Forensic Evidence

in Elder Mistreatment

Cases

Module 9

Nursing Responses to Elder MistreatmentAn IAFN Education Course

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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

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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

Learning Objectives

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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?

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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

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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

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Nursing Roles

Nursing roles in evidence collection can vary depending on factors such aso Practice setting policies

o Jurisdictional requirements

o Type of mistreatment and circumstances of case

o Experience/education of the nurse

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Nursing Roles

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

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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

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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)

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Evidence Collection Kit

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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 o 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.)

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Questions

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

involved?o Procedures and techniques?

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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

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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

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Chain of Custody

Seal evidence bags/envelopes with tape; do not use staples

Label each item of sealed evidenceo Patient's nameo Description of item o Source of materialo Name of person who collected itemo Name of person who sealed evidenceo Date and time it was collected and sealedo Names of those who release and receive evidenceo Time it is transferred

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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

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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

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

Sealing and Labeling Evidence

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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

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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

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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.

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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

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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.

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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. 25

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

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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?

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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?

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Closing Assessment

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

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