☛ TS Telemedicine helps prosecute sexual assault cases
A little Eureka facility and a group of doctors a couple of hundred miles away are making a big difference in caring for Humboldt County's sexual assault victims and locking away their assailants.
A telemedicine facility set up at St. Joseph Hospital has been operating for about six years now, letting nationally recognized experts from the University of California at Davis sit in on local sexual assault exams. A study released in the medical journal “Pediatrics” last month found that telemedicine facilities, like Eureka's, greatly improve the quality of sexual assault examinations.
Cassie Burgess, Humboldt County's Sexual Assault Response Team coordinator, explained that Eureka's telemedicine facility allows doctors from UC Davis to telephonically sit in on consultations, offering suggestions and support for local providers and an instant second opinion.
”That's amazing in and of itself,” Burgess said, adding that utilizing telemedicine is like having some of the nation's sexual assault experts in the room with her during an exam.
The recently released study, titled “Using Telemedicine to Improve the Care Delivered to Sexually Abused Children in Rural, Underserved Hospitals,” found that about half of the care providers in rural communities that used telemedicine changed their examination and evidence-collection techniques at the suggestion of a consulting expert.
”Telemedicine is not only a tool for consultation, it's also a tool for teaching rural providers how to examine children and better test for evidence,” said Kristen Rogers, one of the study's authors and a professor of pediatrics at UC Davis Medical Center.
The study looked at the effectiveness of consultations performed at two rural Northern California clinics linked via telemedicine to experts with UC Davis' Children's Hospital Child and Adolescent Abuse Resource Evaluation Center.
UC Davis provided each of the study sites with videoconferencing equipment and coloscopes -- lighted magnifying instruments used to examine the vagina and the cervix. An expert in Sacramento then uses the equipment to “sit in” on consultations, providing guidance on all aspects of the examinations by viewing the local care provider, the patient in the exam room and the images captured by the coloscope.
The study included 42 sexual assault cases, and found that 47 percent of the consultations resulted in changed interview methods and that nine, or more than 20 percent, resulted in better evidence collection.
Asked how telemedicine could make such a large difference, Rogers turned to an example. She recalled a case where a child claimed to have been raped, but went through almost an entire telemedicine exam and doctors couldn't find any physical evidence.
”It was hard to find evidence, but one of the things that she had said during the exam is that (the assailant) kept whispering in her ear throughout the rape,” Rogers recalled. “We were able to say (to the local provider), 'Why don't you swab the child's ear?' Lo and behold, they got DNA evidence off that.”
District Attorney Paul Gallegos said the use of telemedicine locally has been a great asset to his office, as it provides the examinations with immediate peer review and makes their findings carry much more weight in court.
”Peer review augments any potential challenges to the SART conclusions so they are less subject to attack,” Gallegos said. “When it's done, it improves the SART exam, which means it improves the case ... it means it has increased reliability for us, for the court and for those members of the community that serve on the jury.”
According to referral numbers from state agencies, instances of child maltreatment -- a kind of blanket category including neglect, physical and sexual abuse -- are well above the state average in Del Norte and Humboldt counties. Statewide, the instances of maltreatment are about 49 per 1,000 children. That number jumps to more than 86 per 1,000 children in Humboldt and balloons to more than 125 instances per 1,000 children in Del Norte.
Claire Knox, chair of the Child Development Department at Humboldt State University, cautioned that those types of data are always tricky and have a lot to do with nomenclature, but said several factors could contribute to the state's more rural areas seeing higher levels of child maltreatment, and specifically higher rates of child sexual assault.
Isolation, unemployment and emotional and financial stress can contribute to higher child maltreatment rates, Knox said, adding that even a lack of childcare arrangements can play a role. Limited access to resources and the fact that people are more likely to commit those types of crimes when nobody is around are big contributing factors, she said.
”When (people) are emotionally needy, they may turn to behaviors in which they might not otherwise engage,” she said. “Community systems in which there are heightened levels of abuse of alcohol and drugs also reduce barriers and constraints.”
Del Norte County District Attorney Mike Riese said his office deals with lots of child sexual assault cases, many of them without the help of telemedicine.
Rogers said UC Davis made efforts to place one of its test sites in Del Norte, but things didn't work out.
”We offered it to them and the timing wasn't right,” she said. “They weren't ready yet to have telemedicine in their county.”
Riese said emergency room doctors and nurse practitioners handle the majority of his county's examinations. He would not say how often child sexual assault cases are dropped due to a lack of evidence.
Burgess said one of the positives of Eureka's telemedicine facility is that it takes child sexual assault victims out of the emergency room, where they sometimes had to wait for hours to be seen, and into a more comfortable environment. Burgess said it also empowers the local care providers to know they have experts looking over their shoulders.
Gallegos said the results simply speak for themselves.
”About every time we've used (evidence from telemedicine examinations) we've got a conviction,” he said.
Times-Standard staff writers John Driscoll, Sean Garmire, Thadeus Greenson, Jessie Faulkner, Erin Tracy and Sharon Letts contributed to this report.
A Times-Standard Staff Report
Posted: 02/23/2009 01:30:19 AM PST
Comments on TS site:
numbers - "About every time we've ... got a conviction. Grammar aside, just how many such trials have there been? Or plea bargains? Certainly hasn't been a lot of news coverage of such successful outcomes. And why is it that the TS never seems to ask the obvious follow up question?
In the dark - Asked how telemedicine could make such a large difference, Rogers turned to an example. She recalled a case where a child claimed to have been raped, but went through almost an entire telemedicine exam and doctors couldn't find any physical evidence.
"It was hard to find evidence, but one of the things that she had said during the exam is that (the assailant) kept whispering in her ear throughout the rape," Rogers recalled. "We were able to say (to the local provider), 'Why don't you swab the child's ear?' Lo and behold, they got DNA evidence off that.
What'd I miss? Someone was arrested for sexual assault for whispering in a child's ear, based on presence of (I assume) saliva but an absence of (I assume) seminal or physical evidence below the waist?
Not to nitpick....but no clarity given that the whispered remark, "Rogers recalled", is in no way related to Kristen Rogers, quoted in the article.
I'm all for the use of any evidentiary-gathering tools when it comes to catching perps. The best solutions to much of our social ills is good parenting, loving family structure, etc, etc, etc.
Captain Crunch - I applaud the article and the subject of the article. What makes me what to vomit is the quotes from the buffoon who is our DA. Did he even know that SART had this equipment before the interview? Who explained it to him? What about how he singlehandedly dismantled the CAST operation? Cassie Burgess is a fantastic person and should get many, many awards for her work. Gallegos needs to be recalled.
cocoa puffs - Right on captain. Aside from the good news about telemedicine, the article is a puff piece for the DA. The impression is left that his office is cutting edge, but there are no facts to demonstrate that telemedicine has played any role in any Humboldt case, ever. But hey" we got convictions". Really. Name three, and tie
them in detail to telemedicine.
GOOD QUESTIONS! Note that the program set up predates Gallegos.
