Thursday, October 19, 2006

Understanding SANE, IV

Kathleen Eckelt continues her pathbreaking work on the case, with a summary post at Forensic Talk. The post, which focuses on the medical shortcomings and peculiarities in the state’s evidence, complements mine on the legal and academic side of the case.

Eckelt’s ten “strikes” against the medical evidence possessed by the state divide into five broad categories: (1) new—and critical—material; (2) alcohol- and drug-related issues; (3) law enforcement procedures; and (4) logical inconsistencies in the accuser’s stories in light of the medical evidence that exists.

1.) New Material

Eckelt raises serious concerns about the relationship between the medical evidence and two central elements of what appears to be the state’s case (which, admittedly, always seems to be changing as new facts emerge to contradict then-existing theories): the accuser’s claim that she was strangled; and her assertion that she broke off four of her false fingernails fighting off her attackers.

Eckelt writes that “the strangulation bit alone made me question her story.” Why?

The combination of alcohol/drugs and the compression which would have been caused by the type of choke hold that was demonstrated to the media, I believe she would have passed out immediately . . . Of course, show me some signs, show me where she was so hoarse afterwards she could hardly talk and I might feel differently. But, let me see ... Wasn’t Kim just saying on 60 Minutes that there was nothing wrong with the accuser afterwards

Eckelt also reasons that the fingernail evidence is inconsistent with the story told by the accuser. She wonders how, to begin with, the accuser managed to break the fingernails at all, when “according to all witnesses and the photos, she wasn’t in any condition to fight off a kitten, much less three strong, young athletes.”

And if, in fact, the accuser had sought to fight off her attackers with her fingernails, there “should have been blood under her nails. There should have been deep, crescent shaped or long scratches on the perpetrator.”

2.) Alcohol- and Drug-Related Issues

More so than any commentator, Eckelt has been ahead of the curve in analyzing how the combination of flexeril and alcohol might have accounted for the accuser’s odd behavior on the night of the party.

Eckelt also wonders why the accuser, diagnosed as suffering from chronic back pain, was still taking flexeril, which is supposed to be confined to the acute phase (3-6 months), after which “there is usually no need for muscle relaxants.”

The accuser’s continuing access to flexeril caused Eckelt to ask some uncomfortable questions, answers for which don’t seem to help Nifong’s case:

  • Why was this woman, with a chronic back pain problem, getting Flexeril at this point?
  • Did she recently have an accident or a DV incident?
  • Was the fact that she was knowingly mixing it with alcohol, to the point of impairment, an indicator of past drug/alcohol abuse behavior?

Eckelt has experience diagnosing health care fraud, and comments that “one of the red flags in claimant fraud is the over exaggeration of symptoms. However, those exaggerated symptoms seem to disappear when the person doesn’t know that they’re being observed - or video taped.” In this instance, we have the surreptitious videotape of the accuser dancing, in a limber fashion, at the same time she was claiming in hospital visits that she could barely walk.

3.) Law Enforcement Procedures

Eckelt has been masterful in dissecting the seemingly false medical judgments contained in the Gottlieb report. She continues her efforts in this post, observing that Gottlieb claimed to have asked the SANE nurse if the accuser’s injuries were “consistent with sexual assault”; she replied, “Yes.”

According to Eckelt,

We don’t talk like that. In fact, I’ve never had a detective ask me if a patient’s injuries were consistent with sexual assault. They just ask if she had any injuries and I tell them yes or no and what type. But then again, maybe they do things differently in North Carolina.

Eckelt also casts doubt on the performance of the Durham Access Center, whose officials asked the accuser if she had been raped—holding out a path that might prevent her being involuntarily committed. “That goes back to my days in nursing school,” Eckelt recalls, “when we were taught to never put words in our patient’s mouths. We don’t give them ideas. I have followed those instructions for over 30 years now and still adhere to them.”

4.) Inconsistencies

Eckelt also notes a variety of logical inconsistencies in the medical side of the state’s case such as the lack of DNA or other transfer of evidence, or the lack of corroboration for the accuser’s “injuries” of any type from Kim Roberts.

Where does Eckelt’s analysis leave the case? Not only did Nifong bring a case based on procedural fraud in the legal arena; but the medical report that he claimed persuaded him a rape occurred actually is dramatically inconsistent with the accuser’s stories.

Eckelt’s work raises the disturbing question of whether Nifong constructed out of whole cloth the medical case as he did with the procedural handling of affairs. But of course, to quote Eckelt, “Then again, maybe they do things differently in North Carolina.”


Anonymous said...

That is the most comprehensive analysis I have ever seen of medical evidence in a criminal case. Kathleen Eckelt is a marvelous and learned expert. Hearing from her is enlightening and interesting. After all, most of us are not exposed to SANE exam reports regularly!

Anonymous said...

The compliments are probably getting tiresome, but your coverage of the lacrosse case continues to be much better than what a reader can find in the local newspapers. Has the N&O put Neff under wraps? Will Sill ever apologize for the March 24 and 25 stories, which played such a large part in creating the atmosphere for Nifong to operate? Will pigs fly?

Anonymous said...

this woman has not seen the medical report anymore than anyone else so take her comments with a grain of salt. until the sane nurse and the duke doctor testify, the medical facts are still unknown at this point.

Anonymous said...

To 4:28
I have seen all medical reports and they are even more supportive of the fact that a rape was impossible, statistically and medically, than Ms Eckelt claims.

Anonymous said...

The 4:28 am comment is not well-taken.

Numerous media outlets have seen the medical reports and reported on them. The facts are quite well known. Additionally, the defendants legal motions have extensively quoted from and disclosed the information contained in the medical reports. As the N.Y. Times Duff Wilson has reported, the medical report does not disclose much, a couple of non-bleeding cuts on the ankle and knee and diffuse edema.

There is some issue as to whether the SANE nurse will attempt to add details to her examination based on Gottlieb's straight from memory report. However, Gottlieb cannot testify to the accuser's examination by the SANE nurse, nor can he testify to what he says the SANE nurse told him. It is highly doubtful that testimony regarding the medical condition of the accuser that goes far beyond what is documented in the medical report would be offered, or if it were offered that it would have much credibility. There is a standard rule in cases involving medical testimony of document it, or it doesn't exist.

So the referenced comment is not very accurate at all.

Anonymous said...

Here is my guess as to how the SANE exam fit into the progress of this drama: The officer who spoke to the SANE nurse heard only one thing - that sex had happened(vaginal edema) and there was some light bruising. This information, especially what documented evidence of sex, was taken by Nifong to mean that Duke Lacrosse DNA was certainly going to be found on or in the AV. The case he expected to fight would therefore have been a HE SAID, SHE SAID type of dispute. That would have served his political requirements brillantly and at no risk to himself.
When the DNA evidence failed to materialize, he should have slowed way down. When the second round of testing came back Duke negative (but boy friend positive) and he had learned of the vibrator, he should have gone full-stop. Everything that he has done since is dishonest and corrupt.
As to the matter of the motives of any of us ho post on this case: Anyone who has seen a false claim of rape or sexual harassment up close will never stop running to the barricades when that situation comes up. And there are lots out there.

Anonymous said...

I would suggest that some of the information we are hearing about now suggests prescription drug abuse. I am quite familiar with this as a physician. Patients come to the ER with complaints of back pain etc. and hope they will get an inexperienced physician that will prescribe muscle relaxants or something stronger such as narcotic pain medication. The fact that the false accuser went to UNC hospital several days later to complain of pain while she had already resumed her stripping routine is suggestive of one of two possibilities.... she wanted to falsely document continued complaints of pain to support the hoax, or she was in need of more Flexeril or pain medication. I would guess the latter. In addition most patients that are given Flexeril for back pain would not consider taking it before going out or consuming alcohol. This is suggestive of abuse, and if so, false complaints of physical pains are nothing new for this woman. This would cast doubt on any of the "pain" she complained of on the night of the party.

Anonymous said...

"this woman has not seen the medical report anymore than anyone else so take her comments with a grain of salt. until the sane nurse and the duke doctor testify, the medical facts are still unknown at this point."

The medical report has been leaked to the media and the basic conclusions are agreed by the defence and Nifong; her injuries were several scratches on her knees and diffuse edema - which could be due to her sexual activity prior to the lacrosse party (the vibrator incident, her driver, her boyfriend).

It's known that she didn't ingest a 'date rape drug' such as GHB etc (acknowledged in discovery by Nifong) but the rest of her toxicology report has not been released. That would be of some interest not to show she is a drug addict but that she could have been severely impaired.

I am more interested in what she did with her escort money, ie, where it all went. Similarly I would be interested in whether she falsified financial aid documents for college as her escort income would be unreported income. That's a 'credibility' issue.

The drug issue was something I raised a long time ago on John's blog; patients who take muscle relaxers know not to take alcohol and their prescription bottle would also have such a label. The impairment is rather severe - especially with up to 40 oz of malt liquor/liquor (beer/colt45type and her mixed drinks).

Anonymous said...

It should be noted that the 'SANE nurse' was actually a SANE nurse *in training* and her conclusions are based on limited experience and as the SANE nurse who does 'understanding SANE' has noted it is standard practice for trainees to be supervised by actual SANE nurses. This doesn't appear to have happened here.

Yes, the nurse in question has experience being a nurse (she is not 'fresh' out of school) but she whether or not or 'opinion' matters at all is open to debate.

That is a serious problem and it is the hospital's 'fault' - skimping on SANE nurses is pretty sad, ie, a supervising nurse. There's a reason for having such a supervising nurse; credibility on the witness stand.

I know you are hell bent on having this case go to trial but you should at least examine what is known, ie, what has been filed, who the relevant people are in the case, etc. This is not that hard and you don't have to turn to KC for (all) the info: WRAL, N&O, etc have the PDFs of filings, etc archived.

Anonymous said...

Hmmm, I know that History Profs are not supposed to be math whizes, but even they should know that 5 is not equal to 4.

Anonymous said...

To Anon 7:15
Your comments fit with the insight several others have suggested in referrence to the DNA exam.
Everyone who owns a TV these days knows from CSI, etc. that DNA testing is very hard to evade if contact is made and fluids deposited. For the LAX players to deny, unequivacably, that anything took place, they must have been sure.
Afterall, if you have had sexual contact with a stripper at such a party and you find yourself accused of rape, the obvious defense is to insist that it was consensual, (or merely contractual).
But only a lunatic would deny it all outright if anything had actually happened. DNA testing would nail you and you would have forfeited your best defense.

Anonymous said...

To 4:28am

You obviously have not read all of the medical documents that are out. The Duke doctor can not come out and makeup things like Gottlieb can. The medical profession has ethics unlike police departments. The doctor would be gone!!! Gottlieb seems to be a star in Durham.... How very sad.

Anonymous said...

I was very interested to hear that Eckelt questioned the method used to establish the rape complaint---i.e., they asked the AV "if she had been raped." I mentioned this months ago on the FODU site, and was quickly put in my place by those who said that was standard practice. But Eckelt says "we were taught never to put words in our patients' mouths. We don't give them ideas." I think this is very significant. I think the AV, out of it and afraid of being committed, found a convenient "out" was presented to her on a platter. Once she said "yes" she was surprised that her story was believed and catapulted into the mainstream media. She probably thought, if she never identified her assailants, it would go away as her last false claim had. She made up a fantastic story to begin with, never realizing anyone would actually believe it. She simply wanted to get home, get back to work, and get more flexiril.

Anonymous said...

From the beginning I was skeptical about what the medical exam would show. Nifong said it was "consistent with" rape and many commentators relied on that statement to believe a rape had occurred. But even before the DNA results came out and the full content of the medical report was released, I knew that "consistent with" had very little meaning. The vaginal swelling could also be consistent with consensual sex and with use of a vibrator, as we now know occurred.

I was also impressed early on by the flat denial of the team that any intercourse occurred. Like 2:37 said, had there been any intercourse a logical defense would have been stated that it was consensual, but to flatly deny it would be legal suicide if DNA matched anyone.

Anonymous said...

When i first heard of this story, I, like many others, immediately asumed the boys were guilty. I couldn't imagine a woman claiming rape if it had not occurred. My suspicions were first aroused when the boys didn't claim "consensual sex." If ANY of them had had sex or any physical contact with her, they would have been out front with a consensual story. Otherwise they were taking a huge risk and facing almost certain conviction. I think it was Dan Abrams first suspicious moment, too.

Anonymous said...

"She made up a fantastic story to begin with, never realizing anyone would actually believe it. She simply wanted to get home, get back to work, and get more flexiril."

Do you think Nifong actually believed it? Maybe he simply wanted to get elected.

Anonymous said...

Don't know if Nifong believed it (which is possible, at least at first) or if he just wanted to believe it. Regardless of whether his initial intentions were good or not, he had many opportunities to do the right thing--to do his job. I don't know how much of this is his stubbornness, and how much is simply misconduct. Doesn't matter--it's still wrong.