Editor’s note: This story is the second part of an eight-week series focused on the issue of sexual assault in Steamboat Springs and Routt County. To view the entire series as it unfolds, visit steamboatpilot.com/news/in-our-shoes.
STEAMBOAT SPRINGS — After a sexual assault, there’s often more than just the evidence in the room where it happened. There’s the evidence, including DNA, injuries and other trace evidence, that can be found on or in a survivor’s body.
As part of a forensic medical exam, a sexual assault nurse examiner can look for injuries and anything abnormal on a survivor’s body and collect or document other evidence. These nurses are specially trained to care for a person after a sexual assault.
The forensic exam, frequently called a rape kit, is time-consuming, but forensic nurses work to make it as comfortable as possible for the survivor.
The exam is important because it can preserve evidence — including documenting injuries and collecting DNA and details of the victim’s story — that can be used to investigate a crime.
Steamboat Springs Police Department Commander Annette Dopplick said the value of the exam goes beyond collecting evidence for an investigation. A forensic exam is also an entry point for victims to receive specialized medical care.
“We want our victims to be treated, so whether or not the case ever ends up in any kind of prosecution, I encourage victims to take care of themselves,” she said. “A piece of that is getting medical care.”
After a sexual assault, the survivor has the option to report it in several ways, and if they do choose to report, they can also decide to obtain a forensic exam.
“Not everybody has to have an exam. Just because you do the forensic medical-legal exam it doesn’t mean we have to do the kit, which is the evidence collection piece,” said forensic nurse examiner Patty Oakland, who also coordinates the forensic exam program at UCHealth Yampa Valley Medical Center in Steamboat Springs.
Oakland is trained as a registered nurse and a nurse examiner and has worked as an emergency room nurse for eight years. She trains new forensic nurses as an instructor for the Colorado SANE/SAFE Project and co-chairs the Social Justice Committee for the International Association of Forensic Nurses. She’s also working toward two master’s degrees in nursing and criminal justice.
Beginning the exam process
A forensic exam starts at the emergency room, and ER staff will tend to any injuries or medical issues first.
“The first, most important part is your health, your safety and that you feel taken care of medically,” Oakland said. “From there, we can collect the evidence, if you want it, and that’s driven by the patient as long as they can consent to that.”
Then, a survivor meets with the forensic nurse and a victim advocate to understand options for reporting and what the forensic exam entails.
Oakland said forensic nurses can collect evidence for up to five days after an assault, but the sooner, the better.
“Past that point, our bodies are healing; biological evidence is going to wear away. You won’t have that person on you forever,” Oakland said. “But even if you’ve eaten or drank or thrown up or peed or pooped or had diarrhea or showered, I’m still going to collect evidence, and we’re going to talk through what we could or couldn’t find.”
A survivor can decide not to undergo the evidence collection part of the exam or to skip certain parts of it. A forensic nurse will look for evidence based on the story a survivor tells, so they’ll skip steps if it’s unlikely to turn up evidence.
“From your story, I might believe that I might be able to find something, so there are certain steps that I will choose,” she said. “If you’re not comfortable with those steps, you can stop me at any point.”
She’s also happy to take breaks — a survivor can pause the exam to eat a meal, drink a comforting beverage or decompress with a victim advocate or a loved one. Oakland said the exam takes an average of about five hours, including these breaks.
Survivors can bring a friend or loved one with them to the emergency room, but they will be asked to step out of the room for portions of the exam. Oakland said this is because she doesn’t want somebody in a victim’s life to be affiliated with that moment and that trauma. A victim advocate can also be there to help a survivor through the process.
What happens in the exam?
Each forensic exam is different, based on what happened to the person reporting sexual assault.
The first — and according to Oakland, the most difficult part of the exam— is telling the forensic nurse what happened. It takes a while, she said, because the nurse must type a survivor’s report word for word.
“I think this is the hardest part for everyone — the actual telling of the story and what happened to your body and what brought you to the hospital,” she said.
She suggests having a victim advocate in the room to tell that story to. Though Oakland is listening, she spends a lot of time looking at her computer screen as she types exactly what you’re saying. After that, Oakland will start working through the sexual assault incident form.
“This talks about where there might be any kind of assault, penetration (or) DNA evidence,” she said.
While law enforcement won’t always get medical records, they will get the incident form.
This requires clear, plain language of what happened. Survivors can expect Oakland to use language such as vagina, penis, anus and phrases such as oral penetration or penile penetration.
“I know that’s uncomfortable,” she said. “That’s not what our culture is used to, but I want to make sure I understand fully what happened to your body. Then if this does go forward to a court and to a jury, they understand fully in plain language.”
She’ll ask when the last time a survivor had consensual sex, so in case a person had consensual sex prior to an assault, investigators know there’s evidence of that, too.
Once Oakland has heard the survivor’s story and knows where to look, she’ll conduct a head-to-toe exam, looking, listening and feeling parts of a survivor’s body to make sure there are no injuries. She’ll take a series of photographs of injuries or foreign stains — such as a bloodstain — that might have occurred during the assault.
She’ll check for signs of strangulation. Oakland said blood clots that occur due to strangulation can shift for up to a month after the incident, so she likes to warn survivors of the continued risk of a stroke.
If a survivor hasn’t changed or showered, the nurse will have them undress over a drape to catch any small, trace evidence such as hairs or carpet fibers that might fall off of a person’s body or clothing. This drape is folded up and placed in a paper bag as evidence. The survivor’s clothing will also be bagged as evidence.
Then, the forensic nurse will look for other trace evidence on a survivor’s body, such as foreign hairs or carpet fibers.
Using sterile cotton swabs, Oakland will swab a survivor’s mouth to collect their DNA, which will later be used by investigators to identify what DNA belongs to the survivor and what belongs to a suspect. Oakland will also swab any areas on the outside of the body where a suspect might have left any sort of body fluid, including semen or vaginal fluid.
She’ll comb a survivor’s pubic hair for these small particles. If there was a struggle, Oakland might take scrapings or nail clippings from under a survivor’s nails. Oakland uses a new comb and a new pair of nail clippers for each patient.
“If they’re too short, or if you just got a manicure and you don’t want your nails cut, that’s fine too,” Oakland said. “My idea is not to create any further discomfort for you.”
This also factors into how Oakland conducts the most physically invasive parts of the exam — looking for injuries and collecting evidence from the anal and genital areas.
“I know it’s an uncomfortable thing to go through, and I try to make it comfortable as possible for you,” she said. “I try to go slow. I talk about where my hand is located, and work myself down.”
At a female survivor’s discretion, Oakland will use a plastic speculum and a colposcope to examine if there are any internal injuries or foreign objects. She’ll again swab for ejaculate.
“We’re going to make sure there’s no bruising, bleeding or any kind of injury I note just from looking at it,” she said. “I use a really gentle technique to retract and actually observe all of the different anatomy.”
If there are injuries, she uses a camera attachment to take pictures of those injuries.
In cases of anal penetration, Oakland might also examine a patient’s bottom, using the colposcope to examine possible injuries to the anus and rectum.
“Even though I am taking pictures of your genital regions, it is not often, and I haven’t heard of it much at all that these pictures would be used in a court case,” Oakland said. “It just really shows any injury that you might’ve endured. It’s intimidating to have pictures of your genital region taken, but I really try to take care of you the best I can, and everything else is covered.”
These photos are used by law enforcement to verify that an injury did occur, and an attorney might look at them to later describe the injury. Oakland also uses these photos to remember the injuries and evidence she collected in the event she testifies in court.
After the exam
“The last thing we’re going to do is talk about what does life looks like after an exam and what are your options from here and what are your choices and who in our community is here to support you,” Oakland said.
She connects patients to a victim advocate if they want to, and she gives them information if they’d prefer not to talk to an advocate or to contact an advocate later.
“My goal is to be the bouncer in this room,” Oakland said. “You’re going to tell me who comes in and out and who is going to help you.”
Oakland will also discuss options to treat, pay for and find care for possible sexually transmitted diseases. She also addresses concerns about pregnancy and other follow-up care.
“We can talk about if you want your parents to know, or if you want your significant other to know and how to talk to them about that. We’ll work through that,” she said. “I’m also happy to bring a Mind Springs (Health) employee in for any kind of mental health evaluation if you’re feeling suicidal in any way or homicidal in any way. We can talk about that and address that while you’re still here, and this is a safe place.”
And, after Oakland examines a survivor, she takes steps to separate the individual from the incident.
“Because of the work I do in a small town, I don’t want to remember you for this moment and this story,” she said. “When you leave, I take a minute and I’m going feel for you and think of you, but I let it go in that moment.”