Do’s and don’ts of evidence collection
Applicable tips for a faultless exam
Evidence collected in the ED from a sexual assault is often later used as an integral part of the victim’s case. Errors made in documentation on the part of medical personnel during this important step may hinder the victim’s credibility. It is imperative to remember the correct procedures to avoid contaminating the evidence or misrepresenting the victim’s statements.
Errors are commonly made when collecting evidence from a sexual assault, says Suzanne Brown, RN, CEN, sexual assault nurse examiner at Inova Fairfax Hospital in Falls Church, VA.
"When you are examining a sexual assault victim, it becomes not just a medical exam, but also a legal exam," she notes. "If you do not collect evidence properly, it can hurt the victim’s case."
Here are tips for collecting evidence of sexual assault:
• Don’t put clothing evidence in plastic bags. "Always use paper bags, because the plastic tends to seal in moisture. While the evidence is being stored, you can get overgrowth of bacteria or fungus [which may contaminate the evidence]," says Eileen Allen, RN, coordinator of the Monmouth County Sexual Assault Nurse Examiner (SANE) program in Freehold, NJ.
• Don’t alter damage to clothing evidence. "If you have to cut clothing evidence, cut along the seams, not through holes caused by rips or use of weapons," Allen says.
• Do dry specimens before packaging them. "If swabs are used to collect oral, vaginal, or anal samples, they can be dried by being stood upright in a test tube rack or by pushing the shaft of the swab through the top of a tissue box so the cotton tip is in the air," advises Allen.
• Do package evidence correctly. "You can collect the best evidence in the world, but if you don’t have everything signed and sealed, it can’t be used in court," says Brown. "If a box had no seal on it, someone may have tampered with it, so it can’t be used."
• Do put evidence in separate paper bags. "For example, put underpants in one bag and a shirt in another. This prevents cross-contamination of evidence. If the victim says her assailant ejaculated on the outside of her shorts, and there is now seminal fluid on the shoulder of her shirt, you will have to explain how it got there," says Brown. "That creates a little hole, so maybe it didn’t happen the way the victim said it did. If you collect things separately, it prevents those kinds of issues."
• Do label all evidence. "All evidence should be labeled to include the name of the person you collected it from, the date of collection, and the name of the person who collected it. That begins the chain of custody of evidence," says Allen.
• Don’t break the chain of custody. "Once evidence is labeled and sealed, it must be turned over to law enforcement immediately or stored under lock and key until it can be turned over to police," says Allen. "You can’t leave it sitting on the counter and turn your back on it, because if anyone else might have access to it, the chain of custody might be broken."
Once you start collecting evidence, you can never leave the room for any reason, stresses Linda Ledray, PhD, RN, FAAN, director of the Sexual Assault Resource Service in Minneapolis. "If you forgot something or if you leave to care for another patient, you’re breaking the chain of custody," she says. "You need to put the evidence in a locked refrigerator until you turn it over to the police."
• Do use the victim’s own words. "The history of the assault should include a brief description in the victim’s own words of exactly what happened to them, specifically including the position of both the victim’s and assailant’s bodies when the assault occurred, as well as any specific acts of physical contact or penetration," says Allen.
Avoid using medical jargon in the patient’s chart, except in the description of medical findings, advises Patricia Speck, MSN, RN, FNP, CS, nurse coordinator for Memphis (TN) Sexual Assault Resource Center. "Drawings with objective descriptions of color, temperature, size, depth, and sensitivity are good court evidence and meet the criteria for fact-based evidence," she says.
The details of which acts occurred and in which sequence may become important, says Allen. "For example, if the victim reports she was assaulted in the front seat of an automobile, and was forced up against the door, it might cue the examiner to look closely at the skin surface on the victim’s back, where pressure marks or bruising might be noted," she explains.
• Don’t include subjective comments. "Opinions, like hymen not intact,’ or patient appears drunk’ are discouraged," says Speck. "In addition, legal terms like rape and sexual assault or abuse on the record are discouraged. In at least one case in Memphis, the judge disallowed a physician’s ED record because the documentation was biased."
Instead, use descriptions that provide the reader with a fact-based picture of the evaluation. "For instance, The hymen was annular with two acute lacerations at 4 and 8 o’clock. Blue-black hematomas present at the capillary ring adjacent to the lacerations. Red bruising of the posterior fourchette. Edema present in the surrounding vestibular tissue’" Speck suggests.
By using fact-based descriptions, nursing diagnoses will also remain objective. "For example, Blunt trauma to the hymen and vestibule,’ may result in nursing diagnoses such as, Rape trauma syndrome-acute stage,’ Alterations in intimacy,’ Alteration in elimination,’ Pain syndromes associated with genital trauma,’ or other client-driven and identified problems," says Speck. "Opinions are not valuable in this scenario."
Sources
For more information about managing sexual assault victims in the ED, contact:
• Eileen Allen, RN, Monmouth County Prosecutors Office, 132 Jerseyville Ave., Freehold, NJ 07728. Telephone: (732) 431-7000. Fax: (732) 780-7502. E-mail: [email protected].
• Suzanne Brown, RN, CEN, Inova Fairfax Hospital, SANE Program, 3300 Gallows Road, Falls Church, VA 22042. Telephone: (703) 698-1100. Fax: (703) 280-3821. E-mail: [email protected].
• Patty C. Feneski, RN, ENP, Desert Samaritan Medical Center, 1400 S. Dobson, Mesa, AZ 85202. Telephone: (602) 835-3720. Fax: (602) 357-2642.
• Linda Ledray, PhD, RN, FAAN, Sexual Assault Resource Service, 525 Portland Ave. S., Minneapolis, MN 55415. Telephone: (612) 347-5832. Fax: (612) 347-8751. E-mail: [email protected].
• Susan McDaniel Hohenhaus, RN, CEN, FNE, North Carolina Office of Emergency Medical Services, P.O. Box 29530, Raleigh, NC 27626-0530. Telephone: (919) 733-2285. Fax: (919) 733-7021. E-mail: [email protected].
• Patricia Speck, RN, MSN, FNP, CS, Memphis Sexual Assault Resource Center, 2675 Union Ave., Memphis, TN 38112. Telephone: (901) 272-2020. Fax: (901) 274- 2769. E-mail: [email protected].
• The Sexual Assault Nurse Examiner Development and Operation Guide (DOJ-OVC, 1999) is available free through the Department of Justice’s Office for Victims of Crime. To obtain a copy, contact the Office for Victims of Crime Resource Center at P.O. Box 6000, Rockville, MD 20849. Telephone: (800) 627-6872 or (202) 307-5983. Fax: (301) 519-5212. .
• A free drug testing service is available for EDs investigating sexual assault cases. The test is a series of three assays designed to detect certain drugs in the urine, including alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, GHB, marijuana, and opiates. For more information, contact El Sohly Laboratories, Inc., 5 Industrial Park Drive, Oxford, MS 38655. Telephone: (601) 236-2609. Fax: (601) 234-0253. For testing, call (800) 608-6540. For general information about drugs and assault, call (800) 608-6540.
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