Understanding Levicy

At the Liestoppers forum, SANE nurse Kethra posted a long and highly informative item critiquing the performance of SANE nurse-in-training Tara Levicy. Below are quotes from the relevant sections of Kethra's post.

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Tara Levicy was acting as a SANE under the specific direction of Dr. Julie Manly, a fourth-year resident. Both Dr. Manly and Tara Levicy performed a “general physical” examination and documented the results with Dr. Manly doing the vaginal exam and collection portion of the forensic collection. Both found no trauma. The statement Ms. Levicy gave to Sgt. Gottlieb on March 21, 2006 runs contrary to all physical findings:

“I asked her if the exam was consistent with blunt force trauma, and she replied, ‘Yes,’" Sergeant Gottlieb wrote in the notes of his March 21 interview with the nurse. “She stated the victim had edema and tenderness to palpitation both anally and especially vaginally. She stated it was so painful for the victim to have the speculum inserted vaginally that it took an extended period of time to insert same to conduct an examination. I asked her if the blunt force trauma was consistent with the sexual assault that was alleged by the victim. She stated the trauma was consistent with the victim’s allegation.” (Gottlieb’s notes).

The first inherent problem with this statement is that it is given in the first person. That means it looks like Ms. Levicy is speaking as if she did the exam rather than simply watch which we now know is exactly what occurred. However, Ms. Levicy did not disabuse the police of that notion. The second was Ms. Levicy’s inaccurate portrayal of the “extended” vaginal exam. We shall revisit that shortly. The third was the outright lie of blunt force trauma as the record will indicate.

The ONLY part of the SANE that Ms. Levicy was directly responsible for was the clothing collection (done wrong) and the oral swabs as well as the head to toe visual examination. (SANE document) Everything else was performed by Dr. Manly. Yet Ms. Levicy puts herself forth as the person who did the exams. Instead of saying something like “in observing Dr. Manly’s exam, I noted,” she instead makes statements that leave her appearing to be the examiner. This, as any RN will tell you, is very unprofessional and is in fact professional misrepresentation.

Dr. Manly met with the defense in October of 2006. She stated to the defense that NO ONE from the District Attorney’s office OR the DPD had spoken to her as of yet. This is no surprise given Ms. Levicy’s representation to the police of her being the examiner (and Nifong’s incompetence). It is in this interview we find out from Dr. Manly that she had seen a white exudate vaginally and just “assumes” its semen (she forgets to document this small fact however). It is also in that series of interviews she comes up with the alternative explanation from “semen” to a “yeast infection.” The facts are this, a yeast infection is incredibly common, VERY easy to diagnose (even a nurse can figure it out ) and for a Physician who supposedly has done “hundreds” of pelvic exams to mistake a vaginal discharge from yeast as semen is just stunning. The two substances look nothing alike, they smell nothing alike and if Dr. Manly was unsure, then she should have done the fast test for yeast which was not done nor did she employ a wood’s lamp which would have fluoresced semen but not yeast. At the very LEAST a woods lamp should have been employed (semen, fibers, urine and other substances fluoresces under a woods lamp) Needless to say, the slides Dr. Manly produced would have shown nothing but yeast had this gone to trial . . .

Dr. Manly also remembered that the “patient was screaming and resisting the vaginal exam in such an extreme fashion that the vaginal portion took an hour to complete.” This behavior by Crystal Mangum was in direct contradiction to the level of non-injury found. She put on a good show for the examiners needless to say.

Dr. Manly goes on to state, “Mangum was different in several ways. Most rape victims are withdrawn and quiet but cooperative. Mangum, on the other hand, called attention to herself by screaming; Manly had never seen that behavior before, she told defense lawyer Doug Kingsbery in October. Amazingly, Dr. Manly makes no note of the out of character behavior or her observations of that behavior in the formal record as far as I can tell at this time. I would wholly agree with Dr. Manly’s assessment of the normal demeanor of rape victims with one caveat, I have seen screaming behavior but that is from a truly badly injured victim (vaginal/anal tearing) and ONLY before pain meds are offered. None of the findings from the exam support this behavior.

The important part of the above is that Dr. Manly alone is responsible for the vaginal exam and Dr. Manly made ONE notation on the SANE paperwork that being “diffuse edema of the vaginal walls.” Dr. Manly did not make a note as to patient demeanor nor to the extended amount of time the vaginal exam too OR to the finding of a “white exudate.” Dr. Manly did sign the SANE as having participated but Tara Levicy signed the SANE as the examiner. In interviews with the DPD she took credit for Dr. Manly’s examination and in interviews with the DPD did nothing to disabuse them of the notion she was wholly responsible for the exam. These statements were rightfully attributed to Ms. Levicy by the DPD based on what she was quoted as saying, when in fact it was the Physician’s note and examination that she was claiming as her own work.

Ms. Levicy committed on the worst acts an RN and a SANE can commit—that of injecting her opinions and beliefs onto the patient and into the case. Ms. Levicy stepped out of her required role as an impassionate forensic examiner and into the role of a feminist with an agenda. She made stated conclusions not based on an evidence based practice, but instead based on her own personal agenda and skewed world view. No where in the SANE exam or the medical examinations that occurred was there any evidence to support Ms. Levicy’s statements of “Signs consistent with sexual assault during her test.”

There was no evidence to support her statements to Gottlieb on March 21, “I asked her if the exam was consistent with blunt force trauma, and she replied, ‘Yes.’” “She stated the victim had edema and tenderness to palpitation both anally and especially vaginally. She stated it was so painful for the victim to have the speculum inserted vaginally that it took an extended period of time to insert same to conduct an examination. I asked her if the blunt force trauma was consistent with the sexual assault that was alleged by the victim. She stated the trauma was consistent with the victim’s allegation.”

Nor did the evidence support her statements made on January 10, 2007: “Ms. Levicy stated she asked if condoms were used and Ms. Mangum said ‘no’ but wasn’t really sure. Ms. Levicy stated that it was her opinion as a [sexual assault nurse examiner] that ‘victims can never be sure if condoms are used because if they can’t see them how would they know for sure. You can’t feel them so you have to realize there is always a possibility that a condom could have been used.’” Even her own documentation denied this claim.

Instead ALL physical examination documented, directly contradicts these ongoing claims made by Ms. Levicy. Incredibly enough, Ms. Levicy herself notes in the systems examination portion of the SANE “Head, back neck, chest, breasts, nose, throat, abdomen and upper and lower extremities were all “normal” and in the Pelvic Examination portion of the SANE Ms. Levicy writes “Diffuse edema of the vaginal walls” (echoing the actual Physicians findings since she did NOT do the vaginal exam) and recorded “nothing notable” in the subsection for the anal exam.

In DIRECT contradiction to not only her own notes, but those of Dr. Manly and other Physicians and nurses that examined Crystal Mangum, she begins telling her “she was raped” conclusion to DPD. She not only was inaccurate as a forensic examiner but she was untruthful. There is no documentation that supports her claims of “the victim had edema and tenderness to palpitation both anally and especially vaginally” (Gottlieb notes) other than Crystal Magnums’ hour long display of hysterics for the Physician which interestingly is NOT noted in Levicy’s documentation. It is somewhat beyond me that a patient could present like this and the SANE documentation indicate “nothing notable” . . .

Ms. Levicy continues this interjection of personal beliefs into the case as late as January 10 of this year when she is interviewed by Mr. Wilson. In this interview she changes her story, negating her very own documentation “Ms. Levicy stated she asked if condoms were used and Ms. Mangum said ‘no’ but wasn’t really sure (the SANE does not reflect a “wasn’t sure” statement by Ms. Mangum. Ms. Mangum states NO). Ms. Levicy stated that it was her opinion as a [sexual assault nurse examiner] that ‘victims can never be sure if condoms are used because if they can’t see them how would they know for sure. You can’t feel them so you have to realize there is always a possibility that a condom could have been used” She also tows the feminist line of “I wasn’t surprised when I heard no DNA was found because rape is not about passion or ejaculation but about power.” While this statement is true about finding semen and it is true about what rape is, it is not true about DNA. This shows Ms. Levicy’s glaring ignorance of forensics and the most basic of science facts. To add to her own presentation of just how ignorant of basics she is, she calls Mr. Wilson back a few days later and states “A few days later, Levicy called Wilson with second thoughts. She wanted to clarify her statement about rape and power. “Ms. Levicy stated that there are numerous reason [sic] why semen is not found in a victim and include: 1) condoms were used; 2) No ejaculation; 3) It didn’t happen.”

Someone with a modicum of intelligence must have spoken to Ms. Levicy and basically told her the basic facts that she apparently slept through in Nursing 101.

Ms. Levicy, in her zeal to be a big bad forensic nurse, misrepresented to lay persons the true facts in this case. The police depend on us as forensic nurses to give them accurate information with impassionate observation. If you, in a haze of egotistical stupidity, misrepresent the facts and observations to the police, the police believe you. They have to believe us, we are their experts, and we are their teachers and most of all we are their translators. We as SANE nurses translate the medical gobbledygook into plain understandable English. These men and women are NOT medical professionals and depend on us WHOLLY to give the facts and just the facts, ma’am, to them. If we lie, misrepresent, embroider, expand or expound we mislead them and they go down the primrose lane blindfolded.

In Closing:

Ms. Levicy’s actions were unconscionable, unprofessional and the inherent sign of an incredibly biased person and nurse. She alone, is responsible for the start of this witch hunt in my opinion. By not telling the actual facts, by misrepresenting to the police the signs and symptoms of a rape victim, by “embroidering “the true patient findings and historical story, by her sheer ignorance of appropriate forensic evidence collection technique, her sheer ignorance of basic pathophysiology, her sheer ignorance of general medical conditions and the identification of those conditions and by her glaring egotistical need to portray herself as an expert, she sent the police down the trail of deception. Combine that with a rogue prosecutor and shoddy police work (didn’t they read the stupid medical reports for themselves?) she almost put 3 innocent men in jail.

I have no doubt now that she made those statements to the police and as irritated as I am with Sgt. Gottlieb, I have no doubt she made those statements as well given her continued performance as late as January 10, 2007. This nurse needs to turn in her license and stop “helping” sexual assault victims. Until she can learn compassionate investigation, dispassionate factual statements and the difference between right and wrong, she should have no part in nursing. I am guessing she missed the required ethics portion of Nursing School.