In Macomb County, Michigan, a unique and effective relationship was established that provided an immense benefit to the entire community (Betzold, 2004;Kirschke, 2005). In 1999, Turning Point (a provider of sexual assault, domestic violence, and shelter services) established the Forensic Nurse Examiner (FNE) Program in Macomb County and employs a full-time forensic nursing team. This program provides forensic examinations to adult, adolescent, and pediatric patients, free of charge to community members. In 2000, the team was expanded to provide services to law enforcement agencies for suspect examinations. In 2004, Dr. Werner Spitz, Chief Medical Examiner of Macomb County at that time, requested that the FNEs provide consultation services on a case involving a suspicious death.

This case involved the body of a female, found naked, indicating to a high suspicion of sexual assault. The FNE unit responded to the morgue where a thorough forensic evaluation, examination, and evidence collection process was completed. From that incident, the late David Woodford, head of the Serology and Trace Evidence Unit of the Michigan State Police Forensic Science Division at that time, contended that if nurses could collect such valuable evidence for cases in the morgue, the team could be used even more effectively at the scene of a crime. It was then recommended that the FNE team should be used in all suspicious deaths (not just known homicides) to collect trace evidence from the body before it is removed from the scene.

This author, the initial and current program director of the Forensic Nurse Examiner Unit, and Woodford joined with Dr. W. U. (Werner) Spitz to create and operate a joint forensic investigation team. Spitz required that the nursing team complete the Wayne State University/Michigan State Police Medicolegal Death Investigation course before responding to suspicious death scenes. The original vision was becoming a reality because of the support of all key players in the forensic science community.

In his proposal to law enforcement administrators, Spitz stated,

Woodford addressed the quality of evidence collected by the forensic nursing unit and stressed that nurses are “trained to examine a body, they do it every day; they are the ones who should be doing this.” He also stressed, “The nurses are not there to take over the crime scene; they are strictly responding to examine the body… nothing else.” The fact that evidence has been lost under these and similar circumstances captured the attention of these law enforcement agents. The evidentiary value of paint chips or paint swipes alone has resolved vast numbers of such cases.

Crime laboratories are capable of comparing the layers of paint applied to vehicles and matching them to fragments of paint from the clothing or soft tissue lacerations resulting from pedestrian/motor vehicle collisions. Transfer evidence from the vehicle to the victim may allow the identification of the make, model, and color, as well as the year of manufacture. Forensic scientists may also determine if the headlights were on or off at the time of impact from filaments recovered from clothing or tissue. Likewise, the precise point of impact on the body from the colliding vehicle will indicate if the decedent was walking, running, or standing still at the time. Therefore, observation and recovery of evidence with identifiable forensic characteristics may be critical in discovering the unknown vehicle and driver (Saferstein, 2007). The opportunity to consider a new approach to preventing the lost of critical evidence was persuasive. With full support and official endorsement of the Macomb County prosecutor, forensic nurses were formally sanctioned and accepted for their designated roles in collecting on-scene evidence and providing courtroom testimony. In coordination with the Michigan State Police Forensic Science Division and the Macomb County Sheriff’s Department Evidence Technician Unit, the forensic nursing and law enforcement teams trained together to better understand one another’s role at the scene. When classes began, there was an obvious social and cultural divide among the classroom teams, with nursing on one side and law enforcement on the other. However, the environment soon changed. Mock crime scene scenario assignments required the teams to work together to recover all essential evidence. This innovative investigative program established through a joint health and justice endeavor has already improved the rate of successful prosecutions of suspicious death cases in one community.

Before actual on-scene investigation, an intense training period for the joint units included mock crime scenes requiring both medical and criminal investigations. One scenario involved a convenience store robbery where the victim was stabbed multiple times and was pronounced dead at the scene. Law enforcement officers processed their portion of the scene for fingerprints and footprints while the nurses processed the body for trace and physical evidence. In another mock crime scenario, a female victim was found dead at the scene, partially clothed, with obvious bite marks on the body. Law enforcement officers promptly realized the potential value of the FNE observing their skillful collection of evidence from a body. They agreed that they could and should work together to improve the on-scene evidence-gathering processes (Fig. 19-1). The forensic pathologist, however, maintains the responsibility for the identification and documentation of precise injuries during the autopsy.

The FNE’s induction into the realm of law enforcement crime scenes began with instructions based on the foundation of evidence collection as a scientific method. This theoretical concept developed by the French pioneer, Dr. Edmond Locard (1877–1966), formulated the basic principle of forensic science in the recovery of evidence. This method is founded on Locard’s exchange principle, which states, “Whenever two surfaces come in contact with one another, there is a mutual exchange of matter across the contact boundary” (Lee, 2001, pg. 115). In brief, every contact leaves a trace (Box 19-1).

Nurses who provide forensic services must have appropriate skills and credentials to ensure that medicolegal evidence recovery is being accomplished in accordance with practice standards and expectations of the crime laboratory. Appropriate education, training, and certifications also help to establish credibility when providing courtroom testimony. Attesting to these requirements, the nurses who work with the Macomb County’s Medical Examiner Office, Sheriff’s Department, and Office of the Prosecutor are expected to meet such requirements. For example, the FNE director is certified in emergency nursing, forensic nursing, and medical investigation. She also holds additional certification from the American Board of Medicolegal Death Investigation (ABMDI) and is a certified sexual assault nurse examiner (SANE).

The purpose of the FNE evidence collection team is to help law enforcement agencies in Macomb County develop proof that a crime has been committed, to corroborate or disprove an alibi, to establish that a certain person committed a crime, or to ascertain that a certain person did not commit a crime. Such evidence is also used to connect a victim to a suspect and to associate the suspect to a crime scene. Evidence is often able to reflect the modus operandi (MO), or pattern of behavior, such as how the crime was committed, which may help identify an assailant. These elements of crime can also be established by evidence recovered from the crime scene (Lynch, 2000).

Since the FNE must be prepared to testify in court, an understanding of the various classes of evidence must be well understood. Evidence may be any type of admissible proof that can be presented during a legal proceeding in an attempt to influence a judge, attorney, or jurors about a particular point (Garner, 2004). Types of evidence are: direct evidence, eyewitness evidence, witness statements, and circumstantial evidence. Physical evidence, or statements that establish circumstances from which other facts at issue can be inferred, is often called “real evidence.” This can be either direct or circumstantial evidence. Medical evidence differs from criminal evidence in the sense that its purpose is to provide proof regarding the mechanism of injury or cause and manner of death. This evidence is the responsibility of the medical investigator, not the criminal investigator. On the other hand, the focal purpose of the law enforcement investigation is to prove that a crime has been committed and, if so, to establish who committed the crime (Lynch, 2006).

The objective of medicolegal death investigation is to identify, collect, document, preserve and secure medical/forensic evidence. “Physical evidence encompasses any and all objects that can establish that a crime has been committed or can provide a link between a crime and its victim or a crime and its perpetrator” (Saferstein, 2007, p. 33). Physical evidence is generally located at the crime scene or it may be found on the body of the victim or suspect (Box 19-2). Evidence from both sources is equally important in a medicolegal death investigation. In some jurisdictions, evidence recovered from the suspect in custody has also become a responsibility of the FNE. Accompanied by a police officer, the FNE responds to the place of custody (jail, prison, or hospital) and performs a thorough evidence collection process (www.nursetv.com/ visit profiles; Waddell, 2009).