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Certified Legal Nurse Consultant Specializes in Sexual Assault Cases

The term “sexual assault” refers to forced sexual intercourse. The term used in your state, region or area may be called “sexual abuse” or “rape.” It is important for each person to check the law’s legal definition in their state.

How many of these statements have you heard as a Certified Legal Nurse Consultant reviewing a sexual assault case?

  • There was a delay in seeking treatment and/or reporting the assault.
  • They know each other and they were on a date.
  • There were no injuries.
  • They were calm when they arrived.

CLNC® consultants should focus on the facts in a case, not the assumptions while at the same time being alert to how others might interpret the case.

Many times the survivor may delay seeking treatment or reporting the incident. The delay in seeking care may have been because the victim was in shock. They could have been threatened, unconscious or waiting for a friend or family member to arrive to assist them. The survivor of a sexual assault is a trauma patient; and they will have the same psychological reactions as any other trauma patient. The reactions you may see documented are that they were calm one minute, crying or angry the next and withdrawn or even confused at another time. A Certified Legal Nurse Consultant should not focus on whether or not the victim delayed seeking care or delayed reporting the assault to determine if the case has merit.

Saying the victim knew the attacker so they can’t claim assault is not necessarily a strong defense. According to the Rape, Abuse & Incest National Network (RAINN), 73% of sexual assaults are committed by a nonstranger and 38% by a friend or acquaintance. 93% of juvenile survivors know their attacker. Of the 93%, 34.2% are family members, 58.7% are acquaintances and only 7% are strangers.

Knowing the attacker, being on a date with them or even being married to them does not give the “okay” to be sexually assaulted. “No” means “no” when said to a spouse, dating partner, relative, friend, any kind of acquaintance or a stranger.

A physical examination, even in a child victim, may not reveal any injuries. Factors that can affect the injuries are anatomy, physiology, how much force was used, how much the victim resisted, the time lapsed between the assault and the exam and the grooming of the victims. Everyone’s anatomy is not the same and this is true of the genital area and the hymen also. If there was an injury or difference documented, it is important to know if it is an anomaly or an acute injury. Also, realize there are other types of injuries beside sexual assault that can cause an injury in the genital area or even cause a ruptured hymen. The vagina and cervix are vascular areas and heal quickly. If time has elapsed before the examination, any injury might be healing or healed. If injuries were documented, then you may be able to determine if the injury was acute by checking the records to see if the victim was examined a few days to a week later. If another examination was completed, compare the documentation of injuries. If documentation confirms that the anatomy is the same and no further sexual assault was found to have occurred, then it was probably not an acute injury.

Legal nurse consultants should also be aware that estrogen can play a role in whether there might have been injuries noted with the exam. Estrogen in females makes the cervix thicker and more redundant. Injuries might be less likely to occur during the child bearing years when there is usually more estrogen in the body. The victim’s resistance to the attack and the force and object(s) used have an effect on any injuries sustained. If the victim did not resist the attack, the examiner may not discover any injuries. The victim’s cooperation should not be confused with their willingness to have intercourse. They may have feared for their life, been too traumatized to resist, been drugged, intoxicated or the attacker could have threatened them, a loved one or even a pet.

Child victims may have been “groomed” by the predator. Grooming is the process of desensitizing the child. The predator usually has some type of relationship with the child. This relationship provides the predator with the opportunity and access to the child to engage, entrap, prepare and trick the child into accepting the sexual abuse. The grooming can start with subtle behaviors or statements and once the victim responds favorably, some form of sexual activity begins, and often progresses. When there is less resistance, there may be little to no injury sustained or noted.

Remember that a calm victim does not indicate whether assault did or did not happen. A Certified Legal Nurse Consultant needs to review and consider all information and documentation – the subjective and objective data obtained during the physical exam and the history of what occurred. Gather all records from other disciplines that might have spoken with or examined the victim after the assault. Review the records to be sure the examination was conducted thoroughly, to learn what type of practitioner performed the exam, that all evidence was collected and stored properly and that the chain of evidence was followed.

Most areas have at least one hospital and sometimes several that have a sexual assault nurse examiner (SANE) or sexual assault response team (SART). A SANE is a registered nurse who has had specialized education to provide comprehensive care to sexual assault patients and demonstrates competency in conducting a forensic exam and who has the expertise to give effective courtroom testimony. SARTs are set up in a similar style with a multidisciplinary and community-based approach to caring for and assisting the victim. The teams usually consist of local law enforcement, prosecutors, judicial members, a victim advocacy group, the hospital, SANE members and any other professionals with a vested interest in assisting victims of sexual assault.

With a thorough review of all the information, a definite response to the question of whether the victim was really sexually assaulted still cannot always be given. The response that can be given is the results of the examination, the injuries sustained and any behaviors noted that were or were not consistent with the history obtained.

Guest Blogger Profile

Cheryl Garrison RN, CEN, SANE, CLNC has 18 years of emergency nursing experience and has been a SANE nurse for 8 years. She is cofounder of Class Act Consulting Services, LLC in Kansas specializing in emergency and abuse cases. Her company has assisted the local district attorney in the victims unit on various abuse cases. Her company partners with an elite group of Certified Legal Nurse Consultants who specialize in various nursing specialties including labor and delivery to hospice, home health and Medicare fraud cases.

P.S. Comment and share the type of case you sometimes make assumptions about the most often as a legal nurse consultant.

2 thoughts on “Certified Legal Nurse Consultant Specializes in Sexual Assault Cases

  1. I enjoyed your very well written concise article. I appreciate the brevity having been an ER nurse myself for 19 yrs!

  2. Thanks for your insight into this field. I appreciate the emphasis you put on the patient/victim and their individuality. I hope to take the SANE course one day. Thanks for your perspective!

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*The opinions and statements made by Vickie Milazzo, the founder of Medical-Legal Consulting Institute, Inc. are based on her experiences and expertise, should not be applied beyond the specific context provided, and do not guaranty or project actual results. Vickie Milazzo is no longer involved in the operations or management of the business, but is involved as an independent education consultant.

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