IAFN Conference 2013 at the Disneyland Hotel, Anaheim California

The Place

Another IAFN Conference has come and gone. Held in the golden land of California, the forensic nurses conference basked in the delights of the Disneyland hotel. It was not a bad place for a conference, but my thoughts echoed those of others around me. 

This was not the place I imagined having a forensic nursing conference. 

There’s something about being surrounded by cartoon figures such as Goofy at a breakfast bar, and listening to the Cinderella theme, that didn't put me in the mindset of forensics, but hey, don’t get me wrong. I can bring out my inner child with the best of ‘em, and I did. And the evening fireworks every night were spectacular!

Still, in the future, I'm hoping for a forensic conference in Hollywood or in San Diego, or Las Vegas, New Orleans or New York. You know, in the very LEAST at where some of the major CSI shows took place. (Not that I ever watched CSI.)

At this conference, the new IAFN logo was unveiled and proved to be an interesting surprise. No one I spoke with knew that it was going to change before the conference, and that was disconcerting to some, but when I asked about the reasons for changing it, the thoughts behind it were reasonable. Easier visibility on electronic communications, and a simpler design. Still, I've got to admit, I miss the old logo. The new one looks almost identical to the logo for the International Nurses Association, and is more 'nurse' or Red Cross oriented than medico-legal. Regardless, the messages of "Leadership, Care and Expertise," are excellent, and they are forensic nursing core values that I believe all of us can stand behind.

Retrieved from: www.iafn.org, 24 Oct. 2013.

Retrieved from: http://www.inanurse.com. 24 Oct. 2013.

On the Bus to the Crime Lab!!

As you can see from the pictures above, quite a few of us (2 bus-loads) took a Monday evening trip to the crime lab after listening to presentations all day. And so, we offloaded at the Brad Gates Forensic Science Center.

We had a wonderful 45 minute presentation which informed us of the evidence the crime lab processes there, and were able to visit two forensic departments (one for fingerprints and another for toxicology) before we were informed that we had to leave. Apparently, we'd run out of time for our bus drivers! We were disappointed, and many of us wished for more time to tour, but it was still an interesting experience.

Crime Lab Walls

Amazing photographs of some "how they used to do it" moments in time, from the Brad Gates Forensic Center!

The Presentations

From Monday through Thursday, I attended the following presentations:

1. Forensic Nursing Application of Criminal Trial Testimony (by Jenifer Markowitz and Sasha Rutizer)

2. Clinical Forensic Nursing Evaluation in the Strangulation Patient (by Sally Sturgeon and Bill Smock)

3. You Say Munchausen, I Say Murder (by Kathy Koetting and Nancy Duncan)

4.  Navigating Military Justice: The Forensic Nurses Role as Witness and Expert Consultant (by Jenifer Markowitz and Sasha Rutizer)

5. Work with Me! The Benefits of Collaboration Between         Forensic Nurses and Forensic Scientists (Julie Valentine and Suzanne Miles)

6. Murder or Overdose? A Case Study of Death by GHB (by Trinka Porrata)

7. Healing Neen (by Tonier Cain)

8. Fifty Shades of Grey: Normalized Violence or Private Pleasure? (by Ann Troy and Catherine Carter-Snell)

9. Autoerotic deaths: Challenges for Death Investigation 

10. Crime Scene Investigation for the Health Care Provider

11. The Neurobiology of Trauma

(More soon! This is a work in progress, so please come back!)

Why Examine the Suspect?

I've heard it so many times. "We examine the victim but not the suspect." Really? My brain whirls and I have to try to understand this idotic notion. It's almost as simple as an equation If A+B=C, then C-A must=B.
But in the forensic sexual assault world, apparently examining A (the alleged victim) is good enough.

Please, forensic examiners, and persons of common logic, if you examine the victim then fight for examining the suspect as well. Law enforcement has no place in the examination of, and collection of , forensic evidence of the suspect.

In cases of crime, we are supposed to assume that the accused is innocent until proven guilty, but the rampant advocacy of alleged sexual assault victims does not do this. They often immediately begin calling the suspect the "perp" or perpetrator, and the thought is that law enforcement and/or medical will not pay to have the forensic kit done so why do it?

I shake my head in shame that people ever think such a thing. If there was a crime committed, or alleged, then ALL of the crime scene must be examined including the individuals present at the crime. And it is much more than a simple DNA swab. The examiner must do a head to toe exam on the suspect just as one was done on the alleged victim. You never know what you'll find, or what you don't find. And that information has a huge bearing on the case. The Judge and Jury deserve to have ALL of the details. Tox screen levels, trace evidence, photographic evidence, etc.

Let's just say it. There is NO reason that the accused or the suspect in a sexual assault case (or in any crime where there is clinical forensic evidence) should not get a forensic exam. (The assumption being that the victim has made a report and requests an exam.) A suspect exam is needed to pair with the accuser's exam and the rest of the evidence from the place the crime allegedly took place as well as from witnesses. When we fail to do a suspect exam we do a disservice to the justice system. Plain and simple.

So you won't get your exam paid for by VAWA. Find another group who WILL pay for it. The other thing I often hear is, "Well, I'm the only examiner and can't examine both the alleged victim AND the suspect." Concerns over cross contamination and objectivity are cited as reasons why. I say this is bullshit. If an examiner needs to perform an exam, there are perfectly acceptable ways to do this.

In the case of cross contamination and only one examiner, the examiner completes the alleged victim first, showers and change clothes and the suspect exam is done in a completely different room or a room that was wiped down thoroughly before the exam was done. In terms of objectivity, a SAFE/SANE examiner is a medicolegal professional who is ethically bound not to pick sides of a case. We are experts. There should be no loyalty to an alleged victim or a suspect. Our job is to collect forensic evidence, regardless, and when the case goes to trial our role is to help the courtroom understand the results on a scientific evidence based case. It is really that simple.

So, next time you wonder whether your facility should be doing suspect exams, stop asking the question because the answer is "yes". If you do alleged victim exams, then you should do suspect exams as well. The suspect may be innocent, or the alleged victim may have been sexually assaulted/raped, but no one will have the information to decide completely if you don't give them all of the evidence available. Suspect full exam, including photographs of injuries, tox kit, BAL level, STD testing, the full works . . . is important. Look at your protocols and if they do not include suspect exams, change them so they do.

One of the greatest issues I have with many programs in general is the desire to fall back and say "we can't because...." It's important to always change the perspective to: "If we had to, HOW could we do it?" The second question opens up a number of possibilities. Possibilities that can really make a difference for the judge and jury deciding the case.

Think carefully about this. Remember that much of the outcome depends on you, in that evidence needs to be collected correctly, expert-witness testimony needs to be done in a non-biased, professional and ethical manner, and the court will only have the evidence that is collected in order to decide the case (aside from witness testimony). The lives of individuals are at stake. A victim may lose the opportunity for justice, or an innocent man/woman may go to prison for several years and have their name placed on a sex offender registry for the rest of their lives. We owe it to the courtroom to give them as much evidence as we can, so they can make the best decision they can.

*Disclaimer: The statements above do not reflect the opinions or attitudes of the DoD or the US Navy or any other government entity, but are solely those of the author.

Getting Your Foot in the Door...

Many forensic nurses, or wanna-be forensic nurses, want the prestigious jobs to come their way at the drop of a hat. Just go to any forensic conference, and novices in forensic nursing dream out loud about starting their own businesses...hanging out their own shingles...before they've even obtained a modicum of education and experience.

Seasoned nurses also want the process to be easy, and many want to start making money as quickly as possible, and in some instances (for the very lucky) this dream becomes a reality.  However, for the vast majority of nurses, this does not happen.

How DO you, as a forensic nurse, break into the forensic field?  How do you start making any money at it?  The truth is that a forensic business usually requires tons of networking, making contacts and establishing a name for yourself along the way.  For many new to the business, getting the foot in the door comes with one simple word.  "Volunteer."

Many years ago, I attended a forensic conference in which Dr Marcella Fierro (forensic pathologist) was speaking.  I knew she was the Chief Medical Examiner at Richmond Virginia's Office of the Medical Examiner, and I'd always wanted to assist with autopsy.  I approached her after the lecture and told her how much I would like to tour the ME office in Richmond. She gave me her card and told me to come anytime. 

A few weeks later I took her up on the tour, and after we walked around the facility I asked her if I could perhaps volunteer at the morgue assisting with autopsy. I remember Dr Fierro looking me up and down, and asking me if I minded scrubbing floors and weighing bodies.  I emphatically answered that I would be happy to do whatever they needed, and before I knew it, I was assisting the autopsy assistants with scut work on weekends.  A couple of months later, one of the forensic pathologists asked an autopsy assistant to show me how to do the Y-incision on a body, and to let me assist them with the preliminary part of the autopsy...taking out the "block" (tongue, espophagus, lungs, heart...)  It was one of the most exciting days of my life.  I went from assisting the autopsy assistant to being the primary autopsy technician on a case, and I would ask the head autopsy technician for minor help when I got stuck or needed a fresh pair of eyes.

My point of this story is to reenforce that the "sweet" jobs don't usually come easy.  Sometimes, if you are in the right place at the right time, or if you know somebody in the business, a job falls into your lap. Most of the time you have to work for it. But if you are willing to start at the bottom and learn the ropes, in most cases, the work will begin to come your way and you'll be given more opportunities to work in the area you'd like to.  It also helps to be humble.  Confident, but humble.

I recently moved to Ventura California two years ago. I'd approached the medical examiner twice to volunteer for autopsy, but the ME never contacted me back...essentially (non-verbally) telling me he wasn't in the market for volunteers.  Just because I was unable to work with him didn't mean I stopped asking for volunteer work in other areas.  The Ventura Police Department has just asked me to submit an application for their volunteer program, where (after I'm trained) I'll assist with fingerprinting and other scut work, and the LA Coronor's Office has taken my volunteer application for autopsy assisting and so I may be able to volunteer there on weekends. My overall take-home story is that if you want to break into the forensic world and actually work within the system, you are often going to have to pay your blood, sweat and tears first.

Keep in mind that of all of the professions, forensics and forensic nursing typically pays the least.  Death Investigator saleries are anywhere from $25,000.00 to 48,000.00. Autopsy Technicians and/or Assistants have salaries ranging from $25,000.00 to $41,000.00.  Both positions can be extremely difficult to break into, and many people stay in these positions for years. Other roles, such as legal nurse consultant (LNC) and Sexual Assault Nurse Examiner (SANE) are easier to break into, and often make better money, but the attrition rate is high because of the call hours and additional duties required such as testifying in court, etc.

Whatever route you choose to take, remember that for most professionals it requires a large degree of committment, tenacity and patience. If you are up to the challenge, and willing to donate a good chunk of your time in volunteer work, you may eventually get that foot in the door and find yourself working in a career that most people only get to watch on T.V.   You'll have to decide if the minimal pay, and (sometimes) health hazards are worth it, but if you are doing what you love then in most cases it certainly is. Best of luck on your forensic pathway, wherever it leads you...


*****

*Disclaimer: This blog is solely the opinions and experiences expressed by the author and in no way reflects the opinions, policies or beliefs of the U.S. Government, the DoD or United States Navy.

The 19th Scientific Assembly: Forensic Nursing in the 21st Century 2011

From 19-22 October 2011, approximately 476 forensic nurses and physicians met at the Hyatt Regency Montreal Hotel in Montreal/Quebec Canada.

This trip really began, for me, after landing around 10:30PM at the Montréal-Pierre Elliott Trudeau International Airport in Montreal. I was taken in a taxi, by "Mahmud" (originally from Lebanon, but who had come here as a reporter 37 years ago, and has one daughter who has borne 4 grandchildren...) to my hotel at the Travelodge across from the Hyatt. The Travelodge was half the cost of the Hyatt, and this conference was already beyond my budget.

The following are lectures/presentations I've attended the past few days:

Wednesday:

• Assessing Drug Ingestions: Toxidromes and Toxicology
• Do Come Over, Someone Has Killed Father (The Crime Scene Discussion of Lizzie Borden)
• The Coroner's Inquest: The Impact of Death Investigation on Prevention
• Motor Vehicle Collision Investigation and Reconstruction: Role of the Forensic Nurse

Thursday:

• Implementing a Clinical Forensic Nursing Program: Beyond the Obvious
• Bridging the Gap to Excellence. A Holistic Approach to Forensic-Medical Care in Military Treatment Facilities
• GHB Addiction
• Forensic Nurses Performing QI Studies in Forensic, Criminal Justice, and Investigative Settings

Friday:

The morning keynote address by Helene Berman, RN, PhD was titled "Context Matters: Trajectories of Violence in the Lives of Girls".

Dr Berman's presentation was sobering in terms of considering how our North American culture continues to affect violence in our society. Movies, T.V. shows, Video Games inundate us with violence, desensitize us and depict acts of violence toward young girls, teens and older women. In her talk today, she discussed "gendered socialization", and how our culture needs to pay attention to the problem of violence in our communities. Her talk highlighted what most of us are already aware of, but brought the issue to the forefront.  As she closed, she discussed the roles we, as forensic professionals, need to pay attention to methods of violence prevention in our society.  What remains crystal clear, however, is that there is no distinct path, no easy road, to changing North American culture. There is no quick fix, no single answer, in order to solve this problem. The goal among all forensic nurses should be to become more involved in government/legislation, and work within local communities to educate communities concerning violence.  The multilevel strategies we use to get there will hopefully not only leave long-lasting footprints for years to come, but blaze a pathway for a better world in the future.

Sessions I attended:

• Scene Investigations: Evidence Recognition, Protection and Documentation.
• Blending Forensic Nursing and Army Public Health Nursing to Aid in Eradicating Interpersonal Violence
• Confronting Youth Gangs as a Forensic Nurse
• (My own presentation): Interpersonal Safety of U.S. Military Women in the Deployed Environment of Afghanistan: A Grounded Theory Approach

Overall Musings:

All in all, the conference has been both exhausting and invigorating. The time spent rising early in the morning coupled with jet lag and a few beers the night before, along with long hours sitting and listening to interesting presentations...still has taken a toll on my body. But the connections, the meeting of old friends and new, the stories and backgrounds of such wonderful professionals is enough to galvanize any said 'under-achiever' into action.

'Under-achiever' was a phrase I've heard often at the conference, although I think that anyone who's convened at this professional forum is far from an 'under-achiever'.  Whether ADN/LPN, RN, NP or PhD/MD, each person is here to absorb information, share information, and each one is actively seeking ways to make valuable contributions to their communities in terms or violence prevention and/or response. Instead of professing (even jokingly) to be underachievers compared to our peers, let us each smile and simply congratulate each other on our activities and recognize those around us for their great efforts. Each of us makes our own contributions, whether seemingly great or small in society...and we never know the impact the slightest action may make. So be humble, all, and also know your self worth, and continue to make the world a better place one fingerprint, one footprint, one bit of trace evidence at at time.

~Cin

*****

*Disclaimer: This blog is solely the opinions and experiences expressed by the author and in no way reflects the opinions, policies or beliefs of the U.S. Government, the DoD or United States Navy.