The Curious Case of Crystal Mangum’s Sexual Assault Examination Report

Levicy Allegedly Withholds Pages, Adds "Evidence"

(This article represents my opinions only, and is solely for discussion and debate purposes. Thanks to Kethra, Baldo, Quasi, and JSwift for suggestions, but all conclusions are mine.)

Authored by sceptical

SUMMARY

The SANE exam of false rape accuser Crystal Mangum was performed March 14, 2006 in the Duke University Medical Center Emergency Department (ED) by Dr. Julie Manly, assisted by SANE-in-training Tara Levicy. Levicy incompletely recorded the findings in the Sexual Assault Examination Report (SAER), mistakenly co-signed the SAER as the examiner, and was responsible for turning over the SAER and her notes to the police. Standard procedure is for the SAER to be sealed with the "rape kit" specimens and given to police the same day to be logged in as evidence to maintain the chain of custody. Instead, allegedly, Levicy improperly retained parts of the SAER and her notes for weeks afterwards. SAER pages concerning Mangum's physical examination were turned over to Durham Police Sgt. Mark Gottlieb on March 21 when he personally served Levicy with a subpoena for Mangum's medical records. It was not until April 5 that Levicy gave to Police Inv. Ben Himan the additional withheld SAER pages with the history of the "assault;" a written nursing note by Levicy purporting to give Mangum's March 14 recounting of the event; and Duke ED electronic medical records of Mangum's visit. It is unclear why there was a delay between receipt of the subpoena on March 21 and tendering of the records on April 5. The retained SAER pages, which were allegedly altered, and Levicy's nursing note turned over April 5 contained details of the case which were not known on March 14, indicating they had been added after the fact. Withholding sections of the SAER and then later allegedly amending them with notations helpful to the prosecution was unethical and possibly illegal.

PROLOGUE

The SANE exam was a key piece of evidence in the 2006 Duke Lacrosse rape hoax. SANE is an acronym for “Sexual Assault Nurse Examiner.” Written records and comments to police and prosecutors from SANE in-training Tara Levicy R.N., an inexperienced nurse and feminist who performed part of the exam, propelled the case ahead by giving credence to the false accuser, Crystal Mangum.

Mangum was brought to the Duke University Medical Center (DUMC) Emergency Department (ED) at about 2:45 a.m. on March 14, 2006 after claiming she had been raped at a party. She had originally been taken to Durham Access Center by Durham police, who thought she was drunk and needed to be committed for her protection. During the intake interview, Mangum, knowing otherwise she was going to be involuntarily confined, nodded yes when asked by a nurse whether she had been raped. She was then transported by police to DUMC for evaluation.

During the night shift (before 7 a.m.) at DUMC she was seen by seven nurses and physicians, as well as by police officers. She gave differing accounts of the “assault” to each one of those who interviewed her.

Mangum was first evaluated at 2:53 a.m. by triage nurse Jenni Hauver R.N. Mangum said she had been sexually assaulted and claimed to be in pain (pain score 10/10). Hauver noted she was anxious but on exam found Mangum to be “in no obvious discomfort.”
http://news.justia.com/cases/featured/north-carolina/ncmdce/1:2007cv00953/47494/

Resident physician Jaime Snarski M.D. interviewed and examined Mangum beginning at 3:18 a.m. “Mangum reported to Dr. Snarski that she was “stripping at a bachelor party,” and “the bachelor [and] other guys…put their fingers and penises” in her “vagina against her will.” To Dr. Snarski, Mangum complained of extreme pain, but denied being hit. When asked to describe the pain, Mangum said it was “only in her vagina.” “(McFadyen et al, para. 295).

The ED attending physician Joshua Broder M.D., who was Snarski’s supervisor, also saw her. She ''denies other physical assault,'' Dr. Broder wrote after initial examination in the Duke ED. http://query.nytimes.com/gst/fullpage.html?res=9407E2DF103EF936A1575BC0A9609C8B63&sec=&spon=&pagewanted=4

Another nurse Carol Schumoski R.N. checked Mangum about 3:28 a.m. “Mangum reported that her pain was a “10.” When Schumoski asked Mangum to describe the pain, Mangum said it was “down there.” Nurse Schumoski also examined Mangum for symptoms associated with pain, and found none. Shortly thereafter, Nurse Schumoski found Mangum, alone, resting quietly in no apparent distress. “(McFadyen et al, para. 296). Investigator Buffy Jones of the Durham Police Department (PD) also questioned Mangum about her story at about 3:50 a.m.

DUMC had a roster of certified SANE nurses and an on-call schedule for them. Rather than bring in the on-call SANE nurse to do a SANE exam, someone, possibly the ED charge nurse, decided to wait until the day shift would arrive. Mangum was allowed to sleep on a gurney in the ED.
The assignment to do the SANE exam was given to SANE in-training Tara Levicy R.N. Ms. Levicy had started a 15 month “fast track” nursing program at the end of 2003. By February 2005 she had received her R.N. and a North Carolina nursing license (granted February 8, 2005). Her first job out of nursing school was in the DUMC ED. In August 2005 she was allowed to begin work on SANE certification, even though international standards call for at least 3 years of experience. Thus, by March 2006, Levicy had only little more than a year total of nursing experience and only 7 months of SANE training.
http://liestoppers.blogspot.com/2008/05/our-collective-voice-allegations.html

Levicy had completed the classroom requirements for SANE certification, but as of March 14 she had not yet received her certificate. She had not completed the Practical part of SANE training where she would observe exams by an experienced SANE and later do her own exams while under close supervision of an experienced SANE. Therefore, Levicy’s assignment by the Duke ED to do Mangum’s SANE exam without appropriate SANE supervision was improper, and Levicy was acting beyond the scope of her nursing practice.

Levicy had arrived at the Duke ED at approximately 6:45 a.m. She began to interview Mangum at about 7 a.m. According to Levicy’s account, Mangum told her 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 (Carrington et al. para 119). Levicy talked to Mangum for about an hour and also took photographs.
http://durhamwonderland.blogspot.com/2007/05/levicy-exam.html

Because Levicy had not received her SANE certificate, she was not authorized to perform the pelvic exam on Mangum. A resident physician in her last year of training, Julie Manly M.D., joined Levicy about 9 a.m. and they commenced the SANE exam.

WHAT IS A SANE EXAM?









Figure 1 - A Sane Kit

According to the blog Forensic Talk’s Kathleen Eckelt R.N., a SANE with many years of experience:

" ‘A medical evidentiary examination is given to victims of sexual assault and other forms of abuse and is performed to collect physical evidence and document findings that can be used to identify, prosecute, and convict an assailant.

While an evidentiary examination includes an array of medical components, including assessment of injuries and crisis intervention, its main purpose is to meet the needs of the legal system...’

The SANE examination is usually completed by an RN with advanced sexual assault forensic training and experience. The nurse carries the designation of Sexual Assault Nurse Examiner (SANE), Sexual Assault Forensic Examiner (SAFE), or Forensic Nurse Examiner (FNE).
The nurse's report usually consists of several pages of in depth questions regarding the patient's past medical history, the alleged assault, as well as documentation on the collection of evidence.”
http://harfordmedlegal.typepad.com/forensics_talk/the_sane_report.html

The nurse’s report is commonly called the Sexual Assault Examination Report (SAER). This is a pre-printed form which includes check-offs, underlined spaces for written responses and open spaces for additional responses.

The form varies from state to state, but general features (adapted from Eckelt) include:

1. Identification information: Date, name, address, phone number; Date, place, time of incident; Date, place, time police notified; Date, place, time of admittance to ER; Name of Detective; How brought to the hospital

2. Informed consent of patient for the procedures

3. Physician’s orders for tests, medications and treatment

4. Patient’s past medical history: allergies, illnesses, chronic diseases, history of STDs, birth control use, medications, drug and alcohol use.

5. Sexual contact history: Date of last consensual sexual contact; Condom used?; Foreign objects (dildo, vibrator, other) used?; Date of last menses.

6. Assault information: Number of assailants, name if known, sex, race, age. How assaulted? Condom used? From what angle were they assaulted? Position of patient during assault? Any kissing, licking, fondling, biting, gagging, binding, blindfolding by assailant? Any verbal threats? Any physical force? Any weapons? Did the assailant (s) give the patient any alcohol or drugs? Did victim injure assailant? Any scratching? Did patient shower / bathe / drink liquids / brush teeth, etc. after the assault?

7. Physical examination: General examination of head, eyes, ears, nose, throat, neck, chest, heart, abdomen, extremities, and skin looking for signs of injury or trauma. Pelvic examination including examination of labia, hymen (if present), vagina and cervix. A speculum is used to visualize the vagina and cervix to look for discharge, redness, menses and cervical injuries. Techniques often include a Woods lamp exam using UV light to visualize semen and a colposcopic (Medscope) exam which makes injuries visible by magnifying the view of internal tissues.With each of these tests, photos are taken to document the findings. An external exam of the anus and an internal rectal exam is done to look for tears, bleeding or other signs of trauma.

8. Evidence collection: All significant clothes are collected, especially the underwear. Swabs are taken of all suspected areas, including the mouth, plus (4) vaginal / cervical swabs, and (2) perineal / anal swabs are done if need indicated. Other specimens obtained include fingernail scrapings, pubic hair combings, and pulled hair may be done, depending on the protocol. Attention is also paid to any feminine hygiene products, debris, and foreign material. Blood samples are taken for the patients DNA. A blood pregnancy test and RPR to check for Syphilis is usually done as well. Depending on the protocol, blood and urine samples may also be taken for toxicology tests. A urine test for GHB is taken if any date rape drugs are suspected. Swabs and culture are taken to check for Chlamydia and Gonorrhea.

9. Discharge. Patient is given antibiotic to prevent STD and urged to see a gynecologist and get HIV testing. She is given the name and phone number of the detective assigned to the case, and well as counseling resources.

There are several medical records generated by a SANE exam.

First, the medical facility involved has its own medical records, which may either be hand-written or computerized (electronic medical records). These document the patient’s admission to the Emergency Department and general medical and nursing evaluation.

Second, the SAER pre-printed form has several components listed above, including past medical history, history of the assault, physical examination, and pelvic examination.

Third, most jurisdictions have a medical evidence inventory list to identify what swabs and other specimens, including clothing, were collected. This is important for the chain of custody required for evidence items in criminal cases.

The normal procedure is for the SAER to be completed on the day of the exam by the SANE nurse, signed by the nurse, and included with the specimens in a sealed bag or box (Fig. 1). The evidence inventory list is also sealed in the bag or box. The sealed “rape kit” is then passed from the SANE nurse to appropriate law enforcement officers, preserving the chain of custody.

While this is the normal sequence of events, this is not what happened on March 14, 2006, and thereafter, with the SANE exam of Crystal Mangum in the Duke ED.

CRYSTAL MANGUM’S SANE EXAM

As noted above, because Levicy had not yet received her SANE certification, Julie Manly, M.D. performed the pelvic exam on March 14 with Levicy acting as a “scribe,” writing down the findings.

The resulting SAER, along with Mangum’s other medical records, was placed under seal by a judge in the criminal cases against Duke lacrosse players Reade Seligmann, Collin Finnerty and Dave Evans. However, motions in the criminal cases and the complaints in the three civil rights lawsuits (Evans et al v. Durham et al.; McFadyen et al v. Duke et al.; and Carrington et al v. Duke et al.), as well as some blog and press reports (especially from Prof. KC Johnson and the News& Observer’s Joe Neff) , inform us about the exam and the disposition of the products of the exam—specimens, the SAER, and Mangum’s other medical records.

According to the McFadyen et al lawsuit (para. 302-7)
302. At approximately 9:00 a.m., Defendant Julie Manly, Duke Physician, initiated the SAE with Defendant Levicy in tow. Manly conducted the SAE, while Levicy filled in the blanks and checked boxes on the pre-printed SAER.
303. Defendant Manly never completed Mangum’s SAE; it was abandoned in midstream because Mangum refused to allow the exam to continue.
304. To initiate the pelvic exam, Defendant Manly inserted a speculum, which allows the examiner to use a coloposcope to visually inspect the vaginal walls and cervix at high levels of magnification. Mangum quickly protested and insisted that the examination cease. According to Levicy, Mangum was responding to intense pain. However, if Defendant Manly believed Mangum’s pain was too severe to continue with the pelvic exam, the appropriate medical response was to diagnose the source of the pain and treat it. Once the pain (and its source) is treated, the exam can continue. That did not happen.
305. When Defendant Manly abandoned the SAE, much of the SAE had not been done.
For example:
A. No pelvic exam was conducted.
B. No rectal exam was conducted.
C. No forensic toxicology tests had been ordered.
D. No forensic blood draw was taken.
snip
307. Several photographs were taken in the SAE that did, in fact, show injury to Mangum’s feet and knees. However, even the nominal injuries documented in the SAER were not new.
http://news.justia.com/cases/featured/north-carolina/ncmdce/1:2007cv00953/47494/

According to the Carrington et al lawsuit (para. 124-129)
124, Levicy took notes during Dr. Manly’s pelvic exam. According to Levicy’s notes, Mangum had no vaginal or anal tearing, bleeding, or bruising, no grimacing, no sweating, no changes in vital signs, and no other symptoms ordinarily associated with the serious pain of which she complained. Her head, back, neck, chest, breasts, nose, throat, abdomen, and extremities were all unbruised and normal. There was no sign of rectal penetration; as noted above, Levicy recorded “nothing notable” in the section of the SANE form labeled “Anal Exam.” Snip
126. Dr. Manly’s only diagnosis of any abnormality in the pelvic examination was “diffuse edema [i.e. swelling] of the vaginal walls.” Snip
128. During the examination, Mangum screamed hysterically, and complained of severe pain when Dr. Manly inserted a speculum for vaginal examination. This behavior was highly atypical for a rape victim who lacked any bruising, bleeding, tearing or other visible physical injury.
http://dockets.justia.com/docket/court-ncmdce/case_no-1:2008cv00119/case_id-47871/

Thus, Mangum’s exam ended prematurely without a full pelvic, colposcopic, or internal rectal exam. Whether Mangum actually withdrew consent for the exam or just was uncooperative is unclear. However, Dr.Manly did manage to obtain evidence specimens, including oral, vaginal, and rectal swabs from Mangum.

At the conclusion of the exam, according to Levicy’s notes, the evidence was collected, gathered up, and delivered to the custody of a representative of the “Law Enforcement Agency,” Duke Police Officer Joyce Sale. (McFadyen et al para 310). The same day the items were turned over to the Durham Police Department and logged in as evidence, preserving the chain of custody.
Therefore, the SANE exam was incomplete because of Mangum’s hysterics— most importantly, since she would not allow full insertion of a speculum there was no colposcopic exam (required for a diagnosis of “blunt force trauma,” among other injuries) or exam of the cervix.

Also, the documentation of the SANE exam was incomplete. For example, Dr. Manly noted a white discharge in the vagina. She thought it was sperm, but later concluded it may have been due to a vaginal yeast infection.

http://www.newsobserver.com/100/story/565336-p3.html

Whatever the cause, Levicy and Manly did not document the presence of the white fluid nor do any tests to identify the substance. Furthermore, Levicy did not fill in all the boxes and spaces on the pre-printed SAER, leaving some of them blank.

THE PRODUCTS OF THE SANE EXAM

According to the “DNA motion” in the criminal case (Motion to Compel Discovery: Expert D.N.A. Analysis 12/12/06, p. 2):

“The “rape kit” in this case contained cheek scrapings, oral swabs, vaginal swabs, rectal swabs, a pubic hair combing, and a pair of white panties collected from the accuser at the Duke ER that morning. Also collected from the accuser were four items of clothing: a pair of red lace underwear, a red lace halter top, a white knit skirt, and a white knit top.”

http://www.newsobserver.com/content/news/crime_safety/duke_lacrosse/20061213_dukelacrosse.pdf

The “rape kit” specimens were turned over to the North Carolina State Bureau of Investigation (SBI) by CSI Angela Ashby of the Durham PD on March 27 for processing and analysis. Other specimens from the March 16 search of the party house at 610 N. Buchanan, including false fingernails, a towel, and floor swabs, were also sent to the SBI.

What is not so certain is what happened to the documentation of the SANE exam. An evidence inventory was likely included with the specimens turned over March 14 to the police to document their source.

We also know that some pages of the SAER were retained by Levicy for up to 3 weeks later and not included with the specimens, as is standard SANE procedure.

On March 16, at 11:01 a.m., Durham PD Investigator Ben Himan called Levicy to inquire about the medical evidence relating to Mangum’s claims. It is not clear why Himan called Levicy instead of Dr. Manly or Theresa Arico, R.N., Levicy’s supervisor. However, it is known that Levicy improperly co-signed the SAER as the examiner, when in fact Dr. Manly was the sole examiner. Levicy’s mistaken signature misled the police as to her role in the procedure, and she apparently did not disabuse them of the error.

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” (Carrington et al, para 150). According to 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. http://durhamwonderland.blogspot.com/2007/05/levicy-and-law-enforcement.html

However, Levicy’s assertion that HIPAA laws (Health Insurance Portability and
Accountability Act) prevented disclosure was incorrect—in those regulations there is a clear exception when information is for law enforcement purposes.

On March 20 the Durham PD prepared a subpoena for Mangum’s medical records (Fig. 2). (A subpoena was not required for a SAER, but was needed for her other records).
The subpoena was addressed to Arico, the head of the SANE unit at Duke hospital. This in and of itself is unusual because normally a subpoena would be issued to the director of medical records at the hospital.
























Figure 2 - The subpoena for Magnum's Medical Records

On March 21 Sgt. Mark Gottlieb, Himan’s supervisor, personally served Levicy, rather than Arico, with the subpoena at Duke University Hospital.

Gottlieb later summarized his meeting with Levicy:

"I asked her if the exam was consistent with blunt force trauma, and she replied yes," Gottlieb wrote.

The nurse, Tara Levicy, "stated the victim had [swelling] and tenderness to palpitation both anally and especially vaginally. She stated it was so painful to have the speculum inserted vaginally, that it took an extended period of time to insert same to conduct an examination. I asked her if the 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."

http://www.newsobserver.com/1185/story/479650.html

According to the Carrington et al. lawsuit (para 185), “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…”

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).

Also, Levicy told Gottlieb there were signs of anal rape, although no findings such as rectal tenderness or swelling were noted in Dr. Manly’s exam.
http://durhamwonderland.blogspot.com/2007/05/levicy-and-law-enforcement.html

A new analysis of the McFadyen et al v. Duke et al lawsuit (submitted by attorney Robert Ekstrand) reveals that during their March 21 meeting at Duke Hospital Levicy gave Gottlieb some parts of the SAER pages she had withheld on March 14. These pages apparently contained all or part of the physical examination pages of the SAER.

According to the complaint in McFadyen et al.:

791. Levicy, Arico, and DUMC all condoned and ratified Nifong’s repeated recitation of the claim of trauma in interviews televised locally and nationally, and in local and national newspapers and magazines. Yet, there was no evidence of blunt force trauma consistent with rape. According to the SAER documentation that Levicy submitted on March 21st, it is plainly obvious that the pelvic exam was abandoned at its inception because Mangum protested Manly’s use of a speculum. Penetrating blunt force trauma, if it existed, would be found on Mangum’s cervix. Mangum’s cervix, however, could not be observed without the aid of (1) a speculum and (2) a coloposcope. The March 21st SAER documents make it clear that the coloposcope was never used in the pelvic exam because Mangum refused the insertion of a speculum.

If Ekstrand is correct about these assertions in his complaint, then Gottlieb, and through him the Durham PD and District Attorney Mike Nifong, received part of the SAER on March 21. This conflicts with previous reports that Nifong and the Durham PD did not receive any SANE documentation until later, on April 5 when the rest of Mangum’s Duke medical records were turned over.

We do know that some of the history pages of the SAER were in fact not given to the Durham PD and thence to Nifong until April 5, 3 weeks after the SANE exam, when Levicy met with Inv. Ben Himan to give him the subpoenaed records. It is not known why it took from March 21 to April 5 for Duke University Medical Center to deliver the records; normal procedure is to respond to a subpoena in less than 2 weeks.

According to typewritten case notes kept by Himan:

4/5/06 1027hrs - Arrived at Duke Hospital and spoke with Sane Nurse Levicy about Wellsoft medical records of victim.4/5/06 1055hrs - Received triage and discharge and nurse notes from Ms. Levicy.
http://liestoppers.blogspot.com/2007/07/inv-ben-himans-typed-notes-part-1-march.html

Therefore, on April 5, Levicy turned over the following materials to police and prosecutors :

1) The Wellsoft medical records of Mangum are the reports from the Duke ED electronic medical record system called Wellsoft EDIS. This is used for all patients who come in to the ED. The Wellsoft records would be the source of the notes taken by the various nurses and physicians who interacted with Mangum before 7 a.m.

2) A hand-written nursing note written by Levicy purporting to record the story of the “attack” recounted to her by Mangum back on March 14.

3) The remaining SAER pages, mainly those dealing with information about the history of the “assault.”

However, there are major problems with the notes written by Levicy, as well as the SAER pages she turned in on April 5.

First, there were important changes to the withheld SAER pages which had to have been made well after the SANE exam to include new evidence which was not available on March 14.

According to the McFadyen et al complaint:

785. Levicy did not produce significant portions of the SAER until April 5, 2006, weeks
after DUMC’s March 21, 2006, subpoena and subsequent production of medical records to Gottlieb. In the intervening time, Levicy re-created those portions of the SAER that were not completed on March 14th after the SAE was abandoned. On April 5, 2006, Levicy produced the remaining material portions of the SAER to Himan, including what Levicy claims to be a handwritten transcription of the SANE interview of Mangum, and several pages containing strike-outs and other addenda that do not conform to the facts of the SANE exam, but instead attempted to conform the SANE exam to what Levicy understood to be the evidence at the time.

For example:

A. Levicy falsified the medical record of Mangum’s SAE by fabricating a transcript
of her interview of Mangum in order to conform the SANE interview to what Gottlieb reported in his sensationalized application for the NTID Order to be Mangum’s account of the sexual assault.

B. Levicy falsified the medical record of Mangum’s SAE by revising and annotating Mangum’s contemporaneous responses on the pre-printed SAER forms to conform them to the evidence police believed existed at the time. By way of illustration, on one of the late-submitted pages of the SAER, a question asked if any efforts were made to conceal evidence. Levicy’s original notation, “no,” was struck through, and the (formerly empty) “yes” blank was checked. Further, a handwritten notation near the revision states, “wiped her off with a rag.” In this revisio Levicy conformed the SAER with the fact a towel containing semen had been seized during the search of 610 N. Buchanan.

However, after Levicy submitted this page on April 5th, police and Nifong learned that, although the towel did contain semen matching one of the residents (who was then a suspect), Mangum’s DNA was not on the towel.

The “wiped her off with a rag” comment is important because while the SANE exam was done on March 14, the house where the towel was found was not searched until the evening of March 16. A contemporaneous SAER would not have mentioned the towel (there is no other evidence that Mangum had in fact said anything prior to police or others about being wiped off with a towel).

The version of the “assault” turned in April 5 by Levicy purporting to represent the history given by Mangum on March 14 is remarkable for its consistency with the written statement by Mangum the next day (April 6) and with the Non-testimonial Identification Order request submitted by Gottlieb. There are details of the “assault” which do not appear in any other of Mangum’s earlier accounts—such as anal rape. There are also aspects of this version of Mangum’s history which could only have been concocted after March 14 because they resulted from the search of 610 N. Buchanan on March 16—such as a semen stain on the floor of the bathroom. Again, this reflected additions after the fact in Levicy’s nursing notes.

The McFadyen et al complaint states:

(785) C. The next day, on April 6th, Mangum gave her first (and only) written statement in the case. She wrote an account remarkably consistent with the SAER interview transcript Levicy gave Himan the day before. In a move transparently designed to conform her account to the existent evidence of semen found by police in the bathroom, in the case, Mangum writes an “add-on” paragraph at the end of her statement. The add-on paragraph reads, in toto, “I would like to add that Adam ejaculated in my mouth and I spit it out onto the floor, part of it fell onto the floor [scratch out] after he pulled his penis out.”

786. The falsifications in the SAER were plainly designed to conceal the fact that Mangum did not report any of the detail that appeared in Gottlieb’s application for a NTID Order that was published widely on the internet. In other words, the fabrications were designed to corroborate the sensationalized version of Mangum’s account that Gottlieb falsely reported in his factual sections of the application for the NTID Order.

Based in part on Levicy’s allegedly altered records and false testimony to police, DA Nifong decided to go ahead with indictments of Seligmann and Finnerty (April 17) and Evans (May 15) despite negative DNA evidence linking any lacrosse player to Mangum.

Levicy continued her efforts to promote the prosecution’s case long after the DNA results came back negative. She and Arico met privately with DA Nifong on June 9, 2006; curiously, no notes were taken by any of the parties about the meeting. Levicy kept “spinning” her story up to and including January, 2007 when she met with Himan and Inv. Linwood Wilson. For example, at this meeting Levicy claimed Mangum was not sure condoms were used, even though this conflicted with all of Mangum’s previous statements. Also, when asked about the SBI finding no semen in the “rape kit” samples, Levicy said, “I wasn’t surprised when I heard no DNA was found because rape is not about passion or ejaculation but about power.” Apparently she did not realize that DNA tests were sensitive enough to detect skin cells and that ejaculation was not required for a DNA match.
http://durhamwonderland.blogspot.com/2007/05/levicy-and-linwood.html

It was only after Nifong recused himself and Special Prosecutors were appointed that she admitted that a rape might not have happened.

CONCLUSIONS

The SANE exam of Crystal Mangum on March 14, 2006 was incomplete because it was terminated early due to her hysterics. Specifically, no colposcopic, cervical, and internal rectal exams were done.

The SANE examiner who obtained specimens and who attempted to do a pelvic exam was Julie Manly M.D. and not SANE in-training Tara Levicy R.N., who had not yet received her SANE certificate and was an inexperienced nurse.

Tara Levicy R.N. obtained a history from Mangum prior to Manly’s attempted exam and she acted as a “scribe” for Manly filling out parts of the SAER. The documentation was incomplete with facts such as a white vaginal discharge not noted, and spaces left blank in the pre-printed form.

Both Manly and Levicy signed the SAER as the examiner. It was improperly signed by Levicy because she did not perform the pelvic exam. As a result, Durham Police investigator Ben Himan called Levicy about the SANE procedure. Himan and his supervisor Sgt. Mark Gottlieb followed up only with Levicy and never interviewed Dr. Manly or Theresa Arico R.N., Levicy’s superior and head of the Duke SANE program.

False statements by Levicy confirming Mangum’s claim of a sexual assault were a major basis for search warrants, the Non-testimonial Identification Order, and the indictments of Seligmann, Finnerty, and Evans.

The “rape kit” specimens (including oral, rectal and vaginal swabs, hair samples, and clothing) were turned over by Levicy to the Duke Police on March 14, along with an evidence inventory documenting their source. Parts of the SAER were improperly held back by Levicy and not included with the specimens. Duke Police transferred the “rape kit” the same day to Durham Police, who turned them over to the NC State Bureau of Investigation on March 27.

Durham Police Sgt. Mark Gottlieb met March 21 with Levicy at Duke Hospital to deliver a subpoena for Mangum’s medical records, even though the subpoena was addressed to Theresa Arico R.N. At the March 21 meeting, Levicy turned over some of the withheld SAER pages which detailed Mangum’s physical examination. Thus, as early as March 21 Durham Police and DA Mike Nifong had documentation which was inconsistent with the brutal gang rape by three men claimed by Mangum.

For unknown but suspicious reasons, the rest of Mangum’s medical records from Duke were not given to police until April 5. Three types of records were turned over:

First, the Wellsoft EDIS electronic medical records from the Duke Emergency Departments concerning Mangum’s visit on March 14. These computerized records detailed findings by the seven nurses and physcians who interacted with Mangum that night.

Second, a nursing note written by Levicy purporting to be a contemporaneous record of the history she took from Mangum on March 14. There is evidence that Levicy allegedly wrote this note long after March 14 because it included details that were only known following the March 16 search of the party house by police. The story as presented by Levicy bolstered police claims in the NTIO application and Mangum’s written statement of April 6. There are suspicions of coordination and collusion.

Third, the rest of the withheld SAER pages were also turned over April 5. The SAER is supposed to be completed the day of the SANE exam (March 14) or shortly thereafter. Levicy allegedly altered these pages long after the fact with details available only after the March 16 search. These alterations were not properly signed and dated, as required for changes to medical records.

Levicy violated SANE and nursing standards by retaining pages of the SAER for up to 3 weeks after giving the “rape kit” to police, by making claims based on evidence not available at the time of the exam, and by allegedly altering the withheld SAER pages to conform to these claims.

Levicy’s alleged improper changes to her nursing note and the SAER after the fact were an attempt to confirm Mangum’s false claims of rape, provide a justification for search warrants and indictments, and promote the prosecution of three innocent men for a rape that never happened.
REFERENCES

EVANS et al v. DURHAM, NORTH CAROLINA, CITY OF et al
http://news.justia.com/cases/featured/north-carolina/ncmdce/1:2007cv00739/46882/

MCFADYEN et al v. DUKE UNIVERSITY et al
http://news.justia.com/cases/featured/north-carolina/ncmdce/1:2007cv00953/47494/

CARRINGTON et al v. DUKE UNIVERSITY et al
http://dockets.justia.com/docket/court-ncmdce/case_no-1:2008cv00119/case_id-47871/

NY Times article on Gottlieb notes
http://query.nytimes.com/gst/fullpage.html?res=9407E2DF103EF936A1575BC0A9609C8B63&sec=&spon=&pagewanted=4

Kathleen Eckelt R.N. on SAER
http://harfordmedlegal.typepad.com/forensics_talk/the_sane_report.html

DNA Motion 12/12/06
http://www.newsobserver.com/content/news/crime_safety/duke_lacrosse/20061213_dukelacrosse.pdf
Ben Himan’s Case Notes

http://liestoppers.blogspot.com/2007/07/inv-ben-himans-typed-notes-part-1-march.html

News & Observer series “Rush to Judgment” by Joe Neff

http://www.newsobserver.com/1537
http://www.newsobserver.com/100/story/565336-p3.html
http://www.newsobserver.com/1185/story/479650.html

Liestoppers articles on Levicy by sceptical
http://liestoppers.blogspot.com/2008/05/our-collective-voice-allegations.html
http://liestoppers.blogspot.com/2008/05/our-collective-voice-part-ii.html

Durham in Wonderland articles on SANE by KC Johnson
http://durhamwonderland.blogspot.com/2007/05/levicy-exam.html
http://durhamwonderland.blogspot.com/2007/05/levicy-and-law-enforcement.html
http://durhamwonderland.blogspot.com/2007/05/levicy-and-linwood.html