Our Collective Voice: The Allegations against Tara Levicy and Duke University Medical Center

Tara Levicy being questioned before the NC State Bar

Part I of the allegations against Tara Levicy and Duke University Medical Center; researched and complied from the NC AG Summary of Conclusions, NC State Bar files, Court Motions, Depositions, News articles, and from the two civil complaints filed in Federal court against multiple defendants including Levicy and DUMC. The author is sceptical, a well known and respected Blog Hooligan.

Part I

Introduction: The Discrepancy

On the night of March 13-14, 2006 the Duke University men’s lacrosse team, on-campus for mandatory workouts during Spring Break, held a party. Two strippers were hired for the event, a practice not uncommon for Duke and other college sports teams (as many as 20 Duke organizations had reportedly done so in the year before). However, this party went awry and one of the dancers, Crystal Mangum, alleged early on March 14 that she was sexually assaulted. Three team members (David Evans, Collin Finnerty and Reade Seligmann) were later indicted on charges of rape.

The statements of a Sexual Assault Nurse Examiner (SANE) were key to the investigation and subsequent indictments. A probable cause affidavit for a search warrant stated:

“Medical records and interviews that were obtained by subpoena revealed that the victim had signs, symptoms, and injuries consistent with being raped and sexually assaulted vaginally and anally. Furthermore, the SANE nurse stated the injuries and her behavior were consistent with a traumatic experience.” (1)

A little more than a year later, after an exhaustive investigation by the North Carolina Attorney General, all charges were dropped and a report issued stating “it was in the best interest of justice to declare these three individuals innocent of these charges.”

The report specifically addressed the medical forensic findings in the case and found:

“No medical evidence confirmed her [the accuser’s] stories. The SANE based her opinion that the exam was consistent with what the accusing witness was reporting largely on the accusing witness’s demeanor and complaints of pain rather than on objective evidence.” (2)

The role that the SANE nurse, Tara Levicy R.N., played in the Duke lacrosse case was pivotal. Her false and misleading statements to police and to prosecutors were the foundation of the initial investigation, the indictments, and the persistence of the prosecution long after the case began to fall apart. This article reviews the story of the involvement of Tara Levicy and her superiors at Duke University Hospital in the Duke lacrosse rape hoax.

(Note: Some of this information was obtained from two civil lawsuits filed against Duke and Durham by lacrosse players. Material from the suit filed by attorneys Charles Cooper and colleagues (Carrington et al v. Duke et al.) is referred to as (C paragraph number). For the text of the Cooper suit see: http://www.bork.com/downloads/02-21-08-Complaint.pdf Information from the suit filed by attorneys Robert Ekstrand and colleagues (McFadyen et al v. Duke et al) is referred to as (E paragraph number).) For the text of the amended suit see: http://www.ninthstreetlaw.com/docs/amended_complaint.pdf

Conclusions

(Reference citations and arguments supporting these assertions are listed in the article and notes.)

A. Tara Levicy was a feminist activist as evidenced by her education, writings, and statements.

B. Tara Levicy obtained her nursing degree and license through a fast-track that allowed her to receive her R.N. after only 15 months of training.

C. Duke University Medical Center (DUMC) improperly allowed Tara Levicy R.N. to begin SANE training after only 5 months of nursing experience; international standards call for at least 3 years of experience.

D. Duke University Hospital erred in delaying Crystal Mangum’s SANE exam for more than 4 hours until after Levicy arrived. for the morning shift on March 14, 2006 , instead of calling in the on-call SANE nurse. (DUMC was reported to have had a cadre of 14 trained SANE nurses and had a policy requiring one to be on duty at all times.)

E. DUMC provided inadequate SANE supervision for Levicy because as of March 14 she had not received her SANE certificate (although she had completed the certification requirements) and was still considered “in training.” The pelvic exam was done by a resident, Dr. Julie Manly, because Levicy knew that she did not yet have the SANE certificate (a requirement to perform forensic pelvic exams).

F. Levicy incompletely filled out the SANE report form describing Dr. Manly’s findings and her own, leaving spaces blank and failing to note important information such as Mangum’s hysterical behavior.

G. Levicy incorrectly signed the SANE report as the examiner, even though Dr. Manly had performed most of the exam and specimen collection.

H. Levicy either gave the Durham Police the impression that she was the examiner, or did not correct their impression that she was. (Dr. Manly was never interviewed by the police or prosecutors.)

I. Levicy falsely represented the results of the SANE exam to the police and prosecutors as being consistent with a vaginal and anal rape, and with “blunt force trauma,” even though the objective findings of Dr. Manly’s exam did not support such conclusions.

J. Levicy’s comments to the Durham Police were the foundation for the initial investigation, search warrants, the indictments of the players, and the continued prosecution of the case because Mangum’s stories and identifications kept changing.

K. Levicy’s superior at DUMC, Theresa Arico R.N., backed up Levicy in a newspaper interview and did not correct her distortions of the SANE exam. Arico also later accompanied Levicy to a meeting with prosecutors. However, no DUMC attorneys were present—a clear failure of supervision in a medical-legal case.

L. There was a delay in turning over the subpoenaed written SANE report to the Durham Police; during this time it is alleged Levicy improperly altered the SANE report with amendments favorable to the prosecution.

M. After DNA results came back negative, casting doubt on Mangum’s story, Levicy continued to bolster the prosecution case. She is reported to have met or talked at least seven times with police or prosecutors, again without DUMC legal advice or supervision.

N. Neither Dr. Manly nor Nurse Arico came forward to correct the widely publicized claims that the medical evidence backed up Mangum’s allegations. DUMC management also remained silent.

O. Even though Mangum repeatedly said condoms were not used, Levicy continued to raise this possibility months later in order to explain the negative DNA results.

P. Levicy allowed her ideological bias to outweigh her ethical requirements as a SANE to be objective, thereby obscuring the truth and prolonging this case which was based on fraudulent allegations.

Levicy’s Background, Training, & Feminist Ideology

Tara Levicy was a Women’s Studies major at the University of Maine, from which she received a B.A. degree; she did not initially study nursing as an undergraduate student there. (3)

She was involved in outdoors activity as a whitewater rafting guide and became certified as a Wilderness EMT (Emergency Medical Technician). (4)

At the end of 2003 Levicy began a fast-track nursing training program, taking advantage of her previous undergraduate courses. . “In late 2003, she went back to school at a 15-month program at the University of Southern Maine, which allows humanities majors to nursing degrees,” according to blogger Prof. KC Johnson, an expert on the lacrosse case. (5)

By February, 2005 she had completed her training, received her R.N. and nursing license (granted February 8, 2005), and began her first job out of nursing school working as a nurse in the Duke University Hospital Emergency Department (C 115).

In August 2005 she began work on her Sexual Assault Nurse Examiner (SANE) certification. Duke University Hospital had improperly allowed Levicy to apply for SANE certification after only five months of nursing experience, even though the standards of the International Association of Forensic Nurses require at least three years of nursing practice (C 116). By March 14, 2006, when she examined Crystal Mangum, she had been certified for less than 2 weeks (C 115). She had not yet even received her certificate in the mail and still had “in-training” status.

Thus, Levicy went from someone with no nursing training at the end of 2003 to R.N. licensure in a little more than a year, and then to SANE certification within a few more months.

Levicy was an ardent feminist. In a 2003 article about female medical problems in the wilderness, Levicy wrote, “A few years ago I produced and directed Eve Ensler’s, The Vagina Monologues, a whole night dedicated to hearing women’s stories about their vaginas. I can clearly remember people’s startled response to the word “vagina” when I was promoting the play.” (6)

She went on to suggest in the article, “If saying the word vagina feels foreign, then I recommend looking into a mirror and saying, ‘Vagina…vagina…vagina.” (6) Other evidence of her feminist leanings is that Levicy was involved in Planned Parenthood as a healthcare associate until she began her nursing training at the end of 2003. She also later made a statement about her views concerning rape to an investigator in the lacrosse case. In her January 10, 2007 interview with Inv. Wilson, Levicy “stated that she wasn’t surprised when she heard no DNA was found because rape is not about passion or ejaculation but about power.” (C 463)

In summary, Levicy was a strong feminist who in March, 2006 was inexperienced both as a nurse and as a SANE.

Mangum’s Examination at Duke University Hospital

After being picked up by the police after the ill-fated lacrosse party, Crystal Mangum was taken to Durham Access Center where she was asked during the intake interview whether she was raped. When she nodded yes, likely to avoid involuntary confinement, she was transferred to Duke Hospital. Mangum arrived at the Duke Hospital ER at 2:40 a.m. March 14, 2006 (C 104).
She was seen by three doctors and four nurses at Duke Hospital (C 106). Defense attorneys for the indicted lacrosse players had access to her medical records, which were later sealed. Some journalists also obtained access to the records through confidential sources. The medical records have not been made public.

According to these records, Mangum told several different stories about what had happened. She complained of pain but did not exhibit objective signs of pain (C 106). Mangum was seen by a triage nurse (Jenni Hauver R.N.) at 2:53 a.m. who described her as “anxious” (E 294).

“She reported that she was suffering from pain of “10/10”-- however the ESI Pain Documentation portion of the medical records indicates that she had no facial distress indicating pain, that she was not sweating (a common response to intense pain), that she did not change her body position in any way to indicate that she was uncomfortable, and that she had no changes in her vital signs (pulse, breathing blood pressure) that would have corroborated her complaints of pain,” according to a motion by attorneys for the lacrosse players (7).

In Mangum’s chart, Nurse Hauver noted that Mangum was “in no acute distress, no obvious discomfort,” despite Mangum’s claims of pain (E 294).

From 3:14 – 3:40 a.m. Mangum was seen by Dr. Jaime Snarksi, to whom Mangum complained of extreme pain, but he found no abnormal physical findings (E 295).

Another nurse (Carole Schumoski R.N.) evaluated Mangum at 3:28 a.m. and Mangum again said her pain was a “10,’ but the nurse’s exam was negative and the nurse later found Mangum resting quietly in the Emergency Department in no distress (E 296).

Thus, all seven nurses and doctors who examined Mangum in the Duke Emergency Department between 2:40 a.m. and 7 a.m. found no objective medical or physical evidence of an assault (C 112).

Mangum had to wait until the arrival of the morning shift for her SANE exam, a procedure involving taking a history, doing a physical exam including a pelvic exam, and obtaining forensic samples such as swabs of the vagina, anus and mouth. Delays in the SANE exam can lead to degradation of evidence.

It is uncertain why there was a delay in her SANE exam between 2:40 a.m. until after 7 a.m., when she was finally seen by Levicy to take a history, and until after 9 a.m. when she actually had a pelvic examination. Duke Hospital policy requires at least one SANE to be on duty at all times. As of November 2004, Duke Hospital employed 14 fully trained SANE nurses on a full-time basis (C 114). The hospital policy was to have a SANE on call for night admissions to the Emergency Department, yet no one was called in even though Mangum arrived at 2:40 a.m.

According to blogger Professor KC Johnson, “SANE nurse-in-training Levicy arrived for work at 6.45 a.m. the morning of March 14. Since Mangum still hadn’t been seen by a SANE nurse, the Charge Nurse asked Levicy to examine the patient. It remains unclear as to why Duke allowed a SANE nurse-in-training to perform this task without supervision from a certified SANE nurse.” (5) There was also no supervision by a physician to start.

Beginning after 7 a.m. Mangum told another version of her story to Levicy (C 106). Mangum told Levicy that she was raped by three attackers vaginally, orally, and anally; that she had been pushed, pinched, and kicked; that she had lost fake fingernails in the struggles; that she had pain in her vagina, anus, face, shoulders, neck, abdomen, back, buttocks and legs; and that no condoms had been used (C 119)

Because she had not yet received her SANE certificate, Levicy was not authorized to perform the pelvic exam. Mangum was examined at about 9 a.m. by Dr. Julie Manly, a fourth-year resident (E 302). It was Dr. Manly who took oral, vaginal and rectal swabs; collected hair, blood, and skin cell samples; and who performed a pelvic exam (C 122). These specimens are also known as a “rape kit.”

Levicy took notes during Dr. Manly’s pelvic exam of Mangum (C 124). Levicy filled in the blanks and checked boxes on the pre-printed Sexual Assault Exam Report (SAER) form (E 302).

The only signs of physical trauma noted were three small scratches on Mangum’s lower leg, which she had prior to the lacrosse party as verified by pictures taken there (C 125) The only finding on the pelvic examination was “diffuse edema of the vaginal walls” (C 126). According to the Cooper lawsuit, this swelling “can be caused by smoking, sex within 24 hours of the vaginal exam, frequent sex, antidepressants, or taking Flexeril” (C 126). It is known that Mangum used a vibrator, had sex with her driver, and may have had a yeast infection just prior to March 14, all of which could have contributed to the vaginal swelling (C 126).

While Mangum screamed when Dr. Manly tried to insert a speculum, Mangum did not have any of the physical signs of severe pain, such as sweating, facial distress, changes in her vital signs such as heart rate, or changes in her body position (C129). It also should be noted that Mangum had previously been described by a nurse as resting comfortably in the Emergency Department (E 296). The pelvic exam took more than an hour because Mangum resisted having the speculum placed.

An article by Joe Neff of the Raleigh News & Observer on 4/16//07 summarized, ”In the Duke Hospital emergency room on the morning of March 14, 2006, Dr. Julie Manly conducted a pelvic examination of Crystal Gail Mangum. Mangum said three men had gang-raped her for half an hour. The doctor also collected evidence: thong panties; swabs of the mouth, vagina and rectum; a cheek scraping; a blood sample; and hair from Mangum's head.

“Manly made one physical finding: "diffuse edema of the vaginal walls," or generalized swelling. The doctor was assisted by Tara Levicy, a nurse in training to conduct rape exams “The kit was passed from Levicy to Duke police to Durham police, who delivered it to the State Bureau of Investigation laboratory March 27.” (8)

There was one other finding of Dr. Manly which was not recorded on the SAER by Levicy or Manly but which colored Manly’s perception of the situation—a whitish vaginal discharge which Manly assumed at the time was semen. It was only months later, when questioned by defense lawyers, that Manly recognized a different diagnosis. (Neither the police nor prosecutors ever interviewed Manly).

As Neff related in the News & Observer on 4/18/07:”On the morning of March 14, Levicy had asked Dr. Julie Manly to perform the pelvic examination on Mangum. Manly had performed numerous rape exams.

“Mangum was different in several ways. Most rape victims are withdrawn and quiet but cooperative. Mangum, on the other hand, called attention to herself by screaming; Manly had never seen that behavior before, she told defense lawyer Doug Kingsbery in October.

“Manly made one notation on the rape kit report: "diffuse edema of the vaginal walls." It was the only medical evidence in Nifong's files that might support Mangum's version of what occurred at 610 N. Buchanan Blvd.

“In an interview with Kingsbery, Manly said she did not recall seeing that kind of swelling in any of her previous sexual assault exams. Manly had seen similar swelling in others of the hundreds of routine pelvic exams she had performed, but there were other reasons for it.

“During the exam of Mangum, Manly had seen discharge she assumed could be semen. After learning the rape kit turned up none, Manly came up with another possibility:

“Mangum had the whitish discharge and vaginal swelling common to a yeast infection."

It's a routine and unremarkable diagnosis -- one that could have been discovered much earlier in Mike Nifong's investigation (9)

Dr. Manly was remiss in not diagnosing the cause of Mangum’s alleged pain and not documenting, diagnosing and treating Mangum’s whitish vaginal discharge. Manly did not perform simple tests at the time which could have demonstrated whether the discharge was semen, due to yeast, or caused by another type of vaginal infection. She also poorly documented her part of the exam, including Mangum’s hysterical demeanor, the unusually long length of time to insert the speculum, and even the presence of the vaginal discharge.

Due to Mangum’s lack of cooperation, the SANE exam was incomplete, with no colposcopic exam to visualize the vaginal walls and cervix, and no internal rectal exam (E 305). (An external rectal exam by Manly was noted to be normal).

Thus it was Dr. Manly, and not Levicy, who performed most of the SANE exam, including the pelvic examination and collection of the “rape kit” specimens. Manly and Levicy cosigned the SANE report form; however, it was Levicy who signed the SAER form as the examiner. This form, as part of Mangum’s medical records, has not been released publicly. However, defense attorneys and some journalists had access to the form.

It was improper of Levicy to sign the SANE report in a way which gave the impression that she was the examiner. In fact, she reportedly could not even visualize the pelvic exam as a witness, which was performed with difficulty by Manly due to Mangum’s apparent histrionics (10).

According to the Ekstrand lawsuit, “Defendant Tara Levicy did not peform Mangum’s SAE. Levicy’s report of the exam, Sexual Assault Examination Report (“SAER”), however, fails to disclose that fact or the fact that Dr. Julie Manly actually performed Mangum’s SAE” (E 298).

Levicy did not do so, according to the Ekstrand suit, because “she was not qualified or authorized to do so pursuant to DUMC policy. By signing the SAER and failing to clearly document those facts on the SAER, Levicy knowingly created a false and misleading medical record in order to create the false impression that DUMC deemed her qualified and competent to collect and interpret forensic medical evidence and to give credibility to her unfounded observations”(E 299).

It has also been reported that Levicy was incomplete in her documentation, leaving blank a number of sections of the SANE report form.

As an inexperienced nurse, Levicy believed Mangum’s screaming was consistent with rape, while the more experienced Dr. Manly knew that this was unusual behavior for a true rape victim. The veteran nurses who had seen Mangum earlier recognized that her subjective complaints of pain were not corroborated by physical findings, however, Levicy was gullible in believing Mangum’s performance.

As the Attorney General’s report noted, Levicy’s attitude was based “largely on the accusing witness’s demeanor and complaints of pain rather than on objective evidence.” (2) The North Carolina Attorney General, having reviewed all the medical records, specifically stated that no medical evidence confirmed Mangum’s stories.

Mangum was released from the Duke Hospital early in the afternoon of March 14.

Levicy’s False Statements to the Police and Prosecutors

Two days later, at 11:01 a.m. on March 16, Durham Police Department (DPD) Investigator Ben Himan called Levicy to inquire about the medical evidence relating to Mangum’s claims. Levicy told Himan that “due to HIPAA laws she was unable to divulge patient information,” but that “there were signs consistent with sexual assault during her test” (C 150). According to Prof. KC Johnson, in a later interview with defense attorneys, Levicy confirmed that she had, in fact, passed along to Himan this diagnosis—based, she said, on her subjective evaluation of the hysterical Mangum’s pain. Johnson summarized Levicy’s faulty logic: “In other words: Mangum said she was raped. Mangum said she was in pain. Therefore, the physical exam corroborated Mangum’s story” (10).

This false declaration by Levicy was a critical factor in launching the rape investigation because Mangum’s accounts had been contradictory and changing (C 153). Levicy’s statements also later prolonged the rape investigation as Mangum had difficulty in identifying her attackers, and as exculpatory evidence for the lacrosse players began to emerge.

Based on Mangum’s accounts and Levicy’s seeming confirmation of an attack, the Durham Police obtained a subpoena for Crystal Mangum’s medical records on March 20 (C 184).

The Durham Police questioned and subpoenaed Levicy because she had signed the SAER as the examiner. After they found out she was such a willing witness, they never interviewed Dr. Manley or the other nurses and physicians who examined Mangum in the Duke Emergency Department.

On March 21 Sgt. Mark Gottlieb personally served Levicy with the subpoena at Duke University Hospital (C 151, C 185). According to the Cooper lawsuit, “Levicy made crucially false and misleading statements to Gottlieb about the nature of the physical and medical evidence. She told Gottlieb that the examination of Mangum had revealed physical evidence of ‘blunt force trauma,’ and that the blunt force trauma was ‘consistent with the victim’s statement’ alleging a forcible gang rape by three men” (C 185). However, no colposcopic exam (required to diagnose blunt force trauma) had been performed, and there was no mention of physical trauma in the written SANE report (except the three lower leg scratches from an earlier injury).

According to the lawsuit, “Levicy also advised Gottlieb that the evidence corroborated Mangum’s claims of both vaginal and anal rape. She stated that Mangum ‘had edema and tenderness to palpation both anally and especially vaginally.’ The reference to anal edema and tenderness was entirely fabricated” (C 186).

The New York Times later reported Gottlieb’s records of his meeting with Levicy: “’I asked her [Levicy] if the exam was consistent with blunt force trauma and she replied, ‘Yes,’”Sergeant Gottlieb wrote in the notes of his March 21 interview with the nurse. “She states that the victim had edema and tenderness to palpation both anally and especially vaginally that it took an extended period of time to insert same to conduct an examination. I asked her if blunt force trauma was consistent with the sexual assault that was alleged by the victim. She stated the trauma was consistent with the victim’s allegation.” (11)

According to KC Johnson, “In her November 15 [2006] defense interview, Levicy confirmed that Gottlieb’s report quoted her accurately. [Defense attorney] Doug Kingsbery then asked Levicy how she defined this term. It meant, she said, that the tissue had been forced against. And how did she diagnose that Mangum experienced ‘blunt force trauma’? Her subjective observations of Mangum in pain.

“So, in short: ‘blunt force trauma’ amounted to a nurse who never came into contact with a woman who lied about rape passing along the assertions of a patient who showed no physical signs of pain, much less ‘blunt force trauma’—and who was behaving atypically from real rape victims.” (10)

There was a major discrepancy about whether Mangum’s exam showed any evidence of anal trauma.

KC Johnson wrote: “…according to the Gottlieb memorandum, she [Levicy} stated that Mangum ‘had edema and tenderness to palpitation both anally and especially vaginally.’

“Yet Julie Manly’s examination had shown no anal edema or tenderness; indeed, the doctor later told defense attorneys, she had expressed surprise that no anal bruising existed given Mangum’s claims. Nor did the March 14, 2006 report co-signed by Manly and Levicy contain any mention of anal edema. And Levicy later admitted that she had no first-hand knowledge of either the vaginal or the anal examinations, since she couldn’t see Mangum during Manly’s work.” (10)

Levicy’s false statements that “there were signs consistent with sexual assault” made to Himan on March 16, and that the accuser had suffered ‘blunt force trauma” and “edema and tenderness to palpation both vaginally and anally” to Gottlieb on March 21 were the linchpin of the police investigation.

The key application for a non-testimonial identification order (NTO) made by Gottlieb on March 23 stated: “Medical records and interviews that were obtained by subpoena revealed the victim had signs, symptoms and injuries consistent with being raped and sexually assaulted vaginally and anally. Furthermore, the SANE nurse stated the injuries and her behavior were consistent with a traumatic experience” (C 189). The NTO application, which became public and ignited the media firestorm, placed decisive emphasis on Levicy’s statements (C 205) to justify the unprecedented order for all the lacrosse players (except for a black team member) to submit to DNA testing and photographs.

According to the Cooper lawsuit, “By March 23—before Nifong took an active role in the case—Levicy’s false and misleading statements to the Durham police had ensured that the hoax would become, at the very least, a humiliating public spectacle for all the players. Moreover, the NTO application’s allegation that the rape complaint was supported by medical evidence collected by Duke Hospital—an allegation that owed its existence entirely to nurse Levicy—gave the spurious rape allegations a powerful aura of credibility to the media and the public” (C 210).

Durham District Attorney Michael Nifong took over supervision of the rape investigation on March 24 and began a series of over 70 media interviews in the week of March 27-31 (C 273). Nifong in his statements repeatedly based his condemnation of the lacrosse players on the March 14 exam at Duke Hospital which he claimed was consistent with a sexual assault (E 782). For example, at an April 11 public forum Nifong said, “Duke University Hospital is the best trauma center in the area. The nurse was specially trained in sexual assault and I would just point out that my conviction that a sexual assault actually took place is based on the examination that was done at Duke Hospital” (C 274). On April 18 Gottlieb and Himan filed an affidavit claiming that the medical records and interviews with “the SANE nurse” “revealed the victim had signs, symptoms and injuries consistent with being raped and sexually assaulted vaginally and anally” (C 274).

Duke University was in possession of the records which refuted these false claims, especially those of anal rape and strangling or choking. However, neither Levicy’s superiors nor Duke University Hospital took any action to correct her distortions concerning Mangum’s exam. Specifically, Dr. Manly had personal knowledge about the medical exam and yet failed to come forward, even in face of intense news coverage about the details of the case. Neither did the attorneys for DUMC, who had the subpoena for Mangum’s medical records which had been served on Levicy on March 21.

Thus, Levicy mischaracterized her role in the SANE exam to police, misinterpreted the results of the exam, mislead the police about the medical evidence, and failed later to correct the misperceptions she had created. Manly, Arico and DUMC management did not adequately supervise Levicy, who still had “in training” status. Nor did they address the use of Levicy’s misleading statements, which they knew to be false, as the basis for police requests for search warrants, non-testimonial identification orders, and indictments.

Next Part II: The allegations that medical records were altered and a critique from a SANE Nurse