Quarterly newsletter of the Colorado sane project
Colorado SANE
North Colorado Medical Center
North Colorado Medical Center (NCMC) located in Greeley, has recently re-started its
Sexual Assault Nurse Examiner (SANE) program. NCMC’s SANE program went live on
July 1, 2012. The program has nine specially-educated sexual assault nurse
examiners working to provide medical-forensic healthcare services around-the-clock
in collaboration with their physician advisor, Michelle Stoltz, MD.
Ani Matt, RN, the program coordinator, says "Our specially trained nurses here at
North Colorado Medical Center have a unique opportunity to help our community-atlarge. We are excited and honored to offer a holistic approach to those that are
impacted by sexual violence by meeting their medical needs and collecting evidence
that can be used to assist the criminal justice process. This service to adults and
children of sexual assault and abuse is helping to make our community a safer place
every day and positively impacting patients' lives through excellent patient care."
The NCMC SANE program will serve Weld County and the surrounding areas, and
has been working closely with the Weld County SART, including law enforcement,
prosecutors, and advocacy agencies.
See more about the program on NCMC’s website. To see all the SANE programs
currently operating in Colorado, visit the Colorado SANE Project’s map page.
Issue 6
October 2012
Special points of interest:
In this issue:
Education and Certification
2
CDC Updates STI Tx Guidelines
3
DFSA Drug Highlight: Insulin
3
Research Review
4
Forensic Guru Corner
5
Education and Announcements
6
 Register now for SANE Education in January &
February!
 CDC updates STI treatment guidelines
 Diabetes medications are being used to facilitate
sexual assault
 Nurses should evaluate the quality of educational
programs and ensure they meet requirements for
certification.
 Untested sexual assault evidence collection kits
may be held by law enforcement rather than being
submitted for testing by CBI
2
Education and Certification in Forensic Nursing
….or Does Completing this SANE Course Mean I’m Certified??
It is always interesting to talk with nurses interested in attending a
SANE education course or discuss with someone who has recently attended a 2 or 3 hour in-service on use of the Colorado sexual
assault evidence collection kit and get the proverbial question,
“Does this now mean I am certified as a SANE?”
Here is the short answer to that question….NO!
The American Nurses Association (ANA) defines certification as a
means of measuring competency and the identification of competent nurses that will promote the public welfare for quality in health
care. Certification is additionally defined by the American Board of
Nursing Specialties as the formal recognition of the specialized
knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote
optimal patient care.
exams.
As licensed healthcare professionals it is our responsibility to be
good consumers of healthcare education. There are logically
some things we should consider and questions we should ask
when seeking forensic education opportunities.
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What clinical or academic agency is sponsoring the education?
What are the educational objectives of the offering?
What are the qualifications of the instructors/educators?
Is the curriculum a product of evidence-based practice?
Is the curriculum delivered in a framework of evidence-based
education?
Is the education approved for continuing nursing education
(CNE) credits?
As licensed healthcare professionals providing an improved response to victims of crime, we have a fundamental The practice of
forensic nursing
responsibility to be accountable for the care we provide and the impact of our care on patient outcomes.
has been recogCertification in the field of forensic nursing and specifically the role nized as a specialty area of nursing practice by the American
of the sexual assault nurse examiner (SANE) requires successful Nurses Association since 1995. The Scope and Standards of Focompletion of a board examination. Certifying organizations typi- rensic Nursing, based on the foundational scope and standards of
cally require certain qualifications in order to sit for a certification nursing practice was co-published by the ANA and IAFN in 1997
exam, which in addition to licensure as a registered nurse can
and updated in 2009. Professional nursing standards are authoriinclude completion of appropriate education, documented clinical tative statements that reflect the current state of knowledge in a
competency, submitting an application to sit for a board examina- specific discipline and articulate the values and priorities of the
tion, and, of course, payment of appropriate fees related to the
profession. These authoritative statements describe the responsiboard examination process. The examining board for certification bilities for which clinicians are accountable in order to promote
as a Sexual Assault Nurse Examiner is the Forensic Nursing Cer- safe, competent and ethical care within the specialty (Peterneljtification Board, an arm of the International Association of Foren- Taylor & Bode, 2012).
sic Nurses (IAFN), which offers certification as SANE-A for adult
and adolescent patients and SANE-P for pediatric patients. In the The University of Colorado Colorado Springs (UCCS) offers foUnited States and Canada, many nurses who choose a specialty rensic nursing education and a standardized SANE education
become certified in that area, signifying that they possess expert course that is based on the scope and standards of nursing practice, scope and standards of forensic nursing, state and national
knowledge.
standards, evidence-based clinical recommendations, and the
At least one study found that certification has a dramatic impact
experience of clinical and education experts in forensic nursing.
on the personal, professional and practice outcomes of certified
nurses. Overall, nurses in the study stated that certification ena- “Violence has been identified as the major health problem
through-out the world. Violence is of epidemic proportion &
bled them to experience fewer adverse events and errors in pathe health consequences of violence are great. ...Being forentient care than before they were certified (Cary, 2001).
sically competent isn’t an option...it’s an obligation,” (Lynch
V, 1995).
This discussion about certification and education was prompted
by a recent conversation with an attorney who suggested the firm
was representing a hospital facility after the pursuit of legal action References:
by a patient seen in the hospital emergency department for a
American Nurses Association. (2004). Nursing: Scope & standmedical-forensic exam and evidentiary collection. Reportedly a
ards of practice. Washington, D.C: Nursebooks.org
healthcare provider employed by the facility had attended informal
Cary A.H. (2001) Certified registered nurses: results of the study
education that reviewed use of a sexual assault kit and a clinical
of the certified workforce. Am J Nursing, 101, 44-52.
response to patients needing care after sexual assault. The
healthcare provider reportedly returned to the hospital suggesting Peternelj-Taylor, C. & Bode, T. (2010) Have you read your forenthat following the informal education to be ‘certified’ and capable sic nursing: Scope & Standards of Practice? Journal of Forensic
of providing expert care to patients that had a need for evidentiary Nursing, 6, 55-56.
3
CDC Updates STI Treatment Guidelines
The Centers for Disease Control and Prevention (CDC) recently published a revision to the 2010 Sexually Transmitted Diseases Treatment Guidelines. Cefixime (Suprax®) is no longer
recommended as a first-line prophylactic treatment for prevention of gonorrheal infection due to antimicrobial resistance. The
recommended regimen for treatment of uncomplicated gonorrhea is a single dose of ceftriaxone 250 mg IM plus either a
single dose of azithromycin 1 g orally or doxycycline 100 mg
orally twice daily for seven days (CDC, 2012). Following the
recommended protocol should help protect the effectiveness of
ceftriaxone against N. gonorrhoeae. Hospitals should update
their policies regarding prophylaxis and treatment for sexually
transmitted infections accordingly.
Centers for Disease Control and Prevention. (2012). Update to
CDC’s Sexually Transmitted Diseases Treatment Guidelines,
2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections. Morbidity and Mortality Weekly
Report, August 10, 2012, 61/31, pp 590-594.
DFSA Drug Highlight: Diabetes Medications Recently in Colorado, perpetrators have used insulin or oral diabetic medications ,which stimulate production of insulin, to facilitate sexual assault. These medications are legal and easily-accessible for a
person who is diabetic or lives with someone who is diabetic. When injected in or ingested by a person who does not have diabetes, these medications can cause hypoglycemia (low blood sugar)
which may result in dizziness, sleepiness, confusion, stroke-like symptoms, altered mentation, seizures,
and even death in the victim of sexual assault. References:
Colorado Drug-facilitated Sexual Assault (DFSA) Kit Educational Module. 2012. http://www.uccs.edu/bethel/sane/
coloradodfsa.html
American Diabetes Association. 2012. Common Terms. http://www.diabetes.org/diabetes-basics/common-terms/
common-terms-f-k.html
American Diabetes Association. 2012. Living with Diabetes: What are my options? http://www.diabetes.org/living-withdiabetes/treatment-and-care/medication/oral-medications/what-are-my-options.html
View the Colorado Drug-Facilitated Sexual Assault Kit Education Modules for more information on drugs commonly used
to facilitate sexual assault. 1.0 CNE credits are available for completion of this program. For drug-related questions, contact the Rocky Mountain Drug and Poison Center at 1-800-222-1222.
www.uccs.edu/bethel/SANE.htm
4
Research Review: Evidence Testing Patterson, D. & Campbell, R.
(2011). “The Problem of Untested
Sexual Assault Kits: Why are some
kits never submitted to a crime
laboratory?” Journal of Interpersonal Violence, 27/11: 2259-2275.
This article reviews the likelihood of
law enforcement submitting a sexual
assault kit to a crime laboratory for
analysis. The authors note recent media
reports of untested sexual assault kits
and attempted to determine what factors prevent law enforcement from
submitting kits for analysis.
a missed opportunity to find evidence are collected, regardless of submission
that could impact the investigation of a or testing, to determine the need for
sexual assault case. They describe previ- additional funding.
ous research showing that cases in
Semen can last in the body for 72 hours or more after a sexual
encounter, even if the victim performs cleansing acts, and may be
found on clothing or bed linens after even more time has elapsed.
which DNA evidence is found are more
likely to be successfully prosecuted,
demonstrating the importance of having
physical evidence collected and tested.
The authors also note the usefulness of
The authors found no significant differ- DNA evidence in identifying a suspect,
ence in kit submission correlated with or a perpetrator behavioral pattern that
victim demographics, findings of ano- could help LEOs identify a suspect. The
genital injury, consumption of drugs or authors also note previous research
demonstrating that DNA evidence can
alcohol, or relationship between the
victim and suspect. However, they did still be found on a victim, even after the
find that law enforcement was less like- patient has bathed or otherwise cleaned
him- or herself.
ly to submit kits when the victim had
bathed between the time of the assault The authors recommend that LEOs
and the time of evidence collection, and work with a multidisciplinary group
more likely to submit kits when physi- involving forensic scientists, prosecutor
cal (non-anogenital) injury was docuand law enforcement supervisor to demented by the SANE. High case loads velop a decision tree to determine
for LEOs made it less likely that a kit
when sexual assault kits should be subwas submitted to the crime lab for anal- mitted to the crime lab for analysis.
ysis, while high engagement between
They also recommend that crime labs
LEOs and SANEs made it more likely develop a system to track all kits that
that the kit would be submitted.
In the Midwest county in
which the study took place,
only 58.6% of sexual assault kits were submitted to
a crime lab for testing by
law enforcement officers in
the county. 82.5% of victims had conducted some
type of self-cleaning (e.g.,
bathing, douching) after the
assault.
The authors note that untested sexual assault kits are
Burg, A., Kahn, R., Welch, K.
(2011). “DNA Testing of Sexual
Assault Evidence: The laboratory
perspective.” Journal of Forensic
Nursing, 7, 145-152.
This article explains the process and
scope of DNA testing in sexual assault
cases and describes CODIS, a national
database of DNA profiles. DNA results
from a case in which the suspect is not
identified because the perpetrator was a
stranger, and/or the victim was
drugged, can be submitted to CODIS in
hopes of finding a match that may help
law enforcement identify a suspect or a
behavioral pattern that could help with
the investigation.
The authors note that although a victim
may report vaginal assault, semen may
be present around the anus or on clothing or linens. They also note that saliva,
blood, skin, and hair roots can also be a
source of DNA. Samples
from the victim and any
consensual sex partners are
important in order to rule
out “unknown sources” of
DNA evidence. The article
also explains the reasoning
behind the number of
swabs used for evidence
collection, why areas are
swabbed simultaneously
rather than sequentially,
and why evidence must be
dried and packaged in paper
containers.
www.uccs.edu/bethel/SANE.htm
5
FORENSIC GURU CORNER
There has been significant media attention recently related to untested sexual assault evidence collection kits.
As the article on the previous page describes, there has
also been research conducted to examine the extent of
this problem in some states. The Colorado SANE Project interviewed Sheri Murphy of the Colorado Bureau
of Investigation regarding this topic.
Colorado SANE: Tell us about the Colorado Bureau of
Investigation laboratories. Where are they located?
How are they accredited? Are they qualified to submit
evidence into CODIS?
Murphy: The Colorado Bureau of Investigation (CBI)
has 5 laboratories serving the state of Colorado. The 3
largest of those perform DNA analyses – at the Denver,
Grand Junction and Pueblo labs. The laboratories of
CBI are accredited through the American Society of
Crime Laboratory Directors – Laboratory Accreditation
Board (ASCLD-LAB). We are qualified to submit profiles to the Combined DNA Indexing System (CODIS).
tody over 30 days. So yes, by either definition, we do
have a backlog. As to SA [sexual assault] evidence, our
turnaround time is approximately 4-6 months.
Colorado SANE: Why is there a backlog and how is CBI
planning to address that?
Murphy: CBI labs analyze evidence from cases throughout most of Colorado covering crimes from felony
property crimes to homicides. I feel CBI Forensic Services is always looking for people and technologies to
make ourselves most effective and efficient to serve the
agencies and citizens in Colorado.
Colorado SANE: Is it your understanding that all evidence collection kits are being submitted to the lab for
analysis?
Murphy: I do not have access to information that could
tell me if all sexual assault cases in Colorado have physical evidence submitted to the CBI Forensic Services Division. I have heard of studies done in other states that
found the reasons
Even if forensic analysis doesn’t directly benefit the sexual assault case for which evidence was for not submitting
collected, having the suspect’s DNA profile entered into CODIS may provide future benefits. evidence included:
Colorado SANE: What is the benefit of your CODIS
access?
Murphy: Because of the mobile nature of our society,
being able to enter samples into CODIS gives opportunities to solve crimes that had no suspect identified
through normal investigations. Because CODIS is a national network of DNA laboratories, it also has linked
cases between jurisdictions that were previously unknown to be related. Cases that appear to be isolated in
nature may in fact be the result of a serial criminal.
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The case was solved without the analysis
Charges were dismissed
Charges were never filed
The officer felt the analysis would not be useful.
Again, these are not answers from Colorado law enforcement. These answers may or may not apply to
specific law enforcement agencies around Colorado.
Colorado SANE: Does CBI encourage law enforcement
officers to submit evidence from all sexual assault cases
for forensic analysis?
Colorado SANE: Do the CBI labs currently have a back- Murphy: CBI will accept any evidence that has an assolog of evidence to be analyzed?
ciated criminal investigation by the submitting law enMurphy: The term backlog refers to evidence that is in forcement agency.
our custody waiting for analysis. The definition from
For more on the Colorado Bureau of Investigation, visit
NIJ [National Institute of Justice] is evidence in our cus- cbi.state.co.us
www.uccs.edu/bethel/SANE.htm
6
ANNOUNCEMENTS 
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University of Colorado Colorado Springs is now offering a Certificate in Forensic
Nursing. The certificate program requires completion of 12 credit hours provided
in an online format. Courses address strategies for violence prevention and multidisciplinary response to violence. For more information on this program, contact
the UCCS Beth-el Extended Studies Program at bees@uccs.edu or 719-255-4486.
Looking for free CNE credits for your SANEs? Have them complete the online
Colorado DFSA Kit Education Module anytime for 1.0 CNE.
October is Domestic Violence Awareness Month, and Forensic Nurses Week is
November 12-16. Consider planning a marketing or fundraising event for your
SANE program or SART to coincide with these national events using resources
from The National Resource Center on Domestic Violence and/or International
Association of Forensic Nurses.
Memorial Hospital’s Forensic Nursing program was recently featured in the
Colorado Springs Gazette.
Looking for SANE clinical opportunities? 9Health Fair is now scheduling volunteers
for its fall fairs—nurses can perform well-female pelvic exams. Contact Kimberly
Penney at 303.996.2131 to coordinate the nurses and mentors.
Colorado sane
project
Offices for the Colorado SANE
Project are located at:
The University of Colorado
Colorado Springs (UCCS)
Beth-El College of Nursing &
Health Sciences
1420 Austin Bluffs Parkway
Colorado Springs, CO 80918
www.uccs.edu/bethel/SANE.html
Colorado SANE Project
Director
Val Sievers: 719-255-3585
vsievers@uccs.edu
Colorado SANE Project
Assistant
Kori Magallanez:
719-255-4354
kmagalla@uccs.edu
EDUCATIONAL OPPORTUNITIES Fall 2012 Advanced Forensic Nurse
Examiner Education Course at UCCS
November 7-9, 2012
Register at www.uccs.edu/bethel/
afne.html
Spring 2013 Sexual Assault Nurse
Examiner Education Course at UCCS
Adult/Adolescent/Courtroom session:
January 14-17, 2013
Pediatric session: February 12-14,
2013
Register at www.uccs.edu/bethel/
sane.html
Colorado SANE Peer Review
January 9, 2013 at 9:30 a.m.
Contact your SANE Program Coordinator to participate. CNEs available.
Colorado Drug-Facilitated Sexual
Assault Kit Education Modules
Free education available anytime
online for 1.0 continuing nursing education credits.
Colorado IAFN
Day of Education: Forensic Nursing
DATE CHANGE: November 16, 2012
For more information, visit: http://
community.iafn.org/colorado/home/
Email future educational opportunities or announcements to Kori Magallanez at: kmagalla@uccs.edu