Nonconsensual Pelvic Exams
To make a difference:
https://www.change.org/m/end-forced-pelvic-exams compiles state efforts to pass laws against non consensual pelvic exams. Most recently, a petition with 110,354 supporters succeeded in creating a law in Connecticut.
Across U.S. medical institutions, many medical students can access patients who are under anesthesia for treatment, and perform practice invasive exams without their explicit consent. This practice leaves patients feeling violated and hesitant to seek treatment. To repair trust between patients and their care providers, 14 states have established protective laws. However, the scope of these laws vary extremely: some protect only female patients, others require only vague, easily-missed warnings in paperwork.
As this issue has garnered public outrage in recent years, the Department of Health and Human Services’ Centers for Medicare and Medicaid Services has begun requiring consent for pelvic, breast, and other sensitive examinations, in order for Medicare and Medicaid reimbursement. An April report by the CMS’s Directors, Quality, Safety & Oversight Group and Survey & Operations Group revised informed consent guidelines, adding these requirements for informed consent forms:
- Whether practitioners other than the operating practitioner, including, but not limited to, other physicians, residents, advanced practice providers, and medical and other applicable students (such as nurse practitioner and physician assistant), will be performing important tasks related to the surgery, or examinations or invasive procedures for educational and training purposes, in accordance with the hospital’s policies.
- Important surgical tasks include: opening and closing, dissecting tissue, removing tissue, harvesting grafts, transplanting tissue, administering anesthesia, implanting devices, and placing invasive lines. Examinations or invasive procedures conducted for educational and training purposes include, but are not limited to, breast, pelvic, prostate, and rectal examinations, as well as others specified under state law.
- A written consent form is required for patients undergoing anesthesia procedures, but patients with the ability to verbally affirm consent for procedures that do not require anesthesia should have their medical record reflect that consent was given. In both instances there is written documentation of consent for any examinations.
They leave any further requirements for state laws to decide, but added recommendations:
- Name of the practitioner who conducted the informed consent discussion with the patient or the patient’s representative.
- Date, time, and signature of the person witnessing the patient or the patient’s legal representative signing the consent form.
- Indication or listing of the material risks of the procedure or treatment that were discussed with the patient or the patient’s representative.
- Statement, if applicable, that physicians other than the operating practitioner, including, but not limited to, residents, will be performing important tasks related to the surgery, in accordance with the hospital’s policies and, in the case of residents, based on their skill set and under the supervision of the responsible practitioner.
- Statement, if applicable, that qualified medical practitioners who are not physicians who will perform important parts of the surgery or administration of anesthesia will be performing only tasks that are within their scope of practice, as determined under State law and regulation, and for which they have been granted privileges by the hospital.
While this is a monumental advancement, it is important to note that many of the details are still left to state legislation, such as the definition of an “invasive procedure” and required documentation of the procedures. California lacks laws defining consent form requirements; CA Bus & Prof Code § 2281 (2023) only disallows non consensual pelvic exams, without discussion of other invasive practices or paperwork. You can write to local representatives to express concerns about these shortcomings. Further, as mentioned earlier, many states remain without a state-level law protecting patient consent rights. It is always a good idea to have multiple levels of protection, if federal legislation changes in the future.
To make a difference:
https://www.change.org/m/end-forced-pelvic-exams compiles state efforts to pass laws against non consensual pelvic exams. Most recently, a petition with 110,354 supporters succeeded in creating a law in Connecticut.
Read through the CMS report:
