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Maintaining the chain of custody: evidence handling in forensic-cases

AORN Journal, Oct, 2003 by Mary Margaret Evans, Pamela A. Stagner

There is an epidemic of interpersonal violence in the United States, and it is the responsibility of medical personnel to identify, treat, and refer victims of abuse to appropriate authorities and ensure that items that may be presented as evidence in courts of law are not compromised. Clinical forensic nursing is a relatively new field that unites the disciplines of nursing science, forensic science, and criminal justice to protect victims' legal, civil, and human rights. (1) The term forensic derives from the Latin word forensics, meaning a public debate or forum or pertaining to the law. (2) The intertwining of law and medicine forms a medico-legal or forensic case.

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Forensic nurses diagnose and treat patients affected by interpersonal violence and serve as expert witnesses to educate juries about violence issues. They also work with district attorneys and law enforcement personnel to establish protocols specific to their communities to ensure admissibility of evidence in court.

Until the mid-1980s, forensic nurses either were trained on the job or sought their own education. In 1986, the American Academy of Forensic Sciences proposed a formal program in forensic nursing, and the same year, the University of Texas, Arlington, established such a program. (2) Today there are hospital-based training programs, state and national certification, and master's degree programs for forensic nursing, and this discipline is becoming formally established in emergency care settings throughout the country.

Memorial Hermann Hospital, Houston, houses the only forensic nurse examiner program in Houston. A forensic nurse examiner is an RN who is specially trained to provide comprehensive treatment to patients who are victims, suspects, or perpetrators of interpersonal violence. Forensic nurse examiners maintain competencies in medical forensic examinations and have the ability to serve as expert witnesses in courts of law. (3)

The coordinator of forensic nursing services at Memorial Hermann Hospital recognized the need to establish a formal program. Considering statistics on sexual assault alone, the necessity of such programs is evident. The youngest sexual assault survivor ever treated at Memorial Hermann Hospital was two days old, and the oldest was 94 years old. These types of crimes are disturbing, and their victims need advocates who are competent in both medical and legal settings.

Memorial Hermann Hospital has established policies and procedures for collecting and handling evidence in the OR. Staff members receive inservice education about the protocol.

EVIDENCE AND THE CHAIN OF CUSTODY

Whether or not a perioperative nurse has formal training in forensic nursing, he or she must ensure proper collection and disposition of evidence. The perpetrator of a crime should not go free because forensic evidence was mishandled; however, protocols for collecting evidence and maintaining the chain of custody often are not clearly established. What happens to a bullet once it is turned over to the pathology department? Is it guarded continuously or locked in a controlled area? Can a nurse confidently state that the chain of custody remained unbroken and evidence has not been tampered with if called upon to testify in a court of law?

Commonly, forensic evidence collected surgically is sent to the pathology department as a biological specimen. Bullets, in particular, are pieces of evidence that can be altered by pathology procedures, and many times, the proper chain of custody is not maintained during the process. These forensic specimens should be collected as such initially and transferred to the appropriate authority as soon as possible.

Crucial items, such as clothing, often are omitted as evidence. For example, using a bullet hole as a convenient starting place, clothing commonly is cut off and tossed aside or placed under a stretcher. When the patient is transferred from the OR to another unit, the clothing may be misplaced. Maintaining the chain of custody involves preserving the integrity of evidence by documenting its possession from the moment of collection until the moment it is introduced in court. (4) Perioperative nurses are responsible for identifying, collecting, and preserving evidence and for securing evidence in a designated area of the OR. These steps are crucial to establishing and maintaining the chain of custody.

IDENTIFYING. Perioperative nurses first should identify evidence. Examples of forensic evidence include clothing, debris from patients' hair or bodies, and injuries that are the result of sharp or blunt force trauma. The type and location of wounds should be documented correctly to preserve the details of these injuries. The most common types of physical evidence identified in the OR are bullets; pieces of glass, wood, or paint; and bloodstained clothing.

A forensic nurse examiner may be required to collect additional evidence, by hair combing, swabbing, and fingernail scraping or by performing an examination for sexual assault. If a physician requests a comprehensive medical forensic examination, the forensic nurse examiner on call should be notified to conduct the examination. A full medical forensic examination includes taking a patient history and conducting a head-to-toe assessment for trauma, including a detailed genital examination, to evaluate forensic evidence. (3)

Health Care Industry

Maintaining the chain of custody: evidence handling in forensic-cases

AORN Journal, Oct, 2003 by Mary Margaret Evans, Pamela A. Stagner

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