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Sexual Assault in the Courtroom

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1 Sexual Assault in the Courtroom
Lydia Vandiver, RN, SANE-A, SANE-P, CFN Clinical Coordinator Albuquerque SANE Collaborative

2 What is Sexual Assault/Sexual Abuse?
LVandiver 10/2012

3 Legal Definition Criminal Sexual Penetration is the unlawful and intentional causing of a person to engage in sexual intercourse, cunnilingus, fellatio or anal intercourse or the causing of penetration, to any extent and with any object, of the genital or anal openings of another, whether or not there is any emission. From Responding to Sexual Assault, Domestic Violence, and Stalking: A Guide for Law Enforcement in New Mexico LVandiver 10/2012

4 Criminal Sexual Penetration
First degree: on a child under 13 years of age or great bodily harm or great mental anguish… Second degree: on a child years of age; on an inmate when the perpetrator is in position of authority; resulting personal injury; aided by one or more persons; armed with a deadly weapon; in commission of any other felony… Third degree: all not otherwise specified… Fourth degree: when perpetrator is at least 18 and 4years older…. From Responding to Sexual Assault, Domestic Violence, and Stalking: A Guide for Law Enforcement in New Mexico LVandiver 10/2012

5 Criminal Sexual Contact
CSC is the unlawful and intentional touching of or application of force, without consent, to the unclothed intimate parts of another who has reached his 18th birthday, or intentionally causing another to touch one’s intimate parts… CSC of a minor…unclothed intimate parts of a minor, under 13 or when in position of authority… From Responding to Sexual Assault, Domestic Violence, and Stalking: A Guide for Law Enforcement in New Mexico LVandiver 10/2012

6 Other Possible Related Crimes
Contributing to delinquency of a minor Indecent exposure Kidnapping False imprisonment Incest LVandiver 10/2012

7 Overview of Sexual Assault
History of Sexual Assault Even though rape has likely occurred for as long as humankind -Mythology -Bible -Early written history The study of its incidence and impact is fairly recent… LVandiver 10/2012

8 Overview of Sexual Assault
Sexual Assault is not about… ~lust, arousal, passion, intimacy, sex Sexual Assault is more about… ~cruelty, humiliation, objectification, anger, power and control Many myths exist about sexual assault LVandiver 10/2012

9 Consequences of Sexual Violence
Spans all socioeconomic and ethnocultural groups Committed more frequently against women Most victims suffer lifelong effects Trauma is associated with medical, psychological, social, spiritual, and sexual health consequences and related costs LVandiver 10/2012

10 Social Impact of Sexual Violence
Violence Against Women Act of 1994 Since 1994 terms used in laws include sexual assault, sexual battery, and sexual abuse Previously terms used reflected actual penile penetration of the vagina Sexual aggression can be prosecuted within marriage whereas it was excluded in the past LVandiver 10/2012

11 Social Impact of Sexual Violence
Definition of sexual penetration has been broadened to include vaginal, anal, oral by penis, finger, or objects Focus is on the behavior of the offender rather than the victim’s resistance Restricting the use of the victim’s prior sexual conduct as evidence LVandiver 10/2012

12 Social Impact of Sexual Violence
Narrow definitions and under reporting of interpersonal violence, sexual assault, and stalking contribute to incorrect statistics Individuals not legally married are often not adequately represented in statistics Data about men who have been sexually assaulted is limited The same is true in same sex relationships LVandiver 10/2012

13 Effects of Sexual Violence
Statistics most often represent numbers pertaining to the frequency and type of assault but do not convey the devastation experienced or the profound effects on victims lives The “lived event” of each individual varies and is experienced differently LVandiver 10/2012

14 Effects of Sexual Violence
“The intimacy of it stings. Since then I’ve always thought that under rape in the dictionary it should tell the truth. It is not just forcible intercourse; rape means to inhabit and destroy everything.” from the book lucky by Alice Sebold LVandiver 10/2012

15 What is SANE? LVandiver 10/2012

16 Sexual Assault Nurse Examiners
SANE Programs started in mid 1970s First New Mexico SANE started in 1996 Nationally there are over 600 programs 12 programs in New Mexico Services are private, confidential, and free Report to law enforcement is optional LVandiver 10/2012

17 Sexual Assault: A Sane Response
Activating SANE Need informed consent Must be within the 5-day window for adults, 3 day window for patients under 12, STI meds given up to 30 days, wellness exams always provided DV exams also provided Patient needs to be medically cleared Call SANE to arrange exam LVandiver 10/2012

18 Sexual Assault: A Sane Response
Who can activate a SANE response: Emergency Departments Law Enforcement Community Partners such as Rape Crisis Family/Friends The Patient/Victim/Survivor Almost anyone LVandiver 10/2012

19 Sexual Assault: A Sane Response
Focus of the SANE Exam Provide patient education and assist patient to know their options Provide medical care to the patient Collect forensic evidence Assist patient to move from victim to survivor Testify in court if so needed LVandiver 10/2012

20 SANE DISPATCH LVandiver 10/2012

21 Testimony by SANEs Unbiased, non judgmental, truthful
Medically relevant and factual Forensically factual LVandiver 10/2012

22 Testimony in Sexual Assault Cases
Sexual language can be embarrassing for some people to talk about It can also be difficult for some people to listen to Slang, medical terms and sexual acts may be difficult to interpret LVandiver 10/2012

23 Testimony in Sexual Assault Cases
It can be hard keeping a straight face and staying calm when some things are discussed Attorney: Nurse Vandiver, Your credentials are quite impressive, but isn’t it true, that you are not a doctor? Witness: No sir, as I stated earlier, I am a Registered Nurse. (What I am thinking is-what a moron…he calls me Nurse…he heard me describe my training…) LVandiver 10/2012

24 Things People Actually Said in Court
From Disorder in the American Courts Attorney: What is your date of birth? Witness: July 18th. Attorney: What year? Witness: Every year. LVandiver 10/2012

25 Things People Actually Said in Court
From Disorder in the American Courts Attorney: So the date of conception of the baby was August the 8th Witness: Yes. Attorney: And what were you doing at that time? Witness: Getting laid. LVandiver 10/2012

26 SANE testimony Includes description of time elements as well as time spent with the patient Post assault interval-important to correlate healing of injuries or lack of injury Time spent interviewing Time spent doing exam LVandiver 10/2012

27 SANE testimony Sequence of exam needs to be explained Consent
Demographics Medical history Post assault hygiene Offender information LVandiver 10/2012

28 Narrative Medical not investigative Detailed, written word for word
Patient is encouraged to use their words, also to describe what they felt Often the hardest part of the exam LVandiver 10/2012

29 Narrative Many times patients are embarrassed, feeling ashamed, blaming themselves The interviewer needs to take their time and give good, thorough explanations If necessary the interviewer should slow the patient down and ask questions LVandiver 10/2012

30 Narrative Acts may sound consensual: “we had intercourse”
“I performed oral sex…” “I laid on the bed and took my clothes off…” LVandiver 10/2012

31 Explaining the Question May be Important
Were you drinking? When was your last alcohol? Did you injure the perpetrator? When was your last consensual sex? LVandiver 10/2012

32 Clarification of Patient’s Statements
“He licked my cookie” “then, he did it” “he plugged the outlet” “down there” “we had sex”…”you know” LVandiver 10/2012

33 We Often Have to Educate
“He asked me if I would have sex with him.” “I told him no.” “He told my Dad he had sex with me, but all I can remember is he put his fingers in me, then he put his tongue in.” LVandiver 10/2012

34 Questions May Need Rephrasing
“Did he ejaculate?” “When was your last period?” “Are you sexually active?” LVandiver 10/2012

35 Forensic Nursing Application of forensic aspects of healthcare combined with nursing education Provides direct care to patients Liaison between medical profession and criminal justice system Continuity of care from crime scene to court of law LVandiver 10/2012

36 Steps of Evidence Collection
From the forensic perspective, everything we do during the medical exam is aimed at detection, collection, and preservation of evidence Physical evidence may be used to determine facts in a given situation Evidence must be appropriately managed LVandiver 10/2012

37 Chain of Custody Begins with the person collecting the evidence
Refers to the need for absolute accountability at every step in the evidence collection process LVandiver 10/2012

38 Urine Collect for toxicology if SA narrative indicates black out or memory loss Consider collection if patient seems disoriented, confused or has difficulty with recollection Complete DFSA form Do specific gravity and pregnancy test LVandiver 10/2012

39 Physical Evidence Determined by patient narrative
Inspect any other areas that may have physical evidence Alternate Light Source Collect sample using swabs Collect foreign bodies and air dry Clearly label and place in separate envelopes or bags LVandiver 10/2012

40 Miscellaneous physical evidence
Suction ecchymosis (hickeys) Bite marks Foreign debris/fibers Crusted stains Tampons, pads, diapers Condoms Two swab method, tape, post-it notes, LVandiver 10/2012

41 Evidence collection New technologies, breakthroughs such as DNA profiling Trends in standardization, protocols Ultimately depends on quality of the exam and expertise of examiner Ensure that the process becomes as good as it can get LVandiver 10/2012

42 Physical injuries Physical trauma, including genital injury, is not an inevitable consequence of rape -serious injuries occur in less than 5% -death in less than 1% Physical injuries are found in 60% LVandiver 10/2012

43 Physical injuries Most often involve the head, neck, face and extremities Risk of injuries increases in stranger assaults, location of assault and with other factors Areas of tenderness without bruising should be documented carefully Bruises may appear one to two days later, they can return for follow up photos LVandiver 10/2012

44 Sexual Assault Injuries
Result from restraining methods of the perpetrator From violent acts of the perpetrator And from the resisting efforts of the victim LVandiver 10/2012

45 Injuries Patterned injuries Pattern of injuries Abrasions Avulsions
Bruises/contusions Bite marks Lacerations/tears Cuts/incisions Petechiae Traumatic alopecia Slap injuries Firearm injuries Stab/puncture injuries Sexual assault trauma LVandiver 10/2012

46 Normal genitalia Be descriptive of genital structures
-identify normal anatomic variants -describe accurately and precisely Use sexual maturity rating system -estrogen effect on female genitalia -pubic hair, breast development, male genitalia LVandiver 10/2012

47 Normal female genitalia
LVandiver 10/2012

48 Male anatomy LVandiver 10/2012

49 Anal Anatomy LVandiver 10/2012

50 Clock orientation LVandiver 10/2012

51 Lithotomy positioning
LVandiver 10/2012

52 Labial separation, supine
LVandiver 10/2012

53 Midsagittal view of female
LVandiver 10/2012

54 Penetration into vaginal vestibule
LVandiver 10/2012

55 Labial Coitus LVandiver 10/2012

56 Sexual assault injuries
Absence of genital injury does not provide proof of consent lack of contact delayed reporting lack of magnification lack of training or experience of examiner known sex partner nonaggressive perpetrator/nonresistant victim false allegation LVandiver 10/2012

57 Diagram * LVandiver 10/2012

58 Again, Sometimes it is Hard to Keep a Straight Face
Attorney: “Could the injuries you described be caused by an extra large penis?” SANE is thinking: Will the next question be to describe an extra large penis or do I have to look at that guys penis or do I have to talk about personal experience…yikes, what’s next… SANE: “Injuries can be caused by fingers too and women can deliver babies without having trauma…” LVandiver 10/2012

59 Psychological Aftermath
The anguish may not always be visible The trauma is as real as any other wound Emotional styles are individual and unique LVandiver 10/2012

60 Psychological Aftermath
Lack of trust Fear Self doubt and blame Social isolation Anger LVandiver 10/2012

61 The eyes are the window to the soul…
LVandiver 10/2012

62 Frustrations for SANEs Testifying
Time consuming Expensive Loss of wages Stressful Lack of consideration from judicial system Few cases go to court LVandiver 10/2012

63 After Testifying Don’t be self depreciating Debrief with a friend
Reflect on how you did and what changes you can make in your practice Remember each time you testify you learn something that will make you a better witness next time LVandiver 10/2012

64 ACKNOWLEDGMENTS The patients and their families that have survived this trauma The nurses from Albuquerque SANE Collaborative for taking the pictures LVandiver 10/2012

65 Questions? LVandiver 10/2012

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