Forensic nurses help provide comfort and justice for victims of sexual abuse

Angela Dillahunty demonstrates how she utilizes the culpascope in forensic exami

Sexual abuse is a subject that makes people extremely uncomfortable, but one that is an ugly, prevalent reality for millions of victims in the U.S. each year.

Nearly 70 percent of all reported sexual assaults affect children ages 17 and under, according to U.S. Department of Justice statistics.

For the victims of sex abuse that are brave enough to seek help, it is critical that evidence is collected quickly and appropriately so that it can be used in a court of law. But it is also important that victims receive prompt evaluation and compassionate care.

In hospitals across the country, forensic nurses have become the bridge between the justice system and the health care system, accepting the role of a qualified medical professional trained to observe, recognize, collect and appropriately document evidence that ultimately becomes foundational to establishing the legal causation and responsibility for traumatic injury.

Forensic nurses have a dramatic impact on the ability of law enforcement agencies to gather the evidence needed to convict sex offenders, said Detective Mark Hogge, who works with the Beaumont Police Family Violence Task Force.

“The difference is like night and day,” Hogge said. “They gather all this information for us that we can’t. … Not only do they do a head-to-toe medical examination on the patient and do all the documentation, they take the patient history so that it is admissible in court and shows a consistency in the victim’s statement.”

Angela Dillahunty, a forensic nurse examiner and program coordinator of St. Elizabeth’s Forensic Nursing Services at Christus-St. Elizabeth in Beaumont, said when a sexual assault patient comes to the ER, they are taken to triage, where ER nurses take vital signs and collect information about medical history, but do not get into specifics about the assault. The hospital utilizes an alert program so that the appropriate specialist can respond.

If abuse is identified, the ER nurse issues a forensic alert and a forensic nurse responds to help provide care for the patient.

The patient will be taken to a private waiting area apart from other patients where the forensic nurse will conduct a head-to-toe, detailed examination and assessment of the patient’s entire body, photo documentation of injuries (such as bruises, cuts and scraped skin), and collection of clothing. This exam is complex and on average, takes 3-4 hours.

“Their body is the crime scene,” Dillahunty said. “That’s where the forensic evidence is going to be. We’re looking for anything out of the ordinary.”

For children, the forensic examination room contains books and toys to make the environment more comfortable. It is important, Dillahunty said, for the nurse to be completely honest with the child.

“You have to develop a rapport first, particularly with the kids,” she said. “So they will come in and play with the toys and color or blow bubbles and we talk to them about why they are here.”

A magnifying optical device called a culpascope is used to examine the genital area of the victim, whether adult or child. Dillahunty said she lets the child play with the culpascope, which also consists of a light and camera, to reassure the child that nothing is going to hurt.

DNA and other body secretion samples are taken.

Once the patient’s exam is done and all the evidence is collected, the hospital notifies the Rape Crisis Center under patient request and provides the patient with clean clothes to change into if their clothing has been collected for forensic evidence.

The DNA is then sent to the appropriate location and the patient is given medication to treat or prevent sexually transmitted infections they might have contracted during the assault.

If the victim is under 18 or over the age of 65, the police are automatically notified.

St. Elizabeth’s Forensic Nursing Services works with law enforcement agencies in eight surrounding counties. Law enforcement and Child Protective Services may then refer children of sexual abuse from 2-12 years old unless they are mentally challenged to the Garth House, a non-profit child advocacy center where a forensic team conducts an interview with child victims following their examination at St. Elizabeth.

When children arrive they are interviewed in a safe, non-threatening environment and their statements are recorded. This eliminates the need for a child to disclose their abuse over and over again as the investigation continues. After the interview, caregivers are given information about follow-up care and other helpful resources.

“This makes a more complete investigative process,” said Garth House Executive Director Marion Tanner. “You’ve got all your pieces. You’ve got the child’s statement; the medical evidence — it just helps the police and CPS to do a much better job and follow their case all the way through to the district attorney’s office.”

Dillahunty said she hopes the work she and other forensic nurses do will continue to help make a difference in Southeast Texas.

“By helping what’s happening to them be identified you can then prevent it from happening to them again in the future as well as to other children,” she said.


This article was originally published in the June 2014 issue of Vital Signs, a tri-annual magazine published by The Examiner Corporation focusing on the medical industry in the Golden Triangle. The article won a first-place Texas Medical Association Anson Jones award. Vital Signs can be found in your local hospital or doctor’s office waiting room.