
P.O. Box 599 Parlin, NJ 08859
www.nj-iafn.org e-mail: contact@nj-iafn.org
A New Year Begins....
The "New Jersey Chapter of the International Association of Forensic Nurses" (NJ-IAFN) begins the Year 2000 with new officers after the election held last December. Many thanks to the hard work and perseverance of outgoing President Mary Szaro and Vice-President Catherine Dougherty, for having the vision and the energy to start the original organization, and to succeed in having it accepted as the very first state chapter of the IAFN.
Year 2000 NJ-IAFN Officers
:
| IAFN | Phone: 856-256-2425 |
| East Holly Avenue, Box 56 | Fax: 856-589-7463 |
| Pitman, NJ | e-mail: iafn@ajj.com |
| 08071 | website: www.ajj.com |
| The next meeting of the NJ-IAFN will be on March 2nd, 2000 at 9:30 p.m. at Seton Hall University, College of Nursing, after the course on Forensic Photography. |
In This Issue:
| The "New Jersey Chapter News" is the official newsletter of the NJ-IAFN, Inc. Editor: Alice Lloyd, RN. We welcome articles and comments. |
NJ-IAFN Membership Update
Membership fees of $25 are due for the year 2000
If you have not already sent in your renewal form and dues, we ask that you do so now. There is a renewal form included with this newsletter. Those who paid for membership in September of 1999 or later will be counted as being paid up for the year 2000. NJ-IAFN membership entitles you to attend NJ-IAFN meetings, receive the newsletter, receive notices of upcoming events and to vote in elections of officers. Whenever possible, we offer discounts to NJ-IAFN members at educational and other events sponsored or co-sponsored by us.
Membership is open to all nurses and student nurses who are working in or interested in the field of forensic nursing. Associate membership is also available to non-nurses who are actively involved in the field of forensic science and who support the concepts of forensic nursing.
You must join the International Association of Forensic Nurses (IAFN) in order to join the New Jersey Chapter. IAFN membership does not automatically make you a member of a chapter, according to the guidelines as presently set up by the IAFN. State and local chapters require a separate application form and separate membership fee.
Membership in the IAFN, however, does automatically make you a member of whatever geographical region your state is considered to be a part of. According to present IAFN guidelines, you do not have to apply separately or pay a separate fee to be considered a member of your region.
The Mid-Atlantic Region – IAFN
New Jersey is included as part of the Mid-Atlantic Region, which consists of New York, New Jersey, Pennsylvania, Maryland, Delaware and the District of Columbia. The Mid-Atlantic Region, formed in 1997, has its own Board of Directors, Officers and State Representatives and holds quarterly meetings and educational programs, with an annual program usually held at the University of Pennsylvania. The head of the region is titled the Mid-Atlantic Regional Representative, and reports to the IAFN Board of Directors. For information about the Mid-Atlantic Region, mail or fax inquiries to:
The Mid-Atlantic Region – IAFNThe next Mid-Atlantic Regional event will be a mini-conference, "Violence and Its Victims," April 7th & 8th in Crofton, Maryland.
Mid-Atlantic Region Election Results
Kathy Brown, CRNP, Ph.D., and University of Pennsylvania SANE Training Program Director, was elected as the new Mid-Atlantic Regional Representative, during an election held this past November. Ms. Brown is a member of the adjunct faculty in the forensic graduate program at the University of Pennsylvania, as well as the national Chairperson of the IAFN’s Education Committee. Ms. Brown will be taking over from Eileen Allen, BSN, Monmouth County SANE Program Coordinator. Ms. Allen was essential in forming the Region in 1997 and in making it as active as it has become. Ms Allen received the Mid-Atlantic Region’s Outstanding Achievement Award in 1998.
State representatives that were elected include Debbie Holbrook of Delaware, Alice Lloyd of New Jersey and Rina Rovere of New York. The representatives from the other states were not up for reelection at this time and will continue in their current positions.
The Forensic Nursing Forum
The Forensic Nursing Forum, affiliated with the New Jersey State Nurses Association, was formed last year as a means for Forensic Nurses in New Jersey to be more proactive in legislative and nursing regulatory issues. It is not affiliated with the NJ-IAFN, but we do encourage our members to join. You must first join the ANA/NJSNA. The Forum charges no additional dues and holds meetings on an as-needed basis. For more information about the Forensic Nursing Forum contact the New Jersey State Nurses Association by phone: 609-883-5335 or (toll free) 1-888-876-5762 or visit their website at
www.njsna.org. Mary Szaro, the current President of the Forum can be reached via e-mail: NJAFN@aol.com.Sexual Assault Nurse Examiner (SANE) Update
NJ-IAFN worked hard this past year to promote SANE nursing in New Jersey. In May of 1999, NJ-IAFN and CentraState Medical Center in Freehold co-hosted a SANE/SART Developmental Workshop, with guest speaker Linda Ledray, RN, Ph.D., SANE. The workshop included a panel of state and local representatives representing the different components of a SART (Sexual Assault Response Team).
Dr. Ledray is Director of the Sexual Assault Resource Service in Minneapolis, MN and works with the Department of Justice, Office for Victims of Crime, to promote SANE/SART nationwide. For information on how to host your own workshop, visit the SANE-SART website at www.sane-sart.com.
The SART panel of speakers included:
SANE Nurses: Susanne Roberts, Deborah Johannemann, and Denise Viscuso
Law Enforcement: Det. Sgt. Stephen Bauman of the Ocean County Sheriff’s Department
Rape Care Advocacy: Vicki Lunde, State Rape Care Program Coordinator
Forensic Science: Pamela Smith, Biochemistry Unit, East Regional State Police Lab at Sea Girt
Hospitals: CentraState Medical Center’s Senior VP/Corporate Counsel Alice Guttler and ED Nurse Manager Cyndy McCarty-Kowalski
Criminal Justice: Deputy Attorney General James Gilson
Prosecutor's Office: Barbara Stolte, Middlesex County Asst. Prosecutor, Sex Crimes Unit (Ms. Stolte was unable to attend, due to the earlier than expected birth of her baby.)
"Wanted: Nurses Interested in Helping Victims of Sexual Assault"
In summer of 1999, NJ-IAFN mailed informational flyers about SANE Nursing to hospitals and other selected nursing agencies, in order to spread the word about available grant funding and to give nurses an opportunity to learn more about SANE nursing and training. NJ-IAFN also held two informational meetings in September of 1999 for those nurses who responded to the flyers and expressed an interest in learning more. Our heartfelt thanks goes to Seton Hall University in South Orange and to Community Medical Center in Toms River for hosting those meetings. Special thanks also goes to Deputy Attorney General James Gilson, for taking time out of his busy schedule to be our guest speaker at both meetings. We had a good response to the flyers that were sent and good turnouts for both sessions.
SANE Grant Funding Available
New Jersey County Prosecutors’ Offices had a unique opportunity in 1999 to apply for grant funding to develop SANE programs in every county. There was up to $100,000 of federal grant money available through the Victims of Crime Act (VOCA), which each county’s Prosecutor’s Office could apply for to use to start up a county-wide SANE program. This money could be used to reimburse nurses for their SANE training (after 6 months of working as a SANE), to pay for the cost of the SANE exams, to buy necessary exam equipment such as a colposcope, and to provide comfort kits for sexual assault victims and beepers for the nurses.
Federal grant money has been available in the past through the Violence Against Women Act (VAWA), which other agencies have utilized to start up and to maintain SANE programs. Presently there are SANE programs in Camden, Middlesex, Monmouth, and Sussex counties, with many other counties working towards or about to start up their own programs.
Seton Hall University Hosts New SANE Training Program
Thanks to the hard work of program director Leona Kleinman, the very first SANE training was held at Seton Hall University January 5th-9th, 2000, with guest lecturer Dr. Linda Ledray. Topics included everything from SANE/SART program development to forensic evidence collection, colposcopy, Rape-Trauma Syndrome and care of rape victims. The final day included a mock trial held at Seton Hall Law School. Twenty nurses completed the training, and the program was so well received that Seton Hall has already scheduled another one in May, plus they plan to incorporate SANE training into their Nurse Practitioner Program.
NJ-IAFN SANE Council Formed
The NJ-IAFN has formed a SANE council to coordinate information about SANE nursing, SANE training programs, SANE/SART programs statewide and to help nurses who are interested in training and working as SANEs. Carole Boutilier, SANE Program Coordinator for Sussex County, is the chairperson of the council, which also includes Lisa Arbolino, Kim Lewis and Ann Marie Savoye. Any other NJ-IAFN members that are interested in helping out with the SANE council can contact NJ-IAFN for more information.
Editorial: The Future of SANE in New Jersey
by Alice Lloyd, RN
(The views expressed in this editorial are my own and not necessarily those of the NJ-IAFN or the IAFN.)New Jersey is presently at a crossroads in the implementation of SANE programs, SANE training, and the overall practice of SANE nursing. There are representatives from many different areas: Law Enforcement, Legislature, Rape Care Advocacy, Division of Criminal Justice, Attorney General’s Office; that are justifiably involved in determining how these programs will be set up, who will fund them, how the SANE nurses will be trained, and who will train them. The weakest voice amidst all those concerned with developing SANE/SART programs is that of Nursing, and more specifically Forensic Nursing. Non-nurses and non-health care agencies are forming advisory councils, proposing legislation, developing guidelines, making proposals to the state legislature and the state Board of Nursing and essentially deciding without us what the role of SANE Nurse will be.
This situation is not unique to New Jersey. Other states have dealt with these issues in the past or are presently dealing with them. In an effort to standardize SANE nationally, the International Association of Forensic Nurses (IAFN) has developed guidelines for Forensic Nurses, SANE nurses, SANE training, and Pediatric SANE Training. The IAFN is working on developing a national certification for the specialty of Forensic Nursing similar to that of other specialties, such as Emergency, Critical Care and OB/GYN Nursing.
Should SANE nursing be legislated and regulated or should it be treated as a nursing specialty? As Pat Speck, of the Memphis Sexual Assault Resource Center, wrote during a similar discussion on the IAFN-SANE Listserv: "the point I made with the (Tennessee) Board of Nursing was to treat us like other new nursing specialties, like hospice care, informatics or case management. No one set up rules and regulations in other emerging nursing specialties that had the effect of creating barriers to practicing the new nursing specialty, like Maryland, North Carolina and Kentucky (in her opinion) did. One reason no barriers were erected was because they based their clinical practice in nursing terms (not technical ones) that are understood by the (Board of Nursing.) Consequently, in Tennessee the educational components are not regulated by rules and regulations at this time - only recommendations, standards, and guidelines."
One argument put forth for regulation of SANEs is that SANEs are collecting evidence for legal purposes and therefore need some form of state-approved certification in order to be credible in this role. But is the role of a SANE more that of an investigator/collector of evidence or that of a nursing caregiver to victims of sexual assault? As Linda Ledray, Director of the Minneapolis Sexual Assault Resource Service put it: "If SANE nursing was only about evidence collection, then technicians could be trained to do it." Pat Speck also had a comment on this issue: "We invite closer scrutiny as forensic nurses when we teach only technique - like how to collect a kit or use a colposcope... but nursing requires critical thinking - forensic nursing requires critical thinking with the application of forensic principles."
Legislation has been proposed to the NJ State Senate (see the proposed Senate Bill #2244 printed below), that would require that all SANE Nurses, all SANE training programs and all County SANE programs receive certification and approval from the State Attorney General’s Office. This legislation would also give each county’s Prosecutor the job of appointing the county SSANE (State Sexual Assault Nurse Examiner) Program Coordinator to run the county’s SSANE Program.
How this would affect existing SANE programs, that are hospital or rape care center based instead of Prosecutor based, is not clear. How this would affect those nurses already working as SANEs is not clear. How this would affect those victims who seek help, but do not press charges against their assailants, is not clear. How this would affect the appearance of objectivity of SANE nurses testifying in court is not clear. How this would affect the ease with which the SANE training program or the exam could be updated is not clear. (Kentucky, the first state to legislate its SANE programs, has to pass new legislation or regulation if they want to update or change any part of their training or the exam.) How a non-nursing agency, such as the Attorney General’s Office, will be able to certify competency for nurses who are performing physical and psychosocial assessments on sexual assault victims, and planning follow-up care, is not clear.
What is clear is that New Jersey SANEs and Forensic Nurses need to come together and decide for themselves what their views are on these issues, and then ensure that those views will be presented along with those of the other agencies. We need to add our professional expertise to decisions regarding care of sexual assault victims, SANE programs and SANE training.
Decisions that are presently being made will have a lasting effect on victims of sexual assault, SANE nurses, SANE training and SANE/SART programs in New Jersey for years to come. Now is the time for us to come together and create a strong Forensic Nursing Voice to help guide these other agencies. Without our input, the decisions that will result may not be what are best for victims of sexual assault or for SANE nursing.
I urge you to make yourselves aware of what legislation is pending and decide for yourselves what effect it will have. I urge you to discuss these issues with your fellow nurses, forensic or otherwise. I urge you to write to the Board of Nursing and to your state legislator and voice your professional opinion about these issues. I urge you to join the NJSNA and the Forensic Nursing Forum, and to use these avenues to get your opinions heard.
By being aware of the issues and uniting together as professionals, we can use our combined voices and strength to help create a realistic and workable version of SANE/SART. In doing this, we will also create the best possible atmosphere for victims of rape and sexual assault to be able to come forward and get appropriate care and treatment, regardless of whether or not they plan to press charges against the offender; as well as create the best possible environment for nurses to work and develop professionally as SANE nurses.
Legislative Update:
There is presently a bill that has been introduced to the New Jersey State Senate that directly affects how SANE programs will be set up, SANE Program Coordinators appointed, and how SANE nurses will be trained and certified. This bill does provide for payment of SANE coordinator salaries, which was not included in the grant money available through the Victims Of Crime Act (VOCA).This bill can be found on the Internet at: http://www.njleg.state.nj.us/9899/Bills/s2500/2244_i1.htm
SENATE, No. 2244, State of New Jersey, 208th Legislature
Statement:
This bill establishes a Statewide Sexual Assault Nurse Examiner program (SSANE) in the Office of the Attorney General. The SSANE program shall ensuree more timely and accurate collection of forensic evidence for use in prosecuting suspected rapists and create a compassionate way to treat sexual assault victims.
Specifically, upon the implementation of the certification process for a forensic sexual assault nurse examiner, the bill requires the county prosecutor in each county to appoint or designate a certified forensic sexual assault nurse examiner to serve as a program coordinator to administer the SSANE program in the county. The county prosecutor may appoint an employee of his office to serve as program coordinator or designate an employee of a licensed health care facility to serve as the county’s program coordinator.
Under the provisions of the bill, the program coordinator shall:
The bill requires the Attorney General, in consultation with the New Jersey Board of Nursing, to establish a certification process for forensic sexual assault nurse examiners. An applicant for certification as a forensic sexual assault nurse examiner shall be a State licensed, registered professional nurse who has a minimum of two years nursing experience in the State, certification verifying the completion of a forensic sexual assault nurse examiner training program approved by the Attorney General, and the ability to demonstrate clinical competence in performing a forensic sexual assault examination. The Attorney General shall certify an applicant who meets the requirements of the certification process as a certified forensic sexual assault nurse examiner and, in consultation with the New Jersey Board of Nursing, oversee the administration and development of curriculum, instructor qualifications and regulations necessary to implement the certification process.
The bill also requires the Attorney General to establish the Sexual Assault Nurse Examiner Program Coordinating Council comprised of the Attorney General or his designee, the Director of the Division on Women in the Department of Community Affairs or his designee and the program coordinators from each county. The coordinating council shall oversee the SSANE program and make recommendations to the Attorney General on the administration of the program in each county.
The bill provides civil and criminal immunity to forensic sexual assault nurse examiners, licensed physicians and licensed health care facilities in which a forensic sexual assault examination is performed, when acting in response to a request from a law enforcement agency or a program coordinator to perform an examination pursuant to the provisions of the bill.
The bill repeals P.L. 1997, c.328 which established the Sexual Assault Nurse Examiner program in Monmouth County since this bill establishes a Statewide program.
The bill also directs the Attorney General to adopt rules and regulations necessary to effectuate the purposes of the bill.
Finally, the bill appropriates $1,130,000 from the General Fund to the Department of Law and Public Safety to fund the program coordinator positions in each county.
Woods Lamp Effectiveness Questioned:
An article published in the December 1999 issue of PEDIATRICS* questions the ability of the standard Woods Lamp (WL) to accurately detect the presence of semen. This study was intended to determine if physicians using Woods Lamp analysis could distinguish semen from other products, such as A&D ointment. The investigators found the Woods Lamp itself to be unreliable in detecting semen. None of the 29 semen samples, wet or dried, fluoresced under the Woods Lamp. When an alternate light source was used however, it was discovered that "the optimal fluorescence of semen appears to be at a longer wavelength than that provided by the standard WL... at a wavelength near 490 nm rather than 360 nm." *
The article went on to say, "Regardless of the light source used by the examining physician, when sexual assault is suspected, forensic samples should be obtained for definitive confirmatory studies (DNA analysis) and the light should be used only as an adjunct in the investigative process."*
*PEDIATRICS, Vol. 104 No. 6 December 1999 Karen A Santucci, MD; David G. Nelson, MD; Kemedy K. McQuillen, MD; Susan J. Duffy, MD; and James G. Linakis, Ph.D., MD
SANE as Expert Witness
Denise Viscuso, SANE nurse and Camden County SANE Program Coordinator, was recently qualified as New Jersey's first Forensic Nurse Expert during a rape trial in October of 1999. Earlier last year, SANE nurse Susanne Roberts qualified as an expert in Women’s Health while testifying in a rape trial. SANE Nurses have qualified and testified as experts in other states for years, and have usually been considered credible and reliable.
Two recently published articles, however, are critical of two SANE nurses who testified as expert witnesses in two separate trials. The first article was published in the Fall 1999 issue of the "Scientific Sleuthing Review."1 In this article, a SANE nurse from Virginia was criticized for her testimony in answering the question of "whether or not an injury to the genital region of the victim could have been consistent with a virgin’s having consensual sex for the first time." The SANE nurse "explained a woman’s anatomical reactions to a sexual stimulus which is consensual" and stated that "consensual sex was plainly out of the question in this case, because when the human sexual response is triggered (in the course of consensual sex) injuries do not occur."2
The article criticized the SANE on two issues. First, that she could say this, in light of other experts having published articles about consensual injuries and gynecological conditions that can mimic injuries. And second, because in Virginia, an expert is not allowed to give an opinion on the ultimate issue of guilt or innocence of the defendant. By testifying that the one injury observed could only have been caused by non-consensual sex, the author felt that the SANE nurse was testifying directly that the defendant was guilty of rape. The case was appealed for this reason, but the Virginia Supreme Court, by a vote of 4 to 3, upheld the admissibility of the nurse's testimony, over the strong dissent of three of the judges.
The second article was published in the Winter 1999 IAFN newsletter.3 It is about a SANE expert witness in California whose testimony and credibility was completely corrupted by her inability to recall details from the one scientific article upon which she had based her opinion. The IAFN article points out that "when it comes to expert witness testimony, an expert needs to state that the injuries they are testifying about are based on their experience seeing these injuries. When necessary, specific detailed knowledge of a published journal article must be the professional expectation by any expert witness when they rely (or even consider) on an article for all or part of their expert witness testimony."4
SANE Nurses testifying as expert witnesses will become more and more common in New Jersey as SANE programs expand statewide. The expertise that the SANE will bring to the courtroom will carry great weight in helping a jury to determine whether or not injuries are the result of consensual or non-consensual sexual intercourse. Realizing the impact of their opinions and basing these opinions on knowledge, experience and current scientific principles and research will help the SANE to appear credible and reliable in court. This, along with being more aware of what is expected of an expert witness and being prepared for courtroom testimony, will help future SANE Nurses to avoid similar occurrences such as what happened to the two SANEs in California and Virginia.
Not All Forensic Nurses are SANE
The majority of this newsletter has been devoted to issues involving SANE nursing. While SANE is an important topic at this time in New Jersey, and while the majority of forensic nurses do seem to be SANEs; there are many other sub-specialties of forensic nursing that we plan to write more about in upcoming issues.
For example, many nurses in New Jersey are presently working as Medicolegal Death Investigators with their County Medical Examiner’s Offices. Other nurses in New Jersey are involved in investigating child abuse/neglect, elder abuse and/or are working with victims of domestic violence. New Jersey is one of the few states in the nation that has a domestic violence response team, which operates out of Middlesex County. While the advocates who respond to aid these victims and their families are not required to be nurses, there are many nurses working in that program.
Other forensic nurses work in psychiatric institutions, trauma centers, schools, CCU/ICUs, as correctional nurses, legal nurse consultants or in the area of tissue/organ donation. There are many areas of nursing that overlap with the forensic arena. There are only a few nursing schools in the country, however, that offer a degree in forensic nursing at this time. There are also only a few hospitals in the country that offer the public a "forensic nursing program," where one area of the hospital is set apart for the forensic nurse to see all of these types of patients. This type of generalist forensic nurse program will hopefully be the way of the future. Similar to the American Board of Medicolegal Death Investigator's slogan of "Every Scene, Every Time," I foresee a time in the future when we will have "a forensic nurse on duty in every hospital, on every shift."
Internet Corner:
This is only a small part of what is available on-line.... just to get you started.Upcoming SANE Training Programs
MARCH:
APRIL:
MAY:
JULY:
OCTOBER:
For information on programs held at Rutgers University, contact:
Dr Gayle A. Pearson, Assistant Dean,
College of Nursing
Center for Professional Development
Phone: 973-353-5895
Fax: 973-353-1700
E-mail: gaylep@andromeda.rutgers.edu
For information on programs held at the University of Pennsylvania, contact:
For information on programs held at Seton Hall University contact:
Jackie Fowlkes
University of Pennsylvania, School of Nursing
Center for Professional Development
Phone: 215-898-4522
E-mail: jfowlkes@nursing.upenn.edu or visit their site at: www.nursing.upenn.edu/ce/Conferences.htm
Seton Hall University
College of Nursing
400 South Orange Avenue
South Orange, NJ 07079
Phone: 973-761-9314 or 973-761-9286
Upcoming Forensic Education Seminars
Instructor: Det. Dave Gamble, Forensics Unit, Monmouth County Prosecutors Office
Cost: $20.00 ($15 for NJ-IAFN members and Seton Hall Students)
*Seating is limited, call first to register, at 973-761-9314 or 973-761-9286
**There will be a short NJ-IAFN meeting after the seminar.
OCTOBER:
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New Jersey Chapter of the International Association of Forensic Nurses |
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Membership is open to all nurses and student nurses interested in, or working in, forensic nursing. Associate membership is also open to non-nurses who are actively involved in the field of forensic science and support the concepts of forensic nursing. If you would like to join the NJ-IAFN, please complete the application below and mail it, along with a check in the amount of $25.00 payable to "NJ-IAFN" to:
NJ-IAFN
NOTE
: NJ-IAFN members are required to be members of the parent association, the IAFN.-----------------------------------------------------------------------
NJ-IAFN MEMBERSHIP APPLICATION
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