The SANE Report

Updated from previous Xanga site.

     There has been much speculation and comment recently regarding the SANE nurse's report of the alleged victim in the Duke University rape case.

   Questions vary from toxicology tests to the injuries of the accuser. Reading the various on line reports and commentary on this topic, there seems to be misinformation regarding what's in the report and what isn't.

   How the SANE report is set up varies according to each facility's protocols. However, all reports should cover certain standard information needed to help facilitate investigation of a case.

What Is a Medical Evidentiary Examination?

" A medical evidentiary examination is given to victims of sexual assault and other forms of abuse and is performed to collect physical evidence and document findings that can be used to identify, prosecute, and convict an assailant.

  While an evidentiary examination includes an array of medical components, including assessment of injuries and crisis intervention, its main purpose is to meet the needs of the legal system..."

   The SANE examination is usually completed by an RN with advanced sexual assault forensic training and experience. The nurse carries the designation of Sexual Assault Nurse Examiner (SANE), Sexual Assault Forensic Examiner (SAFE), or Forensic Nurse Examiner (FNE).

    The examination itself is usually carried out in a separate room in order to provide privacy and maintain the integrity of the evidence.

   The nurse's report usually consists of several pages of in depth questions regarding the patient's past medical history, the alleged assault, as well as documentation on the collection of evidence.

The following is a short summary of the examination process:

                 Medical Examination      

                                                            

        After arrivinng at the hospital, the patient is usually put into either a private family room or a private room in the Emergency Department (ED). In the past, the patient was usually seen by a physician in the ED but today, she/he is usually seen by a  forensic nurse examiner.

General Info

• Date, name, address, phone number...
• Date, place, time of incidence
• Date, place, time police notified
• Date, place, time of admittance to ER
• Name of Detective
• How brought to the hospital

  Informed Consent Signature

               This is needed before any exam can take place. The patient must be given all relevant information as to the process of the examination, the collection of any and all evidence, and the taking of and disbursal of photographs.

           The patient must be made aware of what to expect, with regards to the nurse's report, and the evidence, after the exam is completed. The patient has the right to refuse any part (or all) of the exam. The patient must be awake, alert, and able to make an informed consent.

Physician's Orders - Physican's orders for all tests, medications, and treatments must be in the chart and signed off.

          Medical Info                                                            

Past Medical History - I always ask my patients for all significant past and current medical history including illnesses, accidents, injuries, and diseases, medications, and drug / alcohol use: Are they Diabetic? Do they have High Blood Pressure? Do they have a history of vaginal infections or STD"s Are they on birth control? Any children? Any allergies?....

Sexual Contact History: Date of last consensual sexual contact? Condom used? Last menses? Foreign objects used?- this is important for:

          #1 To establish a possible identity of a DNA contributor. In an adult exam, the patients are of an age to be sexually active. It's not uncommon to find DNA other than the accused.

          #2 We need to establish whether any bleeding is due to trauma or menses. Sometimes the menses can mask bleeding from trauma. The patient's last (or current) menses is documented, as well as the internal examination findings.

         #3 We need to know if any foreign objects could have caused any trauma.

    Assault Info                                                                               

   Patients are asked a number of questions to aide in determining what happened during the assault, the severity of the assault, and the identity of the assailant(s) if known. We also note the patient's demeanor throughout the exam and document it. Was she tearful, angry, trembling, calm, drowsy, etc.?

• Number of assailants, name if known, sex, race
• How assaulted? Condom used?
• From what angle were they assaulted?
• Position of patient during assault?
• Any kissing, licking, fondling, biting, gagging, binding, blindfolding by assailant?
• Any verbal threats?
• Any physical force?
• Any weapons?
• Did the assailant (s) give the patient any alcohol or drugs?
• Did victim injure assailant? Any scratching?
• Did patient shower / bathe / drink liquids / brush teeth, etc.?

        Physical Exam                                                                                  

• Physical injuries?     No / Yes     Photos / Diagrams
• Genital injuries?       No / Yes    Photos / Diagrams
• Foley balloon used? Hymenal injuries?

  The foley is a long catheter which is usually inserted into the bladder. We use it to aide in visualization of any injuries of the hymen. The catheter is inserted vaginally, the balloon inflated, then it's pulled back just a bit to push the hymen outwards for better visualization. This technique is usually used with children or sexually inexperienced females.

• Woods lamp

   The woods lamp uses UV light to show up body fluids on the patient. Semen will show up bright green. Swabs are taken if reading is positive.

• Medscope

           The Medscope is used to improve visualization of injuries. Injuries can be seen on the monitor and photos can be taken.

• Toluidine Dye

         We always use the Toluidine Dye. The dye is put on, allowed to sit for a few moments, then wiped off. The dye will become attached to any injuries, making them easier to visualize. If there are no injuries, the dye wipes off completely.

   Any Positive findings are documented and photographed. In photographing injuries, photos are taken before and after the dye is applied. Photos are also taken with and without scale.

        Speculum Exam   

• Cervical injuries ?     No / Yes    Photos / Diagrams
• Redness? Lesions? Menses? Discharge?

         Anal Exam

• Anal / Rectal trauma?
• Tears?
• Bleeding?
• Normal orifice?

        Evidence Collection                                                         

• All significant clothes are collected, especially the underwear
• Oral swabs
• Swabs taken of all suspected areas, plus (4) vaginal / cervical swabs, and (2) perineal / anal swabs are done if need indicated
• Fingernail scrapings
• Pubic hair combing
• Pulled Hair may be done, depending on the protocol
• Feminine hygiene products
• Debris
• Foreign material
• Blood samples are taken for the patients DNA. A blood pregnancy test and RPR to check for Syphilis is usually done as well. Depending on the protocol, blood and urine samples may also be taken for toxicology tests. A urine test for GHB is taken if any date rape drugs are suspected.          
• Swabs and culture are taken to check for Chlamydia and Gonorrhea.

        Discharge

• Prior to the patient's discharge, she is given an antibiotic to help prevent sexually transmitted diseases. This does not prevent HIV.
• If consent has been obtained, and the pregnancy test is negative, the morning after pill is given.

• Helpful brochures regarding sexual assault and victim's services are given to the patient.

• Case number and detective's name is given to the patient.

• Discharge instructions are given. Patients are also encouraged to make a follow up GYN appointment and to have HIV testing done.

      Victim's Advocate                                                     

             The patient is asked if she would like to talk to a victim's advocate at the beginning of the interview. If the patient says yes, then she will talk with her immediately after the exam (depending on protocol).

   Any discussion between the patient and the victim's advocate is private and not usually part of the SANE report.