Saturday, September 16, 2006

Understanding SANE

At this stage, no serious observer of events in Durham could deny the magnitude of D.A. Mike Nifong’s procedural improprieties. Medical procedures, on the other hand, have received far less attention. It seems almost inconceivable to believe that the DNA test would yield no matches, given the specific type of attack alleged and the short time thereafter until the accuser’s arrival at the hospital. I’m not alone in this skepticism, of course; the D.A.’s office itself assured the court on March 23 that “the DNA evidence requested will immediately rule out any innocent persons.”

Beyond the DNA, those of us without medical knowledge must rely on the experts. Fortunately, a new and comprehensive site has recently appeared. Forensics Talk is the work of Kathleen Eckelt, a certified Forensic Nurse Examiner with over 30 years of clinical nursing experience. She’s also president of Harford Medlegal Consulting, which specializes on issues relating to forensic nurses.

The site provides a wealth of material, but three items particularly jumped out at me.

1.) The accuser’s injuries are inconsistent with the attack that she described.

The accuser alleged a violent, 30-minute, gang rape, in which she was kicked and hit; and in which she scratched her attackers. Eckelt observes that as "kicking is usually done with shoes on,” there “may be an imprint bruise from the tread of the shoe,” or a “swinging kick may result in a curved imprint,” with injuries most likely to occur to the face, neck, groin, back, and chest. No such injuries appear to have been documented in this case.

Likewise, recent prosecution claims that the accuser experienced blunt force trauma seem dubious; Eckelt describes the condition as characterized by contusions, lacerations, abrasions, and bites—all injuries that the accuser didn’t possess. According to the SANE nurse-in-training, Tara Levicy, the accuser did show diffuse edema on the vaginal walls—which Eckelt argues often isn’t even classified “as consistent with sexual assault.” She can say definitely, however, that she has "not seen simple edema (alone) as a classification of blunt force trauma. If it's not a classification of blunt force trauma, then how could it be consistent with it?”

Finally, Eckelt all but dismisses insinuations that the accuser might have been given a date rape drug. She reports, “Although each person can react differently to any drug, the amnesia produced by these drugs is pretty acute. It’s not usually a matter of a person's memory just being a bit fuzzy. It’s usually a matter of not remembering anything at all past that first drink.” The accuser, of course, alleged no such thing.

I wonder how many experienced SANE nurses New York Times reporter Duff Wilson spoke to before publishing a front-page article implying that diffuse edema is consistent with blunt force trauma and a date rape drug could have been used?

It’s worth noting that the Department of Justice’s SANE Development and Operation Guide reinforces Eckelt’s observations. The guide goes to great lengths to contend that the absence of evidence ought not be determinative, but also (page 69 of this link) lists a variety of injuries to be expected in a violent rape. The accuser, in this case, had none of these injuries.

Take, for instance, injuries associated with choking—the part of the attack that Nifong personally demonstrated on national television. "Since most assailants choke using their dominant hand,” reports the DOJ guide, “the fingertip pattern can identify the assailant’s handed-ness. A righthanded assailant can usually . . . leave a single thumb bruise at the right lateral neck and several finger tipbruises to the left lateral neck.” The SANE nurse-in-training’s report recorded no such evidence of fingertip bruises.

2.) Sgt. Mark Gottlieb’s “notes” lack procedural credibility.

The Times has reported that Gottlieb produced a typed set of notes, many months after the fact, that were not corroborated by any contemporaneous handwritten notes. The many inconsistencies between Gottlieb’s document and the pre-existing case file included his recapitulation of an alleged conversation with Levicy on March 21, in which Levicy allegedly described the accuser’s injuries in terms far more severe than she documented in her report.

According to Eckelt, if Gottlieb’s notes are true, then Levicy was negligent. “Everything is supposed to be documented,” she notes, at the time of the exam. Now I've had detectives call me up and ask questions. However, it’s usually been during, or right after, the exam and the answers to questions about any evidence or trauma is already in the chart. I always document it as I observe it.” Indeed, “in the medical field, whether written by physicians, nurses, physical therapists, or nursing technicians, the standard protocols for our documentation are all the same. We’ve all been taught that, according to the courts, ‘If it’s not written, it’s not done.”

Eckelt has other reasons for suspecting that Gottlieb’s reminisces are fictional. Indeed, the sergeant has a reputation in Durham for going overboard with his tales, as he seems to have done in this case. In addition to the new description of “blunt force trauma,” Gottlieb’s notes claim that Levicy told him the accuser uncontrollably screamed after a male nurse unexpectedly entered the examination room. The SANE nurse-in-training, alleges Gottlieb, had to race back down the corridor to calm the accuser.

After reading of Gottlieb’s version of events, Eckelt writes,

I was just floored with that statement and really question it. The standard protocol for sexual assault victims is to provide a private room, preferably locked, in which to do the exam . . . We do not have hospital personnel walking in and out of the room during an examination. That simply isn’t done. We maintain strict privacy for our patients and control over all evidence. Once an exam is finished, we call security and have the evidence locked up until the detective can pick it up. Never would we allow someone, especially a male, to just walk in to get supplies or anything else and I can’t imagine any other SANE nurse allowing it either.

Once again, the DOJ guidelines reinforce Eckelt’s arguments. Page 68 of the above link observes “physicians need not be concerned that injuries will be missed by the SANE if they understand that she will err on the side of caution when evaluating and referring sexual assault victims to them.” Yet in this case, Gottlieb implies that Levicy showed more restraint when dealing with other medical professionals and in her medical report than she showed five days later in a private, undocumented talk with him?

3.) Duke Hospital appears to have violated protocol.

Eckelt observes that “experienced SANE nurses can make a conclusion as to whether any injuries are ‘consistent with’ sexual assault,” but the “key word here is experienced.” Such experience, Eckelt believes, is necessary to testify as an expert witness, although she concedes that the standards in North Carolina might be looser on this score.

In any case, Eckelt argues that “standard protocol” dictates a SANE nurse-in-training—like Tara Levicy in this instance—“must have another experienced SANE nurse, or a physician, in the room with her during the whole exam, so that she can be evaluated and later certified to perform exams on her own.” Moreover, this observation must be documented: “the supervising SANE nurse’s (or physician’s) name should have been written on the standardized examination form. If there is no name written there, then that means there was no one supervising the new SANE nurse ‘in training.’”

Who supervised Levicy during an examination that Gottlieb’s notes describe as having lasted several hours?

At this stage, I suppose no one should be surprised that the procedural irregularities in this case dated from its inception.

12 comments:

Anonymous said...

I have read other accounts from SANE Nurses who basically agreed with these comments. It either comes down to did Nurse Levicy exaggerate in comments to Gottlieb, or did Gottlieb & Himan lie in that 23 march order signed by Judge Stephens? Or both!

Anonymous said...

I am a SANE nurse and am astonished by the claims these police officers have made against the medical professonals in this case. Either they were grossly incompetent or the officers are lying (I tend to lean to the latter).

As to supervision, there was (according to reports) a Physician present for the examination.

Anonymous said...

I am a Physician. It is absolutely true that the first rule of charting taught everyone is "If you do not record what you do, you cannot say later that you did it." This is especially important in referrence to an examination. Doing a careful exam and then skipping the step of recording it and then telling a police official later that you DID do a carfeul exam - no way that happened. When people take short-cuts (or cheat) on charting they do it to make themselves look better, not worse.

Anonymous said...

Gottlieb wants us to believe that he was told that the AV was severely distraught during the SANE exam. Later on, Nifong hinted that she was given a date-rape drug. Taken together this would help strength the proscecutions theory that her early problems keeping her story straight or remembering the details of her attackers appearance were all due to her being, in fact. brutally assaulted.
If so, however, it shines a very harsh light on Nifongs refusal to even look at exculpatory evidence before issuing any indictments. If they really believed the AV was assaulted by three team members and they really believed she was too traumatized to have solid recall, then good exculpatory evidence for one team member would have been a godsend. It would have HELPED them find the guilty ones by ruling out the innocent.
That is, if they were really looking at all.

Anonymous said...

Will this become a legendary legal case as an example of the worst form of prosecutorial abuse and police corruption? What do lawyers who read Professor Johnson's analyses think?

Anonymous said...

This has become the case in which no evidence is touted as "evidence." We saw this before in the infamous Little Rascals case in Edenton, North Carolina, which also featured prosecutorial and police misconduct, as well as a number of wrongful convictions. (That they later were overturned still does not absolve the court system of North Carolina from wrongdoing.)

Likewise, in the infamous child molestation "sex ring" witch hunt in Wenatchee, Washington, during one trial, the prosecutor had the nerve to publicly declare that the lack of any physical evidence at all was "proof" that the defendant must have been guilty.

I will say outright that unless the charges are dropped before trial, these young men are in grave danger. A Durham jury is likely -- as KC so aptly put it in an earlier post -- to engage in "jury nullification" for the prosecution. Look, Liefong, Baldo, and the other liars in this case are NOT going to back down. They cannot do so without having to admit to their own criminality. Thus, they will do whatever they can to frame these three people.

It is our job to put the heat on the judges and others who are involved in the disposition of the case. One attorney told me, "I never before have believed so much in the innocence of my client." But the rest of us have a duty as well, and that is to keep putting on the heat.

William L. Anderson

Anonymous said...

I believe it is likely that Nifong first received his information about the SANE exam verbally from Gottlieb since they did not get the written report from DUMC until later. I am suspicious that Gottlieb exaggerated the findings, although we will not know for sure until Nurse Levicy and Dr. Manley make a statement or testify.It is plausible that Gottlieb pressured Levicy to come to certain conclusions when he talked to her later. There are no HIPPA restrictions with respect to a police investigation. This is an area that merits further investigation.

sceptical

Anonymous said...

The SANE exam comments attributed to Nurse Levicy run counter to SANE Training. Much of the SANE training is how to gather evidence for a Court of Law as they already know medical procedures. I do not believe she said this. If she did she will never be allowed certification.

I believe somebody from the DA's Office wrote that statement for Officer Himan which was in the 23 March Non-Testimonial Order.

Anonymous said...

duke should never have let an inexperienced nurse do the exam and if the woman was acting hysterical, why did they not do a toxic screen? the way the case was handled medically does not make sense. the most experienced nurse should have been there along with the doctor.

Anonymous said...

I have been trying for almost 2 years to find out what exactly happened to my brother, and finally had a local NC paper print this.....PLEASE help my family!!!! We are here in Cleveland, and getting LE there to help has been a disgrace!

PLEASE print this article, and truly have justice for my beloved best friend!!!

Johnsville News
"Injustice anywhere is a threat to justice everywhere." - Martin Luther King Jr.


--------------------------------------------------------------------------------



Friday, November 17, 2006
Durham's Darkside
This is a follow up to this small item posted on Nov. 9th:

I have to stay in Durham - PLEASE help me! My name is Rhonda, and my brother was found executed in Durham NC, on May 05, 2005. His name is Allen Jackson Croft Jr. The sheriff there refuses to send us the reports, tests, and information we requested via the FOIA. This is the same department that handled the Duke rape, and the most recent fiasco of being caught on tape, plotting murder for hire, trafficking in drugs, and women for forced slavery as prostitutes, and counterfeiting. I have been threatened to be charged if I did not stop calling them to ask about the GSR results, and what they was doing about his case...

ALLEN JACKSON CROFT, Jr., died Wednesday, May 11, 2005, in Durham. He was 46 years old. Allen was born in Beckley, W.V. and attended West Virginia Tech, where he received a bachelor's degree in Computer Science. He later graduated from his beloved school, the University of Virginia (UVA), with a master's degree in Computer Science. Allen was employed at IBM for 25 years as a computer programmer and was a member of the UVA Alumni Association.

Rhonda Fleming has been writing about her brother's case at Websleuths.com. She tells a sad story of incompetence and "massive corruption" in Durham law enforcement. It sounds all too familiar.

some excerpts from Websleuths.com thread:
(Attn: Durham NC) In The Name Of My Brother

(Rhonda Fleming, sister of Allen J. Croft) -
I am hoping someone will be able to help me. concerning my brothers death. He was 46 and weeks away from retiring from IBM, in Durham NC. He was found executed May 11, 2005 on the American Tobacco Trail under a tressel, a "supposed," suicide. The sheriffs department boggled the case, and failed to adhere to protocol, and do an investigation. It has taken me over a year to glean what facts I have obtained. My mother and I both wrote under the FOIA, for ALL the facts, as they "closed," his case. A year later the detective for the case sent us a report, and it was full of hearsay, lies, and ineptness. He allowed 2 people to take his computer who were neighbors, and besides doing no handwriting analysis, or autopsy, they completely did nothing. The pictures I do have shows the crime scene, and he has only a couple of drops of blood on his clothes, (which, they also did NO GSR tests on.) There was NO powder burns to the wound, nor was there blood on the gun, his arm, or shirt. The position of his body also doesn't make sense, nor the fact he was pronounced dead 6 hours prior, yet was covered with maggots? I am PRAYING someone out here may help my family! I know we need legal help, but we are poor, and hoping someone will help pro-bono. He was an amazing man, and deserves better than to have died this way. Then, treated like roadkill....Please offer ANY advise, even though I have contacted EVERY official there is, the SHERIFF is, "untouchable," and nobody is willing to help...

The sad part to all of this, is that LE again, is more concerned with politics, than MURDERS! Durham is still more concerned with the rape case, than to solve our loved ones deaths! My brother was found executed under a bridge 3 weeks after Janet Araboa was killed, and I have had NO PRESS, and have had to fight and beg to glean what facts I have received!...

Finally I am getting help from BriAnne Dopart, she is the crime scene reporter for the Durham Herald Sun.....She is going to do a story about unsolved murders in Durham, and the tremendous political climate that is preventing LE from doing their jobs.....

The stench that reeks from the county officials is repulsive! These people are elected officials, hired to protect, serve, and seek justice! The WHOLE system is a quagmire of incompetence, and corruption!

More than a few bad apples [in Durham Law Enforcement], there are the ORCHARDS!... I am furious over the fact the rape case has received more media attention than unsolved murders and police gone gangsters!!!!


If there is anybody who may information, please contact me:
RhondaFleming2@msn.com
RhondaFleming@webtv.net
sources:
In Loving Memory of Allen Jackson Croft Jr.
Allen Jackson Croft Jr.- death notice

related:
Durham Justice Scandals !! - TalkLeft
Durham is a Business - $$ - Peek inside - TalkLeft
Law Enforcement Looks At Growing Gang Culture In Durham - WRAL
Film Documents Gang Violence In Bull City - WRAL
Durham's Gangland - LieStoppers forum
Durham's Gangland - The Johnsville News

Anonymous said...

I have been trying for almost 2 years to find out what exactly happened to my brother, and finally had a local NC paper print this.....PLEASE help my family!!!! We are here in Cleveland, and getting LE there to help has been a disgrace!

PLEASE print this article, and truly have justice for my beloved best friend!!!

Johnsville News
"Injustice anywhere is a threat to justice everywhere." - Martin Luther King Jr.


--------------------------------------------------------------------------------



Friday, November 17, 2006
Durham's Darkside
This is a follow up to this small item posted on Nov. 9th:

I have to stay in Durham - PLEASE help me! My name is Rhonda, and my brother was found executed in Durham NC, on May 05, 2005. His name is Allen Jackson Croft Jr. The sheriff there refuses to send us the reports, tests, and information we requested via the FOIA. This is the same department that handled the Duke rape, and the most recent fiasco of being caught on tape, plotting murder for hire, trafficking in drugs, and women for forced slavery as prostitutes, and counterfeiting. I have been threatened to be charged if I did not stop calling them to ask about the GSR results, and what they was doing about his case...

ALLEN JACKSON CROFT, Jr., died Wednesday, May 11, 2005, in Durham. He was 46 years old. Allen was born in Beckley, W.V. and attended West Virginia Tech, where he received a bachelor's degree in Computer Science. He later graduated from his beloved school, the University of Virginia (UVA), with a master's degree in Computer Science. Allen was employed at IBM for 25 years as a computer programmer and was a member of the UVA Alumni Association.

Rhonda Fleming has been writing about her brother's case at Websleuths.com. She tells a sad story of incompetence and "massive corruption" in Durham law enforcement. It sounds all too familiar.

some excerpts from Websleuths.com thread:
(Attn: Durham NC) In The Name Of My Brother

(Rhonda Fleming, sister of Allen J. Croft) -
I am hoping someone will be able to help me. concerning my brothers death. He was 46 and weeks away from retiring from IBM, in Durham NC. He was found executed May 11, 2005 on the American Tobacco Trail under a tressel, a "supposed," suicide. The sheriffs department boggled the case, and failed to adhere to protocol, and do an investigation. It has taken me over a year to glean what facts I have obtained. My mother and I both wrote under the FOIA, for ALL the facts, as they "closed," his case. A year later the detective for the case sent us a report, and it was full of hearsay, lies, and ineptness. He allowed 2 people to take his computer who were neighbors, and besides doing no handwriting analysis, or autopsy, they completely did nothing. The pictures I do have shows the crime scene, and he has only a couple of drops of blood on his clothes, (which, they also did NO GSR tests on.) There was NO powder burns to the wound, nor was there blood on the gun, his arm, or shirt. The position of his body also doesn't make sense, nor the fact he was pronounced dead 6 hours prior, yet was covered with maggots? I am PRAYING someone out here may help my family! I know we need legal help, but we are poor, and hoping someone will help pro-bono. He was an amazing man, and deserves better than to have died this way. Then, treated like roadkill....Please offer ANY advise, even though I have contacted EVERY official there is, the SHERIFF is, "untouchable," and nobody is willing to help...

The sad part to all of this, is that LE again, is more concerned with politics, than MURDERS! Durham is still more concerned with the rape case, than to solve our loved ones deaths! My brother was found executed under a bridge 3 weeks after Janet Araboa was killed, and I have had NO PRESS, and have had to fight and beg to glean what facts I have received!...

Finally I am getting help from BriAnne Dopart, she is the crime scene reporter for the Durham Herald Sun.....She is going to do a story about unsolved murders in Durham, and the tremendous political climate that is preventing LE from doing their jobs.....

The stench that reeks from the county officials is repulsive! These people are elected officials, hired to protect, serve, and seek justice! The WHOLE system is a quagmire of incompetence, and corruption!

More than a few bad apples [in Durham Law Enforcement], there are the ORCHARDS!... I am furious over the fact the rape case has received more media attention than unsolved murders and police gone gangsters!!!!


If there is anybody who may information, please contact me:
RhondaFleming2@msn.com
RhondaFleming@webtv.net
sources:
In Loving Memory of Allen Jackson Croft Jr.
Allen Jackson Croft Jr.- death notice

related:
Durham Justice Scandals !! - TalkLeft
Durham is a Business - $$ - Peek inside - TalkLeft
Law Enforcement Looks At Growing Gang Culture In Durham - WRAL
Film Documents Gang Violence In Bull City - WRAL
Durham's Gangland - LieStoppers forum
Durham's Gangland - The Johnsville News

Anonymous said...

The Medical Examiner is just another tool LE use to their "disposal!"