{"id":1689,"date":"2020-06-16T08:08:26","date_gmt":"2020-06-16T16:08:26","guid":{"rendered":"http:\/\/sdc.wastateleg.org\/dhingra\/?p=1689"},"modified":"2020-09-17T00:09:57","modified_gmt":"2020-09-17T00:09:57","slug":"new-law-requires-consent-for-pelvic-exams-on-unconscious-or-anesthesized-patients","status":"publish","type":"post","link":"https:\/\/senatedemocrats.wa.gov\/dhingra\/2020\/06\/16\/new-law-requires-consent-for-pelvic-exams-on-unconscious-or-anesthesized-patients\/","title":{"rendered":"New law requires consent for pelvic exams on unconscious or anesthesized patients"},"content":{"rendered":"

From The News Tribune<\/a><\/p>\n

A new law took effect Thursday that prohibits medical providers from doing pelvic examinations on women without their consent if they will be unconscious or under anesthesia.<\/p>\n

It took lawmakers two years to pass\u00a0SB 5282,\u00a0<\/a>in part because they crafted an exception to protect sexual assault victims.<\/p>\n

Doctors have been required to get informed consent from patients to perform medical treatment including pelvic exams. But an omission in state law didn\u2019t prohibit them \u2013 or medical students practicing under their authority \u2013 in cases when women would be unconscious or under anesthesia.<\/p>\n

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Stephanie Wahlgren, a sexual assault nursing examiner at PeaceHealth St. Joseph Medical Center in Bellingham, said she supports the new law.<\/div>\n<\/div>\n

\u201cIt\u2019s important to have informed consent when doing anything genital. As health care providers, it\u2019s our mission and our duty to get informed consent, especially for an exam or treatment being performed if a patient is unconscious or under anesthesia,\u201d said Wahlgren, a member of the legislative council for the Washington State Nurses Association.<\/p>\n

Although the medical profession is more diverse today, in the past there was a \u201cpaternalistic view that male doctors knew best for their female patients and they didn\u2019t need to get consent before doing an exam while they were unconscious,\u201d said state Sen. Marko Liias, a Lynnwood Democrat who sponsored the bill that became law.<\/p>\n

The new law prohibits a medical provider \u2013 or a student practicing under his or her authority \u2013 to perform a pelvic exam on a patient who is under anesthesia or unconscious.<\/p>\n

There are two exceptions.<\/p>\n

One is if the patient or the patient\u2019s representative gives consent and the exam is necessary for diagnostic or treatment purposes.<\/p>\n

The other is if sexual assault is suspected. In those cases, evidence may be collected if a patient is not capable of consent due to a longer-term medical condition, or if evidence will be lost.<\/p>\n

Health care providers who violate the new law are subject to discipline by the Washington Medical Commission that ranges from a fine to loss of their license.<\/p>\n

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Liias said in other states, medical students have been allowed to practice pelvic exams on women who are unconscious or under anesthesia who have not given their consent.<\/div>\n<\/div>\n<\/div>\n<\/div>\n

\u201cI am assured by the University of Washington Medical Center that they do not engage in this practice when they train their students,\u201d Liias told a Senate committee in 2019 when he testified for the first time about his bill.<\/p>\n

The UW Medical Center has informed patients for decades that residents and students will be part of their care for obstetrical and gynecologic surgery which could include exams under anesthesia, if indicated, and requested consent, said Dr. Barbara Goff, a professor and chair of the UW Medicine Department of Obstetrics and Gynecology.<\/p>\n

When the Legislature passed the bill this year, the consent form was changed to specifically highlight that residents and students involved in the clinical care of the patient may do a pelvic examination under anesthesia as part of the surgical procedure and patients can opt out as they could previously, Dr. Goff said.<\/p>\n

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In 2018, the public radio program \u201cThis American Life\u201d reported that a biomedical ethicist in New York, Phoebe Friesen, found that medical students had been involved in\u00a0<\/b>doing practice pelvic exams\u00a0<\/b>without patient consent \u201cat hospitals all over the country.\u201d<\/div>\n<\/div>\n<\/div>\n

One of the producers of the show, Lilly Sullivan, explained why she couldn\u2019t interview women who have been examined under anesthesia without their consent.<\/p>\n

\u201cThese exams don\u2019t become part of a woman\u2019s medical records. They don\u2019t go into their charts at the hospital. And of course, this happens while they\u2019re unconscious. So pretty much, by definition, anyone who\u2019s gone through this will probably never know,\u201d she reported.<\/p>\n

THE EVOLUTION OF THE BILL<\/h3>\n

The first version of Liias\u2019 bill said a health provider could perform a pelvic exam without the consent of a patient who will be anesthesized or unconscious if a court ordered it for the purpose of evidence collection.<\/p>\n

That language was removed after Kim Clark, senior attorney for reproductive rights, health and justice at Legal Voice, expressed concern about it. Legal Voice is a nonprofit women\u2019s rights group based in Seattle.<\/p>\n

\u201cIt is unnecessary because Washington courts do not have the authority to order that a sexual assault survivor undergo medical exams without their consent. The Code of Criminal Procedure does not permit that,\u201d she told lawmakers at a 2019 hearing.<\/p>\n

Clark also said providing an exception for court orders is \u201cpotentially harmful\u201d because it could discourage women from reporting sexual assaults and \u201cencourages distrust in the medical profession.\u201d<\/p>\n

Two Democratic lawmakers from King County, Sen. Manka Dhingra and Rep. Tina Orwall, crafted a new exception for the bill based on the state\u2019s model sexual assault protocol, Liias said.<\/p>\n

When the bill was amended earlier this year, Rep. Nicole Macri, D-Seattle, said the provision came at the request of law enforcement and prosecutors.<\/p>\n

The goal, she said, was to ensure that evidence could be collected from sexual assault victims who have developmental or other long-term disabilities that prevent them from providing consent.<\/p>\n

The new law says health care providers can do a pelvic exam \u2014 without the consent of patients if they\u2019re unconscious or under anesthesia \u2013 if sexual assault is suspected. In those cases, evidence may be collected if patient is not capable of consent due to a longer-term medical condition, or if evidence will be lost.<\/p>\n

Wahlgren, the sexual assault nursing examiner, said informed consent is the \u201ccornerstone\u201d to her work.<\/p>\n

\u201cThe exception to this rule is when a patient presents to the Emergency Department intubated with a breathing tube and there was a question to the assault being a sexual assault. This is the only time that I collect evidence without an informed consent and it is only if there is no next of kin or spouse to make that decision for us. We do our best to obtain consent from next of kin prior to evidence collection.<\/p>\n

\u201cThe evidence collection process does not always entail a pelvic examination. It includes taking swabs from the genitals, but the only time our recommended state guidelines encourage a pelvic exam is when there is hemorrhaging from the genital region and\/or there was an object used during the sexual assault and there is a possibility of lacerations that need repaired,\u201d she said.<\/p>\n

Wahlgren said health care providers refer to it as \u201cassumed consent\u201d if a sexual assault victim is unconscious and evidence must be collected. Law enforcement usually is involved through 911 calls and the transport of an unconscious victim to the hospital in an ambulance.<\/p>\n

\u201cWe don\u2019t give the evidence over to the police until we get informed consent from the patient,\u201d she said.<\/p>\n

Russell Brown, executive director of the Washington Association of Prosecuting Attorneys, said the new law balances privacy interests with the need to collect evidence in sexual assault cases.<\/p>\n

\u201cI hope this threads the needle appropriately,\u201d he said.<\/p>\n

By James Drew<\/p>\n","protected":false},"excerpt":{"rendered":"

From The News Tribune A new law took effect Thursday that prohibits medical providers from doing pelvic examinations on women without their consent if they will be unconscious or under anesthesia. It took lawmakers two years to pass\u00a0SB 5282,\u00a0in part because they crafted an exception to protect sexual assault victims. Doctors have been required to get informed consent from patients to perform medical treatment including pelvic exams. But an omission in state law didn\u2019t prohibit them \u2013 or medical students practicing under their authority \u2013 in cases when women would be unconscious or under anesthesia. Stephanie Wahlgren, a sexual assault…<\/p>\n","protected":false},"author":16,"featured_media":1691,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"disable_featured_image":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[28],"tags":[],"class_list":["post-1689","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-in-the-news"],"yoast_head":"\nNew law requires consent for pelvic exams on unconscious or anesthesized patients - Sen. 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Doctors have been required to get informed consent from patients to perform medical treatment including pelvic exams. But an omission in state law didn\u2019t prohibit them \u2013 or medical students practicing under their authority \u2013 in cases when women would be unconscious or under anesthesia. Stephanie Wahlgren, a sexual assault...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/senatedemocrats.wa.gov\/dhingra\/2020\/06\/16\/new-law-requires-consent-for-pelvic-exams-on-unconscious-or-anesthesized-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"Sen. 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