Its a scene that happens in emergency rooms across the country: In the rush to care for a patient, evidence that can tie a suspect to a crime is often lost, unnoticed or disturbed.
Now an ER doctor at Carolinas Medical Center is spearheading a program to teach medical personnel from around Charlotte and the country the basics of crime scene investigation. It comes as hospitals and law enforcement agencies across the country increase their efforts to work together on the issue.
At a recent course, doctors, nurses, police officers, prosecutors and defense attorneys learned how evidence collection works in the ER. As the doctor begins treating the gunshot victim, a forensic-trained nurse cuts away clothing, mindful of preserving entrance and exit wound evidence. The nurse photographs the patient, measures the wounds, examines the gunshot residue and documents everything on standardized forms.
CMC officials held the first forensic training class in April and plan to continue to provide the 40-hour course throughout the year.
The class trains medical personnel and others how to collect forensic evidence and how to ask victims questions that could lead to arrests and convictions.
It also reinforces the importance of carefully documenting evidence.
I know how to determine entrance versus exits wounds, said Dr. Jayne Batts, the ER physician at CMC who helped organize the forensic training at the hospital and expand it into a class for first responders all over the country. I know whats important to ask a patient about the crime.
Sometimes those questions are the last words a patient hears before surgery or death.
Similar programs in the region collect evidence in sex abuse cases, but the Charlotte-Mecklenburg program was the first of its kind in the Carolinas applied to such a wide range of crimes.
The hospital evidence collection in Charlotte-Mecklenburg began in 2003 and since then has aided in the investigation and prosecution of serious assaults, domestic violence, rapes and murders, according to Charlotte-Mecklenburg police officials and prosecutors with the Mecklenburg County District Attorneys Office.
The expanded program comes amid a national push to integrate emergency medicine and criminal investigations, according to the International Association of Forensic Nurses, a professional group dedicated to promoting forensic collection training in U.S. hospitals.
We want to get physicians, nurses and law enforcement to work together in preserving evidence and interpreting wounds, said Dr. Bill Smock, a police surgeon from Louisville, Ky., who taught CMCs first forensic training class in April. Carolinas HealthCare Systems is leading the country in evidence collection. In hospitals across the country, evidence gets lost every day.
ER forensic steps
Before nurses began consistently collecting evidence, the police department dispatched crime scene technicians to the hospital. Theyd come if they were available and sometimes after being delayed by forensic collection at the crime scene, which could take hours, Batts said.
She helped establish the Clinical Forensic Nurse Examiner course. For the past 10 years, the course has been offered twice a year to ensure that every victim of a violent crime in Mecklenburg County received the same standard of care.
Carolinas Medical Center, Presbyterian Hospital, Lake Norman Regional Medical Center in Mooresville and NorthEast Medical Center in Concord are among area hospitals with nurses trained in forensic medicine. Certification takes 40 hours over five days, CMC officials said.
Batts said her desire to see this kind of training become widespread stemmed from a mistake CMC made in 1999.
We lost the victims clothing, Batts remembered. And I went to the police department and asked what we needed to do.
At least one forensic nurse works each shift at CMC now a goal of Batts when she was first developing the training and forensic collection protocols.
When a patient is transferred from the crime scene to the hospital, the ER becomes the secondary crime scene, Batts said.
CMPD Homicide Sgt. J.D. Furr said detectives undergo quarterly training with Batts to brush up on their own forensic collection skills.
Police say they rely on the skills of forensic nurses in about 90 percent of their assault cases.
The Mecklenburg County DAs Office couldnt say specifically what role the forensic evidence has played in securing cases. But in general, its better to have evidence that has been properly documented by people who know what theyre doing, prosecutors said.
The hospital staff treat and give us their qualified opinion and we use that as a tool in our investigation and in our case at trial, Furr said. Its invaluable.
The forensic nurses also help police determine when patients are lying.
For example: One recent victim came to the hospital and told police he had been randomly shot in the calf by a passing car while walking down University City Boulevard.
But forensic nurses analyzed the wound, noting its size, the prominent tattooing and powder burns. They quickly determined the man had been shot at close range probably from someone who had been standing no more than 15 inches away.
As it turns out, this wound wasnt the result of a random violent act, Furr said.
What really happened? The man had accidentally shot himself and had been embarrassed to admit it.
Through forensics we could see that what the man said was absolutely false, Furr said.
Steele: 704-358-5067; Twitter @steelecs
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