Quarterly newsletter of the Colorado sane project
Colorado SANE
Collecting Clothing in Non-Reported
Cases of Sexual Assault
The Colorado SANE Project recently conducted a survey of
more than sixty law-enforcement officers, victim advocates,
legal professionals, and healthcare professionals in rural
and urban areas of Colorado regarding current practice and
potential issues with the collection of clothing as evidence
in cases of sexual assault that are not reported to law
enforcement. Important findings from the survey are
described below.

92% of law enforcement and healthcare professionals agreed that there
should be no difference in collection of clothing as evidence regardless of
whether the victim initially chooses to report the assault to law
enforcement.

71% of law enforcement personnel reported there is no issue with space
for storage of evidence in their jurisdiction. Those who reported problems
with storage space represented both urban and rural areas of the state.
Several respondents to the survey pointed out that victims sometimes change
their minds about reporting an assault, and evidence not collected during the
initial exam is unavailable later for investigation of the case.
See the Forensic Guru Corner on page 2 for more information regarding best
practices for evidence collection in Colorado.
Continued on Page 3
Issue 5
June 2012
In this issue:
Special points of interest:
Forensic Guru Corner
2
DFSA Drug Highlight
4
Professional Boundaries
5
Scenarios
6
Research Report
7
Announcements & Education Opportunities 8
* The decision of whether to collect clothing as
evidence should result from the patient history.
 SANEs should prepare to manage symptoms of
vicarious trauma.
 Sexual assault survivors who seek treatment and
report to police are less likely to experience
regret.
 Respecting professional boundaries enables the
ongoing success of the multi-disciplinary response.
2
FORENSIC GURU CORNER
The Colorado SANE Project interviewed Sheri Murphy,
Colorado Bureau of Investigation; Detective Mark Slavsky,
Wheat Ridge Police Department; and Sergeant Russell
Lengel, Limon Police Department regarding appropriate
collection of clothing in cases where victims choose not to
report sexual assault to law enforcement.
Murphy: In most cases, the kit is the best evidence. But
that’s not true for every case.
Colorado SANE: If a patient chooses not to report a
case of sexual assault to law enforcement, should
SANEs still collect clothing as part of the evidence collection process?
Slavsky: Personally, as an investigator, I would always
want the clothing and any other evidence available.
Colorado SANE: Based on your experience in your jurisdiction, are law enforcement officers storing clothing
bagged as evidence in cases of non-reported sexual assault?
Lengel: We have had one and the victim refused to provide her clothes to the hospital staff. But, if she would
have provided the clothes they would have been taken
Murphy: I believe if they would do so in a reporting
as evidence. We have had such a limited number [of
case with an otherwise similar scenario, they
should. The non-reporting law in the state of Colorado, non-reported sexual assaults] in our area, I don't think
as I understand it, discusses the collection of evidence this would be a problem to store the clothing as eviduring a forensic exam. Clothing is evidence. I know, dence.
too, there are groups outside Colorado who are proColorado SANE: Do you perceive storage of clothing in
There should be no difference in clothing collection based on whether the patient
chooses to report or not report the assault to law enforcement.
moting the collection of any/all evidence in nonreporting cases.
Colorado SANE: Will law enforcement take the clothing along with the specimen kit?
Murphy: Yes. The law enforcement agency with jurisdiction is responsible for the preservation of the evidence in non-reporting cases.
non-reported cases will be
problematic for law enforcement agencies?
Slavsky: Admin and evidence techs have storage concerns that are legitimate, but I just don’t see nonreports as being that overwhelming in numbers.
Lengel: I don't see this as a problem for law enforcement agencies in rural Colorado.
These interviews reveal that the best practice in accordance with Colorado law is for SANEs to collect clothing
Colorado SANE: Can you describe a case in which
in all cases of sexual assault in which the patient indiclothing was used as evidence in a sexual assault case?
cates by the history that clothing would be considered
Murphy: There are cases where the suspect doesn’t
evidence. There should be no difference in clothing colleave a significant amount of DNA on the victim’s body,
lection based on whether the patient chooses to report
or the victim waits to report the sexual assault. In those
or not report the assault to law enforcement. The clothcases, the clothing may be the only evidence to yield
ing will be collected and stored as evidence by local law
probative DNA results.
enforcement. Remember: Evidence not collected can
Colorado SANE: How important is clothing as a type of never be recovered.
evidence?
Continued on next page
www.uccs.edu/bethel/SANE.htm
3
FORENSIC GURU CORNER
lected during the initial exam (when the case was a nonreport) can be vital to the outcome of the case. Initial
The Colorado Department of Criminal Justice reports
results from a project by the Colorado Department of
that in 2011there were only 50 cases of sexual assault in
Criminal Justice to evaluate this rate in Colorado sugColorado in which the victim had evidence collected,
gests that our rates are very similar to the national rate
but did not report the assault to law enforcement. This
(10-15%).
confirms the above statements that the volume of such
cases should not pose a significant storage problem for SANE programs should coordinate with local law enlaw enforcement.
forcement to prepare them to expect clothing in cases
of non-reported sexual assault and plan for storage caNational data demonstrate that about 15 percent of sexpacity accordingly.
ual assault victims
who initially choose
Colorado law (CRS 18-3-407.5-3c) states that law ennot to report the
forcement officers must collect and store evidence in un
assault to law en-reported cases of sexual assault for two years. Since
forcement eventualclothing is considered evidence in sexual assault cases, it
ly change their
should always be collected by the SANE and provided
minds and do decide
to law enforcement as evidence, if indicated by the victo report; in such
tim's description of the event.
cases, evidence colContinued from Page 2
Collecting Clothing in Non-Reported
Cases of Sexual Assault
Continued from Page 1
The following quotes come from survey respondents.
“If clients later decide to report and the evidence was not gathered, will this significantly impact the quality of their case?”
-Victim advocate
“Sometimes the clothing is crucial as evidence and should always be collected. At worst, the case might never be prosecuted, “Frequently the best evidence available is located on clothing
rather than the victim’s body. Obtaining articles of clothing
but it if is, we will have the evidence we need.”
may be the only opportunity to effectively prosecute the case at
-Law enforcement officer
some future point.”
“I would rather have and not need than need and not have…
-Law enforcement officer
good practice in my opinion.”
“I believe that cases should be handled consistently. A patient
-Law enforcement officer
may change their [sic] mind and feel that their case was com“LEOs [Law Enforcement Officers] always face storage issues,
promised because their evidence was handled differently than
but we cannot allow the storage issues to dictact [sic] whether
someone who chooses to report initially.”
or not we collected crucial evidence.”
-Healthcare provider
-Law enforcement officer
4
DFSA Drug Highlight: GHB & Ketamine In this edition, we focus on two drugs commonly used to facilitate sexual assault: GHB and Ketamine.
Gamma-hydroxybutyrate (GHB) is a central nervous system (CNS) depressant and a Schedule 1 controlled substance, available illicitly as a powder or liquid. The liquid form is commonly mixed into drinks to facilitate sexual
assault, and is colorless and odorless with a slightly salty taste.
Effects of GHB include euphoria, drowsiness, decreased anxiety, confusion, memory impairment, visual hallucinations, and small pupils. Patients presenting under the influence of GHB often exhibit cyclic symptoms, seeming awake and agitated, then becoming profoundly sleepy and obtunded.
The drug is used to facilitate sexual assault because it causes increased passivity and suggestibility, as well as
amnesia.
Ketamine is a dissociative anesthetic that is short-acting . Ketamine can cause sedation, immobility, pain relief
and amnesia. It is sometimes abused for pain relief and to induce hallucinations. The drug is found in powder
form, which can be inhaled or smoked, and as a liquid, which can be mixed into a drink or injected.
People under the influence of ketamine will have a rapid heart rate for a brief time, and also experience nausea,
unresponsiveness, rapid eye movement, dilated pupils, stiff muscles, sleepiness, and secretion of tears and saliva.
The drug effects begin quickly after ingestion, inhalation or injection, and wear off quickly, as well. After the
drug wears off, the patient typically exhibits euphoria and confusion.
Sources:
Colorado Drug-facilitated Sexual Assault (DFSA) Kit Educational Module. 2012.
http://www.uccs.edu/bethel/sane/coloradodfsa.html
Drug Fact Sheet: GHB. United States Drug Enforcement Administration. http://
www.justice.gov/dea/pubs/abuse/drug_data_sheets/GHB.pdf
Drug Fact Sheet: Ketamine. United States Drug Enforcement Administration.
http://www.justice.gov/dea/pubs/abuse/drug_data_sheets/Ketamine.pdf
View the Colorado Drug-Facilitated Sexual Assault 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.
Beth-El College of Nursing and Health Sciences at University of Colorado Colorado Springs
is an approved provider of continuing nursing education by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission
on Accreditation. Provider#: BEC-0114, Exp. Date: 1/01/31/2014
www.uccs.edu/bethel/SANE.htm
5
PROFESSIONAL BOUNDARIES
Several different types of professionals are involved in the process of responding to acts of violence, and
each responder provides an important expertise and role. For the benefit of the victim, all responders
should collaborate to provide a complete and appropriate response. In order to do this, all responders
must understand and appreciate the roles of other responders, as well the governing bodies that designate their practice.
 Law Enforcement Officers: Law enforcement officers are often the first responders in
cases of sexual assault, intimate partner violence/domestic violence, human trafficking, child maltreatment, and elder abuse. The role of the law enforcement officer is to
determine whether a crime occurred and, if so, investigate that crime. Officers are concerned with the collection and preservation of evidence, maintaining chain of custody
and getting accurate information from the victim in a timely manner to enable effective investigation. Actions of law enforcement officers are governed by state and federal regulations.
 Healthcare Professionals: Physicians and nurses respond to physical trauma resulting
from assault, abuse or other violence. Forensic examiners are specially trained to collect
medical-forensic evidence resulting from acts of violence. Healthcare professionals practice under standards specific to their discipline and the policies and procedures of their
employer. For example, physicians are licensed by the Colorado Medical Board, while
nurses practice according to standards designated by the Colorado Board of Nursing.
Collaboration: the work and activity of a number of persons who individually
contribute toward the efficiency of the whole.
-Merriam-Webster Dictionary
 Victim Advocates: Advocates may be community volunteers or professionals with ex-
pertise in such areas as sociology or psychology, and may work for a communitybased or system-based program. Community-based advocates can offer greater confidentiality for victim disclosures. Advocates offer emotional support to the victim during difficult processes such as preliminary interviews with law enforcement, court testimony, or a medical-forensic exam by a healthcare professional. They also assist victims with accessing community services such as a safe house and counseling. Advocates practice according to their relevant clinical specialty and the mission of their employer.
 Criminal Justice Professionals: Attorneys and other legal professionals are primarily interested in suc-
cessful prosecution of a suspect or defense of a client. Successful legal proceedings
are highly dependent on the accuracy and completeness of information collected by
law enforcement and healthcare professionals and evaluation of that evidence by forensic scientists. Legal practice is governed by the Colorado Board of Law Examiners.
 Forensic Scientists: The evidence collected by forensic healthcare
examiners from a victim’s body and by law enforcement officers from a crime scene is
analyzed by forensic scientists at the Colorado Bureau of Investigation crime laboratory. Findings from this evidence provide information to law enforcement in support of
the investigation, whether to exonerate the innocent or support the arrest of a suspect,
and may also be used by attorneys during the course of the legal proceedings. The CBI
Laboratory is accredited by the American Society of Crime Laboratory Directors Laboratory Accreditation Board, demonstrating that it meets nationally-recognized standards
of operation for forensic laboratories.
Continued on next page
6
PROFESSIONAL BOUNDARIES
Continued from Page 5
 Social Services: The Colorado Department of Human Services manages the Child Protec-
tion Services and Adult Protection Services programs. Law enforcement officers (including
system-based advocates) and healthcare professionals are mandated to report suspicions of
child or elder abuse to the appropriate entity in their county, which has authority to protect
children and adults from unsafe environments.
Understanding and respecting professional boundaries enables each professional to conduct his or her
role according to appropriate practice for that profession. All responders should understand and respect
the roles of other responders to enable collaboration for the benefit of the victim. A multi-disciplinary
response is the best practice for managing violence in our communities.
Consider the following scenarios that describe actual situations in Colorado communities that relate to professional boundaries. Think about
how these types of issues arise in your daily work and how you can
appropriately manage the needs of the victim/patient within the standards of your profession.
Scenario 1
The mom of a 4 year old has brought her child to the after-hours clinic
two weekends in a row reporting that her child has ongoing problems
with urination and a discharge. The nurse is suspicious that the child
has been sexually abused. The physician suggests that the child has a
yeast infection and she has no concerns for sexual abuse and has no
plans to report to law enforcement or social services.
Scenario 3
A 25 year old woman goes to a local hospital requesting an evidentiary
examination. She tells a nurse that she remembers having one alcoholic
beverage at a party 48 hours earlier and waking up in an apartment she
was not familiar with and has discomfort in her pelvic area. The nurse
mentions to the responding police officer that she will be obtaining urine
for DFSA testing. The police officer tells the nurse that DFSA collection
will not be necessary since specimen collection for DFSA is only appropriate within 24 hours of ingestion.
Points for consideration:

The appropriate timeline for DFSA collection is up to 96 hours.

The evaluation of patient symptoms and history that may necessitate DFSA specimen collection is the responsibility of healthcare as
opposed to law enforcement.
Points for consideration:

Both nurses and physicians are among many who are mandated
reporters. If the nurse is suspicious, she/he has a responsibility to
report irrespective of the physician’s decision.

Evaluating previous medical records for the child might provide
insight on earlier diagnosis & treatment.
Scenario 4

An RNA urine culture might identify presence of gonorrhea or chlamydia.
A confidential victim advocate in a rural community is accompanying an
adult victim of sexual assault in an exam room in the hospital emergency department. A nurse assigned to provide care to the patient, knocks
Scenario 2
on the door and starts to introduce herself to the patient. The victim
advocate tells the nurse to leave the exam room since the patient/victim
A patrol officer in a college town responds to interview a 19 year old
has not decided if she wants an evidentiary exam.
student who reports being sexually assaulted by an acquaintance at a
party the night before. The officer tells the student that he will not
Points for consideration:
‘authorize’ an evidentiary exam at the hospital since he has concerns

In a clinical environment, the licensed healthcare provider is reabout false reporting, but if she prefers, she can go to the hospital and
sponsible for educating patients about care options, including the
pay for an exam.
medical-forensic examination.

Protection of confidential healthcare information and HIPAA conPoints for consideration:
siderations apply in the hospital.

According to multiple sources the incidence of false reporting of
sexual assault is < 10%, the same as for other felonies in the U.S.  The nurse, as an employee of the healthcare facility and licensed
healthcare professional, is responsible for the role as patient advo
There is no requirement for a law enforcement officer to ‘authorize’
cate, establishing a clinical relationship and assisting the patient in
a medical-forensic examination. The victim/patient makes the deciconsidering examination and treatment options.
sion and can request to have an evidentiary examination.

Law Enforcement is responsible for payment of a medical-forensic  This could be considered patient abandonment.
exam as required by statute when the patient reports a sexual assault. If the victim chooses not to report, DCJ will pay for the exam.
7
Research Review Maier, S., “The emotional challenges
faced by Sexual Assault Nurse Examiners: ‘ER nursing is stressful on a
good day without rape victims,’”
Journal of Forensic Nursing 7 (2011)
161–172_c 2011

SANE training
Reduce responsibilities of program
directors by limiting their length of
service, having an assistant director,
sexual assault who sought professional
treatment were more likely to report the
crime to police. Survivors who sought
treatment and those who reported the as-
SANEs commonly experience vicarious trauma and burnout. SANE coordinators should implement
methods to minimize these effects in order to support their staff and maximize retention.
Advocates, law enforcement and healthcare professionals can help victims make an informed decision
Through interviews with 40 SANEs in
about whether to report a sexual assault, that is least likely to result in regret.
four states, the researchers examine the
experience of SANEs with vicarious trauand rotating on-call schedules so that sault to police were less likely to experima (depression, anxiety, anger, and other
the director is not always the backup
physical, emotional and lifestyle symptoms
ence feelings of regret.
that result from caring for trauma victims)  Provide additional emotional preparaThe author states,
tion for SANEs who have personal
and burnout (“the psychological strain of
experience with sexual assault
working with troubled populations” result“One of the most salient findings

Include discussion of potential vicariing in symptoms of “depression, exhausfrom this study is that people who
ous trauma and burnout, as well as
tion, depersonalization, reduced feelings of
reported their assaults to the popositive coping strategies in SANE
accomplishment, apathy, loss of compaslice experienced significantly less
training
sion, and cynicism” (pg 162)) and what
regret about their decision to do
coping strategies SANE practitioners and
so as compared with those who
programs can implement to manage these Marchetti, CA., “Regret and Police
did not report. Although reportReporting Among Individuals Who
problems.
ing an SA may not be in the best
Have Experienced Sexual Assault,”
interest of every individual, it
Those most likely to experience vicarious Journal of the American Psychiatric
should be an option that is readily
trauma were SANEs who had personal ex- Nurses Association, 2012, 18:32
available to all, and it is important
perience with sexual assault (self or family
that clinicians are informed about
member) and program directors. Common This article acknowledges that fewer than
the complex decision-making procauses of stress included staffing and cover- 20% of rape events are reported to law
cess involved in making the choice
enforcement and that there are clear public
age issues, cases involving children and
of whether or not to report,
extreme violence, the inability to get away benefits to increased reporting (preventing
which is often a difficult choice for
from the job (on-call schedule, community recurrence). Current decision-making thevictims of SA” (pg 36-37).
contacts outside of work), and the lack of ory suggests that we make choices based
follow-up with victims (wondering about “not only on the probability and the value An understanding of how regret is involved
their safety or emotional well-being). Di- of the chosen outcome but also on the
in decision-making can help all responders
amount of regret for alternatives not cho- educate survivors in a way that empowers
rectors and SANEs working in hospitalsen” (pg 33). The study involved comple- them to make the best possible decision.
based programs (as opposed to programs
funded through a state agency or prosecu- tion of a brief online confidential survey by
tor’s office) were most likely to experience 78 men and women
aged 18-25 who had
burnout.
experienced sexual
The author recommends the following
assault in the past five
procedures to minimize vicarious trauma
years. Fifty-one perand burnout:
cent of participants
reported that they

Limit the number of hours SANEs
sought “professional
spend treating victims
treatment” following

Limit on-call hours
the event (a SANE

In order to accommodate the first two exam would be inrecommendations, increase the num- cluded in this categober of trained SANEs by providing
ry), and 36% reported
incentives to nurses who complete
to police. Survivors of
www.uccs.edu/bethel/SANE.htm
8
ANNOUNCEMENTS 





The Colorado SANE Advisory Board would like to welcome its newest member: Karen Sanson of
Valley View Hospital in Glenwood Springs. We appreciate your commitment to supporting SANE
programs in Colorado.
The testing window is now open to apply to sit for the SANE certification exams in October
2012. Visit IAFN to apply and download the Candidate Handbook.
University of Colorado Colorado Springs is now offering a certificate in Forensic Nursing. The
certificate program requires completion of 12 credit hours; courses are offered in an online
format and address strategies for violence prevention and multi-disciplinary 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.
Need to get away? Take a look at these upcoming national conferences:

The National Sexual Violence Resource Center is planning its National Sexual Assault
Conference in Chicago, August 21-24, 2012.

The Emergency Nurses Association is planning its Annual Conference in San Diego,
September 11-15, 2012.

The International Association of Forensic Nurses (IAFN) is planning its 20th Annual
Scientific Assembly in Puerto Rico, October 10-13, 2012.
Save the date for the Colorado Sexual Assault and Domestic Violence Center’s Fall Fundraising
event, September 14, 1600-2000 at the 23rd Ave Sculpture Studio and Gallery in Denver.
Support the St. Anthony’s Summit Medical Center SANE program by participating in the ABATE
Poker Run, a 160 mile motorcycle ride, poker tournament, and party on July 28. For details,
email blemkhul@msn.com or call 970-485-0313.
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.htm
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 Summer 2012 SANE Education Course Colorado SANE Online Peer Review Call
at UCCS
July 11, 2012 at 9:30 a.m.
Adult/Adolescent: August 13-16, 2012 Contact your SANE Program Coordinator to participate. CNEs available.
Pediatric: September 12-14, 2012
Fall 2012 SANE Education Course
Colorado IAFN
Adult/Adolescent: September 24-27,
2012 in Aurora
Pediatric: October 24-26, 2012 at
UCCS
Day of Education: Forensic Nursing
November 9, 2012
For more information, visit: http://
community.iafn.org/colorado/home/
Fall 2012 Advanced Forensic Nursing
Education Course at UCCS
Colorado ENA
November 7-9, 2012
Registration is now open at: http://
www.uccs.edu/~bethel/SANE.htm
2012 Colorado ENA Conference
September 5, 2012
For more information, visit: http://
community.iafn.org/colorado/home/
Email future educational opportunities or announcements to Kori Magallanez at: kmagalla@uccs.edu