Forensic Nursing in the Legal Nurse Consultant Practice

The traditional forensic nurse is on the front lines when treating victims of violence.  Their role is to provide comprehensive care to the victim while conducting a medical forensic examination.  This includes evaluation for evidence collection; providing effective courtroom testimony; and showing compassion and sensitivity towards survivors of violence. The medical wellbeing of a patient is the primary objective of the forensic nurse during the examination.

The forensic nurse that works in private practice as a legal nurse consultant has a far different role.  We never see the alleged victim unless it is in the courtroom.  We never speak to the alleged victim or alleged perpetrator.  We never speak to law enforcement.  We never speak to anyone but our attorney client.  So what is our role?

We evaluate evidence collected by SANE and forensic nurse examiners, police, testing laboratories and other entities.  We read police reports, victim statements, perpetrator interviews, state agency investigation and reporting, review crime scene and victim/perpetrator video and pictorial evidence and more.  In essence, evaluate everything surrounding the case and render an opinion. Think of it as a precise and evidence based intensive peer review of not only the medical records, but of all the collected evidence.

The forensic specialty legal nurse consultant is brought in on cases that cover a wide range of criminal and civil activity.  This can include sexual assault, domestic battery/abuse, child abuse, divorce, wrongful death both civil and criminal, car accident evaluation, mechanism of injury, and much more.

Because the forensic specialty legal nurse covers a much wider breadth of subject matter, additional education in criminal specialties is a requirement.  For example, a forensic nurse could be asked to determine the causation and aging of bruising.  Thus having an intimate knowledge of the pathophysiological process of bruising and mechanism of injury tool mark analysis education will be critical. 

Some of the exemplar cases in which it is critical to have the involvement of a forensic specialty legal nurse are described below.

Domestic Violence

The domestic violence case runs the gamut from verbal/mental abuse to murder.  Frequently injuries are displayed by both parties.  During analysis, the forensic nurse looks at previous medical records if applicable, the statements of the parties, the injuries displayed, crime scene photography and most importantly, picture evidence of the injuries taken a few days apart.  

This allows the forensic nurse to determine if the injuries could occur as is being claimed, are the injuries self-inflicted or that injuries show up several days later that did not exist in the original medical records and pictorial evidence. 

Child Abuse

Child abuse is an extremely delicate area of both medicine and law. It is fraught with emotion and societal imperatives. In today’s environment, the most innocent of injuries only require a medical professional to claim child abuse which then can plunge a family into a nightmare of legal and social services. Due to either concerns of professional and/or legal liability or ignorance about common child injuries, medical professionals tend to err on the side of caution and report an injury as abuse. 

Additionally, the claims of child abuse by parents involved in a divorce or separation is, unfortunately, common.  Each of these claims must be examined with extreme gravity in order to protect the child first and foremost.

It is paramount to first establish if this is abuse and if it is not, why not.  If it is abuse, the forensic nurse provides education to the client attorney as to the how and why of the injury or injuries. In most substantiated abuse cases there is a history of abuse which can be seen by medical professionals in the form of injuries in various stages of healing.  From older healed injuries to newer injuries. 

These cases require the participation of a forensic specialty legal nurse who also has a pediatric specialty and/or an incredibly experienced pediatric nurse practitioner to do the review and analysis.  Children are not small adults and the pathophysiology of causation, wounds, healing and bone healing is unique to children and requires a through and grounded knowledge in pediatric and forensic sciences. 

Adult and Pediatric Sexual Assault

All genders and ages can be victims of sexual assault. Adult sexual assault claims require the use of a forensic specialty nurse to review the medical examinations and evidence collection performed by the in hospital SANE nurse.  Additionally, the forensic specialty nurse also reviews the statements given by all parties, the police reporting and any evidence collection and results. 

The forensic nurse specialty legal nurse is critical in these cases as they intimately know what the SANE nurse should or should not be documenting.  As in all medical record review, knowing and understanding what the appropriate and expected interventions and documentation should be is paramount to an appropriate analysis. Scrutiny and comparison of all alleged victim, alleged perpetrator and any witness statements is critical.  The forensic nurse also looks at injuries, if any, and determines if the injury could have occurred as claimed.  Bruising and marks left on the body can indicate the object or tool used to inflict the injury.

As an example, the alleged victim claims the alleged perpetrator punched them in the head 6 or 7 times so hard they “blacked out.” Does the alleged perpetrator have any injury to their hands as there is an expectation that punching the skull will cause injury to the hand.  Does the alleged victim have any injury to their head as there is an expectation that there will be visible injury after such an attack.  Each injury and claim of how that injury happened needs to be scrutinized by the forensic nurse.

Our founder, Wendy Votroubek, presents her expertise as a forensic nurse at the virtual conference, The Path of the Bullet: A Guide to Criminal Cases. Get details at http://LNC.tips/GSW

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