Forensic Evidence in Elder Mistreatment Cases Module 9 Nursing Responses to Elder Mistreatment An IAFN Education Course The course curriculum was developed by the International Association of Forensic Nurses (IAFN) under grant #2003-DD-BX-K006 from the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice.

Forensic Evidence Part of an assessment of elder mistreatment (EM) may include collecting and preserving evidence of mistreatment on the patient’s body, clothing and/or bedding Forensic evidence encompasses objects that can establish that a crime has been committed or can provide a link between a crime and its victim or a crime and its perpetrator R. Saferestein, Criminalistics: An introduction to forensic science, 1998

Learning Objectives By the end of this module, participants will be able to: Discuss when evidence should be collected from patients in elder mistreatment cases and nursing roles in collection and preservation Describe general strategies for evidence collection and preservation

Case: Mrs. Walker Identify specific types of mistreatment occurring in case study and related needs of the patient Do you think this case requires forensic evidence collection? If yes, why? Who should be notified? What effect do you think evidence collection might have on this case?

When to Collect Evidence Case may have criminal elements In course of an assessment, nurse sees or is told about possible physical signs of mistreatment on patient’s body, clothing and/or bedding Vulnerable older adults present for health care and there are unexplained injuries Consider time limits for obtaining evidence in light of specific case circumstances

Value of Forensic Evidence Growing role for health care providers in last 15-20 years in collecting, preserving and documenting forensic evidence L. Stokowski, Forensic issues for nurses : Part 1. evidence collection for nurses, 2008

Nursing Roles Nursing roles in evidence collection can vary depending on factors such as Practice setting policies Jurisdictional requirements Type of mistreatment and circumstances of case Experience/education of the nurse

Nursing Roles If a forensic examiner is available, what do you think the general role of the attending nurse is?

Practice Setting Policies Health facilities should have clear policies in place that direct nurses and other staff as to their responsibilities related to gathering, preserving and documenting forensic evidence and procedures for carrying out those responsibilities

Supplies and Materials Health care staff should have access to supplies and materials they need to collect and preserve forensic evidence Use of standardized pre-packaged evidence collection kits is common for some types of mistreatment (e.g., sexual assault/abuse)

Evidence Collection Kit

Law Enforcement Involvement If there are signs of EM that suggest the need for forensic evidence collection, nurses should be aware of mandatory reporting requirements and procedures In most jurisdictions, health facilities are required to notify law enforcement of suspected acts of EM that may be criminal in nature (gunshot wounds, domestic violence, etc.)

Questions What do you currently do in terms of evidence collection, preservation and/or documentation when there are physical signs of EM? Policies? What is your role? Who else is involved? Procedures and techniques?

Informed Consent Explain to patient need for forensic evidence collection and what will be done Ask patient for permission to collect evidence Don’t do exam against will of patient Law enforcement does not need to be in exam room when evidence is collected Victim advocates or other support persons can accompany patients, if patients permit

Chain of Custody Documentation of succession of persons responsible for evidence Its purpose is to ensure there is neither alteration nor loss of evidence Begins as soon as nurse locates physical evidence L. Stokowski, Forensic nursing: Evidence collection for nurses: Chain of custody, 2008

Chain of Custody Seal evidence bags/envelopes with tape; do not use staples Label each item of sealed evidence Patient's name Description of item Source of material Name of person who collected item Name of person who sealed evidence Date and time it was collected and sealed Names of those who release and receive evidence Time it is transferred

Sealing and Labeling Evidence Fold the bag over. Secure with tape. Label with a patient ID sticker, contents, source, your name, date and time. Then add transfer information. Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

Sealing and Labeling Evidence All envelopes used for evidence collection need to be sealed and labeled in a similar fashion Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

Sealing and Labeling Evidence Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

Storage of Evidence Put sealed evidence containers into locked evidence storage locker and store until transfer to appropriate agency Access to locked evidence restricted to trained/authorized supervisory staff who understand importance of chain of custody

Handling and Packaging of Evidence Gloves should always be worn to prevent contamination of evidence Practice setting/local procedures and type of evidence collected determines type of packaging used Be familiar with practice setting/local procedures for wet evidence

Clothing Evidence Clothing should be dried, placed on paper sheets to prevent cross contamination, and packaged in paper (not plastic) bags Paper bags are air permeable. If there is any moisture (blood, body fluids and water), it will evaporate through paper, avoiding evidence destruction with mold and bacterial growth Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

Clothing Evidence Trace evidence on clothing and/or on patients may fall off while patient undresses Whenever possible, have patient stand on two sheets/papers while patient is undressing

Clothing Evidence To minimize cross-contamination, separate clothing on the drop sheet Lay large items flat Then individually place each item of clothing into a paper bag Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

Trace Evidence on Body If patient has debris (trace evidence), some of material should be collected and placed into clean and dry container before it is washed away Place debris into clean container (e.g., envelope or sterile plastic cup) Document when debris was collected, from where and by whom Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

DNA Evidence DNA can be retrieved from blood, saliva and semen, as well as hair, hair follicles, bone, skin tissue, mucous membrane cells, and sweat Since DNA from an individual is unique to that person, it can be used to positively identify person from whom the DNA was collected States differ in terms of requirements for DNA evidence collection

Other Uses: Biological Samples Biological samples may used to prove other issues besides contact between patient and suspect (e.g., to document presence of alcohol/drugs or STIs) What procedures are used in your facility/community to collect these samples and maintain chain of custody?

Case Study Questions Precautions evening shift nurse should take to prevent loss or contamination of evidence? Where would forensic nurse look for potential sources of DNA evidence? Other possible types of evidence to preserve? What routine care for Ms. Smith should be avoided until evidence can be collected? In light of your learning in this module, how should the evening shift nurse respond?

Closing Assessment What have you learned from this module that you can apply to your practice setting?