Understanding SANE: Tara Levicy

Recently the defense filed notice that it planned to call as expert witnesses all of Mike Nifong’s expert witnesses save one—SANE nurse-in-training Tara Levicy. A recent post by Kathleen Eckelt explains why.

According to Eckelt, Levicy belongs nowhere near a courtroom as an expert witness. As of March 14, she had almost no experience as a nurse, and was listed as only a SANE nurse-in-training. “It takes time,” Eckelt notes, “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.

The role of a legal nurse consultant—experts who can testify in court—usually requires 10 years of experience, “because the primary job of an LNC is to be able to review medical records to determine if there has been any deviation from the standard of care (SOC) provided to a patient.” A nurse who can testify as an expert witness requires “a strong clinical background which can only be obtained through years of hands on practice.”

Those who train as forensic nurses have similar need for experience. “Forensic nurses,” in short, “are registered nurses with advanced, specialized training in forensic sciences and the law.” They’re not people just beginning their careers as regular nurses, like Levicy was on March 14. In Eckelt’s mind, “there is no way I would have even considered becoming a SANE nurse with only a few months nursing experience, much less walk into court to testify as an ‘expert.’” Indeed, she wonders, “How does one maintain they have ‘specialized knowledge’ when they haven't even finished their training yet?” A SANE-in-training “means you have almost zilch experience,” and that “you should still be supervised by an experienced SANE nurse during any exam” (which appears not to have occurred in this case).

Eckelt solicited a wide range of opinions from professional colleagues in various fields:

An RN:

Six months is not enough time to be an expert on anything. We grow into our positions learning more every day. An expert needs to have a goodly amount of hands on experience beginning as a novice and progressing through out the various stages until reaching expert. I wouldn't consider anyone an expert without a minimum of ten years.

An insurance investigator:

I can say from experience that from an insurance company standpoint, a good expert that would be credible on a witness stand would be someone who has at least 5-10 years’ experience in their field.

In regards to nursing experts, someone who has a masters degree and teaching experience would be an ideal “expert.” In addition, how they would perform in front of a jury is key to being a good expert. Someone with less than 5 years experience is still learning their craft and would be a very unimpressive witness.

Another investigator:

If they are using an expert classification to establish a point, ask them to cite the articles that they wrote on the subject, the cases that they testified in, their education studies on the subject, which court certified them as an expert, what research they conducted.

Retired matron of a forensic hospital in England:

A person can have 20+ years as a forensic nurse but their “experience and expertise” can be limited. I think that it has to be a combination of experience (clinical and/or managerial—all in the field of forensics), academic achievement and the verification and endorsement of at least two others in regards to the area of expertise.

An arson investigator:

Yeah, it is a huge problem in our field. I know people who have 30 years field experience but no degree who don't qualify, but engineers with no field experience or practical training are considered experts. That is why in our field (Fire/Arson) attorneys are almost always doing a Voir Dire and Daubert Challenge in every single case.

A Forensic Scientist:

I use work-product to estimate expertise. Using this standard is far more useful in terms of separating those who have some grasp of what they are doing from those who do not ... real experts don't need to tell you how many years they've been doing what they do, or how many letters come after their name, to support their conclusions; they show their work and render conclusions in such a way that makes their expertise clear to any reader.

An Emergency Room RN:

I cannot imagine any new grad nurse being subjected to a SANE course. It is not that they could not do the course work, you and I both know this, but the sheer experience needed to make judgment calls simply comes with time and time only.

For any nurse manager to subject a new nurse to this is beyond the pale. I understand we are in a nursing shortage, but to subject both the patient and the nurse to this type of experience is unprofessional in the extreme.

Eckelt offered similar testimony from other experts in her post yesterday, and concluded, that "any nurse who should decide to take the SANE / FNE training course and go into forensic nursing should first have several years [preferably at least ten] experience in the ED, Trauma, or Maternal-Child Health fields before venturing forth into this highly specialized area of nursing."

"Most certainly, I do not feel that any SANE nurse still in training should be doing an exam without supervision by another experienced SANE nurse. Even after finishing our training, we still don’t know everything."

This lack of experience perhaps explains the only “injury” that Levicy noticed (“diffuse edema of the vaginal walls") appears to have many explanations other than rape, and is rarely, if ever, found independently of other injuries.

Eckelt's post poses an unanswerable question for Mike Nifong: “If a Medical Director, with many years experience in both trauma and sexual assault, as well as other FNE's with years of experience too, couldn't be sure that what they were seeing was diffuse vaginal edema, how could someone with only seven months nursing, and almost no SANE experience be so certain?”

So, upon what (if anything) did Levicy base her opinion? Her seven months’ experience as an RN, of which she had spent almost no time as a SANE nurse? Or her ideology?

Relatively little has appeared in the public record about Levicy. What is known doesn’t suggest a figure whose neutrality would inspire confidence. Her undergraduate degree, from the University of Maine, came in women’s studies—the discipline that produced copious Group of 88 members, and home of feminist law theory, which contends that women never lie about rape.

She stated that one of her proudest moments in college came when she produced and directed a performance of Eve Ensler’s The Vagina Monologues. Before becoming a nurse, Levicy worked as a healthcare associate for Planned Parenthood, a whitewater rafting guide, and a leader of outdoor programs for the University of Maine. Directly before coming to North Caroline, she was employed by a wilderness program, where she told people, “If saying the word, vagina feels foreign, then I recommend looking into a mirror and saying, vagina . . . vagina . . . vagina.” This rhetoric is not exactly mainstream on issues of gender.

In short, if Nifong could invent a figure to assist him in the medical aspect of the case, it would be Levicy: underqualified professionally, but of the appropriate ideology.

That said, Levicy must be one person who desperately hopes this case never makes it to trial—because if it does, it could be her last trial. The Department of Justice’s SANE Development and Operation Guide states that “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, according to Sgt. Mark Gottlieb’s “straight-from-memory” notes, Levicy blatantly violated this protocol. In her report, she described the accuser’s injuries as non-bleeding scratches on the heel and knee—certainly seeming to carry out the DOJ guidelines by erring on the side of extreme caution in listing “injuries.” But Gottlieb claimed that a week later, Levicy told him that the accuser’s injuries included “blunt force trauma” that was consistent with rape.

If a trial occurs, Levicy is doomed either way. She can back up Gottlieb, thereby ensuring her dismissal as a nurse for violating protocol, and possibly exposing herself to a civil lawsuit from the accuser. Or she can expose Gottlieb as a liar, thereby becoming a persona non grata with the none-too-professional DPD.

No wonder the defense doesn’t view her as an expert. Perhaps Levicy will wind up returning to Maine and her previous career, where at least she can deal with more ethical colleagues.