Forensic Health Dept. Has Been Working with Victims for 25 Years

Collecting evidence of a sexual assault can add to the emotional trauma at a very difficult time. At Palomar Pomerado Health, a separate department was formed 25 years ago to conduct exams on crime victims, staffed by nurses with special training.

Originally brought to PPH by registered nurse Patty Seneski, the Forensic Health Department works with victims of violent crimes to collect evidence for criminal investigations. It’s now headed by forensic nursing supervisor Sue Dickinson, a former emergency room nurse who got involved in 1990 after seeing the need for a separate area for treating crime victims, who couldn’t be given the privacy and timeliness crucial to their evaluations.

“I realized early on that ER departments are not the appropriate place for those types of exams,” Dickinson said, adding that the triage system didn’t help matters. “Victims of sexual assault were low on the list because they were stable. You had to treat someone with a heart attack.”

She said offering privacy not only helps with the emotional well-being of the victim, but ensures that evidence collected will not be disturbed.

The Forensic Health Department is located on the Palomar Medical Center campus and has two facets—the Sexual Assault Response Team, which handles cases involving victims 14 years and older, and the Child Abuse Program, which handles children from birth to 13 years.

The standard SART exam covers forensic photography, the collection of swabs, blood and urine, an external and internal examination, DNA collection, medication to prevent STDs and pregnancy “if they wish,” clothing collection and replacement and more. An in-depth interview is also performed, which varies in time depending on how much has happened to the victim.

“It’s not a brief exam by any means,” said Dickinson of what averages a two-hour process. “Some might be a bit reluctant; it’s certainly their decision.”

She continued: “We see 14-year-olds who are young and innocent and scared, and we see people who are in their 90s. Most do quite well.”

An exam is estimated to cost the department about $1,000, and Dickinson said the program is subsidized by the hospital and by various groups who have donated to the cause. Law enforcement also pays on a per-case basis, though they “don’t break even.” But as far as the economic recession burdening their efforts, Dickinson didn’t give the idea any credence.

“Things are lean for everyone right now, so we have to be careful,” she said. “That’s true for every business and everyone. We still do exactly what we’ve done before.”

The job itself is not a career one can just fall into. Sexual assault nurse examiners require extensive training and a minimum of one year of prior experience in acute care, though the six currently working in the program average about 18 years combined. According to Dickinson, each has taken a 40-hour class detailing forensic exams, sexual assault and state law, as well as logged hours at an advocacy center and crime lab, gone on a police ride-along and completed physician-observed procedures.

It is a labor of love and almost always a second job.

SART only handles cases approved of by law enforcement and, of those, processes anywhere from 175 to 210 each year. The 2005 National Victimization Survey states only 40 percent of victims ever reported being sexually assaulted within five years, a number that has decreased very slightly from 2003.

The number of cases is higher for PPH’s CAP program, which deals with younger victims and issues ranging from any type of child abuse, whether emotional, physical or sexual, to witnessing a violent crime. In 2010, the department saw more than 290 children for forensic interviews and/or forensic exams.

“(The interviews are) done in a way that meets their developmental ability,” she said. “Often they have no context to understand what’s happened. They don’t know what sex is. They may know that something odd has happened, but they don’t know what it means.”

SART and CAP nurses are available on a 24-hour basis. The programs only serve North County, and are used by the several law enforcement agencies within its boundaries including the Escondido, Oceanside and Carlsbad police departments, the San Diego County Sheriff’s Department, NCIS—servicing Camp Pendleton, Miramar, and the Navy—as well as area college and university police.

While findings from the forensic exams are used for criminal investigations, Dickinson said the department doesn’t know the outcome of each case. Rather, they are only told if it requires expert testimony. Whatever the case, the service they provided is a comprehensive one.

“It’s not just a forensic exam; it’s an entire investigation,” she said.