Crimefighting RN
Phil McPeck

Forensic nurse digs deep to investigate the criminal element behind the medical case.

Karen Chabert, RN, takes the mystery out of nursing and turns it over to law enforcement, social services and the courts.

Officially, she’s the continued care coordinator at the Medical Center of Louisiana in New Orleans. But behind the title and administrative duties as head of the hospital’s organ donation program, she’s a forensic nurse.

“I love the element of surprise,” Chabert says, explaining 25 years in and around the ED. “I have a natural curiosity. I’ve always been interested in finding out how things work.”

While emergency physicians, nurses, and technicians see patients’ injuries, Chabert’s eyes, ears, and thoughts are attuned to the possibility that they are the result of a crime.

Gunshot and Stab Wounds Are No-Brainers

In one memorable case, Chabert sparked a homicide investigation into the death of a young man with a head laceration. “The police just thought it was an intoxicated person who was found down,” she says. “It turns out that it probably was a homicide because of the way the wound pattern looked.” That never would have been noticed if there wasn’t a forensic nurse who knew what injury patterns look like.

“We have to be looking for subtle signs of abuse: pattern injuries, different types of bruises that a patient might have, and also some behavior that victims have,” Chabert says.

Chabert says one goal at the medical center, which is widely recognized by its former name, Charity Hospital, is an interview of all emergency patients to better identify victims of domestic abuse. RNs then could make appropriate referrals for shelters, safety plans, and other social services.

The forensic nurse’s role is to present more prosecutable cases to district attorneys. In that regard, and especially in sexual assault cases, Chabert says that the medical center is a leader. It’s notable not only for the state’s first sexual assault nurse examiner (SANE) program, but also for a case management approach to it.

“When a person is a victim of a sexual assault, they’re going to be seen that day and evidence is going to be collected: blood work, cultures,” Chabert says. “Then they need to come back in two weeks and have a follow-up to get the results. For a lot of people, it’s such a traumatic experience that they don’t want to come back.” But because victims brought to the medical center are assigned a personal SANE nurse for initial treatment, repeat visits and the duration of their case through the court system, “Our follow-up rate is 80%, which is the highest in the country,” Chabert says. “I think the victims feel much better cared for, so they’re willing to come back and do what they need to do to put the bad guys away.”

Still, despite the breadth of the field, few nursing positions are dedicated solely to death scene investigation, interviewing crime victims, documenting injuries, collecting, preserving and ensuring the integrity of evidence and notifying families of death, Chabert says.

She created her own position. Five years ago, she wrote a job description for a staff forensic nurse and sold it to the hospital medical director. She included overseeing organ donations because most donors are young, healthy people who die as the result of trauma. “I’m the liaison for the coroner’s office and law enforcement liaison,” she says.

Chabert has a laundry list of how to break into the field. At the top is joining the International Association of Forensic Nurses because that’s the place to learn about SANE courses, scientific seminars and other educational offerings. It’s also a place to network.

Then, she says, get close to crime. Get to know police officers even if they’re on the fringe of an emergency department case. Participate in police ride-along programs and tour the crime lab and coroner’s office. Go wherever necessary to learn how the legal and justice systems work, she says.

It’s a model she shares as a guest lecturer in nursing at Louisiana State, Loyola and Tulane universities.

Chabert, who serves on Mayor C. Ray Nagin’s committee for domestic violence and juvenile justice, says she would like to expand on teaching that also takes her to elementary schools with underprivileged children. “I do the medical consequences of using guns to solve conflict,” she says. “They’re so desensitized. We have fourth-graders here who have witnessed more than one murder.

“When someone gets shot, they want to know whether it was an AK-47. They want to know how many times the person had been shot. They don’t ask how he’s doing.”

Phil McPeck is a freelance writer. To comment on this story, send e-mail to editorca@nurseweek.com.