Forensics Talk

Van der Sloot Intends To Paralize The Court Process, Attorney says

CNN Justice   

  

By the CNN Wire Staff

June 28, 2010 3:57 p.m. EDT  

 

" (CNN) -- Joran van der Sloot, whose claim of unlawful incarceration was denied last week, will appeal and fight to the Peruvian Supreme Court and international courts if necessary, his attorney said Monday.

Van der Sloot, a 22-year-old Dutch citizen, is jailed pending trial on charges of first-degree murder and robbery in the May 30 death of Peruvian student Stephany Flores, 21.

In an attempt to nullify a confession he gave police, van der Sloot claimed his civil rights were violated following his arrest. A judge Friday ruled his confession and detention stand.

His legal strategy now is to "paralyze the process," his lawyer, Maximo Altez, said."  Read More

 

Erie County, PA Forensic Nurse's Findings In Question in 11 Cases

Go Erie.com News

It's with great sadness in my heart that I have to post a link to this story about a forensic nurse whose findings in 11 alleged child sexual assault cases are being seriously questioned by the DA and medical experts. However, I couldn't feel I was being truly objective if I didn't.

   According to the experts, medical records written by Rhonda Henderson, a former forensics nurse in Erie County, Pa, are completely inconsistent with the photographs. District Attorney Jack Daneri has informed defendents and victims of problems with Ms. Henderson's documentation. According to the DA, " More than 20 defendents were convicted of sexual assault in cases in which Ms. Henderson's medical records played a role."

   "The Erie County District Attorney's Office will continue to review its files to locate sexual assault cases involving medical examinations and reports done by nurse Rhonda Henderson." Read More

     A big thanks goes out to the website, Top 50 blogs For Forensic Science Technicians, for naming Forensics Talk number 3 on their blog list!

    This is the third time in as many months that Forensics Talk has been listed among the top forensic blog sites. Please check out their top forensics blogs under Links on the right.

     Thanks also goes out to the college programs referring their students to this blog. One of the primary goals of this site is to educate both lay persons and those new to the forensics field. I hope the information they find on this site is helpful.

   Elsevier, well known publisher of medical and scientific journals and books, is now following Forensics Talk on Twitter.

ER Visits For Pain Reliever Abuse Up 111% In 4 Years

  AN interesting article, just out in USA Today, points to the increase of prescription drug abusers showing up in the hospital ER's lately y - a staggering 111%!

   The thing is, showing up in the ER, with multiple complaints, in an attempt to obtain prescription drugs, is not something new. It's been going on for a long, long time.

    I've either seen it, or been aware of it, throughout most of my nursing career. It's great that the public is now being made aware of it but I feel more attention should have been paid long before now and better steps taken to prevent and investigate such abuse.

   And, let's face it, it's not just about the abuse alone, which is often costly in terms of family relationships, and problems at work. But in terms of health care costs too, as many of these patients don't pay their hospital bills. That, in turn, puts a hefty financial burden on the rest of us. Health care fraud such as this needs to be investigated thoroughly. Please read below:

   USA Today

By Mary Brophy Marcus, USA TODAY

 

    "Emergency room visits for non-medical use of pain relievers have increased at a striking rate over the last five years, according to a new study.

Between 2004 and 2008, the estimated number of emergency department visits linked to prescription pain relievers — including Oxycodone- and Hydrocodone-containing products, and methadone drugs — jumped 111%, from 144,644 visits to 305,885 visits a year, according to a study out Thursday by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC).

ON THE WEB: CDC report

"These drugs are being prescribed more often. As the number of prescriptions increase, we have seen an increase in ERvisits involving the use of the drugs in a non-medical way," says Len Paulozzi, a medical epidemiologist at the CDC's Injury Center. . . " Read More

Whistleblower Claims “Culture of Corruption” Among Inspectors Partly to Blame for BP Gulf Disaster

FraudBlawg

by fraudblawg on June 10, 2010

     "For more than two decades, Bobby Maxwell supervised Minerals Management Service (MMS), a division of the Interior Department and the primary federal agency overseeing safety inspections in the more than 3,500 oil rigs in the Gulf of Mexico. Speaking to CNN, he described the agency’s relationship with oil companies as “a culture of corruption… hunting trips, fishing trips, drug use.” He described the inspections process as nothing more than a formality — “a checklist they would run through quickly, check things off, say things like ‘Hi, Joe. Hi, John. See you at this weekend’s fishing tournament.’ ” Maxwell told CNN’s Abbie Boudreau that no one is asking the hard but appropriate questions about MMS’s inspections process on BP’s failed oil rig:

“What types of inspections? Who did them? Did they give them any waivers? Was the equipment adequate? Did they think they needed a second blowout preventer? Did they demand BP put it in? MMS is responsible for that, too,” said Maxwell. . . " Read More

Children's Testimony May Be Influenced By Co-Witnesses

Medical News Today

  Article Date: 13 Jun 2010 - 0:00 PDT                                                               

     "When children report about an event they can be highly accurate. But if they talk to other witnesses, children's testimony may become tainted. A doctoral thesis from the University of Gothenburg examines children's vulnerability to co-witness influence, and presents a new method that can help child witnesses to provide more detailed witness reports.

Emma Roos af Hjelmsater's thesis is based on a series of studies where children aged 7-13 were interviewed regarding an event they had experienced two weeks earlier. Prior to the interviews, some of the children listened to a co-witness' account of the same event - an account which contained some misinformation. Although the children's reports were generally quite accurate, the results showed that the information provided by the co-witness influenced the children to make errors when they reported about the event.

'The children were influenced to add false information, that is, some of the things they reported had in fact never occurred. But they were also influenced to omit true details', says Roos af Hjelmsäter. . . " Read More

Florida Attorney General Revealing New Strategies For Bioterrorism Preparedness

Medical News Today

Article Date: 10 Jun 2010 - 1:00 PDT

 

     "Florida Attorney General Bill McCollum joined Tampa, Fla. industry leader and decontamination company Zimek Technologies along with Central Florida Fire Chief John Williamson during a special press conference today in Winter Garden, Fla. to jointly announce important homeland security initiatives and key bio-terrorism preparedness. Two leading innovators of technology using anthrax abatement who participated were Joe Mantilla, VP of Corporate Affairs of Zimek® Technologies and Brian Larson, CEO of sBioMed® of Orem, Utah.

"As we've all been reminded recently, the threat of terrorism on American soil has not abated. Law enforcement and first responders, on the front lines of America's homeland security, need every tool at their disposal to respond should another attack happen," said McCollum. . . " Read More

Americans Get Most Radiation From Medical Scans

USA Today

The Associated Press

   "We fret about airport scanners, power lines, cellphones and even microwaves. It's true that we get too much radiation. But it's not from those sources — it's from too many medical tests.

Americans get the most medical radiation in the world, even more than folks in other rich countries. The U.S. accounts for half of the most advanced procedures that use radiation, and the average American's dose has grown sixfold over the last couple of decades.

Too much radiation raises the risk of cancer. That risk is growing because people in everyday situations are getting imaging tests far too often. Like the New Hampshire teen who was about to get a CT scan to check for kidney stones until a radiologist, Dr. Steven Birnbaum, discovered he'd already had 14 of these powerful X-rays for previous episodes. . . " Read More

Myths of Pot Legalization

Crime & Consequences   

     "One of the myths of pot legalization (first for so-called medical purposes, then for any purpose) is that life gets better after it's done.

Well, not exactly.  Thus today's story from the Associated Press:

HELENA, Mont. (AP) -- Montana Gov. Brian Schweitzer says legalization of medical marijuana has not worked out as voters planned, and agrees the state needs a legislative fix.

Schweitzer says he is watching proposals as they come forward and expects lawmakers, convening in January, will have a lot of options. The governor says one of his agencies may pitch its own plan.

Schweitzer says one part of the solution could be to require genetic branding of medical marijuana, which would allow police to trace illegal pot to see if it originated from a caregiver selling medical marijuana.

The medical marijuana law has become one of the hottest topics facing lawmakers as the state deals with an explosion in the number of patients, caregivers and growers."

Tonya Craft Trial: A Pediatric Child Sexual Abuse Physical Exam

   "Symptoms of sexual misuse may include physical and behavioral signs as well as indirect comments made by the child. There are several clues to look for when considering the possibility of child sexual abuse. One sign alone may not be a positive indication; if a number are present, it is wise to consider the possibility of abuse." ¹

    While the pediatric physical exam is important if child sexual abuse is suspected, it's not the only important aspect of an investigation. In fact, child sexual abuse cannot be determined based on a physical examination alone.

   A complete investigation must include a medical and psychological history, physical and behavioral indicators, if any, as well as interviews and statements from the child and any other witnesses.

   "Evaluating a patient for suspected child sexual abuse can be daunting for many pediatric primary care practitioners. The consequences of misdiagnosis can be devastating. Knowledge of common clinical presentations, both physical signs and symptoms and behavioral changes, is paramount. . . " ²

 During a pediatric exam, the Forensic Nurse Examiner may see either normal variations or nothing at all. She may also see physical signs which indicate the possibility of abuse.

   These signs are usually divided into "highly suspicious", "suspicious", and "normal", appearances. This is not a diagnosis. This is the nurse's impression, based on her specific training and experience.

   During the initial Pediatric Child Sexual Abuse training program, forensic nurses are trained with the use of numerous slides showing both normal variations and actual injuries in order to learn the differences.

   Even then, it's not absolute, since some children who have not been abused can show, what seems to be, signs of abuse. The hymenal membrane is elastic and variable and is often influenced by a variety of factors. There are often disagreements between experts as to whether the signs are positive of abuse in a particular case.

Normal Variations ³

1. Lichen Sclerosis - patches on the skin or female genitalia which can later become scarred and look like an old, healed injury

2. Poor hygiene and diaper rash

3. Mongolian spots - these are blue-black birthmarks which often look like bruising

4. Hematomas caused by blunt trauma

5. Hymenal Skin Tags - can appear abnormal

6. Meningococcemia - An acute infection in the blood stream (Septecemia) caused by a bacteria called Neisseria meningitidis

7. Biacin Deficiency

Estrogenized Hymen

   Immediately after birth, the female infant's hymen is highly estrogenized due to the maternal estrogen still circulating in the infant's body. During this period, the hymen is very thick and redundant. Once the maternal estrogen is gone, the hymen becomes very thin and translucent.

   At this time, the hymen becomes crescent shaped and reddish due to the many blood vessels in the area. It should remain this way until the beginning of puberty when, once again, the hymenal tissue will display an estrogen effect. ⁴

 Hymenal Injuries

  It is a myth that the prepubescent hymen is easily injured during activities such as bike riding, horseback riding, and skating. While, yes, genital injuries can occur during these activities, they usually don't cause injuries to the hymen itself.

   That's because the hymen actually sits in a position well protected by the outer folds of the Labia Major and Labia Minora. It's also a myth that prepubertal masturbation will cause injury to the hymen. Prepubertal masterbation is cliteral, not hymenal, so there would be no injury.  [Bays and Chadwick, 1993; Bays, 2001; Emans et al., 1994; Finkelstein et al., 1996].

   Straddle injuries can be quite severe, sometimes even requiring surgery. However, it's the upper, outer sides of the female genitalia that would be injured, not the hymen. Recent studies have shown that hymenal injuries, caused by childhood activities, is extremely rare.

 The Examination

   The role of the forensic nurse examiner, as part of a multidisciplinary team, whether adult or pediatric FNE, is to respond to complaints of sexual assault or abuse.

   FNE's do this by doing the physical exam, taking the child's medical history, collecting evidence, accurate documentation in the chart, maintaining the chain of custody, and by testifying in court if needed. 

   Pediatric FNE's are very aware of the importance of both physical and behavioral evidence of abuse, as well as the legal implications of the child's statements. Therefore, it's vitally important that:

1. Questions should be avoided which would include any suggestion of an answer.

2. Questions should be kept open- ended when possible

3. The child's statements to the nurse be properly documented.

   The Medical History

  What is "Hearsay"?

  Hearsay is when someone hears the child say something related to the case then that person repeats what the child has stated. Generally, hearsay is not accepted in court. There are exceptions though:

   What is The Medical Exception to Hearsay?

 "Any statements or gestures, made by the child, when describing medical history, present symptoms, pain, or other sensations, AND the child's description as to the cause of the illness or injury. Some caregiver's statements may be included under this exception as long as their motive is to obtain treatment for the child." ⁸

   What Are "Excited Utterances"?

This is a statement made when the child is under extreme emotional stress "caused by a startling event."

   When a child makes statements, during the exam, the forensic nurse examiner will document every statement in the chart with quotes. This is done so the child's own words are preserved, as well as providing a record that meets the hearsay exception requirements in court.

  Some examples of basic principles and factors documented in the chart would include ⁹ :

   Nature of the event

  Time Lapses

  Child's Demeanor

  Child's Speech Patterns & tone of voice

  Spontaneity & Consistency of Statements

  Body language & facial expressions

SANE nurse, Sharon Anderson testified, during the Tonya Craft trial, that she took the history after doing the physical exam. This is appropriate considering how frightened most children are when brought into the SAFE unit.

    One of the goals of the forensics nurse is to try to reduce their fear and try to establish some sense of trust. It's better to just get the examination over with, in order to reduce their extreme anxiety, before attempting to obtain any history.

     Doing it this way also reduces the chance that the child's oral history would subconsciously influence the nurse in any way before she does the exam.

 * Behavioral History for Pre-school children:

1. Sexualized behaviors

2. Bed-wetting/soiling, regressive behaviors

3. Unusual relationships with adults

4. Hyperactivity, biting, aggressive /bullying behaviors or being bullied

Emotional Reactions:

1. Reluctance to disclose

2. Embarrassment

3. Anger, anxiety, disgust

4. Depression, fear

5. Sexual Arousal

 The Physical Examination

     While performing the physical exam, the forensics nurse will be doing a head to toe assessment. During the assessment, the nurse will be noting if each area appears normal or abnormal. Any redness, bruising, cuts, scrapes, lacerations, tears, etc. will be measured, photographed, and documented on a body diagram. She'll also be noting things like pubic lice on the child's eyelashes.

   Documentation on the body diagram is imperative, if any injuries or abnormalities are present, since a judge may refuse to allow photographs in court. The diagram will note any injuries/abnormalities specific to each area. A Tanner classification will also be noted in order to document the child's physical level of sexual maturity.

    Injuries will be drawn, along with arrows leading to the measurement of each injury, and any additional notes. During the examination of the genital area, the forensics nurse will be looking for any signs of trauma and/ or STD's.

   She'll also collect evidence using swabs. The swabs will be dried in a dryer, then each one placed in a special evidence envelope, containing the name, date, case number, and site info.

     During the examination, the forensics nurse will take photographs of the child's face, body, and genitalia. Each photograph of an injury or abnormality should be taken in three's: from far away, then closer, then closest, along with a measuring tape, showing the measurement of each wound/abnormality.

   Each wound/abnormality is documented as to type, then length x width x depth, often written on both the diagram sheet and a separate H & P nurse's note. Each photograph is then documented and numbered on a photo log sheet as to both the specific area and the injury/abnormality.

   Once the examination is completed, all evidence is then placed in a large evidence kit, sealed with evidence tape, then signed over top of the tape with the date, time, and nurse's signature. This is done to prevent any tampering.

   Once all is completed, the evidence kit is signed into the evidence locker by both the nurse and security, then locked up until retrieved by the detective.

   Tonya Craft Trial & Documentation

     During the Tonya Craft Trial, while bloggers & media like were condemning Sharon Anderson's testimony, I wrote to my fellow blogger, asking about her documentation. Where was it? Why didn't the defense question her as to what was documented on the diagram sheet, instead of just concentrating on the photographs? I never got an answer.

     Considering that there were references to the defense trying to discredit Ms. Anderson about the documented old "suspicious" injuries, by the bloggers, forums, and news reporters, I'm pretty certain, Dr. Lorandos had that whole, well documented, chart in his hands. He would have been provided a copy during Discovery.

  The documentation and the diagram sheet is an essential part of every chart. Yet, when I searched throughout the blogs and the news reports, I found absolutely nothing referring to it. Experts often disagree when it comes to photographs. That's very common.

   But, it's rather difficult to argue with a well documented diagram sheet. In fact, I surmise that if Sharon Anderson's written documentation was in any way lacking, Dr. Lorandos would have been all over her about it in court. That would be expected.

  Yet, while the bloggers and news reporters were so busy shredding her professional reputation, for some reason, they didn't bother to mention the most important documentation in those records. I wonder why? Hmmm.

   Yet, it appears, Dr. Lorandos chose to focus on the photographs instead. Considering that Ms. Anderson had been admitted as an expert, without any objection by the defense, that should tell people something as to her proven credibility and competence.

 

    

Sources:

1. Steakin, Janet, RN; Lambertson, Mary, RN; Carroll County Pediatric F.N.E. Training Manual, 2005

2. McClain, Natalie, et al., Journal of  Pediatric Health Care, 2000. 14, 93–102.

3. NIH, Web: http://www.niams.nih.gov/Health_Info/Lichen_Sclerosus/default.asp

4. Web: http://www.health.am/gyneco/more/anogenital-findings/

5. Web: https://health.google.com/health/ref/Meningococcemia

6. Web: Journal of Pediatric Health Care, Evaluation of Sexual Abuse In The Pediatric patient, http://www.jpedhc.org/article/S0891-5245(00)70019-8/abstract

7. Web: Paula J Adams Hillard, MD, Imporforate Hymen, http://emedicine.medscape.com/article/269050-overview

8. Steakin, Janet, RN; Lambertson, Mary, RN; Carroll County Pediatric F.N.E. Training Manual, 2005

9. Steakin, Janet, RN; Lambertson, Mary, RN; Carroll County Pediatric F.N.E. Training Manual, 2005