Comerford, Domb seek to ban non-consensual pelvic exams under anesthesia

Massachusetts State House. March 20, 2018. Photo by Gaelen Morse / BU News Service

By Lillian Ilsley-Greene
BU News Service

BOSTON — Massachusetts could become the first state in New England to ban non-consensual pelvic examinations on women under anesthesia as outlined in bills filed by state Sen. Jo Comerford, D-Northampton, and state Rep. Mindy Domb, D-Amherst.

Pelvic exams are used to evaluate a patient’s reproductive organs and diagnose possible medical conditions. A standard exam involves the patient on her back, feet in stirrups, and includes both an external and internal visual exam.

The new bills, S.1219 and H.1865, would require written, informed consent for pelvic exams on female patients sedated for medical procedures. General consent forms would no longer be considered adequate, and care providers would be required to fully inform patients about what will happen during treatments.

The proposed legislation extends its reach to examinations performed by medical students, as the practice of conducting exams on unconscious patients is commonly used to teach students standard procedures.

Comerford said the issue was brought to her attention by constituents who, after hearing that seven states had passed similar legislation, wanted confirmation that non-consensual pelvic examinations were not happening in the commonwealth. While the extent to which the practice continues is unclear, the American Medical Association, American College of Obstetricians and Gynecologists and the Association of American Medical Colleges have all come forward to denounce the practice, with the AMA calling it “a lingering stain on the history of medical education.” 

“What is true is that it’s hard for people to imagine that it would happen in the commonwealth,” Comerford said.

Domb wrote in an email that based on her research, the practice of non-consensual pelvic exams are not happening in Massachusetts, but after hearing about legislation in other states, she and Comerford decided to take action. Consent is always a vital issue, she wrote.

“Since there were no pro-active guidelines in place, we decided to help broker them through legislation,” Domb wrote.

Since the introduction of the bills, many area hospitals have come forward against the practice of non-consensual pelvic exams. In a survey of teaching hospitals done by CommonWealth magazine, Cambridge Health Alliance, VA Boston Healthcare System, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Tufts Medical Center all said they perform pelvic exams only with express consent, either verbal or written. 

While Comerford said she has not heard specific stories of bad experiences about pelvic examinations from her constituents, she described the proposed legislation as a “proactive” measure.

“Another upside of the legislation is that it sparks conversation, it sparks investigation, it sparks information sharing,” she said.

Dr. Heather Sankey works as chairwoman for the Department of Obstetrics-Gynecology at Baystate Medical Center, Springfield’s teaching hospital. Sankey said the proposed legislation made her realize how often her own patients do not understand the procedures they have agreed to.

Laparoscopic surgeries, while performed mostly through a scope inserted through the belly button, do necessitate pelvic exams, Sankey said, adding the same holds true for procedures like hysterectomies.

Patients “may not realize that’s part of the surgery,” Sankey said. “It’s informed me that I need to better explain what is obvious to us, but not obvious to most people … I’ve improved how I explain that.”

Sankey said that allowing students to be present for pelvic examinations is a common learning practice. Prior to all procedures, Sankey said, patients are given the option to ask to not have medical students in the room.

Regarding pelvic examination, Sankey said, “If I can teach the student to be better at it when someone’s not going to feel it, that’s better,” Sankey said. “So under anesthesia is a better time to teach it than it is when [the patient is] wide awake — and then have them do it with a wide-awake woman when they’ve had some experience both with simulation and practice. I like the idea that women are aware of and consenting to it; I just hope they continue to consent to it.”

For advocates, general consent isn’t enough — explicit consent is key.

“It is fundamentally wrong for a profession charged with protecting and healing people to be taught that they don’t need consent to access our bodies,” Marissa Hoechstetter, of Northampton, wrote in an email. 

Hoechstetter has been an advocate for victims of sexual abuse during medical procedures for the last several years, speaking out about her own experience with abuse at the hands of an OB-GYN in New York City. 

Hoechstetter wrote in an email that communities are still shocked to learn that non-consensual pelvic exams continue to be legal in Massachusetts. 

Sankey stressed that a doctor’s primary concern is with the health and safety of the patient over a possible teaching moment for students. She also stressed that pelvic exams are only done when pertinent to certain procedures. 

“I feel like the awareness is good,” Sankey said, but, “when you start regulating things, it ends up sometimes setting up barriers to even talking about things the way you should.” 

“I’m not typically a fan of regulating the relationship between doctors and patients,” she continued. “On the other hand, I am a fan of us communicating clearly.”

This article was previously published in the Daily Hampshire Gazette.

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