Preparing TeleSANEs for Courtroom Testimony:

Telehealth Sexual Assault Nurse Examiner (TeleSANE) programs have expanded access to expert forensic medical care for survivors, especially in rural and underserved areas. As TeleSANEs increasingly provide remote consultation during sexual assault forensic examinations (SAFEs), they are now being called to testify about telehealth-facilitated exams, a role with minimal formal preparation. The first TeleSANE testimony in Texas revealed key challenges in explaining telehealth processes, collaborative Clinician roles, and chain of custody oversight, prompting the need for targeted simulation training. In this case, a TeleSANE was subpoenaed to testify regarding a remotely assisted SAFE. Though clinically experienced, she had never testified in this role and could not secure a pre-trial meeting with the prosecutor. Direct examination focused on clinical care, while cross-examination questioned the reliability of the telehealth platform, the on-site clinician’s qualifications, and the TeleSANE’s ability to oversee evidence handling. She experienced stress responding to questions centered more on the telehealth model than the exam findings. In response, a multidisciplinary team created a TeleSANE Mock Testimony Simulation integrated into the Tex-TRAC Bootcamp. Using a real courtroom, volunteer assistant district attorneys, and structured exercises—including direct and cross-examination with immediate feedback—TeleSANEs practiced explaining their role, telehealth technology, security safeguards, clinician competencies, and remote chain-of-custody oversight. Participants reported increased confidence and improved clarity when answering adversarial questions. This case highlights that TeleSANE testimony presents unique challenges at the intersection of clinical practice, technology, and legal expectations. Role ambiguity, explaining technical concepts in lay language, and the heavy focus on process created vulnerabilities. Simulation training helped close these gaps by allowing TeleSANEs to rehearse responses and refine communication with legal experts. The case raises broader questions about how courts will evaluate emerging telehealth roles and how programs can better prepare clinicians. Implications for practice are: (1) TeleSANEs need specialized courtroom preparation distinct from traditional SANE testimony, particularly regarding technology and shared roles; (2) simulation training strengthens expert-witness performance, confidence, and communication; and (3) forensic nursing programs using telehealth should embed structured testimony preparation into orientation and ongoing education to ensure clinically and legally defensible practice.