Florence Nightingale meets Sherlock Holmes 

When Andrew Michael Warshaw drew his life sentence for murder, it was a nurse who helped put him away.

A 32-year-old drifter, Warshaw had befriended and then raped a woman while staying in a Sterling Heights motel in the spring of 2002. Selling cleaning products door-to-door at the time, he was already wanted for a parole violation in Carson City, Nev., where he’d been convicted of stealing his mother’s jewelry. More significantly, he was also being sought by Flint Township Police, who suspected him of killing a man in Genesee County.

With Warshaw planning a move to Florida, the window of opportunity for making a quick arrest in the murder was closing fast. It could’ve been a clean getaway.

The rape victim, in her mid-20s, was reluctant to call police because of a misdemeanor warrant out for her arrest. Instead, she contacted the 24-hour hotline operated by Turning Point, a Macomb County nonprofit that helps victims of sexual assault and domestic violence.

After the victim was assured that she wouldn’t be arrested, she agreed to come forward. She provided police with detailed information about Warshaw, who was taken into custody before he could flee the state.

When that rape victim called Turning Point, the person on the other end of the line was Renae Diegel, director of Macomb County’s Forensic Nurse Examiners Program — a group of 17 women who use forensic science to solve crimes. The program’s nurses work with all levels of law enforcement when sex crimes are suspected.

Nurses took samples of Warshaw’s saliva, blood, urine, head and pubic hair; penile and rectal swabs (using sterilized Q-tips); pieces of clothing and photos of some suspicious injuries.

DNA samples linked Warshaw to the rape. And the documentation of cuts and bite marks, along with the DNA evidence, helped to definitively tie him to the murder of Stephen Kaplin, a Genesee County man who was stabbed to death after meeting Warshaw in a bar.

The case highlights two aspects of the forensic nurse’s program that have led to its success. It’s a program that demands the people skills of a social worker and the exacting mind of a scientist.

In the Warshaw case, says Detective Mark Schmitzer of the Flint Township Police Department, “The nurses documented it all — that was invaluable.”

Schmitzer says Genesee County law enforcement officials, among others, desperately need a similar program. “We suffer immensely up here from not having it,” he says.

The idea for the Forensic Nurse Examiners Program dates back to 1997, when members of the community got together with Turning Point, local law enforcement agencies, state police and others to see how sexual assault investigations could be improved. It took two years to find a site and raise the necessary money, largely through grants. The initial effort, say many of those familiar with the work being done, has since evolved into a stunning success.

“The program has been around long enough that the nurses are recognized as experts in every part of the community,” says Sterling Heights Police Detective Thomas McMullen. “In the courts, even the defense recognizes them as experts.”

Although the nurses are also called upon to collect evidence in homicides, the bulk of their time is spent on sexual assault cases. They work with hospitals, police departments and other forensic investigators in the county, helping authorities put criminals behind bars and, at times, clearing the wrongly accused.

The overall yearly budget for the program is $170,000, which comes from various grants, donations and $40,000 from Macomb County.

The nurses, who are paid on a part-time, contractual basis, come from across the county. They respond to calls in as quickly as 30 minutes. Besides examining suspects and victims, often literally head-to-toe, they also provide emotional support to victims and their families. As part of Turning Point, they can also connect victims with an array of services.

Werner Spitz, Macomb County’s medical examiner until retiring last year, says the nurses provide an invaluable resource.

“They are extremely good,” Spitz says. “They take evidence which requires meticulous handling — and when you have a lot of work piling up, that help is crucial.”

Spitz’s son, Daniel, current chief medical examiner for the county, concurs. “They are very excited about the work they do — and they do it well,” he says. “I’m using them more and more.”

Most often, however, the nurses focus on the living, providing a level of expertise in sexual assault cases that was often lacking in the past, says program director Diegel.

“The old philosophy when someone was raped was that they would go to the emergency room,” Diegel says. “It just wasn’t a good fit — most nurses and physicians haven’t been trained for evidence collection, or any type of forensic work.”

Such an approach had inherent flaws. Sterling Heights Detective McMullen recalls what it was like before the county’s forensic nurses program was launched in 1999. A specific case involving a 15-year-old sexual assault victim stands out in his mind. He’d taken the girl to a local hospital to be examined. What he saw disturbed him.

“I witnessed two nurses arguing over who was going to perform the task of the ‘rape kit,’” he says.

A rape kit is used to collect evidence, and the nurses were obviously unfamiliar with how to use it. Eventually one of them read the instructions as she went along — hardly a reassuring sight, for either the cop or the victim.

“When it’s something that you’re not proficient at, patients are going to pick up on it,” McMullen says. Equally important, “the kit being collected properly could be the key to the crime being solved. With sexual assault, one out of two things is going to happen — someone is either going to say, ‘It was consensual’ or, ‘No, it didn’t happen at all.’”

Thorough, properly conducted exams can be the key to addressing doubt about what actually happened. When the nurses from Macomb’s forensic team are on the scene, police and victims alike are assured that the process is in expert hands.

Through extensive coursework and training, the nurses learn “head-to-toe assessment,” Diegel says. They’re schooled in everything from dealing with rape trauma to Michigan law regarding sex crimes and the ins and outs of testifying in court. They also learn about forensic photography, DNA and how to document forensic evidence. As a result, they can deliver a higher level of care from the moment they respond to a case.

“In the emergency room, we were busy — we had gunshot wounds, strokes, you name it,” says Diegel, who worked in an emergency room for 11 years. A proper exam for a rape victim, on the other hand, “can take two hours, six hours; you never know.”

The complexity of the examination, Diegel says, basically comes down to one person: the patient: “It all depends at what rate the patient can go through the exam. She’s going to guide the exam.

“Some people have 20 to 30 different injuries. Inspecting them is going to take time — you have to draw it out, measure it.”

It’s also important to approach each case as unique. “Everyone reacts differently to trauma situations,” Diegel says. “Part of our mission is to give people control.”

Cindy Hovan, a nurse who also has an emergency room background, likewise feels that the Turning Point program offers “100 percent better” care than what is available in a typical emergency room.

“Once I started doing it, I realized how much was missing” in emergency room treatment, Hovan says. “The patient really is treated as a whole with this program — I really see a tremendous difference in care.”

Diegel adds: “I don’t want to say no one in the hospital cares. They just don’t have the right training or equipment.”

Diegel says that the treatment provided by her program’s nurses encompasses all the needs of a patient, including the types of damage no medical equipment can diagnose.

“In rape, the injury’s to the soul,” she says.

Victims and their situations vary, requiring the nurses to take different approaches. “Does she need to cry?” Diegel says. “Does she want to get it over with as quickly as possible?”

It’s not only the victim who benefits from being examined by someone freed from the time constraints and chaos of a packed emergency room. Better police work is also a result.

“There is a direct correlation between time and a lack of evidence,” David Woodfard, supervisor for trace evidence and biology for Michigan State Police at Sterling Heights, told Metro Times in an interview for this article shortly before his sudden death two weeks ago from natural causes. “The longer it takes to examine the results from a victim, the greater the likelihood that the evidence won’t be as good.”

The nurses are also an asset because of the way in which they allow police to focus attention at a crime scene.

Before the program began, police had to contend with an array of evidence, of which DNA samples were only one part. Now they can concentrate more closely on other aspects of the case while the nurses collect DNA. Police are also freed of the added task of having to help rape victims cope emotionally. “It’s all being done right — it’s all being done properly,” McMullen says.

In the beginning, however, Diegel says police were wary of using the nurses. Cops were slightly “territorial,” wanting to protect the integrity of their crime scenes, and weren’t altogether sure what to make of this new presence, Diegel says. But that didn’t last long.

“Maybe they were a little apprehensive, but now they’ve accepted it and now they are pretty open to letting us come in,” Diegel says.

Since the program’s inception in August 1999, the nurses have worked on 1,205 cases, most involving sexual assault. There are no statistics as to increases in the numbers of convictions as a result of the program, but Macomb County Prosecutor Eric Smith says conviction rates have definitely gone up because of the nurses’ work.

“With the help they’ve given us, we’ve seen pleas increase in the most serious crimes,” Smith says.

Becoming a forensic nurse takes time, dedication and a fair amount of cash. Basic training for the program, Diegel says, costs $500; the cost of exam certification is $225.

Then there’s 40 classroom hours of pediatric training and 60 hours of clinical training, which costs $500 and requires the nurses take a full week off from work. Death investigation courses, which last three days, also break down to 40 classroom hours and 60 hours of clinical practice, Diegel says, and costs $425.

Add that to annual malpractice insurance costs and membership in the International Association of Forensic Nurses, and the total startup costs for each nurse is $3,000.

But for Miriam DeBoer, an emergency room nurse at St. John Hospital in Detroit, it has been a small price to pay. “I can give back to the community — it’s just in my heart and I love doing it,” she says.

And now, in the case of Diegel, the process has been reversed. She’s the one providing training — to detectives and evidence technicians at the Macomb County Justice Training Center, as well as health care workers and doctors at the county’s hospitals, pediatricians and emergency medical technicians. She also schools prosecutors and defense attorneys.

“I’ll talk to them about rape and explain to them why there will be an injury in a rape — and why there won’t be one,” Diegel says. “I’ll talk about how rape applies to the law and how they should question us in the courtroom, so our credentials will be laid out clearly.”

Many defense lawyers think the nurses’ testimony might adversely affect the outcome for their clients, but this isn’t always so, says Bill Cataldo, a public defender in Macomb and Oakland counties as well as federal court.

Instead, he credits their courtroom presence for acquittals in three of his last five cases. “They’re not a barrier of victory for me,” Cataldo says. “I think it’s good for society — Renae will give me insight into how the process works.”

Such comments should be heartening to Diegel, who sees her job as a mission to find the truth of a situation and not simply get convictions.

“My role is to give the facts of the case,” Diegel says. After that, it is up to the jury to decide guilt or innocence.

When gathering evidence in a sexual assault case, the nurses go about their business systematically, with variations based on the condition of the victim. First, they document a history of what happened, and then they look head-to-toe for bumps and bruises. Then they take pictures. Next are detailed genital exams that study the victim’s tissue.

If she is alive and able to speak, the nurses offer consultation about sexually transmitted diseases and pregnancy, and take clothes as evidence, if needed. The nurses treat the victims at Turning Point and, while there, give out prophylactics to help protect against sexually transmitted diseases.

Then there are the cases in which no crime has occurred. “Sometimes it’s not about putting the bad guy away, but keeping the innocent free,” Diegel says.

One case in Warren three years ago involved a child being taken to the hospital, suffering from genital bleeding with a distinct bruise pattern,” Diegel says.

The nurses were called to the child’s home, where they found police and child protective services staff ready to arrest the mother and separate her from her three children.

After searching the household, which had been newly renovated, the nurses used liquid crystal violet, a chemical compound that helped them discover traces of blood on the child’s bunk bed. As it turned out, the girl had fallen on a side of the bed frame. No one was arrested and, happily, the family unit stayed intact. “It was accidental — we could explain it,” Diegel says. “The whole family could have been ripped apart.”

Detective Lt. Liz Darga, of the Macomb County Sheriff’s Office, recalls an instance in Harrison Township when the skills of the nurses averted sexual assault charges. “We found a young girl naked at home on a bed, and originally, we had no idea what we had,” she says. “We contacted Renae who gathered all the evidence. It was a drug overdose.

“They’re so valuable to us,” Darga says of the nurses. “I’ve never had a problem — they always come out on time and they do an excellent job.”

With the advent of sensational television crime dramas in which DNA is prominently featured, such as the entire CSI franchise, there much misperception among the public as to what the forensic specialists can do — and how fast they can do it, Diegel says.

Many don’t appreciate the basic realities of crime scene testing. “DNA evidence takes a long time to come back — it can take six months to a year,” she says. “Juries don’t know that there’s limited time and money to do these things.”

“There is a huge DNA backlog problem right now,” says Heather Vitta, supervisor for DNA evidence and biology for the Michigan State Police at Northville. The problem is nationwide, she says.

“The demands on DNA testing have far exceeded the capabilities of crime labs,” Vitta says, noting that homicides and rapes aren’t the only crimes for which DNA testing is carried out.

The backlog has only gotten worse as DNA samples are being mandated for more types of criminals. In Michigan, all adults convicted of felonies and certain misdemeanors — including sexual offenses like indecent exposure or prostitution — have been required to submit DNA samples since 1990. The requirement was extended to cover juveniles in 2002. The rationale, Vitta says, is that those who are arrested for lesser crimes often graduate to more serious offenses. If they do, and their genetic fingerprint is on file, crime-solving becomes much easier. The downside, Vitta says, is that the extent of genetic sampling places a burden on the entire system.

Counseling offers a critical component, too, says Dominica Tokarski, who’s in charge of 15 counselors who reply to calls, often in as quickly as 30 minutes, along with the nurses. “We should be the first person the victim sees,” she says. “We give them the lowdown on what’s going to happen with the exam — anything they want to have confidential, we’re the buffer between them and law enforcement.”

Another case that proved how useful the nurses can be to law enforcement took place Aug. 12, 2002, when an 18-year-old girl went drinking with two other teens who took her to an apartment in a Sterling Heights complex.

Once there, McMullen says, she found four men ages 20 to 25, says McMullen. At first, she became intoxicated and passed out. While she was asleep, at least two people dragged her into a dark bedroom, ripped off her shirt and pants and raped her. She convinced the group to let her use the phone by pretending to be calling her sister. Instead, she alerted a 911 operator, who sent police to the scene.

Although the case is not yet closed, authorities have made significant headway with the help of the nurses, McMullen says. “She doesn’t know who did what to her — they all claim that they had no contact with her,” he says. But the nurses turned up DNA from two of the six suspects on the woman’s body, he adds.

Sheila Meshinski, a pediatric nurse at the Detroit Medical Center, says one of the most striking things about working as a forensic nurse can be the positive responses from younger victims. “Sometimes they’ll come out laughing and invite me to their birthday parties,” she says. “That’s a good feeling.”

But at the other end of the spectrum are the frustrations of dealing with a legal system that’s often less than perfect. “You don’t always want to know what happens in your cases,” Meshinski says, “because you can get very wrapped up in them and depressed.”

There’s also the problem of learning to cope with the sometimes gory aspects of a crime scene. In that regard, she recalls the case of Susan Altobelli, a 72-year-old Mt. Clemens woman stabbed by her husband, Rudy, more than 80 times with a steak knife. Pictures from the investigation are gruesome. But dealing with blood-drenched bodies eventually becomes part of the job. “It is something you get used to,” Diegel says.

There are some things, though, that never become routine.

The hardest aspect of the work, Diegel says, is dealing with very young rape victims. “Those cases are always difficult. A child is truly the most tragic case. What can a child do to deserve that? Nothing. I don’t think you ever get used to that.”

Invariably, the most challenging thing for the nurses, Diegel says, is trying to protect the interests of the patient.

“She may be afraid of the legal process — but nonetheless the patient has rights,” she says. “That’s what’s so challenging. It’s not about what I want in solving a case, it’s about what the patient wants.”

The rape and murder of Christine Russell, and the subsequent trial and conviction of her killer, then-19-year-old William Erwin Minnie, is another case in which the nurses brought their expertise to bear.

On Aug. 17, 2002, Sterling Heights police officials asked the nurses to document the crime scene where the 39-year-old mother of two was found strangled to death with a shoelace from a sneaker. A jury would later sentence Minnie to life for the murder.

Law enforcement processed the scene up to the body, questioning neighbors and investigating parts of her apartment. The nurses, meanwhile, went to work. First, they used a comb to take strands of head and pubic hair. Next, fingernail cuttings were taken, as were oral, rectal, cervical, genital and vaginal swabs, and swabs from Russell’s fingers.

“We tried to imagine everything we could possibly need,” Diegel says. Along with an evidence collection kit, the nurses brought scrubs, protective glasses and clothing, exam papers and alternative light sources. In this case, an ultraviolet light that picks up injuries and evidence not obvious to the naked eye was used. Normal cameras were used to further document the scene.

“As a police officer, you have a lot of responsibilities,” McMullen says. “When you’re assigned a case such as this — the fewer things you have to worry about the better. The people who work with Renae know this is going to be part of the package.”

In the courtroom, Minnie’s initial confession was thrown out. But it didn’t matter. In the end, the nurses’ work prevailed in convicting Minnie for the murder. His DNA was found on the shoelace, providing crucial evidence linking him to murder. He’s now serving a life sentence.

“They were instrumental in finding the DNA samples that convicted him,” Woodfard said. “I just wish more communities had them.”

Joseph Kirschke is a Metro Times staff writer. Contact him at jkirschke@metrotimes.com or 313-202-8015

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