Forensic Nursing Chronicles

Once Saddam was captured he went through a complete physical assessment by military Forensic Physicians. This included the usual physical agenda as well as psychiatric interrogations. As opposed to what Saddam did with his prisoners, he was always treated with respect and confidentiality.

He was given the medical care needed to bring him up to optimal health, as well as feeding him the nutrition he needs. He is in “jail” but his accommodations are nothing like what he created in his own jails of Iraq. Comments from former guards that have kept track of Saddam state: “Saddam Hussein likes munching nacho chips, plays a mean game of ping-pong.” This would hardly be even normal free life in Iraq. Forensics in Iraq was non-existent. Inmates in Iraq were beaten, tortured and forced to live in cells that were 8X10 with as many as 40 people.

Forensic nursing for Saddam would include a physical assessment, treatment for any conditions which would have come up. It would also include a mental health assessment to determine if he is competent to stand trial. He also gets ongoing treatment to keep him at his optimal health.

This is the complete opposite of how he treated people. Most were just executed with no reason. The executions were inhumane such has dropping people in a meat grinder feet first allowing them to scream to death.

Forensic nursing is used with inmates to help determine whether they are healthy. It also is used to determine whether they have had any abuse through physical assessment and mental assessment.

The CBS Video clip which was first seen on December 14th, 2003 regarding Saddam’s capture and medical exam. The video itself violates Saddam’s personal rights. In A Physician’s Guide to Clinical Forensic Medicine it states “If a recording has been made in the course of investigation or treatment of a patient but the doctor now wishes to use it for another purpose, the patient’s consent must first be obtained. Recordings are not to be published or broadcast in any form without the explicit, written consent of the patient.” Saddam never gave consent for his medical evaluation to be broadcast on public television.

At the point of his capture, he had no representation as the United States does with all other accused. We all do understand that Saddam is 99.999% guilty, but this should not change our ways of doing medical evaluations and our way of checking in accused. International law is even tougher and we violated several of Saddam’s rights. He had no privacy, he was not represented, he was treated as if he was guilty. This all made the United States look bad. Mistreating Saddam made other countries wonder what we were doing with the prisoners which were not as important.

Several years ago, I was summoned for a deposition. Prior to the time of the deposition, I was unsure which case was being tried. It so happens that this particular case was regarding a patient that I helped to take care of.

I was the RN that was on duty the night a 29-year-old female presented after allegedly being raped. As the primary nurse, I triaged the patient. She was not in any distress. I did an initial interview with the patient and documented as such.

In this particular case, I collected the specimens for the rape kit (excluding the vaginal and cervical specimens). I was responsible for the processing of the specimens, labeling the specimens and sealing the kit. After the physical exam was complete and the police officer had interviewed the patient, she confided in me. She stated that after the rape, she took a sharp-edged pocket knife and stabbed the suspect in the right thigh. I asked if she had reported that incident to the police and she began crying. She asked me to swear to secrecy.

As a forensic nurse and understanding the importance of the information that the victim provided to me, I discussed the implications of the act that she had shared. Legally, I had an obligation to report this activity to the police. This information could help the victim to find the suspect.

In the deposition for this case, I was asked specific details about the case. I answered each question that was asked by the defense and the prosecuting attorneys. Although the patient had asked me not to repeat the information about the stabbing, I was asked about the incident by the defense attorney.

There had been a notation about the incident in the police record, but nothing documented in the nursing record. The defense attorney wanted to know why I had omitted this important information. Although my role as a nurse was to collect specimens and provide support, I also was involved in the reporting of a potential crime of a stabbing.

The stabbing was not something that needed to be documented in the medical record as it was a law enforcement issue. My answer to the attorneys reflected my role as a nurse to care for the patient, but the forensic part to address and report evidence.

As a forensic nurse testifying in court, I would need to answer questions that were directed to me appropriate toward the capacity that I was fulfilling at the time of the incident. I would need to answer the questions honestly and to the best of my knowledge.

If I were a expert for a case, I would have to review the case in its entirety. I then would be able to give an opinion based on the type of nursing that was involved. I would only be able to testify to nursing issues involved.

Lance Armstrong is an unprecedented seven time tour de France winner. Recently there has been an allegation that Armstrong used EPO is 1999, and that allegation is denied by Armstrong.

Although the report seems credible to the tour de France director, disciplinary action is unlikely. There were A and B samples of urine, and the B samples were not tested until last year. There was no test available to check for EPO until 2001.

The problem arises that it could not be confirmed that the urine samples were indeed Armstrong’s. The company that issued the allegations state the urine was Armstrong’s, although the company that actually did the testing stated that it could not confirm the positive result was that of Armstrong.

Samples from testing must be carefully marked using a system to avoid any question of matching the wrong specimen with the wrong athlete. When there is a question about that confirmation, it becomes unlikely that there will ever be total credibility and validity with these specific samples.

Tests designed to check for EPO were not used until 2001. I wonder why the specimens were only assessed last year? If these results had been found in 2001, the findings would have been more credible. For these results to be made public at this late date, with questionable confirmation of the source of those specimens, does not encourage further investigation. I do not believe that anyone will be able to prove the allegations beyond the shadow of doubt.

Manufactured EPO has slightly different characteristics than what is naturally produced in the body. Although the manufactured EPO has the same effect, the amount of sugars attached to the hormone do vary.

Thus, the manufactured EPO has a slightly different charge and weight than natural EPO and the urine test can detect if someone recently ingested EPO (within 2 – 4 days). Blood testing is more costly, but can detect the effects of EPO use over time (used at the 2002 Olympics). Because EPR causes abnormally fast erythrocyte production, this enhanced time-based blood test would identify “suspicious” scenarios. There is at least one new form of EPO that is now undetectable with the urine test alone.

Working as a nurse in the emergency department, patient care comes first. On occasion, the influx of patients is greater than the amount of manpower. Even though nurses try to keep up with charting, on occasion there is reason that charting may not be done as thoroughly or as expeditiously as needed.

A key point expressed by Tsushima & Nakano (1998) is the chart like you will never see the chart again before it goes to court. So many times a nurse can be focused on taking care of the patient that charting may not be as thorough as it needs to be. It is detrimental for the nurse to leave out key times and notations when documenting. It is critical for the nurse to chart to the best of his/her ability. Additions to a record after the fact raises suspicion.

Tsushima, W. T. & Nakano, K. K. (1998). Effective medical testifying: A handbook for physicians. Butterworth-Heinemenn: Woburn, MA.

Autistic boy, 5, dies after controversial therapy
taken from:
The Florida Times Union, August 26, 2005

An unproven treatment for Autism was given to a 5 year old boy that subsequently died from cardiac arrest after receiving the treatment. Though some people believe this treatment may cure this condition, it has not been proven.

The treatment is chelation and the boy had received his third treatment right before the cardiac arrest. CPR proved to be unsuccessful and more tests will need to be done to determine the exact cause of death. Many people believe the autism is linked to preservative containing mercury that is used as a preservative in vaccines used in childhood. The belief in this theory has led to people advocating the use of chelation. This substance causes heavy metals to be excreted in the urine.

This is a great article that combines ethics with FDA testing of new medications. Forensic examination may not only identify the cause of death, but the effects of the chelation on the body in general. The outcome of the tests and autopsy results in general may lead to criminal charges since this drug was unproven to help

Chelation therapy is used in the treatment of toxic levels of heavy metals. These heavy metals include iron, arsenic, lead, and mercury. Chelation binds these metals so they can be excreted in the urine. High levels of mercury are thought by some to be related to the development of autism, thus the unapproved use of these drugs in the treatment of autism.

Chelation use is not without its problems. The levels of magnesium, zinc, and potassium should be checked on this child. A decrease in the levels related to the chelation therapy can cause serious fatigue and the effects of hypokalemia could be implicated in the cardiac arrest of this child.

Hypotension is another serious effect from the therapy, and sources cite giving the aminoacid tyrosine to counter that effect. A tyrosine level may also be indicated along with levels of the heavy metals to assess if there was an initial mercury problem prior to therapy. There can also be chelation of essential minerals such as iron, copper, and zinc. All of these levels should be checked, as well as levels of the chelation medication that were identified as remaining in the body.

There are dangers of kidney damage during this therapy, especially if dehydration is present. The kidneys should be evaluated carefully during the autopsy. There is also an established physician protocol, and the manner of administration should be compared to this standard.

Martha Stewart was tried and convicted for securities fraud back in 2004. She was sentenced to 5 months in a minimum-security prison. As compared to Saddam, her check-in to prison was much more private and confidential. Her prison life was much more public and some feel was easier because of her status. Reading some of her bios, it seems as if she was treated just like
any other prisoner. The wardens treated her just as bad if not worse than other inmates.

Most of the information that came about her life in prison came from Martha herself. She seems to be trying to prove she should not have been tossed into such a hostile place. Her evidence and witness attest that she was guilty. A jury proved her guilt without a doubt.

Martha did not require a lot of nursing in prison, she did explain about her “delousing” on her second day. There is not much in the literature about her medical issues, which is the way our society should treat people when they are incarcerated. As opposed to Saddam, his medical evaluation was publicized on international TV. Martha was given her dignity. Some would
argue that she did not commit as severe a crime as Saddam, but it should not matter.

As far as Forensic Nursing. There is a long process before she goes to trial to determine if she is suitable for trial. First there needs to be a determine of specific needs and the type of referral. There are two types either urgent or routine. It is hard to find any discussion on her referral but she was not a threat to herself or others, so I imagine she was a routine referral.

The next step is the type of assessment, either joint or team. Again, because of patient confidentiality, there is little discussion on this subject but would most likely be joint because of the nature of her crime, there was not much evidence or need to prove her sane or insane. Because of this, a team of people would not be necessary.

The interviewer would research her criminal history. Martha did not have any criminal history before her securities fraud. He would also research Martha’’s Psychiatric history. As far as the public knew, she had none.

Then is the interview with Martha herself. They would go through her life history, thoughts about herself and the crime she was accused of committing as well as feelings of any possible thoughts of self harm such as suicide.

They would also question and assess her attitude toward her accusations. Martha’s speech and orientation would be investigated to check if she would be competent to stand trial. This was all intact for Martha and was deemed competent for trial. She had a trial as any other normal person.

Once Martha was finally committed, she again would go though a thorough psychiatric assessment process. Items included in this assessment would include thoughts and feelings. They would focus on any feelings of potential suicide, or self harm while in prison. Inmates, when first
committed, have deep thoughts of the end of life and this has to be investigated. If there is any question a referral to an appropriate therapist would start immediately.

Self care, sleep patterns and nutrition are assessed. Inmates need to be able to care for self and have good self care habits because of the close socialization with other inmates. A person who does not care for self can easily spread disease to others and cause problems for the institution.

Adequate nutrition is also very important for both physical and emotional wellness. Depression is always a potential problem in prison and the proper diet along with self care preservation and sleep help prevent this. On the subject of sleep; adequate sleep is always essential. A schedule with a regular rest pattern also helps promote wellness.

The individuals own concerns while in prison are also questioned. Things discussed would be items like her home life before incarceration, her feelings of the family she left behind, and things which were undone. In Martha’s case there were other issues such as her businesses she left
behind. Martha was not allowed to conduct business from her place of incarceration. Because of this, it was a big concern for her to make sure she had all her businesses and her estate in order before going in.

Once all this admission data was obtained it would be reviewed by the forensic team to decide appropriate recommendations to the judge on where she should go. It was decided that Martha was not a violent criminal and she was sentenced to a minimum security facility. She had to serve five months and then was sentenced to house arrest with forty hours allowed for work and
shopping and so on .

According to Martha’’s bio, she was not treated any different than the rest of the inmates. It seems, from her diary she kept, that she thought she would be treated special. Martha had to prove herself amongst the other inmates. They treated her badly and the wardens did
nothing to stop it. She was quite appalled. It was quite the reality check for the home maker queen of America.

Martha had ongoing psychiatric evaluations and treatment to help keep her out of depression and help her to adapt to prison life. The treatment was also to help her re-adapt to life back in society. Since she was only in prison for five months, this was not a huge concern but it was evaluated on a continuous basis.

Most of this evaluation would be done by the admissions forensic nurse in the prison system. They would take the complete history and question thoughts and feelings on her current condition and feelings of her impending incarceration.

These nurses would thoroughly document all of this information for the court system as well as for her personal file. They also would do the ongoing evaluations and report all of this information to the forensic physician for any other needed treatment. Martha did not require a lot of assessment but even in her case it was comprehensive and very detailed to uncover any potential possibilities of self harm or to others while she was in prison.

Martha is still under house arrest and is still undergoing some form of forensic assessment and treatment but it gets more and more scaled back the longer she is out. Soon she will be completely out and again a productive person in society. Not that her companies are not
producing while she was in prison. She found she could not buy her way out.