RNs on the Scene

Working in hospitals in Alaska, Idaho and Oregon, Jennifer Schindell, BSN, RN, F-ABMDI, found it odd investigators didn’t come to the hospital more often on cases involving trauma, abuse or neglect.

Here, the officers could have collected evidence from the patient’s clothing and other belongings while gathering information such as injuries and patient statements. Also, Schindell wanted someone from law enforcement who was at the crime scene so she could have asked questions to better understand what had happened to her patient.

Schindell knew someone to walk the line between medicine and law would be indispensable. Instead of waiting around for someone else to lead the way, she took the initiative. After working in med/surg, critical care, neuro/trauma, flight nursing and time caring for inmates in a jail, Schindell began training to become a forensic nurse.

“I started taking criminology classes and started looking into forensic nursing,” she said. “Being a sexual assault nurse examiner didn’t really interest me, but I took all of the classes on evidence collection and learned everything I could.”

Today she is the deputy chief medical examiner and forensic nurse for Linn and Benton counties in Western Oregon. She is also a board certified medicolegal death investigator and is currently enrolled at Oregon State University, where she is set to earn her master’s in medical anthropology next year. She presents frequently on death investigation, crime scene investigation, infant death investigation, strangulation, clinical forensics and forensic photography.

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Medical Examiner’s Office

Laws differ state to state as to who certifies manner and cause of death. In some states it’s a medical examiner, while others have a coroner system, and still others use a mixture of the two. In some states this person must be a physician. In others, the person must be a forensic pathologist. In coroner states, people who may or may not have a medical background are elected to the office.

In Oregon, six forensic pathologists are state medical examiners. In each county, physicians may be appointed as county medical examiners, and medicolegal death investigators like Schindell are appointed as deputy medical examiners.

“My position didn’t exist before 2004 when this became my primary job,” she said. She didn’t walk in the county offices 10 years ago, demanding a job. She volunteered and slowly got her foot in the door. “I was part of the search and rescue team, continued to educate myself and got to know the medical examiner Gary Goby, MD,” she said. “It was a slow process.”

Schindell still works with Dr. Goby in Linn County, where she is a contract employee. In Benton County, she is part-time. Her job, though, is essentially the same in both counties. Schindell documents and gathers information from the scene and body, reviews medical records and gathers information from family and other involved parties. This information assists both law enforcement and physicians tasked with certifying manner and cause of death.

Nurse Coroner

In states like Pennsylvania where coroner systems exist, nurses like Pam Gay, BS, RN, CFN, CMI-II, are serving their communities, while applying their clinical and patient care skills. In 2013, Gay was elected to become the new coroner of York County. Her first day will be Jan. 6, 2014.

She’s one of only a handful of forensic nurses to investigate manner and cause of death. In South Carolina, a team of nurses leads the coroner’s office in Charleston County. Rae Wooten, RN, F-ABMDI, is the coroner; Bobbi Jo O’Neal, RN, F-ABMDI, is chief deputy coroner; and Kimberly Rhoton, RN, is a deputy coroner. In Oregon, Schindell’s colleague Kris Karcher, RN, OR-SANE, is the chief deputy medical examiner and forensic nurse for Coos County, while Julie Burri, RN, holds the same titles in Harney County.

Gay feels her nursing background has prepared her for this new role. She has worked in critical care and in the ED and has taught health occupations at a local high school, mainly training CNAs, before becoming a legal nurse consultant in 2001 then a SAFE (sexual assault forensic examiner) nurse about 3 years ago. She has wanted to run for coroner for a while, but the timing was never right until now.

“Our coroner was very well liked and has held the position for about 16 years,” she said. “When he announced about a year ago that he was going to retire, it seemed like a good time to run for the office. I didn’t want to do it when my kids were small because you’re on call so much. My kids are grown now, so I talked to my husband and it seemed like a good time to do it.”

Coroner Class

When Gay joined several other new coroners and deputy coroners in Harrisburg in November 2013 for training at the State Police Academy, she found many of her colleagues previously worked in law enforcement, as had her predecessor. However, there were others like her with healthcare experience.

“In the class, there were EMTs, funeral directors, a physician and a few nurse deputy coroners, but I was the only nurse elected as coroner,” she said.

In the training, her nursing education came in handy. There were lessons about anatomy and physiology and evidence collection, both subjects of which Gay is well familiar. She learned everything from the routine office tasks like forms and files to aspects of the job often played out on television crime shows.

“It was a lot of new information,” she said. “We learned how to determine the manner of death: is it undetermined, a homicide, a suicide? There were professors from the Forensic Anthropology department at Mercyhurst College who reviewed things we can learn when there are skeletal remains at the scene.

“Some of the things that were helpful to me were an overview of the new technology and learning more about ballistics. We received a lot of information about what we can determine from gunshot wounds. We also learned about our role as coroners if there were to be a mass fatality in our county: who to contact and what the chain of command would look like.”

Working with Families

One aspect of being a coroner is a natural fit for a nurse: how to communicate with and educate families. Schindell says this is the most rewarding part of the job.

“Some of the cases I’ve worked on have been on the news, but the ones that stick out in my mind aren’t newsworthy,” she said. “I feel most useful doing the day-to-day things, helping the law enforcement understand things and reaching out to the families to help explain something or just help them through this difficult time.

“I’ve had people break down and just thank me for talking to them because they didn’t really know what had happened,” she added. “Sometimes these things can fall through the cracks. You can explain things at the scene or shortly after cause of death has been determined, but they may not process it. Going back to the family and be willing to help them and answer follow-up questions is an important community service.”

Gay is looking forward to bringing a nursing viewpoint to the position.

“I bring a new perspective,” she said. “Other coroners tell me a lot of the job is how you deal with the families and how you reach out to the family. It’s so important.”

Working with Gay will be two full-time deputies, one of whom is also a nurse, and three subcontractor deputies. Gay also wants to build a volunteer team to help with death notification, something the voters liked.

“As in any new position, I have great ideas but trying to implement things slowly and being fiscally responsible may pose a challenge. There is a lot of change going on here: the population is growing pretty significantly. They’re aging too so that’s a challenge. It’s an exciting time.”

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‘A Good Fit’

Forensic nursing is still relatively new and changing. Nurses interested in forensic nursing can find experience in a lot of different places, Gay said.

“I would encourage nurses to try to get certified and join a SAFE or SANE program in their ED,” she said. “If the hospital doesn’t have one, try to find a nearby hospital that has started one. If your county coroner is looking for deputy coroners, you can try that.”

There are also a lot of legal nurse consulting, and local attorneys usually need help on medical cases. Schindell advises forensic nurses, who do hope to join a coroner or medical examiner’s office, to be patient.

 

“If you’re in a jurisdiction where nurses aren’t doing this, you may not be welcomed with open arms initially,” she said. “I recommend you be prepared, learn everything you can and remember trust must be earned. With time, it will become clear a competent forensic nurse can be a tremendous asset to individuals and communities impacted by medicolegal events.”

 

Stacey Miller is a freelance writer.

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