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Lydia Vandiver, RN, SANE-A, SANE-P, CFN Clinical Coordinator Albuquerque SANE Collaborative

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Presentation on theme: "Lydia Vandiver, RN, SANE-A, SANE-P, CFN Clinical Coordinator Albuquerque SANE Collaborative"— Presentation transcript:

1 Lydia Vandiver, RN, SANE-A, SANE-P, CFN Clinical Coordinator Albuquerque SANE Collaborative

2 LVandiver 10/2012

3  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  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  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 18 th 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  Contributing to delinquency of a minor  Indecent exposure  Kidnapping  False imprisonment  Incest LVandiver 10/2012

7  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  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  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  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  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  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  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 “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

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16  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 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  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 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  Unbiased, non judgmental, truthful  Medically relevant and factual  Forensically factual LVandiver 10/2012

22  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  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  From Disorder in the American Courts ◦ Attorney: What is your date of birth? ◦ Witness: July 18 th. ◦ Attorney: What year? ◦ Witness: Every year. LVandiver 10/2012

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

26  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  Sequence of exam needs to be explained ◦ Consent ◦ Demographics ◦ Medical history ◦ Post assault hygiene ◦ Offender information LVandiver 10/2012

28  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  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  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  Were you drinking? When was your last alcohol?  Did you injure the perpetrator?  When was your last consensual sex? LVandiver 10/2012

32  “He licked my cookie”  “then, he did it”  “he plugged the outlet”  “down there”  “we had sex”…”you know” LVandiver 10/2012

33  “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  “Did he ejaculate?”  “When was your last period?”  “Are you sexually active?” LVandiver 10/2012

35  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  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  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  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  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  Suction ecchymosis (hickeys)  Bite marks  Foreign debris/fibers  Crusted stains  Tampons, pads, diapers  Condoms LVandiver 10/2012

41  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 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  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  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  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  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

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56  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

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58  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  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  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  Time consuming  Expensive  Loss of wages  Stressful  Lack of consideration from judicial system  Few cases go to court LVandiver 10/2012

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

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