Understanding SANE, V

To the extent that the run-up and aftermath of the election distracted attention from the details of the case, we’ve all missed out on a series of first-rate posts by Kathleen Eckelt at Forensic Talk.

Eckelt, it’s worth remembering, was way ahead of the curve in using her professional experience to cast doubt upon the medical evidence in this case. At a time when Duff Wilson of the New York Times was suggesting that the medical evidence was quite strong, Eckelt was maintaining the opposite.

The recent revelations—the accuser pole dancing in a limber fashion, the former security manager saying she was boasting about getting money from “white boys,” the former manager saying that she frequently passed out in the strip club—suggest that, on the medical front at least, the blogs’ coverage was far superior to that of the Times.

Several recent posts continue Eckelt’s impressive work on this case. Her major conclusions:

1.) The accuser’s behavior is far more typical of someone “hospital shopping” for drugs than of someone who was sexually assaulted.

“Those who engage in drug seeking behavior,” Eckelt noted, “or 'doctor shopping', often hit the various emergency rooms, complaining of extreme pain, hoping to get a physician to prescribe the drug.” Specifically, why, the day after the alleged attack, did the accuser go all the way to Chapel Hill and UNC Hospital to complain of pain and request drugs?

According to Eckelt, “part of the standard discharge instructions given to our patients is to instruct them to call or return to the ER or SANE unit if they have any further problems or bruising showing up . . . The accuser showing up at UNC the next day indicates to me that she did not receive a prescription at Duke, even though she supposedly was in ‘extreme pain.’”

Indeed, Eckelt wonders how the accuser could have received Percocet and Flexeril from UNC even though the doctors knew “that she had mixed alcohol with Flexeril.”

2.) The only item listed on the SANE nurse-in-training’s report—diffuse edema of the vaginal walls—is not characteristic of sexual assault; and, in fact, several behaviors with which we know the accuser was associated would account for this condition.

Eckelt wrote that she recently asked a colleague with almost 15 years experience, who hasn’t been following the Duke case, how she could recognize diffuse vaginal wall edema in a sexual assault case. According to Eckelt, “she gave me this kind of dumb founded look, then asked the same question I’ve been asking myself all along: ‘How could you even see it?’”

Eckelt has “never” seen diffuse vaginal wall edema “by itself, without any redness or other signs.” Yet, according to SANE nurse-in-training Tara Levicy’s report, this is exactly what Levicy saw with the accuser. But, notes Eckelt, “edema, diffuse or otherwise, is not an injury. It is the body’s response to an injury, an infection, or a disease or inflammatory process of some sort.” According to Eckelt, what could cause diffuse vaginal wall edema?

• Smoking
• Sex within 24 hours of the vaginal exam
• Frequent sex
• Tricyclic anti-depressants, or other medications with properties similar to them—such as Flexeril.

It’s unclear if the accuser smokes. But she certainly seems to exhibit the other characteristics.

Eckelt concluded that neither she nor her colleague “felt that diffuse vaginal edema, alone, without any other symptoms or injuries, would be indicative of sexual assault,” and that certainly “neither one of us would be willing to walk into court and state that it is.”

3.) The Inside Edition “pole-dancing” video is extraordinarily damaging to the prosecution’s case.

“Patients who engage in fraudulent behavior or doctor shopping,” Eckelt recently wrote, “are often videotaped by investigators displaying behavior not consistent with their claims.”

According to Sgt. Mark Gottlieb’s infamous “straight-from-memory” report, on March 16 the accuser was, as Eckelt notes, “limping, grimacing, crying, and couldn’t sit down—shifting from one side to the other—not able to sit on her buttocks.” These symptoms would be associated with a herniated disc, yet those with herniated discs could not be captured on the Pole Dancing Video.

Moreover, Eckelt writes that studies have shown those with lower back pain—as the accuser claimed in her multiple trips to UNC Hospital—”have a significant problem with flexion and movement of the hips and lower back.” Again, based on the pole dancing video, it seemed as if the accuser had little difficulty with these matters.

While the person captured on the Inside Edition video thus had few, if any, signs of legitimate pain, she did demonstrate behavior consistent with someone faking an injury for ulterior purposes: “exaggerated symptoms and continued complaints of extreme pain (8 - 10/10) with no obvious physical basis for the pain.”

In Eckelt’s words,

Nurses spend a lot of time dealing with patients’ pain. We’ve seen many different types of people, different types of pain, and different responses. After awhile, we get a sense of what appears to be true pain and what appears to be exaggerated. We know how long it should take for medicine to kick in and how that medicine works on the body to relieve the pain. As I said before, when a patient’s behavior is inconsistent with their claims, red flags go up. In my opinion, with this particular case, red flags are popping up all over the place.

4.) The accuser’s claimed conditions are inconsistent with that of a full-time college student.

Eckelt recently noted that the case reminded her of a previous fraudulent-pain claim, when a patient, a full-time college student, was actually obtaining drugs to sell on the open market. Though he complained to his doctor of extreme back pain, the doctor could find no other symptoms, but initially prescribed the drugs anyway.

When the case was reviewed for insurance fraud, the investigator wondered, “Just how did he manage to sit all that time in those hard chairs, and for studying, when he had such extreme back pain?”

In this case, it would be interesting to ask the accuser’s professors how she behaved in class—did she, for instance, constantly fidget in her seat, indicating the kind of extreme back pain that Sgt. Gottlieb claimed to notice in his “straight-from-memory” report?

In general, the revelations over the last couple of months raise some doubts to me. The accuser hasbeen described as an “honors” student at North Carolina Central. To my knowledge, the only source for that claim is the March 25 article in the N&O—an article that, essentially, is no longer credible.

I teach at a school (Brooklyn College) where a majority of students have jobs; a good chunk work full-time. Yet in my seven-plus years at Brooklyn, I can never recall a student who had anything resembling the schedule described of the accuser in the Jarriel Johnson statement, the recent Joseph Neff article, or a similar piece in the Herald-Sun. These items reveal a person who spent long periods of time—frequently extending into the wee hours of the early morning—in a strip club, where she sometimes, according to the Herald-Sun article, ended the evening passed out.

The Jarriel Johnson statement goes into considerable detail about the accuser’s activities in the days before the lacrosse party. Driving around to “appointments” or strip clubs forms a prominent role in the Johnson narrative; driving the accuser to class (the accuser, of course, had her license revoked) is never mentioned.

How, exactly, did the accuser get to class? Based on the schedule we now know she kept, how did she maintain a regular courseload? Her written statement to police suggests someone operating at a 9^th or 10^th grade reading level. In light of that, and based on the kind of behavior seen in the Johnson statement and recent articles, how did she maintain an honors GPA—at the same time that she was, allegedly, experiencing such extreme back pain that she couldn’t sit properly?

I have no answers to these questions. But—coming at the matter from the standpoint of an academic rather than a SANE nurse—I agree with Eckelt that the accuser’s behavior seems rather atypical of a full-time honors student.

[Update, 5.28: A correspondent and one of the commenters correctly points out that beyond the N&O, the first Newsweek story on the case listed the accuser as a member of the "Golden Key" honour society. I checked the web but couldn't find a link for the NCCU branch of the society; it's unclear, therefore, what membership in the society entails.

I doubt we'll ever resolve the issue of the accuser's academic credentials: this material is protected by FERPA, and my sense is that the defense would obtain access to it only if Nifong claimed in court that the accuser was an honors student.]