Understanding SANE, III

Joseph Neff’s Sunday N&O article offered a glimpse at the concrete results of Mike Nifong’s procedural fraud—a lineup procedure that, quite beyond the three players ultimately targeted, had the accuser:

• claiming to have seen at least two players who authorities knew weren’t at the party;
• falsely identifying the player who made the broomstick comment;
• identifying players with certainty on March 16, but then not recognizing them on April 4;
• recognizing players with certainty on April 4, but not having identified them on March 16 or March 21.

At Forensics Talk, Kathleen Eckelt has done similar work exposing the procedural and factual shortcomings on the medical side of the case. She’s posted several new, significant items, and privately answered several additional questions from me. In light of the recent developments, it seemed useful to summarize the medical information known to date.

1.) The medical “findings” in the Gottlieb report have little, or no, medical credibility.

The procedurally dubious Gottlieb report, which miraculously appeared in July without contemporary handwritten notes to revive Mike Nifong’s moribund case, remains the single most controversial document of the case. Over and over again, the sergeant contradicted other documents in the discovery file—each and every time bolstering the prosecution’s case, often in almost hilariously heavy-handed ways.

Gottlieb’s report, whose medical commentary New York Times reporter Duff Wilson treated as wholly credible, asserted that in a March 21 conversation, SANE nurse-in-training Tara Levicy told the sergeant that her physical exam of the accuser indicated “blunt force trauma”; she diagnosed the accuser with anal edema; and an unidentified male hospital employee walked in to the exam room, causing the accuser to scream uncontrollably. No notation of any of these items appeared in Levicy’s written report; indeed, they were, as Eckelt noted previously, inconsistent either with items in the report or with normal SANE nurse procedure.

Eckelt recently told me of three other factually dubious items in the Gottlieb report. The other item that he added to Levicy’s medical report was a claim that the accuser experienced extreme pain during the speculum exam. According to Eckelt,

In my experience, that’s very unusual. Sure, I’ve had patients who were a 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.

Gottlieb also offered his own medical testimony regarding the March 16 interview he and Inv. B.H. Himan conducted with the accuser. That session has become infamous for the yawning gap between Himan’s contemporaneous notes and Gottlieb’s “straight-from-memory” typed notes regarding the accuser’s descriptions of her alleged assailants. But, according to the Times, Gottlieb added two new medical observations. First, he claimed that the accuser had difficulty sitting on the sofa as she spoke to police. Eckelt is dubious:

My understanding is she had no rectal tears or abrasions. Even so, those are usually healed in a couple days. I’ve never had a patient who couldn’t sit, except for the ones we had to see over at the trauma center or at the nursing homes. I really have to question whether that behavior was due more to her [reported] chronic neck & lower back pain - or whether it was possibly exaggerated symptoms?

Second, he asserted that another police officer told him of observing new bruises on the accuser. Again, Eckelt is dubious:

Bruises can’t be dated. Every pathology book will tell you that. We, as nurses, are not allowed to document “new” or “old” bruises. We have to describe the bruise’s appearance, along with the measurements. Now every bruise goes through stages from red to bluish to yellowish but it can’t accurately be dated. There are too many other factors such as medications the patient is taking, etc.

In fact, according to the N&O, the female officer’s report itself made no mention of the claim. Its only appearance came in Gottlieb’s account of an alleged conversation.

In light of Eckelt’s assertions, I’ll repeat a question I’ve asked before: Times reporter Duff Wilson, who made a great deal of Gottlieb’s version of events, gave no indication in his article of checking to determine the medical plausibility of Gottlieb’s tale. Did Wilson do so? And if so, which expert did he consult?

2.) Two other medical-related items deserve some attention.

First, I asked Eckelt whether the only injury that the SANE nurse-in-training did diagnose, diffuse edema of the vaginal walls, was consistent with anything other than rape. She replied,

According to most of the material I researched, there is always edema of the vaginal walls during consensual sex . . . With stimulation, the vaginal areas become engorged. However, following climax, that engorgement ends very quickly . . . if there is no climax, then the vaginal area could remain edematous for several hours before returning to normal. Of course, we’re talking normal sex here. In the case of the accuser, who knows? I believe that it’s possible but I think that will have to be determined by an expert.

Secondly, Eckelt asked me about the accuser’s alleged limping, reported by the New York Times article. Both she and I find it odd that there has been no mention of the accuser’s boyfriend (the only DNA match to her body or clothes). In fact, I have been told that the initial rounds of discovery didn’t even contain a statement from the boyfriend. Have police interviewed him? If so, did the interview occur before indictments?

3.) The question of who supervised Levicy, a SANE nurse-in-training, remains unanswered.

This issue has arisen before: no evidence that a certified SANE nurse supervised Levicy’s examination, as required. While reiterating that she’s not in any way challenging Levicy’s competence, Eckelt did question

the length of time [reportedly] that the SANE nurse spent with the patient doing the exam. I’ve read where it was 6-7 hours. For a patient with little or no injuries, that’s an exceptionally long time. A normal exam, with no injuries, should take about 1½ to 2 hours if the patient is cooperative. [It is my understanding that the patient was considered cooperative in this case.] If they’re not cooperative, it can take forever! Now if the SANE nurse is brand new, I could see 5-6 hours. Most of us on our unit spent that long with our first few exams. It takes awhile to get used to it. But 6-7 hours? That’s a really long time!

4.) The crime described does not, in most ways, seem to meet what Eckelt has termed the profile of a gang rape.

Eckelt has several interesting posts on FBI-developed rape-case profiling, which one expert says “can be very useful when the crimes at issue involve sex as their primary motive.” Most stranger rapists, she notes, “plan their attacks and most have histories of violence. One in three has a prior record for a violent crime and 25% have been before the court for rape.”

Eckelt cites 15 profile items common in gang rape. Of the 15, only two have any bearing on this case. First, she notes that “most of the [reported] campus gang rapes involve members of fraternities (11%) or athletics (9%).” Second, she observes that the “target victims are usually given plenty of alcohol and/or date rape drugs, or are intoxicated on their own.” In this case, the accuser tested negative for all date rape drugs, according to media reports, though she seems clearly to have been intoxicated.

The deviations from the profile, however, are enormous:

• “If charged, defendants rarely deny that sex took place. Consent is usually their defense.” In this case, every member of the team has been absolutely consistent in denying that any sexual contact ever occurred.
• “Gang rapes can last for hours, often watched & cheered on by all present.” In this case, at least according to what appears to be Nifong’s current speculation, the gang rape occurred hidden from view, with the other occupants of the house wholly unaware of events.
• “Party rape is usually a well-planned event.” In this case, at least according to what appears to be Nifong’s current speculation, the gang rape was wholly spontaneous.
• “Victims can have significant genital injuries.” As Eckelt has previously explained, the accuser’s genital injuries were not characteristic of a violent gang rape.

Nifong knew all of these facts before proceeding with indictment. And yet, according to the N&O, he hadn’t even heard the accuser tell her own (then-current) version of events? Upon what evidence, precisely, did he rely?