. It means, according to myself, as well as other FNE colleagues, that you should still be supervised by an experienced SANE nurse during any exam.

I mean no disrespect to Ms. Levicy. However, while I'm sure that Ms. Levicy has completed her training in the last year, she was still "in training" at the time of the Duke Lacrosse accuser's SANE exam.

   It was her opinion, at that time, that should matter. An opinion that Durham DA Mike Nifong specifically stated he relied upon to aide in bringing charges. An opinion that led to the indictment of the three Duke Lacrosse players. An opinion, from the "sexual assault expert", that helped rile a community, inflame racial tension, and send the media into a feeding frenzy.

  An opinion based on what? Seven months experience as an RN and almost zero experience as a SANE nurse?

   If I knew that my own "expert" testimony might be used to convict anyone -  I would want to make sure that I had enough knowledge, training, AND clinical background experience in order to feel comfortable rendering that "expert" opinion.

   Here are some other opinions from professional colleagues in various fields:

   From Rick, an RN : "... 6 months is not enough time to be an expert on anything. We grow into our positions learning more every day. An expert needs to have a goodly amount of hands on experience beginning as a novice and progressing through out the various stages until reaching expert. I wouldn't consider anyone an expert without a minimum of 10 years. "

  From an insurance investigator:

   "I can say from experience that from an insurance company standpoint, a good expert that would be credible on a witness stand would be someone who has at least 5-10 years experience in their field.

   In regards to nursing experts, someone who has a masters degree and teaching experience would be an ideal"expert". In addition, how they would perform in front of a jury is key to being a good expert. Someone with less than 5 years experience is still learning their craft and would be a very unimpressive witness."

  From another investigator:

   "If they are using an expert classification to establish a point, ask them to cite the articles that they wrote on the subject, the cases that they testified in, their education studies on the subject, which court certified them as an expert, what research they conducted ..."

From John, a retired Matron of a forensic hospital in England:

    "A person can have 20+ years as a forensic nurse but their 'experience and expertise' can be limited. I think that it has to be a combination of experience (clinical and/or managerial - all in the field of forensics), academic achievement and the verification and endorsement of at least two others in regards to the area of expertise"

From Chris, an arson investigator:

   " Yeah, it is a huge problem in our field. I know people who have 30 years field experience but no degree who don't qualify, but engineers with no field experience or practical training are considered experts. That is why in our field (Fire/Arson) attorneys are almost always doing a Voi Dire and Daubert Challenge in every single case."

   From Fred, an insurance fraud investigator and educator:
   "We are a provider of insurance fraud education to the insurance industry. We recently began offering our courses to the private investigator industry. Many times we feel these individuals believe they are well trained, but they in a lot of cases, they are not. Many do not believe they need to be kept up on training. Many never receive additional training once they enter into that industry."

   From Brent Turvey, Forensic Scientist:
   "I use work-product to estimate expertise. Using this standard is far more useful
in terms of separating those who have some grasp of what they are doing from
those who do not ... real experts don't need to tell you how many years
they've been doing what they do, or how many letters come after their name,
to support their conclusions; they show their work and render conclusions in
such a way that makes their expertise clear to any reader."

   From Kethra, an Emergency Room RN:
      "I cannot imagine any new grad nurse being subjected to a SANE course. It is not that they could not do the course work, you and I both know this, but the sheer experience needed to make judgement calls simply comes with time and time only. 

   For any nurse manager to subject a new nurse to this is beyond the pale.  I understand we are in a nursing shortage, but to subject both the patient and the nurse to this type of experience is unprofessional in the extreme."

   Diffuse Vaginal Edema

   The following is quoted from Dr. Dudley's book, Forensic Medical Investigation. It's an example of court questions of an expert:

   " Q: You've got lacerations of the scalp. We will talk about that. But what you have here is focal hemorrhage of neck muscles, right?

    A: That's correct

     Q: Focal, that means focused, correct? Am I right in that?

      A: The way I use the word "focal" is it's localized vs. diffuse. And what I mean by focal, it means it's not spread out all over. It's got a definite area. "   
    Dudley, Mary H. Forensic Medical Investigation. A Comprehensive Review 2002

   As far as recognizing " diffuse vaginal edema" goes, a SANE Medical Director, an M.D. and co-author of a forensics trauma textbook, recently said that, with all her years of experience, she didn't know if she could recognize it.

   

      

    










       So, I have to ask :
      If a Medical Director, with many years experience in both trauma and sexual assault, as well as other FNE's with years of experience too, couldn't be sure that what they were seeing was diffuse vaginal edema, how could someone with only seven months nursing, and almost no SANE experience be so certain?

 

 

 

 

Conviction Resulting from False Confession Overturned

Today the Mississippi Supreme Court overturned the conviction of
Tyler Edmonds who was 13 years old when charged with 1st degree
murder of his half sisters husband, Joey Fulgham.

Tyler was convicted in July of 2004, with no forensic evidence other
than a false confession he made after his half sister begged him to
lie for her. Tyler recanted the confession a couple of days later.
Tyler's half sister, Kristi Fulgham was convicted in December 2006
for Joey Fulgham's murder and sentenced to death.

The Mississippi Supreme court agreed that Dr. Stephen Hayne who
performed the autopsy on Joey Fulgham, over-reached beyond his area
of expertise when he stated that two fingers pulled the trigger of
the 22-caliber rifle used to kill Joey Fulgham. The Supreme Court
found that Dr. Haynes testimony was scientifically unfounded but
carried heavy weight with jurors. The rifle was never recovered.

Justice for Juveniles advocates nationwide applaud the wise decision
of the Mississippi Supreme Court. Cari Barichello, Co-Administrator
of the nationwide online children's advocate group
justiceforjuveniles

.org said " To say we are extremely pleased over
today's ruling is an understatement to say the least. Tyler has
remained one of our largest priorities since his nightmare began at
age 13, because we believe that Tyler is also a victim of Kristi
Fulgham just as Joey was." Barichello says that Tyler has stayed
positive because of his Christian faith and love from his many
friends, family and supporters throughout his incarceration. "While
incarcerated, Tyler has done an excellent job of staying focused on
his education so he will be prepared to become a contributing,
responsible adult once he is given the opportunity and regains his
freedom."

Donna Gallegos of justiceforjuveniles.org said " While this is a
joyous day for Tyler and those who love and support him, his defense
team and his advocates have their work cut out for them." Gallegos
hopes that experts will offer up their expertise in Tyler's second
trial to assist him in obtaining justice. Experts such as a jury
consultant and other professionals such as experts on false
confessions can make a huge difference for this child", Gallegos
said.

Oktibbeha County, Mississippi officials will decide in the next
several days if the 2nd trial will be held in the same county or
moved to a different one. "It is questionable as to the ability of
obtaining a fair trial for Tyler in Starkville, Ms. because of media
publicity and because of Tyler's defense and the prosecutors public
debate concerning Tyler", Gallegos said.

######

Media Contact:
Email Contact: justiceforjuveniles@yahoo.com

GET INFORMED AND GET INVOLVED

Duke Prosecutor's Fourth Victim

Modified 1/02/07 1:35pm

Monday, January 01, 2007                                                 
By Susan Estrich

Fox News

   There are four victims of District Attorney Mike Nifong’s twisted tactics in the Duke Lacrosse case.

     The first three, of course, are the young men who never would have been charged with anything had Nifong adhered to the standard practices in his own office. With luck, they will ultimately be exonerated, and be able to move on with their lives, albeit after having endured a chapter in hell.

The fourth victim is unlikely to be so lucky; she will not be exonerated at trial, and she will not be able to move on with her life. She will be destroyed by this case, and while she is partly to blame for that herself, the other part of the blame rests squarely on Mike Nifong’s shoulders.

The woman is a liar. That is the English translation of the latest round of maneuvers, in which the prosecution dismissed the rape charges because the woman could no longer say, as she once did, that she had intercourse with three men at the party. In other words, she lied when she said she did ...

Full Article

Point of View

     Ms. Estrich certainly pulls no punches in her recent article criticizing Mike Nifong's behavior amid allegations of prosecutorial misconduct. I commend her, and the other media news writers, now jumping on the anti-Nifong bandwagon, for that.

   I just wish everyone - from the DA's office to the community to the news media, would have questioned the extreme inconsistencies in this case from the beginning.

   Perhaps that would have saved these young men from the public scorn and humiliation which undoubtedly will follow them all the days of their lives.

     Perhaps it would have also saved their families from having to bear enormous expense, in order to keep their sons from being railroaded into serving long term jail sentences for something they obviously didn't do.

   And it should have been obvious from the very beginning.

   The whole "rape" scenario was just ridiculous!

    First of all, when I read that the report of a rape was preceded by a 911 call, from Someone complaining that people on the street were calling them names ... well, the hair on the back of my neck stood on end!  

   Even before hearing anything about Kim Roberts, there was just too much of a coincidence. Who does that?

   And then the whole assault scenario, as described by the accuser, just didn't make any sense - even from a lay person's perspective.

    Why were so many pot bangers ready to jump in there, condemning the Duke players, without first examining whether the "facts" made any sense or not? Why weren't the media reporters' famous noses put to use?

   One didn't need to be a forensics expert to smell that something was rotten in Durham.

   People should have used their common sense nine months ago, instead of just jumping to conclusions because they wanted to either:

a) Get back at the "rich white boys",  b) Get back at men in general, or c) Get the highest ratings.

   Justice is not about promoting one's agenda. Justice is not about getting back at someone because of past injustices. Justice has nothing to do with seeing who can get the highest TV ratings.

     Justice is about protecting the rights of our citizens - every citizen!

     Our constitution does not allow us to pick and choose. Our constitution provides rights to everyone, no matter their race or station in life, and it specifically prohibits violating those rights.

   As the old saying goes, it's better that ten guilty men go free, than one innocent man go to jail.

   For some reason, that didn't seem to matter to a lot of people.

  And those people should be ashamed of themselves.

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   The first person who should be ashamed of herself is the accuser.

    Yes, I still refer to her as "the accuser". While I know everyone under the sun is naming her now, my own training, protecting the name of all accusers, is too ingrained in me now, and I just can't bring myself to name her.

   But she knows who she is and what she did. And she knows how many lives, how many careers, she has destroyed with her false accusations.

   I respectfully disagree with Ms. Estrich on one thing. I do not believe this woman is a victim of anything.

   Rather, I believe the "system" , her community, and all of the Lacrosse players have become her victims.

   I believe that she is a "user", a manipulator of a system she well knows. She's been around the block. Even in her impaired state, I believe she knew what she was doing.

   She knew well enough to refuse the original police officer's request to get out of Kim Robert's car. She knew well enough to respond, "Yes" to the inappropriately asked question, "Were you raped?"

  It's easy enough to answer yes, when you don't want to get locked up. She knew the ropes. She knew she had just been given the way out. So what if she manipulated the system? What had it ever done for her?

  Worried about being taken away from her kids? I doubt it. Not too much anyway. Worried about being taken away from her ... ugh ...  "medicines"? I think that's probably more like it. 

   Those exhibiting drug seeking behaviors will often go to extreme lengths not to have their drugs taken away from them - or them away from their drugs.

   This woman might have thought that she would be taken home afterwords. That would explain her changing her claim after leaving the hospital, telling the police officer, instead, that she wasn't raped.

  However, something happened at Duke. She changed her story again. This time, she claimed she was raped again. The police officer made a note that she refused to even talk to him after he confronted her.

That action alone tells me a lot. It indicates to me dishonest behavior. It indicates to me that she didn't want to be confronted with the fact that she was telling different stories.

   Most people don't like being confronted with their own lies. It makes it hard to keep telling those lies when someone is standing there, obviously not believing them.

    It's true that many victims aren't comfortable talking with the police. That's because they feel shame and embarrassment, not only about the assault, but because of having to talk about such intimate details with strangers.

   But that's not the case with this accuser. First she said she was raped, then she wasn't, then she was .... She couldn't keep her stories straight. This is totally different!

   I believe the accuser made a conscious choice, while at Duke Hospital, before being seen by the nurse, to proceed with her false accusations. My personal belief is that she was trying to score prescriptions - hence the "extreme vaginal pain" she supposedly exhibited in the SANE exam.

    I believe that when she didn't get any prescriptions from Duke, she headed over to UNC the next day. There she complained of neck and back pain and hitting her head. Well, she got lucky there, even though a physician wrote a note warning of her risk for abusing drugs. She got her Percocet.

     That of course, was followed by her performance in front of Sgt. Gottlieb, at her home. A performance, I might add, that had any experienced nurse been there to witness, probably would have been laughed at.

    Experienced nurses are not dummies. We deal with manipulation and drug seeking behavior in the clinical arena all the time. We know how to look for the truth. Through our years of experience, we have fined tuned our senses, so that we can usually spot over-acting - not always, but usually.

   Unfortunately, since the police do not have the same medical background, they may not spot this type of behavior as easily. They can't be expected to know the legitimate - and illegitimate -  signs and symptoms of neck and back pain and how it may relate to drug seeking behavior.

   For this is what I believe it was. I believe the accuser's behavior, in front of Gottlieb, was an attempt to have on paper some kind of validation for her "pain", so that she could continue to get prescriptions.

  I believe that's why she told them about the bruises suddenly appearing. It was further validation. Perhaps she didn't remember having her picture taken at the Duke party. Pictures with the bruises already showing. 

   To give Sgt. Gottlieb the benefit of a doubt, here he was, interviewing this woman again who had claimed being hit, kicked, strangled, and raped. She was having trouble moving and sitting. She was limping. She had bruises. She had been seen at UNC and been given Percocet for "extreme pain".

   I believe that this whole mess began because of drug seeking behavior and her desire not to be locked up.

   Of course, I believe she got herself into a bit of a bind after finding out the DA planned to prosecute the case.

    But by then, people were holding rallies, screaming and yelling and pot banging, saying those rich, white boys needed to pay for all the injustice blacks have had to suffer. Reporters were everywhere. Even good old Jesse Jackson was offering to pay for her tuition.

   Well, gee, what was a girl to do?

   Other Issues:

     As much as I hate to say it, I feel it was a mistake to ask the accuser if she had been raped. I am not one to publicly criticize my colleagues. I have nothing but the greatest respect and admiration for all of them.

   I know what we have to go through to get trained and how hard we all work. We are all taught to be strong patient advocates and we do that very well. Perhaps too well at times.

    I don't know what they've been teaching in nursing school since I was taught 30 years ago, but we had it drummed into our heads, from day one, the correct and incorrect way of interviewing patients.

   When asking questions, we are not supposed to supply them with answers. Throughout our careers, we often deal with patients who have mental health issues. To supply them with answers to our questions is courting disaster. This case is a prime example!

  We don't say things like, "Were you raped?" I can't figure out why the nurse even asked that question. So she was upset. A lot of people get upset. That doesn't mean they were raped. If I were the accuser, I would be upset too if I was about to get locked up!

   Even so, the accuser should not have been asked that question like that. She should have been asked something like, " Did something happen?" " Do you want to tell me about it?"  or "Tell me what happened." That puts it right back on the patient to say what did or did not happen. She's telling us. We're not telling her!

   Never once have I asked a patient, " Were you raped?"  Instead I say, "Tell me what happened."

   Again, I don't wish to criticize. However, I believe it was a mistake to have a nurse "in training" doing the SANE exam without another experienced SANE nurse present. I realize a physician was present. However, few physicians take the SANE training course.

   I searched on line for the physician's name in the Duke, local, and state physician directories. It didn't pop up. The only place I found her name was in a near by state.The physician, under that name, was practicing in Internal Medicine, which deals with general practice issues like Diabetes.

   According to the NC state Board of Nursing, that nurse's initial RN licensure shows a date of 8/05.

   According to an article written by Ms. Levicy, she had a BA, not a BSN, and she was working at Planned Parenthood in  2003, in a non-nursing capacity. If the information is correct, it appears that Ms. Levicy was an RN for about seven months before doing the SANE exam. I'm hoping the information, or my interpretation, is incorrect.

   I checked for the NC SANE requirements. I could not find anything. In our state, we're required to have experience in either Critical Care or Maternal / Child Health before taking the SANE course. Most nurses don't go into this field without having many years of experience in other areas. Most of my colleagues have at least 20 years nursing experience.

   After taking the course, it generally takes our nurses about a year to get the extra training required, in order to get the state certification. That training includes, among other things, going to court, police ride alongs, completing so many internal GYN exams, and being trained / observed by experienced staff FNE's. Afterwords, we're responsible for continuing our education through college courses, on line CEU's, conferences, and seminars.

   Even when we receive our state certification, that doesn't mean we're ready to be qualified as an "expert" in court. When I first started working, I was taught by my superior that we can testify as a fact witness but not as an expert witness until we get more experience. We have to get so many cases under our belts first.

   There's an important difference between the two. A fact witness can testify as to the facts observed. An expert witness, however, can render an opinion. Testifying as to whether injuries were "consistent with" a sexual assault would be an opinion.

  Mens Rea

One of the first things we learned about in my paralegal criminal law class was Mens Rea. Intent.

   According to Criminal Law and Procedure, Third Ed., by Daniel E. Hall. J.D., Ed.D.,  "Mens Rea is the mental part, the state of mind required to be criminally liable. It's often defined as a "guilty mind" or possessing criminal intent ... most criminal laws require intent of some degree before criminal liability attaches to an act."

   In most cases, to be guilty of a crime, there must be intent. So I have to ask. What was the intent and where did it lie in this case?