SEXUAL ASSAULT TOPICS

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SEXUAL ASSAULT TOPICS

• 78th Medical Group Instruction
• Rebecca Moody
• Rohypnol and GHB
• Agent Brian Sullivan
• Typical Victim Reactions
• Miranda Benson

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SUMMARY OF REVISIONS

• Excludes in-patient services
• Eliminates jurisdictional issues
• Establishes sexual assault examination team
• Subsections reorganized
• Documentation, General Exams, Pelvic Exams,
  Specimen Preservations
• Outlines prophylaxis of STDs
• HODAC notification

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RAPE CRISIS ADVOCATE

• Is in the best position to encourage advise
• Is prepared to provide immediate continued
  counseling
• Can be trusted to advocate for the victim in an
  unbiased manner
• Is support during police interviews

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REASSURING THE VICTIM

• I often wonder whether we do not rest our hopes
  too much upon constitutions, upon laws and upon
  courts--These are false hopes, believe me these
  are false hopes. Liberty lies in the hearts of
  men and women, when it dies there, no
  constitution, no law, no court can save it, no
  court can even do much to help it.
  

• She/he is safe
• She/he did not deserve her/his victimization
• She/he handled the situation well because she/he
  survived

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ATTITUDINAL ISSUES

• Accept the role of evidence gatherer, as well as
  that of medical provider
• Avoid passing judgment on whether a sexual
  assault occurred
• Avoid judging the life-style or behavior of the
  patient
• Avoid editorializing in the medical record

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DATE RAPE DRUGS

• JOINT DRUG ENFORCEMENT TEAM
• AFOSI DETACHMENT 105

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INTRODUCTION

• TWO DRUGS ROHYPNOL AND GAMMA-HYDROXYBUTRATE
• ORIGIN
• COMMON NAMES
• METHODS OF USE
• EFFECTS
• OTHER FACTS

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ROHYPNOL

• SYNTHETIC DRUG
• DEPRESSANT
• NOT LEGAL IN UNITED STATES

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ROHYPNOL

• MANUFACTURED BY ROCHE CORP
• SMUGGLED INTO UNITED STATES
• PREVALENT IN SOUTHEAST AND SOUTHWEST UNITED STATES

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ROHYPNOL

• SLEEPY, RELAXED, DRUNKEN FEELING
• 2-8 HOUR TRIP
• CAUSES LOSS OF INHIBITION AND JUDGMENT
• MAY CAUSE AMNESIA
• DIZZINESS, DISORIENTATION, NAUSEA, DIFFICULT
  MOTOR SKILLS

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ROHYPNOL

• TASTELESS, COLORLESS, ODORLESS
• SMALL WHITE PILL
• TAKEN WITH OTHER DRUGS OR ALCOHOL

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ROHYPNOL

• DATE RAPE DRUG
• INVOLUNTARY SEDATION
• MYTHS
• DETECTION 72 HOURS AFTER USE

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GAMMA- HYDROXYBUTRATE

• STREET NAMES
• ORIGIN
• SYNTHETIC DRUG
• DEPRESSANT
• JAPANESE STUDY
• BANNED BY FDA

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GAMMA- HYDROXYBUTRATE

• AVAILABLE IN LIQUID OR SOLID
• EASY AND CHEAP TO MAKE
• DOSAGE AND PURITY ARE QUESTIONABLE
• POPULAR IN NIGHTCLUBS

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GAMMA- HYDROXYBUTRATE

• LOW DOSE RELAXED, EUPHORIC, SEXUAL AROUSAL
• HIGH DOSE DIZZINESS, NAUSEA, MEMORY LOSS
• EXCESSIVE DOSE SEIZURES, COMA. DEATH

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GAMMA- HYDROXYBUTRATE

• EFFECT OF THE DRUG IS FAST!
• LONG TRIP!
• ILLEGAL IN GEORGIA BUT NOT A FEDERAL OFFENSE,
  YET!
• GHB IS AVAILABLE LOCALLY IN WRANER ROBINS

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CONCLUSION

• THIS BRIEFING HAS COVERED ROHYPNOL AND
  GAMMA-HYDROXYBUTRATE IN GENERAL TERMS
• IF YOU SUSPECT EITHER OF THESE DRUGS CONTACT
  AFOSI AT 926-2141 OR DURING NON-DUTY HOURS
  THROUGH THE 78TH SFS AT 926-2187

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Domestic Violence Training

• Capt Teri Cortese-Fusaro
• Beverly Lesyea
• Rebecca Moody

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Introduction

• Accountability
• The Role of Medical Personnel in Holding Abusers
  Accountable
• The Role of Medical Personnel in Trial

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Video Tape
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Why is Accountability Important?

• A woman is physically abused in the U.S. every 9
  seconds
• Twenty-six percent of murdered women are killed
  by their husbands or boyfriends
• Thirty percent of women coming to emergency rooms
  with injuries had injuries caused by battering

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Continued

• Medical expenses caused by DV in the U.S. total
  at least 3-5 billion annually.
• More babies are born with birth defects as a
  result of the mothers being battered than from
  all the diseases for which we now immunize
  pregnant women.

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Continued

• Women between the ages of 15-44 suffer more
  injuries due to DV than car accidents, muggings
  and rapes combined
• Women in violent relationships are 75 more
  likely to be murdered when they are in the
  process of ending the relationship

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How Do We Hold Them Accountable?

• Letter of Reprimand/UIF
• Article 15
• Special Court-Martial
• General Court-Martial

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Medical Personnel Role

• Be Alert to the Signs
• Wife injured and husband never leaves her side
• Husband shows unjustified rage if he is not
  allowed to see her
• Check the medical records, are there previous
  accidents?
• Is her clothing torn in a way that seems odd when
  compared to her story?

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Signs Continued

• Could her injury have been caused in the manner
  she described?
• Patient minimizes a significant injury
• Patient is pregnant
• Substantial time delay between time of injury and
  presentation

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What Type of Evidence am I Looking For?

• Bruises, redness, scratches
• Repetitive psychosomatic complaints

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Other Types of Evidence

• Excited Utterances
• Statements Made for Medical Diagnosis

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What Do I Do if I have a DV Case?

• Follow the RAFB Protocol!!
• Call the OSI or SFS
• Document everything immediately
• Draw a Diagram of each every bruise

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Medical Personnel Role in Trial

• Expert Witness
• Lay Witness

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How do we stop it?

• Knowledge
• New RAFB Protocol
• Hold Batterer Accountable

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TODAYS TOPICS

• Victim Characteristics
• Offender Characteristics
• Cycle of Violence
• Family Advocacy Process

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CHARACTERISTICS OF BATTERED WOMEN

• Low self-esteem
• Believes myths
• Traditionalist
• Self-blaming
• Minimizes
• Physical/psychological reactions
• No one can help

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CHARACTERISTICS OF OFFENDERS

• Low self esteem
• Believes myths
• Traditionalist
• Blames others
• Extreme jealousy
• Dr. Jekyll/Mr. Hyde
• No consequences

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RECURRING QUESTION

• Why doesnt she leave?

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RECURRING QUESTION

• Why wont he let her go?

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THE CYCLE OF VIOLENCE
EXPLOSION
HONEYMOON
gt
gt
TENSION BUILDING
gt
gt
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REFERRAL PROCESS

• Referral Received
• Initial Appointment
• Present to CMT
• Treatment Provided
• Close/Resolved

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MALTREATMENT CATEGORIES

• Emotional
• psychological
• property
• Physical
• Sexual

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EMOTIONAL

• May not cause observable injury and adversely
  affects the psychological well being of the victim

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EMOTIONAL

• Psychological
• explicit or implict threats
• controlling behavior
• extreme jealousy
• mental degradation
• isolating behavior
• Property
• breaking or throwing objects
• injury to pets

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PHYSICAL

• Causes physical injury
• Used to intimidate or control

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SEXUAL

• Forcing ones partner to engage in sexual
  activity by using physical violence,
  intimidation, or threats of future violence

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CASE DETERMINATIONS

• Unsubstantiated did not occur
• Unsubstantiated cannot confirm
• Substantiated
• psychological
• physical
• minor
• major
• sexual

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INTERVENTION IS KEY
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RECURRING QUESTION

• WHY DOESNT SHE LEAVE?
• WHY HAVENT WE DONE SOMETHING ABOUT IT?

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Simple 3 Step Approach

• I am concerned
• You do not deserve it
• I know how to help

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Para 4.9.2.3 Medical personnel will annotate
any comments or explanations in quotes. If
quotes are not possible, a summary of the
victims explanation of injuries, as well as any
other relevant spontaneous remarks, will be noted
in the record. Note the victims emotional state
at the time the spontaneous remarks were made.
RAFBI 51-202
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Para 4.9.2.2 During the exam, medical personnel
will chart all injuries on a body diagram with
specific explanation of injury. Security Police
should call the alert photographer to photograph
any injuries. A medical chaperone of same sex,
if possible, will be present for all photos.
RAFBI 51-202
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RAFBI 51-202
Para 4.9.2.1 When a patient enters the
emergency room and is suspected of being a victim
of domestic violence, the patient will
immediately be placed in aan exam room and be
logged in as a sensitive entry. Para 4.9.2.4
Any phone conversations with the victims, alleged
offender, first sergeant and/or unit commander,
will be accomplished on one of the recorded phone
lines if initiated from the ER.
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FEEDBACK

• Captain Fusaro
• tfusaro_at_legal.robins.af.mil
• Ms. Lesyea
• blesyea_at_hosp1.robins.af.mil
• Ms. Moody
• rmoody_at_legal.robins.af.mil

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