In Texas sexual assault cases, the prosecution often relies heavily on evidence collected during a SANE exam which is a forensic medical examination conducted by a Sexual Assault Nurse Examiner. SANE exam results are presented to juries as scientific evidence of assault, and the SANE nurse often testifies as an expert witness. But SANE exam results are not as straightforward as the prosecution suggests, and an experienced defense attorney with forensic training can expose the limitations, assumptions, and potential errors in the exam and its interpretation.
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What a SANE Exam Involves
A SANE exam is a head-to-toe forensic medical examination conducted by a registered nurse with specialized training in sexual assault evidence collection. The exam typically includes:
- Patient history. The SANE nurse takes a detailed history from the patient, including the patient’s account of the alleged assault. This history is documented in the SANE report and can be used as evidence.
- Physical examination. The nurse examines the patient for injuries, redness, swelling, bruising, tears, and other physical findings. Findings are documented and photographed using a colposcope (a magnifying instrument used for genital examination).
- Evidence collection. The nurse collects biological evidence using swabs from relevant body areas, collects clothing, collects nail scrapings, and uses an alternate light source to identify biological material. This evidence is submitted to a crime lab for DNA analysis.
- The nurse completes a detailed report documenting findings, observations, and the patient’s statements. This report accompanies the physical evidence and is provided to law enforcement.
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What SANE Results Actually Mean — And Don’t Mean
Physical Findings Are Not Proof of Assault
This is the single most important point for jurors to understand: physical findings consistent with sexual assault are also consistent with consensual sexual activity. Minor genital injuries, redness, and even tearing can occur during consensual intercourse, particularly when lubrication is inadequate or the activity is vigorous. The SANE exam cannot determine whether the activity was consensual or non-consensual. It can only indicate that sexual contact occurred.
The Absence of Physical Findings Does Not Mean Assault Didn’t Occur
Paradoxically, prosecutors also use the absence of physical findings to support the allegation, arguing that many sexual assaults produce no visible injury. While this is medically accurate, it means the prosecution wins regardless of the physical findings. That is, findings are presented as evidence of assault, and the absence of findings is explained away. This heads-I-win-tails-you-lose framing must be exposed to the jury.
The Patient History Is Not Neutral
The SANE report includes the patient’s account of events as told to the nurse. This narrative is not an independent assessment. It is the accuser’s version of events, filtered through the SANE nurse’s documentation. Yet when the SANE nurse testifies, the narrative can carry the weight of a medical record, giving it credibility it may not deserve.
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How Doug Huff Challenges SANE Evidence
- Examining the nurse’s qualifications and training. Not all SANE nurses have equivalent training. Doug evaluates the specific nurse’s certification, continuing education, experience, and adherence to the International Association of Forensic Nurses (IAFN) guidelines.
- Challenging interpretation of physical findings. Doug retains independent forensic medical experts to review the SANE photographs, colposcope images, and documented findings. Normal anatomical variations, pre-existing conditions, and consensual injury must be distinguished from evidence of assault.
- Challenging evidence collection procedures. DNA evidence is only as reliable as the collection process. Doug examines whether proper protocols were followed: were swabs labeled correctly, was chain of custody maintained, were collection time limitations observed, was contamination prevented?
- Exposing the bias in SANE testimony. SANE nurses are trained to be “patient advocates”. That is, their role is to support the patient. While this is appropriate in a medical context, it can introduce bias into forensic testimony. Doug cross-examines SANE nurses to expose assumptions and ensure the jury understands the limitations of their conclusions.
Contact Deandra Grant Law
If you or someone you love is facing a sex crime accusation in Texas, contact Deandra Grant Law for a free, confidential consultation with Attorney Douglas Huff. Doug is a Partner at Deandra Grant Law and a senior trial attorney who has defended clients against sexual assault allegations, violent felonies, and other serious criminal charges throughout his career. He has been recognized as a published author and national lecturer on criminal defense strategy.
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