The Levicy Exam

Perhaps the most frightening aspect of this case comes in the realization that a massive fraud—the indictment of three innocent people without, as the attorney general publicly declared, any probable cause to do so—required so few figures from law enforcement to execute.

Mike Nifong obviously was the critical player in the case. But he had help:

• from a lab director willing not to report all DNA test results even though state law required him to do so;
• from an office “investigator” who the AG’s report went out of its way to suggest was unprofessional;
• from a police officer who constructed “straight-from-memory” notes that conveniently filled in then-apparent holes in the DA’s case.

And, finally, from a SANE nurse-in-training whose own story appeared to change every time Crystal Mangum’s did.

The conduct of Dr. Brian Meehan, Linwood Wilson, and Sgt. Mark Gottlieb has received considerable attention throughout the case. This and tomorrow’s post will examine the role played by SANE nurse-in-training Tara Levicy. (Levicy has subsequently received her SANE certification, but at the time of the March 14 exam she was still in training.)

If this case had gone to trial, Levicy would have been one of the state’s key witnesses—the only person willing to provide medical testimony to corroborate whatever story Mangum happened to tell on the stand.

Mangum’s Arrival at Duke

Crystal Mangum arrived at Duke University Medical Center just before 3.00am on March 14. None of the various doctors and nurses who examined her, it appears, considered credible her claims of sexual assault. Mangum was behaving in a hysterical fashion atypical of real rape victims; one doctor speculated that she might be a candidate for psychological commitment.

Hospital policy requires any woman who claims sexual assault to receive a SANE exam. According to a November 2004 policy statement, Duke’s hospital employed “14 Duke SANE nurses—enough so there is at least one on-site during all shifts.” Yet a SANE nurse does not appear to have been present when Mangum arrived, and she waited more than four hours for her SANE exam. There has been no clear explanation why Duke failed to provide a timely SANE exam for Mangum.

SANE nurse-in-training Levicy arrived for work at 6.45am the morning of March 14. Since Mangum still hadn’t been seen by a SANE nurse, the Charge Nurse asked Levicy to examine the patient. It remains unclear as to why Duke allowed a SANE nurse-in-training to perform this task without supervision from a certified SANE nurse.

Levicy’s Background

Tara Levicy received a B.A. in women’s studies, with a minor in outdoor education, from the University of Maine. While there, she produced and directed a showing of Eve Ensler’s Vagina Monologues, an event she recalled with fondness. After graduation, she worked as an outdoor rafting guide and an associate at Planned Parenthood in Maine. In late 2003, she went back to school at a 15-month program at the University of Southern Maine, which allows humanities majors to nursing degrees.*

Levicy joined the staff of Duke hospital as an emergency nurse in February 2005. In August 2005, she began work on her SANE certification. At the time that she examined Crystal Mangum, Levicy had less than eight months’ experience as a SANE, and scarcely a year’s experience as a nurse in any capacity.

Kathleen Eckelt is a SANE nurse with decades of experience, who trains SANE nurses in her home state. She noted, “It takes time to develop the ability to make snap decisions needed in emergency situations. It takes time to learn about things like the bio-mechanics of trauma and patterns of injury. It takes time and skill to recognize personality disorders and manipulative and attention seeking behaviors that some patients will exhibit.” Only experience can provide the learning for such matters.

Levicy’s Examination

On March 14, Levicy conducted a detailed interview of Mangum, which lasted more than an hour and became the basis for her report. In the interview, Mangum claimed that she last had intercourse one week before (a statement subsequent DNA tests would prove to be untrue). Mangum denied digital penetration or penetration by a foreign object (a statement she would later contradict). She said her assailants didn’t use condoms. She added that one of her assailants said he was getting married the following day.

As Levicy later admitted in a November conversation with defense attorney Doug Kingsbery, her report did not include a critical piece of information—Mangum’s claim that the “attack” occurred around 1.00am. Levicy did not explain why she omitted this information from her report.

This exclusion was of considerable significance. More than nine months after the alleged attack, Mangum would assert that she was certain the “attack” occurred at 11.40pm. This time frame would have required her to be chatting on the cellphone with her father as she was being dragged against her will back into the house; and also on the cellphone during her dance at the lacrosse house. Photos did not show Mangum talking on the cellphone during the dance--one reason why the attorney general's report dismissed Mangum's last-minute timeline change.

Following procedure, Levicy took photographs of the only “injuries” that she documented during the exam—non-bleeding scratches and bruises on Mangum’s knee and heel. Levicy had no way of knowing, of course, that one of the lacrosse players had photographed Mangum during the dance, which showed these very same “injuries” while Mangum was dancing—or before she claimed she was raped, beaten, kicked, and/or strangled.

While Levicy photographed no other “injuries,” her report described Mangum as in severe pain and demonstrating tenderness to the touch virtually everywhere on the patient’s body. As last week’s Attorney General’s report observed, no objective medical evidence (such as an elevated blood pressure rate or signs of sweating) confirmed Levicy’s diagnosis. Levicy instead cited Mangum’s facial expressions and verbal responses as evidence that the patient was in pain from a rape.

This wholly subjective evaluation proved particularly troubling given Levicy’s apparent biases. As she conceded in a November interview with defense attorneys, she had never seen a woman who had claimed sexual assault behave hysterically as Mangum did during the examination. Did this atypical behavior raise alarm bells? No. Levicy, it turns out, isn’t particularly discerning in evaluating the truthfulness of a sexual assault patient’s verbal claims. When asked whether she had ever received a sexual assault report from a patient that turned out to be false, she replied, “No, never.”

Levicy and Theresa Arico, director of the SANE program at Duke University Medical Center, declined two requests for comment for this post. The day after I contacted her, Levicy’s e-mail address and office phone number disappeared from the Duke website.

The Manly Examination

Because Levicy wasn’t certified as a SANE nurse, she had to find someone else to perform the pelvic examination and evidence collection from the patient’s body. Under normal Duke procedure, this exam would have been conducted by a fully certified SANE nurse. Instead, Levicy turned to a resident, Dr. Julie Manly. Since under normal Duke procedures, SANE nurses rather than residents did such exams, it turns out that Crystal Mangum was the only sexual assault patient treated by Manly during her stay at Duke hospital. (Manly had done a handful of rape exams at her previous hospital, in Idaho.)

As she recounted in a conversation with defense attorney Doug Kingsbery, Manly detected a whitish fluid in Mangum’s vagina that she assumed was semen. Several months later, as she learned more about the case and the results of DNA tests, she realized Mangum was probably suffering from a severe yeast infection. This condition, she further noted, could also explain the only “injury” that Manly’s examination discovered—“diffuse edema in the vaginal walls.”

Manly noted no injuries to the anal area. As a result, the sexual assault form co-signed by Manly and Levicy made no indication of such injuries.

During this portion of the exam, Levicy was simply observing. The SANE nurse-in-training noted that Mangum claimed to be in extraordinary pain when Manly inserted a speculum for the vaginal examination. This item, in her opinion, fortified her belief that the patient had suffered through a traumatic experience. In fact, as Kathleen Eckelt later commented, this behavior should have tipped off Levicy that Mangum was lying:

In my experience, that’s very unusual. Sure, I’ve had patients who were sore, but those were patients who had significant injuries such as redness, tears, and abrasions and their behavior was nothing like that. In those cases, I just used the smallest sized speculum and went very slow and careful. I can’t recall a single exam where I had that much difficulty.

The ability to discern when a patient is likely lying is one reason why most SANE programs—especially at well-regarded hospitals such as Duke’s—require examinations to be conducted by SANE nurses with considerable experience, rather than people who didn’t even have their SANE certificates and whose total nursing experience was less than two years.

Manly also swabbed the vaginal and rectal areas for DNA; in interviews with defense attorneys, she later expressed surprise that she saw no signs of bruising in the rectal area, given the attack that Mangum claimed occurred. No item, anywhere in the rape form, could be construed as even suggesting that Mangum experienced rectal trauma; and Levicy performed no rectal exam of her own, independent of Manly’s work.

Manly further stated that Mangum’s hysterical conduct was not consistent with that of other sexual assault victims that she had treated. Kethra, another longtime SANE nurse who frequently posts at Liestoppers, hypothesized that Mangum’s behavior “was in direct contradiction to the level of non-injury found. She put on a good show for the examiners, needless to say.”

In short, had a trial occurred, Manly would have been a devastating witness for Mike Nifong: the doctor who performed the medical portions of the exam would have said that alternative explanations existed for Mangum’s condition, and that Mangum’s behavior didn’t resemble that of actual victims of sexual assault.

Yet between March 14, 2006, when Manly concluded her exam, and January 12, 2007, when Nifong recused himself from the case, no one from the Durham Police Department or the district attorney’s office ever interviewed Manly.

Levicy, on the other hand, was a favorite of DPD and of Nifong. Tomorrow’s post will examine her interaction with Durham law enforcement.

*--clarified from original