Bills bar non-consensual pelvic exams under anesthesia
Rep. Provost calls the procedure a ‘creepy practice’
AS INCREDIBLE as it may sound, Massachusetts lawmakers say the state needs a law barring physicians, medical students, and health care providers from performing pelvic examinations on anesthetized or unconscious female patients without first obtaining written consent.
“I want to make sure that such exams are never conducted without consent,” said Rep. Denise Provost of Somerville, who described non-consensual pelvic exams as a “creepy practice.”
What’s prompting the legislation (Rep. Mindy Domb of Amherst and Sen. Jo Comerford of Northampton have filed similar bills) is concern that pelvic exams are being conducted at teaching hospitals as part of student training, often without explicit patient consent.
It’s unclear whether any Massachusetts hospitals are actually conducting non-consensual pelvic exams, but the lawmakers say they want to put a stop to the practice if it is happening and prevent it from happening if it isn’t.
But the practice appears to be continuing. According to multiple academic studies and reports, medical students in 43 states, including Massachusetts, are allowed to perform a non-consensual pelvic exam while the patient is under anesthesia for surgery. A review published in April 2018 by Phoebe Friesen, a postdoctoral fellow at Oxford, concluded the non-consensual exams are taking place in hospitals nationwide.
Seven states — Hawaii, California, Illinois, Iowa, Oregon, Virginia, and Utah, already require a patient’s consent, usually in writing, to conduct a pelvic exam under anesthesia. Violators can be charged with a misdemeanor that could be grounds for loss of a medical license.
Under her bill, Provost said patient complaints would be sent to the state board that licenses Massachusetts doctors. She also indicated criminal charges could be filed.
All of the Massachusetts bills would require patient consent for the pelvic exam except when a pelvic exam is within the “scope of care,” or, for example, a woman is already having a gynecological surgery.
Provost said consent for a pelvic exam would have to be explicit. She said consent could not be assumed if the patient merely signed a consent form for general surgery.
According to several academic studies, many medical schools have taken the position that standard consent forms signed by patients at teaching hospitals entitle staff there to do pelvic exams on patients under anesthesia for another procedure.
A Department of Public Health official said that the Board of Registration in Medicine has not encountered the issue of non-consensual pelvic exams, but would investigate if a complaint was lodged.
A pelvic exam is conducted to assess gynecological health. It involves laying on your back on an exam table with your knees bent, feet placed in stirrups. An internal exam takes place with a plastic or metal hinged instrument called a speculum, used to spread open vaginal walls and the cervix. Inserting and opening the speculum can cause tremendous pressure that most women describe as uncomfortable.
In some scenarios, a gloved hand is placed inside the woman to feel for bumps or soreness inside the vagina and along the cervix.
Women and trans men usually ask for a pelvic exam if they experience pain, discharge, or urinary problems. The exams are also conducted during pregnancies to check for abnormalities and infections.
CommonWealth surveyed the 15 teaching hospitals in Massachusetts on their policies for doing pelvic examinations on anesthetized patients, and six responded. Cambridge Health Alliance, VA Boston Healthcare System, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Tufts Medical Center said they allow the exams but only if the patient gives consent. Cambridge Health Alliance and the VA require verbal consent and the Brigham and Tufts require written consent. In its statement, Beth Israel did not indicate what type of consent it requires. The sixth hospital, the Dana Farber Cancer Institute, said it doesn’t do pelvic exams.
Cambridge Health Alliance spokesman David Cecere said doctors with the organization take the issue “very seriously,” requiring verbal consent before all pelvic examinations, including those done under anesthesia, and written consent for all surgical procedures. Pelvic exams must also be part of a surgical need, and not used just as an educational exercise, Cecere said.
At Tufts, students initially learn pelvic examination skills using paid volunteers. During medical school, it is expected that students have an explicit conversation about the pelvic examination with the patient well before the date of surgery, according to Tufts policy.
The Brigham has a patient form dealing with “pelvic examination under anesthesia,” according to a spokesman. These sort of voluntary policies are what legislators are hoping to make mandatory in hospitals statewide.
In the states that have passed laws covering pelvic exams during anesthesia, patients, medical students, residents, nurses, and physicians have testified about their own personal experiences with non-consensual pelvic exams.
Julie Palimieri, a registered nurse in Utah, said that when she was studying to be a nurse at a teaching hospital she witnessed a woman, “sedated and naked from the waist down, have three to four medical students perform a pelvic exam.” Palimieri found out later the exams occurred without consent. “I was shocked,” she told Utah legislators in taped testimony.
Another young woman in Arizona, who wishes to remain anonymous for employment reasons, had stomach surgery performed in 2016 and was informed by a resident that physicians and medical students had performed a pelvic exam on her while she was knocked out.
In 2012, Shawn Barnes, a fourth-year medical student at the University of Hawaii, published a journal article about being asked to perform pelvic exams on anesthetized women “for the sole purpose of my education.”
“To my shame, I obeyed,” he wrote, describing how for three weeks, four to five times a day, he would introduce himself to patients, was told not to specifically mention the pelvic exams, and then performed them while the patients were under anesthesia.
When Barnes raised the issue to the school’s administration, he was dismissed and told he was the first student or resident to express concern over the practice.
After publishing his paper, Barnes took part in efforts to stop the practice, and a bill requiring medical students to seek consent for pelvic examinations under anesthesia was passed unanimously by the Hawaii legislature and signed into law by the governor in June 2012.
Many women say they learned they had undergone a pelvic exam under anesthesia from medical personnel who were uncomfortable with the lack of transparency. It was different for Ashley Weitz, who discovered a pelvic exam had been performed on her by reading about it in her discharge paper work.
Weitz said her doctor at a Salt Lake City hospital told her he did the exam while she was asleep from a sedative because he wanted to make sure she did not have a sexually transmitted disease. Weitz, who did not consent to the exam, said she woke up screaming while it was being performed. She said her doctor didn’t stop when she asked him to.“I’m glad I have confirmation that this happened. It wasn’t malpractice until the governor signed the bill two weeks ago,” she said in a telephone interview.
Weitz said she experienced sexual assault in her childhood, and the unauthorized pelvic exam felt similar. “This felt like the same trauma,” she said.