Clinical work in the emergency department (ED), with its fast pace and constant challenge, did not deter Ms. J from wanting a full-time career as an ED nurse. Ms. J found ED work demanding but immensely rewarding in contrast to what she saw as the monotony of life in general practice. The day-in, day-out routine of seeing patients in an office setting was not for her.
And after just three years on staff in the ED of a large, suburban hospital, Ms. J had experienced the gamut: She had witnessed death firsthand and had played a part in saving many lives. Certain trauma cases were especially disturbing to her — particularly those involving children. But for the most part, Ms. J was always able to leave her work behind when she went home — at least until the day Ms. Y, aged 19 years, arrived in the ED.
Ms. Y had been brought in by police officers after she reported being raped. When Ms. J entered the exam room, Ms. Y was pale and trembling. Ms. J spoke to her soothingly and looked at the chart, where intake personnel had written a description of the events that had transpired that night. According to the chart, Ms. Y, a freshman at the local university, had been walking home from an evening lecture when she was dragged into an alley and sexually assaulted by an unknown male.
Ms. J flashed back to her own student years. She too had been sexually assaulted while in college, and although it wasn’t rape, the aftereffects of fear, anxiety, depression and mistrust had lasted long after the physical healing process.
Ms. J suddenly snapped back to reality and noticed Ms. Y looking at her questioningly. The nurse realized that she must have been gazing off into space, lost in her thoughts. Ms. J went to get a rape-evidence kit, but was more shaken than she would have expected. Her own assault had happened so long ago that she though she was mentally at a point past feeling this kind of emotion.
Health-care practitioners, like all human beings, are not immune to being affected by patients or situations. It is natural for a particular case to trigger unpleasant or difficult memories. Although these situations can occasionally compromise one’s professional demeanor, it is important that it does not impact patient treatment.
When Ms. J returned to the exam room, she had regained her composure and set about collecting the physical specimens and skin scrapings for the rape-evidence kit. When the swabs were collected, she placed them carefully in evidence and sealed the kit per procedure. She then explained to Ms. Y that a crisis counselor would be coming in shortly to speak with her.
But as Ms. J was carrying the evidence kit to waiting police officers, she couldn’t remember whether or not she had included the required documentation within the kit, because she had been so distracted by her memories. Unsure of what to do, Ms. J decided to break the seal to check whether the paperwork was inside. The paperwork was there, so Ms. J resealed the evidence pack with extra tape and gave the kit to the police for laboratory analysis.
Subsequently, an arrest was made: A man was detained on suspicion of raping Ms. Y in addition to several other young women.
The hospital administrator called Ms. J to let her know that the district attorney’s office had called to inquire about procedure the night Ms. Y was seen in the ED. The tamper-evident seal on the rape-evidence kit had been broken, and the DA’s office wanted to question Ms. J about this.
Embarrassed, Ms. J admitted to her supervisor that she thought she had neglected to include the documentation when she first sealed the kit, so she opened it up just to check. ”But everything was there, and I didn’t touch the samples. I simply resealed the kit,” she explained.
The DA who was prosecuting the case informed Ms. J that she might be called to testify if the defense alleged that evidence-tampering might have occurred.
And that’s precisely what happened. At trial, all evidence pointed to the defendant’s guilt — including DNA evidence from the rape-evidence kits of several victims. But the defense argued that since the tamper-evident seal on this kit was damaged, the evidence might be compromised. Ms. J told the jury exactly what she had told her supervisor, that she simply opened the seal to verify that she had included proper documentation.
After a moderately lengthy trial, the defendant was convicted — despite the evidence irregularities. Ms. J breathed deeply, feeling a great sense of relief. The emotional pressure had been intense when there was a chance that this man would walk because she had breached protocol.
Ms. J’s relief was short-lived, however. The defense appealed the conviction, arguing that the rape-evidence kit should not have been admissible at trial because of “chain of custody” violations. “Chain of custody” is a legal term referring to the movement and location of evidence from the moment it is obtained until the time it is presented in court. The appeals court was convened to answer two crucial questions: (1) Did reopening the rape kit — a clear breach of protocol — suggest evidence tampering, and (2) was Ms. J negligent?
Ultimately, the verdict stood, as the appeals court found the sum evidence against the defendant damning and accepted the credibility of Ms. J and her story regarding why the evidence kit was opened and resealed.
After examination, the court upheld the defendant’s rape conviction. The court ruled that a claim of tampering was not supported, because Ms. J did not disturb the actual sample containers. Additionally, the defense could not show that the integrity of the specimens had been violated.
Typically, trial attorneys will attack any breach of protocol in evidence-handling in the hopes that either the evidence will be ruled inadmissible or the jury will question the credibility of the evidence.
Criminal cases can stand or fall based on whether evidence was properly collected, labeled and stored. In this case, a seemingly harmless error might have resulted in the defendant’s conviction being overturned.
Clinicians who work in the ED will probably, at some point in their career, handle and catalogue evidence. When collecting medical evidence, it is crucial to follow set protocol. Had Ms. J been completely focused, she might not have made an error here. Lastly, if she felt that she couldn’t retain her objectivity, Ms. J could have gone to a supervisor and asked to be excused from handling this case.
Ann W. Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.