Evidence of violence: forensic nurses balance health care and justice

Examiners saw 106 patients last year in Abbotsford, one of two Fraser Health sites.

Susan Short (right)

It might be that her memory can’t explain her aching body and confusion. Perhaps her black eye wasn’t caused by her “clumsiness.”

Or maybe, she’s a victim of violence – physical and/or sexual.

She may come alone, with family, or with a police officer, but whatever the circumstances, she has come to Abbotsford Regional Hospital (ARH) shaken and in need of help.

It’s here at the nexus of health care and criminal justice that Fraser Health’s forensic nurses like Susan Short go into action dozens of times each year. Part nurse, part forensic investigator, it is Short’s job both to treat victims of sexual assault or intentional violence – the vast majority of whom are women – and, if they consent, collect evidence that could be vital to a police case.

The program began in Surrey in 1992 and expanded to Abbotsford in 1999. Since then, patient volumes in Abbotsford have grown considerably, from just 10 in the program’s first year at ARH, to 68 in 2013, and up to 106 last year. Across the province, forensic nursing services vary from stand-alone services like Fraser Health’s, to sexual assault response teams that include examiners.

Although the number of patients seen has risen steadily, Short says a lack of awareness still prevents many women from getting the help they need. And despite their training, specialized forensic nurses continue to run into some skepticism in the justice system.

“Most people don’t actually know we exist,” says Short from the small office in ARH’s emergency department from where she co-ordinates the program.

Many victims also don’t know they can receive treatment at the hospital – and even have evidence gathered from their body – without filing an immediate police report.

Anjie Gibson, a nurse with Fraser Health’s Embrace clinic, which provides follow-up care to assault victims, said people “think by coming to the hospital, police are automatically involved.”

Instead, each assault victim who walks into the emergency room is not only in need of help, but is also a walking crime scene who has the right to grant a forensic investigation.

While every patient receives medical care, those who wish to submit to a forensic exam can opt to either have that evidence forwarded to police, or to have it stored on site while they choose how to proceed.

“That often gives that patient time to decide what they want to do,” Short said.

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The forensic nursing unit in Abbotsford is just one of two in Fraser Health, with the other located at Surrey Regional. In Abbotsford, the program employs Short and five other nurse examiners, all women, who have specialized training, and work on an on-call basis alongside their other duties. Patients who come into other area hospitals with evidence of interpersonal violence or sexual assault in the last seven days are taken to the two hospitals to see a forensic nurse, although those nurses can also travel to see a patient if needed. (Those who visit a week after the incident are directed to the Embrace clinic, which was established in 2014.)

Referrals come not only from the ER’s triage unit, but from family doctors and practitioners. Short says many patients feel more comfortable discussing such assaults with another woman who doesn’t have a connection to family members.

But patients remain overwhelmingly Caucasian, with those of South Asian or First Nations background under-represented.

Whether for cultural, personal or other reasons, studies have shown most sexual assaults are never reported. The options given to victims by forensic nurses aims to address that, and the 2014 launch of the mobile Embrace clinic aimed to provide further services to victims who have seen a forensic nurse, and those who never visited a hospital for an incident.

“There are so many barriers in coming into the ER,” Short said.

In Abbotsford, while the forensic exam room doesn’t look anything like a set from lurid CSI police procedurals on TV, the nurses have a full forensic toolkit at their disposal.

The typical patient is a woman in her early 20s. Often she will have more questions than answers, due in part to drinking the previous night.

A toxicology report can help in that regard, as can a blue-light-assisted search for bodily fluids. In consultation with the patient, the nurses will also search for DNA, and examine and document any wounds or marks. While doing so, they’ll also provide standard medical care and look for further injuries.

Abbotsford Police Const. Paul Walker called the nurses’ work “invaluable” and said it regularly allows police officers to bring cases to trial.

“It’s a vulnerable time for somebody going through that, and disclosing that to police is often difficult,” Walker said

“By having someone that is trained in the exam and the collection of evidence, for a lot of people it sets their mind at ease.”

Their importance can be seen in a court case last year, in which Short’s discovery of injuries to a patient was found to contradict the testimony of a man accused of sexual assault.

“The evidence of the injuries noted by the forensic nurse are more supportive of how the complainant testified that the sexual encounter occurred than how the accused says that it occurred,” the judge said while delivering his guilty verdict.

The lack of knowledge – from ordinary people and those who are more familiar with the system – continues to frustrate.

Short recently testified at a trial in which the judge questioned that a doctor might be better suited to collect forensic evidence, even though Short has specialized training and years of experience that most physicians lack.

“It’s like, ‘Judge, you’ve got time for coffee? Because I’d love to chat.’

“Anybody can do this work with specialized training,” she said. “We often hear, ‘Oh, shouldn’t a doctor be doing it?’ and I’d have to respectfully disagree with that because they don’t have the training, they’re not getting any of that in medical school.”