Forensic Evidence in
Elder Mistreatment
Cases
Module 9
Nursing Responses to Elder Mistreatment
An IAFN Education Course
1
Forensic Evidence


Part of an assessment of elder
mistreatment (EM) may include collecting
and preserving evidence of mistreatment
on the patient’s body, clothing and/or
bedding
Forensic evidence encompasses objects
that can establish that a crime has been
committed or can provide a link between
a crime and its victim or a crime and its
perpetrator
R. Saferestein, Criminalistics: An introduction to forensic science, 1998
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Learning Objectives
By the end of this module, participants will be able to:


Discuss when evidence should be
collected from patients in elder
mistreatment cases and nursing roles
in collection and preservation
Describe general strategies for
evidence collection and preservation
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Case: Mrs. Walker



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Identify specific types of mistreatment
occurring in case study and related needs of
the patient
Do you think this case requires forensic
evidence collection? If yes, why?
Who should be notified?
What effect do you think evidence
collection might have on this case?
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When to Collect Evidence

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Case may have criminal elements
In course of an assessment, nurse sees or is
told about possible physical signs of
mistreatment on patient’s body, clothing
and/or bedding
Vulnerable older adults present for health
care and there are unexplained injuries
Consider time limits for obtaining evidence in
light of specific case circumstances
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Value of Forensic Evidence

Growing role for health care providers in
last 15-20 years in collecting, preserving
and documenting forensic evidence
L. Stokowski, Forensic issues for nurses : Part 1. evidence collection for nurses, 2008
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Nursing Roles

Nursing roles in evidence collection
can vary depending on factors such as
o
Practice setting policies
o
Jurisdictional requirements
o
o
Type of mistreatment and circumstances
of case
Experience/education of the nurse
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Nursing Roles

If a forensic examiner is available,
what do you think the general role of
the attending nurse is?
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Practice Setting Policies

Health facilities should have clear
policies in place that direct nurses
and other staff as to their
responsibilities related to gathering,
preserving and documenting forensic
evidence and procedures for carrying
out those responsibilities
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Supplies and Materials


Health care staff should have access
to supplies and materials they need to
collect and preserve forensic
evidence
Use of standardized pre-packaged
evidence collection kits is common for
some types of mistreatment (e.g.,
sexual assault/abuse)
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Evidence Collection Kit
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Law Enforcement Involvement

If there are signs of EM that suggest the
need for forensic evidence collection,
nurses should be aware of mandatory
reporting requirements and procedures
o
In most jurisdictions, health facilities are
required to notify law enforcement of
suspected acts of EM that may be criminal in
nature (gunshot wounds, domestic violence,
etc.)
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Questions

What do you currently do in terms of
evidence collection, preservation
and/or documentation when there are
physical signs of EM?
o
o
o
Policies?
What is your role? Who else is involved?
Procedures and techniques?
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Informed Consent

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Explain to patient need for forensic evidence
collection and what will be done
Ask patient for permission to collect evidence
Don’t do exam against will of patient
Law enforcement does not need to be in exam
room when evidence is collected
Victim advocates or other support persons can
accompany patients, if patients permit
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Chain of Custody

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Documentation of succession of persons
responsible for evidence
Its purpose is to ensure there is neither
alteration nor loss of evidence
Begins as soon as nurse locates physical
evidence
L. Stokowski, Forensic nursing: Evidence collection for nurses: Chain of custody, 2008
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Chain of Custody
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Seal evidence bags/envelopes with tape; do not
use staples
Label each item of sealed evidence
o
o
o
o
o
o
o
o
Patient's name
Description of item
Source of material
Name of person who collected item
Name of person who sealed evidence
Date and time it was collected and sealed
Names of those who release and receive evidence
Time it is transferred
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Sealing and Labeling Evidence
Fold the bag over. Secure with tape. Label with a patient ID
sticker, contents, source, your name, date and time. Then add
transfer information.
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
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Sealing and Labeling Evidence
All envelopes used for evidence
collection need to be sealed and
labeled in a similar fashion
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
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Sealing and Labeling Evidence
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
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Storage of Evidence

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Put sealed evidence containers into
locked evidence storage locker and
store until transfer to appropriate
agency
Access to locked evidence restricted
to trained/authorized supervisory
staff who understand importance of
chain of custody
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Handling and Packaging of Evidence


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Gloves should always be worn to prevent
contamination of evidence
Practice setting/local procedures and type of
evidence collected determines type of
packaging used
Be familiar with practice setting/local
procedures for wet evidence
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Clothing Evidence


Clothing should be dried,
placed on paper sheets to
prevent cross contamination,
and packaged in paper (not
plastic) bags
Paper bags are air permeable.
If there is any moisture
(blood, body fluids and
water), it will evaporate
through paper, avoiding
evidence destruction with
mold and bacterial growth
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
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Clothing Evidence

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Trace evidence on clothing and/or on
patients may fall off while patient
undresses
Whenever possible, have patient stand on
two sheets/papers while patient is
undressing
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Clothing Evidence


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To minimize crosscontamination,
separate clothing on
the drop sheet
Lay large items flat
Then individually
place each item of
clothing into a paper
bag
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
24
Trace Evidence on Body

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If patient has debris (trace
evidence), some of material
should be collected and placed
into clean and dry container
before it is washed away
Place debris into clean
container (e.g., envelope or
sterile plastic cup)
Document when debris was
collected, from where and by
whom
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
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DNA Evidence

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DNA can be retrieved from blood, saliva
and semen, as well as hair, hair follicles,
bone, skin tissue, mucous membrane cells,
and sweat
Since DNA from an individual is unique to
that person, it can be used to positively
identify person from whom the DNA was
collected
States differ in terms of requirements for
DNA evidence collection
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Other Uses: Biological Samples


Biological samples may used to prove
other issues besides contact between
patient and suspect (e.g., to document
presence of alcohol/drugs or STIs)
What procedures are used in your
facility/community to collect these
samples and maintain chain of custody?
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Case Study Questions

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Precautions evening shift nurse should take to
prevent loss or contamination of evidence?
Where would forensic nurse look for potential
sources of DNA evidence?
Other possible types of evidence to preserve?
What routine care for Ms. Smith should be
avoided until evidence can be collected?
In light of your learning in this module, how
should the evening shift nurse respond?
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Closing Assessment

What have you learned from this
module that you can apply to your
practice setting?
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