Nursing Expert Challenged for Opining on Self-Harm Behaviors Without Firsthand Exam of Victim

ByWendy Ketner, M.D.


Updated onJanuary 19, 2021

Nursing Expert Challenged for Opining on Self-Harm Behaviors Without Firsthand Exam of Victim

Court: United States Court of Appeals for the Tenth CircuitJurisdiction: FederalCase Name: United States v. ChapmanCitation: 839 F.3d 1232

In this assault case, an appeals court found no evidence that the trial court had erred in admitting a nursing expert witness’s testimony. The expert offered industry literature to support her opinion that the victim’s self-harm was consistent with the behavior of a domestic abuse victim. The court noted that the expert had not claimed the victim was a domestic abuse victim, only that she observed certain behavioral similarities.

For experts, this case demonstrates the importance of opining only on what your professional research and knowledge can definitively support. Experts are cautioned against testifying with unsubstantiated conclusions that lack adequate evidenceand potentially leave room for challenges from the opposition.


The defendant, an Air Force veteran, was recuperating from surgery in Veteran Affairs (VA) housing when a physical altercation occurred between him and his wife. The wife’s injuries included a fractured index finger, a deep cut on her right forearm, bruises on her face, neck, back, arms, and foot. She later stated that she had inflicted the facial scratches on herself but had previously forgotten. As a result, the United States government accused the defendant of aggravated assault and a jury convicted him. The defendant then appealed this verdict, challenging the plaintiff’s nursing expert witness testimony.

The Plaintiff’s Nursing Expert Witness

Nine days before the original trial, the plaintiff gave notice they intended to proffer expert testimony from a nursing expert witness. This expert was a licensed sexual assault nurse examiner. She intended to opine that sexual assault victims often inflict self-harm as a coping mechanism. The court found that the nursing expert could not testify about a condition called non-suicidal self-harm since this diagnosis only occurs after a person self-harms at least five times during one year. There was no evidence that the wife harmed herself since the altercation. The court did, however, permit the expert to testify that a single trauma could be so serious that a person might hurt themselves often as a tool way to cope.

At trial, the nursing expert also testified that it was fairly common for individuals who have been involved in accidents or under extreme stress to self-harm without recollection of doing so. The nursing expert also cited articles supporting her testimony that self-harm can be a singular event or a regular coping mechanism. The expert concluded that the wife’s self-inflicted scratches were consistent with self-harm exhibited by domestic abuse victims. The expert further discussed that she reached her findings through photos of the wife and had not examined her in person. The expert explained she could not speak to what actually transpired between the defendant and his wife. She also stated that there are many possible reasons why someone may self-harm, including as a way to falsely accuse someone of domestic violence.


In his appeal, the defendant argued the plaintiff’s nursing expert’s testimony was not reliable since the expert had not personally examined or interviewed the wife. To this, the court noted that an expert is given a broad latitude to give opinions, even those not founded on firsthand experience or observation. The expert acknowledged she did not personally assess the victim and opined only that the scratches were consistent with the behavior exhibited by domestic abuse victims as a method to cope with stress. The expert did not testify that the wife was a domestic violence victim nor that this was the reason she scratched herself.

The defendant further argued that the testimony was not based on material fact because there was no dispute that the victim had scratched herself. The court, however, noted that the testimony explaining that the wife’s behavior was consistent with being a domestic abuse victim was relevant in establishing whether the defendant was the aggressor in the altercation. The court also noted that the trial court had allowed the testimony without prejudice to the defendant because the expert was proffered with ample time for the defendant to prepare and retain an expert of his own.


The appeal court found no evidence the trial court had abused its discretion in admitted the nursing expert’s testimony. The motion was denied.

Key Takeaways for Experts

To ensure your testimony can withstand any Daubert or Frye challenge, work with the hiring attorney to understand how your testimony fits into their case approach and to make sure your citations and methodologies are airtight.

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

Find an expert witness near you

What State is your case in?

What party are you representing?