🔎 Mitigating Factors:
Forensic nurse consultants identify mitigating factors related to the injuries. They examine all available documentation to understand the case background and context of the injuries. They also review all medical records of the alleged victim and/or perpetrator for medical conditions or medications that may have contributed to the injuries.
🔎 Severity Assessment:
The severity of the injury needs to meet the definition of the charges. By accurately determining injury severity, forensic nurses can provide expert input as to whether charges could be upgraded or downgraded.
❓ Are the injuries consistent with the explanation?
❓ Are there alternative explanations?
❓ Do the injuries look chronic or recent?
❓ Are there injury patterns that may indicate the type of object used?
❓ Do the medical records provide clear timeline of the medical history?
❓ Were there treatments, previous injuries, or follow-up appointments?
❓ Are there inconsistencies that could indicate underlying issues?
❗ They consider factors like healing time, pain level, and long-term consequences such as disfigurement, scarring, physical limitations, loss of function, and/or risk of death.
📸 They interpret photographs of injuries taken at different stages (immediately after the incident and during healing) and document the extent and progression of injuries visually. The absence of photographic evidence of injuries significantly hinders injury evaluation and analysis
🔎 Expert Testimony:
Forensic nurses can testify in court as expert witnesses. The objective of their testimony is to educate the judge and jury on the medical evidence and issues in order for an informed decision to be made. Their objective analysis can support a defense argument for reduced charges or the prosecution argument for greater charges.
🔎 Collaboration with Legal Teams:
Forensic nurses work closely with attorneys, providing insights into the medical aspects of the case. They collaborate with legal teams to build a stronger defense or prosecution litigation strategy and/or negotiate plea deals.
⭐ Forensic nurses DO NOT directly change the charges but contribute valuable information to the legal process.
Distinguishing the TYPE of wound present and its specific characteristics
Forensic Nurse Consultants see many types of injuries when they are evaluating cases. It is important to know the specific type of injury when reviewing cases.
Some of the more common types of wounds are:
🔴 Incision: Clean, straight cuts typically caused by sharp objects where length is usually greater than depth
🔴 Laceration: Irregular tear-like wounds caused by blunt force or trauma
🔴 Abrasion: Superficial wounds resulting from friction or rubbing of the skin’s surface
🔴 Puncture: Small but deep wounds typically caused by sharp, pointed objects where depth is usually greater than length
🔴 Contusion (AKA bruise): When small blood vessels are torn and leak blood under the skin
🔴 Thermal, chemical, or electrical burns: Skin tissue damage caused by heat, chemicals, electricity, etc.
🔴 Penetrating wounds: Injuries that extend into internal organs or body cavities
🔴 Skin ulcers: A type of chronic sore where the skin layers “break down”
🔴 Avulsion: When a body part is torn off by trauma
🔴 Hematoma: A collection of blood that forms outside of the blood vessels
🔴 Fracture: A break or crack in the bone
It is ESSENTIAL to document the specific identifying characteristics of each wound including:
🔷 Location: The wound’s position on the body can provide insights into the assault or criminal acts
🔷 Pattern and Shape: The wound’s shape, edges, and any visible patterns can help identify potential weapons or objects involved
🔷 Depth: The wound's depth can help assess the weapon, the assailant/size of the suspect, etc.
🔷 Contamination: Detecting foreign materials (e.g., dirt, debris, or clothing fibers) within the wound can provide clues about the circumstances, location, etc. of the crime
🔷 Bruising: Forensic nurses look for bruising to understand the force applied during the injury
🔷 Healing Stage: Evaluating the "freshness" of the wound can help determine when the wound occurred
❗ Photographic Documentation is ESSENTIAL to accurately record the wound and can be used in legal proceedings
Forensic nurses collaborate with law enforcement, attorneys, and other professionals to build a comprehensive picture of the injury. 🕵️♀️🔍
FORENSIC NURSE CONSULTANT AND CASE EVALUATION
Another crucial role of FNEs in case evaluation is analyzing medical records and other pertinent documentation. Discrepancies, inconsistencies, injuries, timeline gaps, documentation, or explanations of events, can hinder the FNE’s analysis and expert opinion and warrant further investigation.
Initial Case Assessment:
FNE LNC's review medical records, forensic reports, police reports, statements, interviews, indictments, Grand Jury testimony, etc. to get case details as to what the prosecution aims to prove, and the defense may try to dispute or mitigate.
Medical Records Examination:
They review medical records looking for discrepancies between the patient’s account and the documented injuries. This also allows for the identification of issues such as pre-existing conditions, medications, or deviations from the standards of care that may have impacted or contributed to the injuries sustained, and incomplete or vague documentation that does not provide a clear medical picture of the patient or injuries. They may also need to evaluate the suspect's medical records to identify mitigating factors to assist in explaining their behavior or to dispute their capabilities to perform certain criminal actions.
Injury Descriptions - Correlation with Explanation:
Forensic nurses compare the documented medical findings and injuries with the patient’s explanation paying close attention to details such as location, size, shape, and characteristics of each injury. 3 key elements are:
Timing: Do the reported time and nature of the injury align with the medical evidence?
Mechanism of Injury: Do the injuries match the described cause (e.g., a fall, assault, self-defense or accident)?
Patterns of Injury: Are the injury patterns typical of the stated cause, or do they suggest a different mechanism (e.g., defensive wounds vs. accidental cuts)?
Timeline and Chronology:
They utilize available records, medical and others, to establish a timeline of events based on records and determine if the injuries correlate with the described sequence of events.
KEY WAYS THAT FORENSIC NURSE CONSULTANTS EVALUATE CRIMINAL CASES
An FNE’s comprehensive understanding of the mechanisms of injury and the resulting insult to the human body significantly enhances their ability to evaluate criminal cases and provide insights into the nature and potential causes of injuries.
The key ways FNEs do this are:
Accurate Injury Assessment: assessing and documenting the nature, extent, and patterns of injuries and distinguishing between different types of trauma, such as blunt force, sharp force, or ballistic injuries.
Determining Cause of Injuries: inferring the potential causes of injuries, determining whether injuries are accidental, self-inflicted, or inflicted by another, and establishing the mechanism of injury.
Correlating Injuries with Evidence: reconstructing the events leading to the injury and correlating physical injuries with other evidence, such as bloodstain patterns, weapon characteristics, and environmental factors.
Identifying Signs of Abuse or Neglect: signs can be subtle and may be easily missed by those without specialized training.
Collaborative Investigations: working with other professionals to guide investigations, support the development of case theories, and assist in formulating questions for witnesses and suspects.
Evaluation of Consistency: determining if the victim’s and/or suspect’s accounts of events correlate with the physical evidence and/or medical findings.
By leveraging their knowledge of trauma, forensic nurse consultants play a vital role in uncovering the truth in criminal cases and providing a thorough and scientifically sound evaluation of injuries.
HOW FORENSIC NURSE CONSULTANTS EVALUATE CRIMINAL CASES!
One of the most important aspects of any criminal case is the EVIDENCE! An FNE uses the myriad of knowledge, skills, and abilities they have developed to assist in criminal cases. One way they do this is to IDENTIFY GAPS IN COLLECTION AND MISHANDLING OF EVIDENCE.
This is CRUCIAL in criminal cases because evidentiary issues can:
invalidate the evidence
compromise the admissibility of evidence
compromise integrity & credibility of evidence in court
cause inconsistencies
create confusion or ambiguity about the origin, context, or significance of evidence with the jury
can WIN or LOSE a case!
Common gaps identiofied by Forensic Nurse Consultants include:
Chain of Custody Issues
Ex. lack of proper documentation and/or tracking of evidence from crime scene to laboratory
Incomplete Documentation
Ex. missing or inadequate documentation of injuries, observations, or collection procedures
Contamination or Tampering
Ex. improper handling techniques or contamination during collection, storage, or transportation
Failure to Use Standardized Protocols
Ex. deviations from established protocols for evidence collection, preservation, and documentation
Insufficient Training
Ex. inadequate training of personnel involved in evidence collection and handling can result in errors or omissions
Inadequate Preservation
Ex. improper storage conditions or delays in submitting evidence to the laboratory
Documentation Errors
Ex. errors in labeling, dating, or describing evidence can create confusion or ambiguity
How can a Forensic Nurse Examiner (FNE) assist with Criminal cases?
Some FNEs choose the route of legal nurse consulting on criminal and/or civil cases. Because of their specialized skills and knowledge, they are equipped to understand and interpret medical evidence within the context of the law.
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Types of cases that benefit from the consultation services of an FNE include:
🔴 Death investigation/homicide
🔴 Physical assault
🔴 Sexual assault
🔴 Human trafficking
🔴 Domestic/interpersonal violence
🔴 Assault
🔴 Strangulation
🔴 Child abuse/neglect/sexual assault
🔴 Elder abuse/neglect
🔴 Malpractice
🔴 Wrongful Death
🔴 Insurance Fraud
🔴 DUI/MVAs
How do we do this??
FNEs who consult or provide expert services do so by
🔷 leveraging their knowledge and skills in forensics, evidence collection and handling, mechanism of trauma, human anatomy and physiology, nursing standards of care and the legal system
🔷 providing expert insights into medical evidence
🔷 helping attorneys, judges and juries understand the significance of injuries, trauma, and other relative health-related aspects
🔷 collaborating with legal teams to ensure proper evidence collection, maintain chain of custody, and adhere to legal protocols.
Their expertise bridges the gap between healthcare and the legal system,
contributing to a more comprehensive understanding of criminal cases.
What is a Forensic Nurse Examiner? (i.e. not "just" a SANE)
Forensic Nurse Examiners (FNEs) are often believed to function solely as a Sexual Assault Nurse Examiners or “SANE” nurse. While that is obviously important work, FNEs are so much more than that!
What is a FNE? Forensic nurses are specially trained RNs or Advanced Practice RNs who work not only with victims of crime but often with the perpetrators as well. They connect healthcare and the legal system and provide trauma-informed care to patients in a variety of settings such as hospitals, medical examiner/coroner’s office, correctional facilities, psychiatric facilities, private investigation firms, child advocacy centers, rape crisis centers, and more.
The patients they encounter are often involved in criminal acts such as:
Sexual assault
Physical assault
Domestic/interpersonal violence
Child abuse
Strangulation
Shootings/Stabbings
Homicide
DUI/Drug related incidents
FNEs excel at:
the collection, handling and management of evidence in a manner that maintains its integrity for court;
performing detailed physical examination to identify injuries and other findings;
completing comprehensive documentation of the incident and relevant medical history, findings, and evidence collection;
providing medical care to crime victims and suspects; and
testifying to their processes, findings and expert opinions of the case.
FNEs are not only essential members of healthcare teams, they are also indispensable members of legal teams.
