COLUMBUS, Ohio (WCMH) – Two Ohio lawmakers have taken aim at doctors’ and medical students’ use of intimate exams on unconsenting patients.
House Bill 89, introduced by state Reps. Brett Hillyer (R-Uhrichsville) and Munira Abdullahi (D-Columbus) on March 7, would, if enacted, bar physicians, nurses and medical providers-in-training from performing a pelvic, prostate or rectal exam on unconscious or anesthetized patients without their prior approval — unless it’s medically necessary.
Abdullahi said it was preposterous to learn that the practice – used for training and diagnostic purposes – has yet to be outlawed in Ohio.
“There are people who are willing to assist science and students, but it’s not fair to use people who are not consenting, who are not aware,” Abdullahi said. “It’s a complete violation of their privacy and human dignity.”
Intimate exams are often used as a training opportunity for medical students and as a way to diagnose patients, according to a March 2020 report from the National Library of Medicine. The exams are most frequently performed on female patients undergoing gynecological surgery but are also used during prostate exams and abdominal surgeries.
Over the last 30 years, however, the report found that opposition to the practice has grown, both within the medical community and outside of it.
The American College of Obstetricians and Gynecologists reaffirmed its guidance in 2020 that consent be obtained for intimate exams that serve no personal benefit to the person. In the early 2000s, the Association of American Medical Colleges called the practice “unethical and unacceptable.”
And the use of unconsenting intimate exams is “strikingly more common than we realize,” according to third-year medical student Alexandra Fountaine, who attends the Ohio University Heritage College of Osteopathic Medicine in Dublin, Ohio.
During a clinical rotation, Fountaine said an instructor – who she noted was not affiliated with her college – asked her to perform a pelvic exam on an anesthetized patient. She refused to do so when she learned the woman had not been informed, and thus did not consent to the exam.
“I didn’t feel comfortable, and I realized that with the right people in place, there’s a way to fight this and to make it so that all medical students understand you do not have to perform these exams, you should not perform these exams,” Fountaine said. “It is a breach of our Hippocratic oath to do no harm, in my opinion, and we should be asking for consent.”
But being asked to conduct a nonconsensual exam puts medical students under an immense amount of pressure, Fountaine said.
“Every move you make when you’re a medical student is shadowed by the fact that the person you’re usually interacting with has some form of evaluation that they’re going to be writing for you and has some influence over your career in the future,” she said. “And that’s just terrifying.”
Emily Gemar, director of public policy for the Ohio Alliance to End Sexual Violence, said the use of intimate exams on knocked-out patients meets the criteria for sexual assault. “When you are unconscious and you’re anesthetized, you can’t consent,” she said.
Conducting an intimate exam without a patient’s consent could also create distrust between a patient and their doctor – a relationship that is already “inherently unbalanced,” Gemar said. A medical provider’s unauthorized penetration could be particularly distressing for survivors of sexual assault.
“A patient’s right to their bodily autonomy always trumps the need for a medical student to get practice in an intimate exam. I think it can be as simple as that,” Gemar said.
Under HB 89, a provider who performs a non-consensual intimate exam could be subject to an investigation and face punishment determined by the State Medical Board.
Criminalization of the practice is not the goal, nor is the “blame game,” said Fountaine, who has been working with the American Medical Student Association and Epstein Health Law and Policy Program to pass HB 89 in Ohio and similar legislation in other states.
“Right now, we’ve been so engrossed in the culture of this being an OK practice,” she said. “I think that we need to first educate people on one, it’s not OK; here’s why … and we need to educate patients as well to understand that when you’re going under anesthesia, you need to be an advocate for yourself and make sure that these are not things that are going to happen to you.”
The Ohio State University College of Medicine has a policy in place that explicitly prohibits the use of intimate exams without consent, following 2011 guidance from the American College of Obstetricians and Gynecology, according to a spokesperson for the Wexner Medical Center.
A spokesperson for OhioHealth did not respond to an NBC4 inquiry about the hospital’s intimate exam policies.
If adopted, Ohio would join 21 other states in outlawing the use of nonconsensual intimate exams, according to the Epstein Health Law and Policy Program. HB 89 would bar the following from conducting exams without prior consent:
- A physician
- A physician assistant
- An advanced practice registered nurse
- A student enrolled in a medical school, osteopathic medical school or participant in a graduate medical education
- A student enrolled in a program or course of study to become a physician assistant
- A student enrolled in or pursuing an advanced practice registered nursing education program
The bill’s consent requirement does not apply in the following scenarios: if the exam is within the scope of the patient’s care; if the patient or patient’s legal representative gives specific, informed consent; if an intimate exam is required for diagnostic purposes or the patient’s medical condition; or if a court orders the intimate exam to collect evidence.
The bill does not specify the manner in which consent must be obtained.
