Welcome to this webinar entitled, A Tale of Two Cases, Lessons Learned as I Moved from Survivor to SANE. Hi, my name is Karen Carroll, and I am currently a forensic nursing specialist at the International Association of Forensic Nurses. I have been a sexual assault nurse examiner for almost 25 years. I have coordinated several programs. I was a forensic nurse at a children's advocator. I also served as a director of the forensic acute care team at two hospitals in the state of New York. I became board certified as a SANE-A in 2003 and board certified as a SANE-P in 2014. And as I said previously, I joined the staff of the International Association of Forensic Nurses in 2020 as a forensic nursing specialist. The planners, presenters, and content reviewers of this course disclose no conflicts of interest. Upon signing in on the attendance sheet, attending the course in its entirety, and completing the course evaluation, you will receive a certificate that documents the continuing nursing education contact hours for this activity. The International Association of Forensic Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. At the conclusion of this activity, participants will report an increased knowledge of strategies and practices that provide a patient-centered medical forensic exam and an increased understanding of how the care received by sexual assault patients can affect their lives and their futures. I have an additional disclosure. This presentation discusses two sexual assault cases in detail, including types of contact and injuries to the genital area. Both patients have given their permission for the details of their cases to be included in this presentation. I entitled this webinar, A Tale of Two Cases, because I will be discussing my own rape and my own experience in the emergency department. And I will also be discussing a patient that I was honored to provide a medical forensic exam seven years after my own experience. Our first patient, which was me, Karen, was 39 years old and an African-American female. She was raped by her husband on July 9, 1994. Our second patient, Gina, was a 43-year-old Caucasian female at the time of her sexual assault. And she was sexually assaulted by her neighbor on November 23, 2001. So first we'll start with my case. Karen was a 39-year-old African-American female who was raped by her 39-year-old husband, Ron, on July 9, 1994, approximately two weeks after he had been ordered by a judge to leave their home. At the time of my rape, I was nurse manager of a local emergency department at a hospital in the city where I lived. My husband, Ron, and I had been living together, happily, so I thought, as husband and wife. On Father's Day in 1994, my husband had gone out to get a newspaper, and while he was gone, the phone rang, and I had a conversation with a female who called looking to speak to my husband, and I subsequently discovered that he had been having an ongoing relationship with this female, that they had a four-year-old child, and I had been married to Ron for four years at this time. She gave me quite a few details where I was able to ascertain that she was telling me the truth. When my husband returned home, I confronted him with the information that I had just obtained, and it subsequently led to an argument, and the argument lasted several hours, but I chose to abruptly cease the argument because I began to feel very uneasy. During the four years of my marriage to Ron, he had never been physically and or emotionally abusive to me. As a child, I grew up in a household where my father did physically abuse my mother, and I had always been very upfront with any gentleman that I dated that I would not tolerate being hit or physically abused. That one time, and only one time, would it take for me to leave the relationship and also to notify the police. Ron was very well aware of this. I do remember, as a child, always getting a sense of when my father was about to physically assault my mom. I just got this sense where I could tell when the first punch or the first slap was going to come. During my argument with my husband, I began to feel as the argument continued, I got that exact same feeling, and so I decided to sort of stop the argument because I didn't want our relationship to become physical. A few hours after the argument had ceased, my husband and I were upstairs in the bedroom. We were sitting on the bed watching television. The telephone rang again, and it was the same female calling, and she was very concerned. She seemed upset, and she asked me, was I okay? She asked me that actually several times. She asked me, did I tell my husband what she had said? And I said to her, yes. She asked me again, was I okay? And I said, yes. And she said, is your husband there now? And I said, yes. And after a few more questions, she hung up. I remembered answering the questions with only a yes or a no because I just didn't want my husband to find out it was her on the phone, and I didn't want the arguments to resume. After I hung up the phone, when I turned and faced my husband, he had this very evil look on his face. I mean, it didn't even look like my husband. His total expression had changed, and it was at that point that he threatened me. He accused me and this woman of plotting against him, and he threatened to physically assault me, at which point I reminded him that if he put his hands on me, I'd be calling the police. He kind of chuckled after I said that, and he turned from me and reached into a nightstand that was by the bed, and when he turned back to me, he had a knife in his hand, and he put the point of the knife right up to my throat and began screaming at me and asking me who was I going to call, and he just kept screaming at me. And at that point, I just didn't take my eyes off the knife. I didn't answer him, and I just said, if I just don't say anything, he will calm down and everything will be okay. He eventually did calm down, and when he turned away from me to return, I guess, the knife to the drawer, I slid my feet off the bed, ran down the stairs of my apartment out the front door, and I ran two blocks to the police station. I was barefoot at the time, wearing only a t-shirt and underwear. When I arrived at the police station, I must have been quite a sight, but they gave me a blanket, put me back in the patrol car, and back to my house we went. When we got to the house, my front door was open, I guess I hadn't closed it behind me when I ran out, but my husband was not home, and we could not find the knife. I stayed at the home of a girlfriend that evening and went directly to family court the next day to get an order of protection. Now at the time of my experience with my husband and this knife, I was the head nurse, at least that's what we used to call them 20 years ago, of an emergency department at a hospital that was approximately five minutes from where I lived. And I knew, having counseled patients and talked to patients who had been in intimate partner violence situations, that violence tends to escalate. And of course, due to my own past history as being the child in an abusive household, I was determined that my own violence was not going to escalate. So I did go to family court. I did speak to a judge. The judge decided that she wanted my husband removed from the home. And so she made arrangements for the police to meet me at home and that they were to come in and to remove my husband to keep me safe. So when I got home, I let the police into my house. I didn't see my husband. He was upstairs in the bedroom. The police went upstairs. I could hear some talking. I could hear some moving around. And then my husband came down the stairs with a sports bag, like a gym bag. And the two police, he didn't say anything to me, just stared at me. And they left out of the front door. That was the end of June in 1994. And I felt like I was safe. He was gone, and I thought that I was going to be okay. Approximately two weeks later, on the morning of July 9th, it was a Saturday, I got out of bed and walked over to the door, opened the bedroom door, and Ron was standing on the other side of the door. He was naked, except for a pair of green plaid boxer shorts. In his right hand was that same knife, and in his left hand were two black ropes. He punched me into my chest, at which point I was knocked back onto the bed. He got on top of me on the bed, put one knee on each of my upper arms so that I was pinned to the bed, and then he tied my wrists to the headboard with those black ropes. When I tried to scream, he took a scarf that I was wearing on my head, and he placed it in my mouth. Then he got up, walked over to my bureau, the dresser drawers, and went through them and found a pair of pantyhose, cut those in half, and tied my ankles to the footboard. So I was tied spread eagle on my bed with a gag in my mouth. He walked around to the foot of the bed, climbed up on the bed, took the knife, cut off my underwear, and that's when the rape occurred. Now I can honestly say that my memory of the assault was as if I was a spectator watching it. It was as if I had floated up to the ceiling, and I could see myself on the bed. I could see my husband on top of me. I could see the rape going on, but I actually have no memory of feeling anything from the waist down. I do remember that during the rape, he would sort of poke me with the knife, and he was saying different things to me, like, this was all my fault, I should have never gone to court, what happens between a husband and a wife is private, those types of things. And it was at that point that I thought to myself, again, just don't move, and this will be over soon, because I was really afraid that I was going to die. After the rape was concluded, he got off the bed, he walked over to the hamper, took a shirt out of the hamper, wiped himself off, and dropped the shirt back in the hamper. And immediately, that's when the nurse in me clicked in, and I thought to myself, there's evidence of him on that T-shirt. It's in the hamper. You have to stay awake, you must watch everything, because if you survive, the police are going to need details, because at this point, they're never going to believe you if you can't tell them everything that happens. So I made myself watch his movements, I made myself watch what clothes he put on when he got dressed, and I also made myself look at the cable box so that I knew exactly what time all this was occurring. He eventually decided he wanted money, and he began to search the room for my pocketbook. He came over to the bed, he took the gag out of my mouth, and it was at that point that I lied and told him that my pocketbook wasn't home, that I needed to call my girlfriend, because I had left my pocketbook with her, and that she was coming to the house to return it to me, and that we were going shopping. And he agreed to let me use the telephone. He cut the pantyhose that were tied to my ankles at the ankle, so they were still actually tied to the footboard, and I thought, okay, that's good, that's proof. He then cut the ropes that had my wrists tied to the headboard, but the ropes were cut at my wrists, so they were still attached to the headboard. And again, I'm thinking, that's good, because that's evidence. He allowed me to sit up, and he handed me the telephone, at which point I thought, okay, this will be my chance to call for help. But unfortunately, he stood right in front of me, put the knife to my throat again, and forced me to call my girlfriend. And of course, I did call her. She had no idea what I was talking about, because we did not have plans to go shopping. But she said something that surprised me, and to this day, she even admits she doesn't know why she asked me, but she asked me, was I okay? And I said, no. She then asked me, was Ron there? And I said, yes. And then she just said, let me talk to him. So I handed him the phone. He sat down on the bed. I got up off the bed. His back was to me, at which point I was slowly backing toward the door, thinking this would be my chance to escape. And then it dawned on me that when I had gotten the order of protection, and after the police removed Ron from my home, I purchased a deadbolt lock that locks from the inside of my apartment with a key. And the key was in my purse, and my purse was in the closet. So there was no way that I was going to get to the closet in my bedroom, open the door, reach in, get my purse, reach in my purse, get the key, get out of the room, get out of the front door while he was still in that room with me with the knife. So I just stood and watched him. I could overhear him sort of mumbling, talking to my girlfriend. He was very stiff and very angry, but then his shoulders began to droop, and he started to cry. His whole demeanor changed. Within a few minutes, he hung up the phone. He turned to me, and he told me that my girlfriend said she'd be over later. And then he asked me, was I okay? I think that just angered me so much that I said to him, you'll have to kill me before I ever let you touch me again. It was at that point that he began to laugh, and he told me that I was going to go back to court. I was going to tell the judge that I had lied and made everything up. He was going to move back in my home, and if I had told anybody about what had just happened, he would kill me. And he said to me, I am not going to jail, but if I do, I will get someone else to kill you. At which point, I believed every word he said. He left the room and walked downstairs into my kitchen, and I heard the refrigerator door open. It was at that point that I dialed 911 and had a conversation with the woman on the phone. I remember hearing a door slam, and I panicked while I was on the phone, and I just hung up the phone because I remembered that I had an extension in the kitchen, and a little red light would go on when you picked up the receiver upstairs in the bedroom. At which point, I figured that Ron knew I was on the phone, and he had escaped the house. The police did come because of my 911 phone call. I was able to show them the t-shirt that was in the hamper. I was able to show them the pantyhose still tied to the bed. I was able to show them the rope still tied to the headboard. I had to give him a photograph of what my husband looked like, and then came the decision to take me to the hospital for what we called back in 1994, to get a rape kit. That was the second nightmare of my experience. Now, at the time, if you recall, I was the head nurse of a hospital emergency department five minutes from my house. I decided not to go to that hospital because I did not want my staff to have to do the rape kit on the boss. So I chose to go to a different hospital, one that I had worked at previously, and also where I had attended nursing school. After triage, I was placed in a cubicle in the emergency department that had just a curtain for privacy. The ED physician entered the cubicle after a short period of time. He did not look at me. He did not address me by name or by anything else. He walked past me to the cabinet, opened the cabinet, took the evidence collection box off the shelf, opened it, and began to read the directions. And it was at that time that I thought, oh boy, I'm in trouble because he's never done this before. Now, remember, this was 1994. I had assisted the ED physicians in the hospital that I worked at to do sexual assault examinations and collect rape kits on patients. I'd never done one myself, but I assisted with enough that I knew the process. And I convinced the doctor to let me show him how to do my own evidence collection. So I was allowed to pluck my own head hairs and my own pubic hairs because that's what we did in 1994. And I was able to show him the different steps of the swabbing. As a part of my exam, photographs were never taken. I don't know if there was any documentation of my injuries. Now, I had no genital injuries that I was aware of, but I did have ligature marks on both my wrists and my ankles. I had an oval-shaped bruise to my sternal area from where I had been punched. I had a very superficial cut on my neck and one on one of my nostrils from when Ron had been poking me with the knife. I guess the knife slipped a couple of times, but I don't recall him documenting any of those injuries. Now, I'd never seen my medical records, so it's quite possible that he did document those injuries. And then when it came time for medications, my memory is them bringing me in an injection. I'm assuming it was Rocephin because it burned a lot when I was given it. However, I was not told what it was or even what it was for. And then the doctor left the room. Now, I did not have an advocate with me at that time. I didn't even know what an advocate was. However, when a detective arrived at the hospital to talk to me, it was the detective that gave me a business card from our local rape crisis program. And he was the one who talked to me about a trained social worker and a program of people that would help me. It was amazing. That information came from police, not from the healthcare. So I did get Rocephin, I guess, which was prophylaxis for STIs. And that was it. I was not offered HIV post-exposure prophylaxis because we didn't have HIV and PEP in New York until 1999. And I was not offered emergency contraception. I don't even know if they were doing emergency contraception following sexual assaults in 1994. However, I had a tubal ligation years earlier. So pregnancy was actually not a concern for me. So now let's talk about my experience in court. Now, I remind you, this is my experience as a victim or a complaining witness, not as a forensic nurse because at that time I was a sexual assault victim. About six weeks after my rape, Ron was arrested in Brooklyn. I assisted the detectives in getting him arrested. So they caught him and it came time to go to grand jury. Now in the state of New York, we have grand jury system. And when a suspect is arrested, I believe they have 10 days but there's a very short window of time. And those 10 days would include either a holiday and or a weekend to have a grand jury trial to determine whether or not this person would be indicted. Now in this grand jury trial, it does not have to be a unanimous decision but the majority of the jurors in the room must believe that it is highly likely that a person has committed a crime and if so, they will offer what's called an indictment. If they don't believe a crime has been committed then the trial ends in what's called a no true bill and the suspect is free to leave the court system. So I did testify in the grand jury. My girlfriend had to testify in the grand jury because she could put him at the scene. Because if you recall, she had spoken to him on the phone and then my husband decided he was going to testify at the grand jury. And that's quite unusual because defendants do not have to but he did testify. And I was not present in the room when he testified but I was told by the ADA handling my case that he told the grand jurors that I had invited him over and that we had had rough sex which is how he tried to explain the injuries and that I had found out the next day that he had a child with another woman. And that's when I decided to call what had happened between us rape. But fortunately for me, the grand jury did not believe him. He was indicted and the charges were first degree rape, first degree burglary because he had to break into my home after being ordered not to come into my home by the court. It was first degree unlawful imprisonment because I had been tied to the bed frame. And then it was two counts of second degree assault because of my injuries and fourth degree criminal possession of a weapon because of the knife. And he was sent off to the Westchester County Jail and bail was placed at $25,000. Which his father paid within a week. And so he was released from jail. The following April, and that would be April of 1995, the trial began. And between September and April, I had met several times with the district attorney prepping for my trial. I had gone three times to the rape crisis program with a social worker because I was petrified to go to court but I was also convinced that he was gonna be held responsible for what he did. So the first day of the trial, I arrive at the courthouse and they made me have a seat outside. Now in New York State, when you are a witness in a trial, you cannot be in the courtroom except for when you are actually testifying. So you do not get to hear other's testimony. You only are there for your own testimony. And I was to be the first witness. So I sat for about four hours waiting to be called into court. The court officer came out and told me to go to lunch, which I did, came back from lunch and waited approximately another three hours outside. And then finally the ADA came out and told me that there would be no trial because they could not find Ron. He had not showed up for court. So I was sent home to return the following Monday and we would try again to have a trial. And exactly the same thing happened. Sat for hours, sent to lunch, come back, sat for hours. The ADA then subsequently comes out and he told me that I could go home, that everything was over, that there would be no trial because Ron decided to take a plea and he changed his initial plea from not guilty to guilty. Apparently on the first day of court when they could not find him, he had been arrested and was incarcerated in Brooklyn, New York. And he had been arrested for selling heroin of all things. And so he was looking at the maximum charge for first degree rape was eight and a third to 25 years. And apparently his possession of these drugs also carried a long term sentence. So he did decide to plead guilty. The stipulation was that he had to plead guilty to the rape case in order to get this plea. I knew nothing of them offering the plea bargain. I knew nothing of the plea deal until that day when the ADA came out of court and told me that I could go home, that there would be no trial. And let's see if I can get you to the page. Okay, so this is the article that hit the newspaper and it gives quite a few details about my case. I mean, the first paragraph just says a former Yonkers man interrupted his trial yesterday to admit that he raped his wife at ninth point last year after she threw him out for fathering a child with another woman. Oh my goodness, not exactly what happened, but anyway, that's what made the newspapers. And then it went on to talk more about details. And of course I was mortified. Now my name was never mentioned, but it wouldn't be too hard for people who knew me to figure out that they were talking about me. So it was just quite difficult. I didn't have the confidentiality that a lot of victims have. I had to go back to work and I did return to work six weeks after my own rape. However, I had to tell the people at my job because my husband was out, had not been arrested at that time. And it is quite common for husbands to visit wives at work. And so I had to let my staff know, hospital security had to know. I parked in the receiving area of the hospital, not in the employee parking lot because the hospital receiving area was the only area that was always on camera so that they could watch me come and go from my job so that I would be safe trying to go to work. And so I unfortunately did not have the privacy that rape victims often have after enduring such an experience. So he did admit in April of 1995 to the rape. And in May of 1995, he was sentenced. He was sentenced to three to nine years. I guess they decided on that sentence because of the plea. Now, remember he was looking at eight and a third to 25 years. That was the maximum sentence for rape in the first degree, but the plea deal was three to nine years. At the time, I thought that that was great. I mean, looking back on it now, that's a terrible sentence, but I felt like I had up to nine years to make myself safe. I was gonna move out of New York. I was gonna change my name. I was gonna go to where he could never find me because he had threatened to have me killed if he went to jail. And I lived for about a year trying to figure out how I was gonna do this. And I guess with empowerment and with speaking and things that I'll talk about in a little bit later in this presentation, I began to realize that I don't need to run, that I don't need to fear. And so I didn't leave. I stayed in my apartment. I just decided I was not gonna give him that power over my life. So now let's talk about Gina's case. Gina, remember this was the 49-year-old school teacher. At 2 a.m. on Thanksgiving morning, she could not sleep. So she decided to do a load of laundry. She lived in a co-op, a condominium type of an apartment building, and the laundry room of her apartment building was down in the basement. She went into the laundry room, down into the basement, but she noticed that a neighbor was also in the laundry room. The neighbor turned off the lights after she entered the laundry room. Now she had gone up to a machine and her back was to the door. He turned off the lights, forced Gina up against the wall. She said he struck her several times and he repeatedly forced digital vaginal penetration. And she said it was quite vicious. He was strong and she was in pain during the assault. She said the only reason she believed he stopped is she started to say the rosary out loud. And she began saying the rosary. He stops with the attempt to force digital vaginal penetration, tells her he was going to leave and for her to stay in the laundry room for like 10 minutes, he didn't want her to leave. He leaves the laundry room. She immediately attempts to flee the laundry room, runs into the hall, runs smack into the defendant again, the suspect again. He forces her back into the laundry room and begins to assault her. And then when the second assault was over, he leaves the laundry room again. And this time she waited about 10 to 15 minutes. She says at that point, when she left the laundry room, she went to a neighbor's apartment, called 911 and the police came. When the police arrived, they took her back down to the laundry room so that she could show them where the assault had occurred. While they were walking down the hall to the laundry room, this same man walked past them. She said she tried very hard not to react, but once he walked past, she said she whispered to the police officers, that's him. And that's how they got arrested. Gina decides to go to a local community hospital, which was about two blocks from where she lived. I got the phone call at about three o'clock that morning because I was on call and I responded to the hospital to see Gina and to offer her a forensic exam. When I first met Gina, just my overall appearance, my overall impression of her is her hair was disheveled. It was obvious she had been crying. She had multiple bruises on her face and on her arms. And those were the injuries I could see immediately. There was another woman in the room with her who was a cousin who was an ADA in another county. She had declined, even though she had been offered the services of an advocate, she had declined them. I began to explain the medical forensic exam. I think one of the first things I remember telling her was that I thanked her for coming in, that she was so brave to do this. And I just simply said, I am so sorry that this happened to you because I just looked at her and it just broke my heart because she had so many injuries. I just thanked her again. I started doing photographs. I took multiple pictures. And then we began the forensic exam, which took approximately three and a half, four hours. At the conclusion of all of the evidence collection, I noticed that her bruises had blossomed and the change was so significant in the size of the swelling and the deepening of the color of the bruises that I took a second set of photographs to show the progression of the bruising in just three hours. It was just that significant. In addition to the multiple non-genital injuries that I found on her body, she had nine separate genital injuries to the vulva, to the posterior foreshad, to the fascia navicularis. There were abrasions, there was swelling, there was bruising, multiple, more than I had seen in my probably then 10 years of doing forensic exams or seven years by the time I got to examine Gina. She also presented me with a brown paper bag and she said to me that those were the clothes she was wearing that were in the bag. When I peered inside the bag, I did see a large pink object that she said to me was her bathrobe. I didn't see anything else, but I did see this large pink envelope. I made the decision at that time not to touch the clothing, not to inspect the clothing, but simply to secure it and to label it. And since she was cooperating with police to turn it over to law enforcement right away. So I can tell you there was something pink in the bag, but that's all I can tell you about the bag. And later on, it turned out that that was probably one of the best things I could have done. We talked about medications. We talked about emergency contraception. We talked about HIV post-exposure prophylaxis. We talked about all of that. And I referred her to our local rape crisis program, made sure she knew kind of what to expect as an ongoing part of the investigation. So I spent, I think a total of five hours with Gina in the hospital. Approximately a year or two, less than two years later, it came time for Gina's case to go to court. I met several times with the ADA on her case, prepping for at least two hours if I were to add up the times that I met with the ADA. Like one time it was 20 minutes, another 40 minutes, maybe then another half hour to prep for grand jury and then to prep for criminal trial. My part of the criminal trial was quite interesting. It took approximately 45 minutes for me to talk about my experience, my credentials, my training to become a forensic nurse, all of that took about 45 minutes. Now I examined Gina in 2001, so there was not certification at that time for saying age, but I did attend several trainings and had been to several IFN conferences. So I talked about all that. I was also the coordinator of the program who just happened to be on call on Thanksgiving. So I was able to talk about reviewing records and quality assurance, all the things that coordinators do. I was able to explain in detail to the jury exactly what happened during the exam process. My goal was to put the jury in that exam room. I was offered as evidence on the stand to review the kit. So I explained each step of the evidence collection process. I talked about medications. I talked about photographs. They presented the photographs as evidence. I was able to explain the injuries that she had. So it was a total of direct exam was probably an hour. Cross-examination was probably another hour. And then there was another hour after that of back and forth, redirect, recross, back and forth, back and forth. The defense attorney's strategy was to try to confuse the jury. And he would question me multiple times about how many times I changed my gloves. He was trying to get lost in the minutia. There was quite a few back and forth questions about my contact with this pink bathrobe. Apparently there was DNA from the defendant on the bathrobe as well as blood from Gina on the bathrobe. And I guess he was trying to make it look like I might've contaminated the robe. But if you recall, I never had contact with that robe. I never removed it from the bag. So if there was blood on the bathrobe, I never saw it. But, and I was so thankful that I had done that. But I mean, we went back and forth on that robe for like a half an hour. It was kind of ridiculous. These are the two assistant district attorneys on the case. And as you can see in the background, that is the trauma gram. And what little you can see of it, you can note that there are multiple, multiple non-genital findings. Now this was a trauma gram that came with our kit. It's not an optimal trauma gram in my experience because the genital section of the trauma gram was very tiny. And so I had to kind of draw vulva freehand to indicate where the nine different findings were. But that's what the trauma gram looked like on her case. Here is a newspaper article that came out after the defendant was convicted. And it talks about DNA and how his blood and her blood were found on the bathrobe, et cetera. And he was found guilty. And this was in 2002. So I saw her in November of 2001. The trial was in September of 2002. And he was sentenced to 30 years, which I think was just phenomenal. So let's talk about quickly the road to recovery. So what happens next? There are so many different ways that sexual assault victims respond to their trauma. And some self-medicate, some do well, some do not. For me, I think the turning point in my healing was about six months after my husband was sentenced. And moved up to a prison in upstate New York. I got a call from the ADA on my case, and he said to me that he needed a favor. And I said, sure, how can I help you? And he said, there will be a vigil against domestic violence in October, and we would like you to speak. And I said, well, what do I have to do? I've never done that before. And he said, just simply tell your story as much as you feel comfortable doing. And so that was the first time I spoke publicly. And that's the little newspaper article that was there. I was told it was going to be at the courthouse, which it was. However, it was outside on the steps, and so there were about 200 people there. I was a nervous wreck, but I just took a deep breath and started talking, and I haven't shut up since. I found out about three years after my assault, while I was working as a nursing supervisor, that my county was planning to start a program where they were going to train nurses to do sexual assault exams. One of our county legislators had read an article that was in the New York Times about Kathy Bell's program in Tulsa, Oklahoma, and they thought that Westchester County should have a similar program. So I found out about it, and I thought, well, if I can teach a doctor to do my own evidence collection, I could probably go and learn how to do somebody else's. So I showed up where they were meeting, uninvited, and just sat down at the table. I still can't believe I did that. And one of the ladies who was chairing the meeting was the director of the rape crisis program that I had gone to after my own assault, and that, interestingly enough, seven years later, Gina had gone to after her assault. However, I showed up at the meeting. The woman looked across the table at me, and she says, don't I know you? And I said, I think so. And she said, aren't you a nurse? And I said, yes. And she said, great. How would you like to coordinate the program? And I said to her, I don't know how to do that. And she said, neither do we. And that's how I got the job as the coordinator of the first sexual assault nurse examiner program in Westchester County, and I believe the third one to start in New York. This is just an article that hit the paper, and that's just another article years later when they were revisiting the issue. I've also been fortunate enough to do a lot of television show appearances. My very first television interview was, believe it or not, with Bill O'Reilly, and he was actually very nice to me. I had no idea who he was. I did a couple of court TV documentary shows, and Lifetime Television did a documentary about women who were victims of violence and those who care for victims of violence. And so since I kind of fit both categories, I was interviewed on that show too. And I think some of my favorite things was to be on Law and Order Special Victims. This is a photograph of a commercial that was for the Lifetime documentary special, and that was taken, believe it or not, outside Yankee Stadium, that photograph. And this is me sitting in the chair next to one of the producers, but I got to sit next to the director and sort of train them about what a forensic nurse would do, and this nurse does this, and who does this, and to show them. I worked on the set of Law and Order six different times as a technical advisor, and so that was also a fascinating process. Got involved in quite a few press conferences. The press conferences love to have a victim, and so since I was comfortable not only talking about my victimization, but also about forensic nursing, I got to do quite a few press conferences. My favorite press conference was in, I believe it was 2005, when Hillary Rodham Clinton was still a junior senator from the state of New York, and they were trying to pass legislation called the CARE Act, and they wanted to ensure that any woman who has care in a hospital that receives federal funding would be offered emergency contraception. And so I got to speak out publicly about why AC is very important to be offered to sexual assault victims. So now we have Gina's road to recovery. Gina was featured in two videos that were produced by the U.S. Department of Justice, and one by the Office of Violence Against Women. I had the pleasure to be in both of those videos with Gina. A lot of the sexual assault nurse examiner programs that started in the early, in the late 1900s, were funded by money from the Violence Against Women Act, from some departments of justice, there were grants out there. And so they wanted to develop videos that would talk about the benefits of the Violence Against Women Act. And so as you can see, the first video was entitled, A Decade of Change, How the Violence Against Women Act Changed the Lives of Three Survivors. There were two domestic violence survivors and Gina, the sexual assault survivor. And then a year later, they wanted to talk about the importance of having sexual assault response team. So they use clips from the 2004 video and photographs that they took of us in 2005, to talk about sexual assault response teams. And then Gina subsequently went on to become trained as a sexual assault advocate. I think she was so impressed with how the rape crisis program had helped her on her road to healing, that she decided that she wanted to be trained and to help others. And that's what she did up until she relocated from New York, and is now currently living in another state. So what are the lessons that I've learned from both my case and comparing to Gina's case? The first lesson I learned is that the hospital that I went to was totally unprepared to take care of me. That was in 1994. And New York State had a standardized sexual assault evidence collection kit in 1991, with, I guess you could call it a protocol, because it came with the manual and it came with instructions, but they still were not prepared. And so I learned, as has a lot of research, even research put out by Dr. Rebecca Campbell, that talked about how important it is to have trained people do these forensic exams. And then of course, I learned that, you know, eventually programs were going to start where they would train nurses how to do this. Another thing that I'd love to mention, which is a great help to those of you who are working in hospitals right now that don't have trained sexual assault nurse examiners or providers who have been trained in evidence collection, is that IAFN has a two-hour free webinar, and it's called No Sane Insight, and there's the web link to get to the webinar. And this training provides clinicians with a greater understanding of the needs of patients that have been sexually assaulted or abused, while improving the overall care and the exam process for these patients. And with the guidance conducted within this training, clinicians are more equipped to provide their patients with trauma-informed, patient-centered approaches, and affording the clinician an increased level of comfort when caring for this patient population. I can only imagine how different my hospital experience would have been had my doctor had some sort of training like this. I also learned how important it is to photo document injuries and to re-evaluate, ongoingly reassess, even in the midst of the current acute exam, because injuries can progress. And I am a witness to that. I mean, Jeanna's injuries blossomed so significantly that I took a whole second set of photographs. And when I testified in court, I was able to explain to the jury how the changes were significant. And so I did learn how important it is to put that jury in the exam room, to walk them through it. And that's what I think my role is in the courtroom, to explain the forensic exam in detail, if necessary, based on the request of the attorney who subpoenas me, to talk about mechanism of injury, to talk about why having a normal exam does not discount the patient's history of the event. All of those things, it's important to be able to explain anatomy and physiology, to help lay people understand why you might not find any injury at all. And while that is still consistent, if the patient gives a history of penetration of a body orifice or a sexual assault. And I also learned how important it is to prep with the attorney. I prepped for hours to get ready for grand jury, and then again for the criminal trial, so that you can help teach the attorney that subpoenas you all about what you do, what findings mean, what are the significance of findings, what's the significance of no finding, prepare for questions that will be asked on direct examination, and prepare for possible questions that might come up during cross-examination. So it's so important. And to me, being confident and competent in the courtroom is equally as important as it is to be confident and competent in the exam room. We do now have a national protocol, which we did not in 1994, obviously. And as you can see here, this protocol was developed with the input of national, local, and tribal experts throughout the country. And it offers recommendations to standardize the quality of care based on the latest scientific evidence. It promotes timely evidence collection. And it is my understanding that within the next year or so, this protocol will be updated for the third time. Because this one that you're looking at here is the second edition. But as science develops new techniques, as things become known that were not known years ago, protocols need to be updated. The International Association of Forensic Nurses has come out with SANE education guidelines. Because as SANE programs become prolific around the country, it is important that the standard of care based on evidence-based practice is being taught uniformly. So that regardless of the state you live in, if you take a training to become a sexual assault nurse examiner or a sexual assault forensic examiner, that you receive the best evidence-based training. And so there are education guidelines. And so that nurses who perform these forensic exams, they can receive this additional specific and didactic and clinical preparation to care for adults, for adolescents, and for pediatric patients. So those two are very big lessons that were learned. So finally, let's just compare the two cases because there's some very interesting things that I've learned over the years when I think of both cases. So when I think of my case, I was married to the victim. Gina's offender was a stranger. I was African-American. My offender was African-American. I was an RN. Gina was a white female. Her offender was a Hispanic male. And Gina was a teacher at the time. My exam was done by the ED doctor within four hours of my assault. I did have evidence collected and I was given medication for sexually transmitted infection to prevent it. Gina had an exam also within four hours, but it was by a SANE, myself, who was trained. She had a kit. She had photos. Clothing was secured and collected. She was offered STI, pregnancy, and HIV prophylaxis. The types of contact. In my case, penile vaginal penetration. There were non-genital injuries. A knife was used. And I was tired and gagged. In Gina's case, there was digital vaginal penetration, nine genital injuries, and she was physically beaten. My sentence, guilty plea, three to nine years. And in Gina's case, let's see if we can get this to show, guilty verdict, and he was sentenced to 30 years. So when I look at the comparison of the two cases, it leaves a lot of questions that are unanswered. And these are questions that I really had to think about. So there were differences in the care that the two of us received, obviously. Our exam processes were different. I had an inexperienced physician attempting to conduct potential evidence. In my case, Gina had a trained examiner who was able to conduct potential, to obtain potential evidence in her case. Medications, I was only offered STI prophylaxis. And because of the time, that may be all that there was to be offered at the time, but no one even told me what the shot was or why it was for. They just came in and said, here, we have to give you a shot. Regina had a detailed explanation and was able to decide what types of prophylaxis she wanted. For follow-up, hospital never talked about follow-up, never even talked about safety planning and safe discharge. It was the detective who gave me the advocacy center follow-up and also was going to arrange for a domestic violence shelter bed because they didn't feel it would be safe for me to return home because my husband was still out there on the loose. However, I stayed with a friend and I was safe. Gina had, even though she declined an advocate present during her acute exam, she did follow up over the period of time between her assault and her criminal trial. And she eventually decided to become an advocate. The differences in sentencing, interesting as to how that happened. Did the race have anything to do with the sentence? I mean, it's an interesting theory to think about. Both me and my husband were African-American. Gina was a white female raped by a Hispanic male. Did that have anything to do with the sentencing? Did the fact that my husband took a plea deal, did that have anything to do with the sentence that he got? Was it virtually a minimal of the maximum? Because the maximum was eight and a third to 25 and he was sentenced to three to nine years. Did the fact that he took a plea as opposed to a trial, did that have any difference with the sentencing? Gina's case ended in a trial where significant evidence was brought before the jury. Expert witness testimony. I have no recollection of who the witnesses were to be in my case and the trial never went forward. Gina had testimony not only from me, but from the crime lab because Westchester County has its own department of laboratory and research. So she had good testimony because it was DNA found. In 1994, our kids didn't even test for DNA. But by the time 2001 came along, Gina's kid did test for DNA. And then again, the relationship between victims and offenders. Stranger versus marital rape. Marital rape was a relatively new concept in 1994. I believe there'd only been one other marital rape case in Westchester County before my case and that case ended in an acquittal. So there was a lot of things to think about. And then of course, we talked before about the differences in the types of contact between the two cases. So these are a lot of unanswered questions and maybe some good things to think about for future research projects. But I just think it's interesting when you compare the two cases. Again, here are the two videos that talked about our case. And I'm going to end this with showing you a brief clip. It lasts approximately one minute from the SART Partnering for Success video where you will hear in Gina's own words how her forensic exam affected her. On this particular morning, I woke up and I decided to throw a load of laundry in. There was a man in the laundry room who I recognized as somebody who lives in the building. In an instant, he turned the light off, closed the door. He had me wedged right up against the washing machine and there was just no way for me to escape. Eric Fisher came to take my statement. And just right from the beginning, I just felt very much at ease with him. I said, I'm going to be here for you. And I'm going to get you through this. And we're going to get through this together. When I was at White Plains Hospital, I heard the officer saying, you know, we need a sane nurse. Is there a sane nurse? And at the time, I didn't know what one was. And I was afraid maybe they didn't believe me and they thought I was crazy. I arrived within the hour and there was Regina in this exam room sitting on a stretcher. She was beaten quite severely, bruised quite badly, but was able to talk to me and tell me what happened. Karen just had a really kind, warm, endearing way about her. And she right away, you know, said, you know, I'm so sorry this happened. This is not your fault. The forensic nurse is your link between the healthcare system and the criminal justice system. It is my job to provide the best care for the patient. And in doing so, ultimately every other member of the team is going to benefit. The SANE knows what I need and what the DA's office needs for a successful prosecution and what we're looking for to solidify our case against the defendant. Right from the beginning, I had a whole team of people, you know, pulling for me and telling me that they were going to take care of this. The outcome was guilty on all counts. Music to my ears. Well, I want to thank you all for attending this webinar. And I just want to say that while the outcome in my case was positive for me, the hospital experience would have been much different for a patient who was not an experienced ER nurse, who was able to then direct the ED physician to collect my own evidence. And so I want to thank you all for attending this webinar. Who was able to then direct the ED physician to collect my own evidence. You heard in Gina's own words, how she felt after her hospital experience and her experience with the other members of the multidisciplinary team. My negative experience in the hospital led me to become a SANE to help ensure that no patient would have an inexperienced and untrained provider collect their evidence in the ED in my county. Gina's positive experience led her to become a trained sexual assault advocate. In the over 20 years since my rape, there have been many thousands of providers across this country who have become trained as SANEs to provide trauma-informed, patient-centered care every day to sexual assault patients. So I want to thank you for all that you do in caring for these very special patients. Feel free to email me with any questions about this webinar. Again, thank you for attending and have a nice day.

webinar

sexual assault victims

SANE

forensic exams

evidence collection

photo documentation

medications

challenges

legal process

ongoing support