Modified 12/24/06 3:18pm
Point of View II 
The latest news to come out about the Duke Lacrosse case, since DA Mike Nifong dropped the rape charges, is that the prosecution is continuing with the sexual assault and kidnapping charges against the three Duke Lacrosse players.
It's now being speculated that the sexual assault was committed either by digital penetration or with objects. It's my opinion that either one of these scenarios is improbable.
Accuser's Memory Problems
First of all, it's a fact that real rape victims are traumatized. In this enlightened day and age, I don't think anyone, with a shred of common sense, is going to question that.
It's also been established, through numerous studies, that real rape victims can have some trouble with memory, especially if they were under the influence of drugs or alcohol. That's a given.
However, as we have seen in this case, there has to be a limit somewhere. In this particular case, I don't know which changes more often - the weather or the accuser's story.
It's a huge leap to go from explicitly saying she was penetrated orally, vaginally, and rectally to suddenly not being sure what body part actually penetrated her!
I can't speak to any other FNE's experience. I can only speak about my own. For the most part, my patients usually have pretty good memories.
Of course, they may have some problems with small details now and then, especially if the assault occurred in the dark, they were impaired at the time, or it was a Blitzkrieg type of assault.
They may come back later in the exam with something like, "Oh, I just remembered ...", and that's OK. That's normal. Even remembering small details later to the police is an expected response.
In any traumatic event, most people are often so overwhelmed with emotion that they can't remember all the details all at once.
But we're talking small details here. Not HUGE ones - like, ugh, whether there were 5, 20, or just 3 assailants - or even whether they were actually raped or not. That is a biggie!
Most patients are able to tell me that right up front. And if they're not sure, they tell me so. Right away. They will say something like, " I'm not sure if I was even raped." I've had patients actually express surprise when I've found injuries because they were so unsure.
When they were unsure, it's usually been because they were impaired. Either a date rape drug was used or the patient was bombed.
However (except for the date rape drug victims), I've had patients who were practically falling off the exam table, yet they were still able to tell me whether they had been penetrated or not - with what and by how many assailants.
Quite often, they are still able to identify the alleged perpetrator, either by name or by description.
The majority of my patients are able to be very specific. They can tell me how many assailants. They can tell me if they were known or unknown. They can tell me where they were fondled, kissed, licked, bitten, hit, kicked, etc.
They can tell me me if they were penetrated or not. They can tell me which orifices were penetrated and by what. They can tell me what was said and by whom. We ask many detailed, intimate questions and they are usually able to answer most, if not all of them.
Sexual assault with an object is rare. In fact, I can't recall a single patient of mine who has claimed violation with an object. Most rapes are committed by persons known to the victim, often a date, or a former boyfriend or husband. They usually don't use objects.
If they penetrate, it's usually with the penis. Digital penetration can also occur along with penile penetration. Those injuries are much easier to spot.
Except for the sadistic type, stranger rapists usually don't use objects either. The sadistic type of rapist likes using objects to torture their victims.
The anger retaliatory type will usually use his fists and most of those injuries are going to be on the upper body, such as the face.
Patterned Injuries
Since I've covered patterns of injuries associated with sexual assault in previous posts, I won't go into too much detail here. For those interested, please check the archives.
However, since there is now speculation that digital or object penetration may have occurred, I'd like to focus on expected injuries from that type of assault.
Rape does not always leave genital injuries. It often doesn't. Just because there are no genital injuries, does not mean there was no rape. However, objects used in assaults cause immediate damage.
It's hard to get around that fact. Objects injure skin and tissue. In fact, studies done have shown that significant anal-genital injuries are more often caused by objects, than by penile penetration.
When the outer skin and inner tissue are injured, not only is there an inflammatory response from the body, but that injury is likely to be very visible.
When objects are used, they damage the epithelial lining of the outer skin or inner tissue, and break fragile blood vessels, causing redness, swelling, bruising, lacerations (tears), and abrasions.
Large injuries, like lacerations, can usually be seen with the naked eye. Tiny, micro-abrasions can be seen with the culposcope. Abrasions will ooze and often bleed. They can help determine the type and direction of the object used.
We are talking about extreme force being applied to sensitive tissue with an inanimate object. Even without tears or abrasions, significant redness, bruising, and swelling, of the outer genitalia, can usually be seen.
Inner vaginal injuries rarely occur with rape. Because the vaginal walls are very elastic, the penis doesn't usually cause any injury to the walls or the cervix, situated at the end of the vaginal vault. That is not the case though if digital or object penetration has occurred.
Forceful digital penetration of the vagina can cause scratches and tears to the outer vaginal area, as well as to the inner vaginal walls. Blunt force trauma from an object can cause significant tears, abrasions, redness, swelling, and often noticeable bleeding.
Both can cause injury to the cervix, with visible abrasions being spotted. I have had spontaeous bleeding occur just from gently touching the cervix with a cotton swab. How much easier would it be for blunt force trauma from an object or fingernails to cause cervical injury and bleeding?
Anal penetration by an object ( or even by a penis) can cause a great deal of injury. Not only will we see redness and swelling but the tears and abrasions are usually larger, encircling the rectal opening, very visible to the naked eye. The anal sphincter is often affected too as delayed sphincter closing can be seen.
DNA: With forceful digital penetration, vaginal epithelial cells can be obtained from beneath the fingernails of the suspect. A swabbing of the suspected object (s) can show the female's epithelial cells as well.
Epithelial cells are those cells which are shed from the skin and also which line the orifices, as well as other parts of the body.
Up until now, it wasn't possible to differentiate the types of skin, oral, and vaginal epithelial cells.
Now a process has been developed by a doctoral student, by staining the epithelial cells to determine which part of the body they came from.
Recent research has also shown that now DNA can be extracted from epithelial cells of the suspects hands, transferred to the skin of the victim.
If taken within 48 hours of an alleged assault, penile swabs can show vaginal epithelial cells of the victim on the shaft of the suspect's penis. In fact, it's now recommended that penile swabs be a routine part of every suspect exam within 48 hours.
Did the three defendants, all crammed into that tiny bathroom, by any chance happen to leave a group of shoeprints in the bathroom? Impressions made in dust and dirt can be lifted, using the same techniques as with fingerprints.
DNA can now be retrieved from the insoles of shoes. Shoe prints collected from crime scenes that match a suspects shoe can link a shoe to the crime scene.
A DNA profile from inside the shoe can link a wearer to a shoe thus increasing the evidential value of the forensic evidence.
With the advance in DNA and forensic crime lab technology, the general consensus is that it's almost impossible now not to pick up something left behind at the crime scene by a criminal.
So my question is, where is all the evidence that should have been left behind by the Duke defendants - both on this woman, her clothes, or in the bathroom?
Did the suspect exam include fingernail scrapings to see if there were any vaginal epithelial cells present?
With three guys crammed into a tiny bathroom, were there any shoe print impressions left in the dirt and dust?
Imprints that may have indicated whether an assault had really occurred or not? Were any suspected objects swabbed?
How many photos were taken by the SANE nurse? This is important. The number of shots correspond to the number of injuries noted. The more injuries, the more shots taken.
With a victim being viciously assaulted in a frenzied 5 minute attack, by either digital or object means, I would expect there to be a significant number of injuries and photos.
Injuries other than some diffuse vaginal wall edema. And, once again, how do we get inner injuries without getting outer injuries first? The outer area is going to be the area of most resistance. So I would expect to see the primary injuries there.
Personally, like everything else that has come out about this case, I seriously question this type of hypothesis. Sexual assault by objects, or by digital penetration, tend to leave far more injuries than rape alone.
Modified 12/29/06 9:31 pm
Hmmm, you are assuming perfect crime scene collections techniques were done in the Duke case.
Not sure why you would assume that. If you really are in the med business, then you would know that perfection isn't possible. You would know that mistakes happen all the time, but only a few are severe enough to be reported; and of those, most are never proven conclusively enough for the patient to receive compensation.
It's obvious what you're agenda is, sorry!
Posted by: Katie | April 27, 2007 at 02:04 PM
What various types of technologies where use in the Duke LaCrosse case?
Posted by: Adrienne Hardy | April 29, 2007 at 11:06 AM
Katie:
I have no agenda. However, I do have a problem with sending innocent people to jail.
Mistakes? Sure, they happen all the time. In this case though, much more happened than just a few "mistakes".
I was told, that when Levicy met with the defense attorneys, she was very hostile, hesitant & evasive.
We are never supposed to act like that! We have been trained, from day one, to never behave in such a manner.
Yet, this nurse, barely out of nursing school, on an apparent fast track to wherever, obviously felt she had the right to behave in such an unprofessional manner.
Sorry, no forgiveness here!
Posted by: Kathleen | May 20, 2007 at 09:50 PM