Patrick Dodd

///Lab Rats n' Cadavers

Arrogance, Abuse, Fraud, and Medical Malpractice:

Arrogance, Abuse, Fraud, and Medical Malpractice:

How Some Physicians Beg for Law Suits

- MC Kean

 

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Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

 

Physicians and mass media often depict patients and their lawyers who file lawsuits against Doctors as greedy, money-grubbing opportunist. 1

It turns out this is more projection than reality. A 1990 study by Harvard researchers of 31,000 medical records subjected to evaluation by practicing doctors and nurses, “found that doctors were injuring one out of every 25 patients (latter studies put that figure closer to one out of every seven patients), and that only 4 percent of these injured patients sued.” 2

Another Harvard study of 1,452 malpractice lawsuits found that more than 90 percent of the claims evidence supported medical injury and 25 percent of the time the patient died, 60% of these injuries resulted from physician wrongdoing. The study also found when “baseless” malpractice suits were brought they were “efficiently thrown out.” Only 145 of 515 patients suffering injury, but where physician fault was unclear received compensation. On the other hand, 236 cases were thrown out of court despite evidence of injury and physician error. 3.

While there is no evidence that malpractice claims are being driven by greedy patients and lawyers, there is an abundance of evidence that greed is driving the malpractice suits. Not the greed of the patients, but the greed of the medical practitioners themselves. In other words, physicians are the greedy, money-grubbing opportunists, and the patients and their lawyers are just fighting back against an arrogant disregard for patient’s rights, dignity, and health, against incompetence and even fraud. In a real way, a vast body of Doctors have waged war on patients, arrogantly imposing their will and their interest against the patients’ will and best interest. Laws, Medical Licensing Boards, even lawsuits have largely failed to discourage profitable, but reckless and abusive practices. Below are a several examples of how Physicians abuse patients for personal profit, a brief analysis of patient protections, followed by some suggestions for fighting back.

1. Kickback driven medicine: An overwhelming number of physicians get kickbacks and other economic incentives from pharmaceutical companies, not only for being willing to prescribe a drug, or implant a devise, but also for research. Often, physicians also get kickbacks from other Physicians, hospitals, and imaging facilities to which they refer patients. Physicians even get kickbacks for implant devises. Influenced by a greed for these kickbacks, many physicians prescribe medications and procedures they know are NOT the most effective response to a problem, or may even be for a problem you do not have. 4. In one study one third of the Doctors interviewed, “admitted they would order unnecessary MRI scans and 25% referred patients to an imaging center where they had a financial interest.” 20.

 

2. Promoting unnecessary surgeries: Physicians often fail to tell a patient of less radical alternatives, fail to disclose and even mislead patients about risks, and encourage a patient to elect surgeries that are not good for their health. “While it is difficult to distinguish "necessary" from "unnecessary" surgeries, some estimates put the latter at 2.5 million a year, resulting in 11,600 deaths a year as well as severe pain and disability for many of the survivors.” 5.  Breast implants are just one example. Implants are never permanent. Most will require another surgery within five years, virtually 100% fail within 10 years. 6.  Reconstruction after a mastectomy requires multiple surgeries (including one on the healthy breast), and thus provides a whole string of opportunities for surgeons to make big bucks. For women with cancer this is particularly cruel even murderous as evidence indicates that physical trauma the like of multiple surgeries can encourage the spread of cancer. 7.  Surgeons virtually never reveal this trauma induced cancer growth risk. Even women’s magazines have described new “perky” breasts, and perhaps even a tummy tuck, as a couple among ten reasons to “be glad you have breast cancer.” 8.

While plastic surgeons claim options for such reconstruction are, “essential to women’s self-esteem“, there are less dangerous roads to dealing with self-esteem issues, patients are not well informed of risks, and surgeons literally peddle reconstruction. The only unsolicited call I ever remember receiving from my breast cancer surgeon was to inquire as to why I would turn down reconstruction. (Wonder if she was to get a kickback from the plastic surgeon, who acted as if he got kickbacks for implants.)

3. Bait and switch: You do a little research, meet and agree to a surgery by a certain physician, chosen for various reasons, experience, sex, bedside manor, temperament; then, once under anesthesia, your surgeon pulls a bait and switch. The person actually performing the surgery is much less experienced, or this may even be their first surgery, or first surgery of this type. Sometimes the surgeon you thought was performing is in attendance supervising. Your life threatening surgery is being used as training and you are an unwitting breathing cadaver. 9

Other times the person you thought was performing the surgery has moved on to a high paying client and left you with a resident under no supervision. The surgeon you thought was performing is paid for miraculously doing two surgeries at once in two different locations. 10 The resident is on salary.

Once limited to teaching hospitals this sort of medical fraud is now infiltrating private practices. While you are never told, while misleading language is used, while students are hidden, and even while out right lies are employed to cover this bait and switch, physicians argue that any reasonable person should know that in teaching facilities students are participating in their care, including the performance of major life threatening surgeries. Patients may or may not know a hospital is a teaching hospital; and the average patient does not know their physician will lie; we are not told the relationship is an adversarial one, rather than fiduciary (one where the physician’s primary concern is our health).

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4. Unnecessary procedures and exams for the sake of training: Extending anesthesia and resulting in physical trauma, excessive bruising, bleeding, and increased infections of patients, physicians often take the opportunity provided by anesthesia to parade in a line of students to perform exams. Although research indicates that 87% of patients would allow training if asked, making this sort of medical fraud unnecessary, it would take time to explain to the patient and the patient might set terms or limitations, such as on the number of trainees to be performing a procedure. 10.

Informed patients while often willing to accept one or two trainees, are less likely, for example, to consent to their pelvic or anus being penetrated multiple times by multiple people. This gang bang approach to teaching is very abusive. While many argue it does not rise to the level of rape as there is no sexual intent, this argument is again invalid. 11

One could argue with such logic that the physical touching and penetration of a prisoner might be torture, but not rape as the intent was not sexual but rather investigative. Statistics indicate that such practices are risking patient health. While Teaching facilities want you to think that you will get superior up to date care at such facilities, this is just not the case. Oregon Health Sciences University is one example. OHSU patient safety ratings reveal a below average raiying for:

1. prevention of death in procedures where mortality is usually very low,

2. absence of foreign body left in during procedure,

3. avoidance of excessive bruising or bleeding as a consequence of a procedure or surgery.

These stats indicate many physicians are prioritizing teaching over patient health and safety. Simply put you are more likely to die from a relatively simple and safe procedure, and will likely suffer greater trauma and pain from procedures performed at OHSU, than non-teaching facilities. The surprise is not that, OHSU is sued on average of 23 times a year, but that this figure is not much higher. One reason may be OHSU has access to the PDX VA. While the V.A. would like vets to think the big teaching facilities are better than the smaller VA facilities; the history of the V.A. also reveals unacceptable abuse and risk of patients for the sake of training. 12.

Again, while cancer patients provide a host of opportunity in this regard the trauma from such practices can feed cancer. Furthermore, physicians do not seem to give any special consideration to a subject already in pain from recent surgeries, and show no qualms about subjecting such patients to more trauma from multiple penetrations by inexperienced students/trainees. No more than teaching hospitals they take pity on the crying children, as a line of students enter their rooms to practice arterial blood gasses, as was described to me by an asthmatic patient who spent their childhood in hospitals.

5. Physicians will lie. Telling your Doctor what you do and do not want to happen to you or your body while under anesthesia is no protection. Physicians often do as they please and simply lie before and after the fact no matter what preferences, you might have expressed. After all, they know even better than the date rapist how effective these drugs are at ensuring their violations of your rights, your body, your health, and their oath remain unknown to you. If you complain, a physician may flag your chart, “don’t ask”. This does not mean they will not seize the opportunity anesthesia provides to violate you, just that they will employ a “don’t ask; don’t tell” policy in relationship to your care. 13.

Doctors are often arrogant and indifferent to the very concept of informed consent. Physicians patronizingly claim to know what is best for patients, while they fail to listen or respond to expressed needs, violate patients expressed will, and even do things to patients they would not allow be done to themselves. 14.

Surely not all the staff is going to go along with this? I have listened to countless stories of this sort of abuse over the last two months, not only from patients, but also from nurses and other physicians I have interviewed. Most indicated that while they did not agree with what was done they did not report violations of consent, or even sexual assault, (such as an anesthesiologist who awakens women from anesthesia by pinching their nipples.) Mind you, I know some of these confessors well, the only reason I can see for their silence is a culture of such silence. 15.

 

6. Physicians target the poor: Physicians target the poor, mentally disabled, and seriously ill patients who are heavily dependent upon the medical access they receive, as they are less likely to file lawsuits. Veterans have historically been part of this pool of the abused poor as many large V.A. Medical facilities are linked to Medical Schools and economic incentives for lawyers to represent victims are minimal. In many cases the awards will not cover the costs of litigation. This is about to get much worse. As physicians look for more ways to avoid State legislation regarding teaching, as physicians look for ever more disempowered patients, as the government looks for ways to cut the costs of caring for veterans, ALL V.A. facilities are about to become teaching facilities. A physician can come from anywhere in the country (or world) to be trained on any vet in any state disregarding the state laws and often Federal Laws as well. The V.A. even employees unlicensed practitioners, and has a history of failing to check credentials. 16.

Now, one will say, the vet can get medical care elsewhere; but illness breeds poverty, and war breeds illness, and you are often not told, mislead, even blatantly lied to as to who provided what care, who did what including what unnecessary penetrations to your body.

Women are particularly vulnerable. Women are relatively few in number within the V.A. system and thus scarce relative to the demand for training specific to women’s health. Female Vets are subject to a sort of intensified trauma resulting from both more frequent and intense abuses by physicians, and for many patients this in conjunction with a history of military sexual trauma. “The problems with sexual harassment, assault and rape are systemic in the military beginning with recruiters, military academies, carrying on through service and at the Veterans Administrations.” 17.

Refusing to respect these women’s requests for female practitioners, pulling the old bait and switch tactic, and using women as vending machines for training multiple students results in not only physical harm, but also serious psychological harm. These practices also increase women’s risk of sexual assault.

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Creating Opportunities for Rape: A woman has a fundamental right to protect herself from sexual assault or rape as she sees fit. The physician undermines this right when the patient is not allowed to exclude, limit, and/or negotiate the terms of male participation from certain types of care and while under anesthesia. Failing to acquire informed consent and refusing full disclosure in a Federal facility is a violation of a patient’s civil rights and should be prosecuted accordingly. While physicians would like you to think, they as a class are above such crimes as sexual assault this is simply not the case.

A Times investigation found 55 licensed practitioners in the state of Washington alone who had rap sheets for sex crimes.” 18. Sexual misconduct is a common problem and protection against offenders practicing in the medical field is insufficient to non-existent.

0nce you are put under anesthesia you have no way of knowing what is being done to you by whom. Medical staff seems to think nothing of leaving women alone under sedation with a man, a stranger to these patients; not something a reasonable woman would ever tolerate if told the truth. Physician’s response to reasonable requests by reasonable women is to simply lie. I know this from personal experience.

Complaining to the V.A. about violations of my requests for, and promises made of, female only staff during procedures like colonoscopies, oophorectomies, and a mastectomy, complaining about being left in the care of men while under anesthesia, and requests for explanations for symptoms synonymous with sexual assault for which the physician claimed to have no medical explanation, has gotten me nothing more than a “don’t ask; don’t tell” flag in my chart by that same Doctor.

It seems many physicians are unwilling to give up even a small fraction of their income, many hospitals unwilling to spend a fraction more, to ensure the safety of women under anesthesia, or even respect women‘s own attempts to protect themselves. It took a movement to get women into the medical profession, and the rest of us were promised the comfort and security of female care only to be betrayed by petty greedy women the likes of those who have betrayed this reporter/patient.

If physicians are willing to lie to patients, to put patients at an unreasonable risk, to seek all sorts of ways to avoid any sort of meaningful informed consent, to even engage in outright medical fraud, how is a patient to have confidence in a diagnosis? How can a patent feel confident that the diagnosis is not motivated more by the need to teach this or that procedure than a thorough analysis of medical history and data? How can a patient know that a prescription or surgical suggestion from their physician is motivated by concern for their well being rather than personal profit? You cannot!

In June 2002, for example, a Chicago cardiologist was sentenced to 12-1/2 years in federal prison and was ordered to pay $16.5 million in fines and restitution after pleading guilty to performing 750 medically unnecessary heart catheterizations, along with unnecessary angioplasties and other tests as part of a 10-year fraud scheme. 19 My own significant other suffered an unnecessary heart catheterization.

 

What protection does a patient have?

Medical Licensing Boards are little help. Sanctions are rarely proportionate to the offense. Physicians are often given no more than a few months of limitations on practice or short suspensions. Even in the most repetitive and/or grievous abuses such as sexual assaults while a patient is under anesthesia or performing high risk unnecessary surgeries, physicians are often given little more than limitations on patient demographics and mandatory counseling. At worse they may receive two to five years suspensions with mandatory counseling followed by reinstatement with temporary supervision.

These disciplinary actions are too lenient and too few to make a difference. “A D.C.-based advocacy group found only 33% of doctors who made 10 or more malpractice payments were disciplined by their state medical board; some—with as many as 31 payments—have never been disciplined.” 20.

Laws are not effective. When laws are changed to help protect patients, the old, “do not ask, does not tell” tactic is employed. This was the case with California consent laws relating to informed consent and using patients under anesthesia as teaching tools for pelvic exams. 21. Illinois followed. 22

At first, many hospitals voluntarily conformed, then after a few big teaching hospitals and their Physician’s thumb their nose at the law, reminded legislatures that the patients are under anesthesia and therefore make lousy witnesses, interest in conforming to the law seemed to fade and continued abuse has to date gone unchallenged. 23

Lawsuits do not work. Rather than clean up their act to reduce risks of suits, many physicians have retaliated against malpractice lawyers and their family members refusing them care or firing their nursing spouses. Patients who sue one physician are refused care by others. Even some Physicians who have testified as expert witnesses on behalf of plaintiffs have suffered retaliation from employing hospitals and State Medical boards.

In Florida, Tampa General Hospital revised its employee "code of conduct" to prohibit staff from testifying on behalf of plaintiffs. (They may testify as witnesses for hospitals and doctors.) “In Jersey City, the medical staff at Christ Hospital voted to remove George Ciechanowski as chief of staff, according to news accounts, because he backed malpractice legislation that many of his colleagues opposed.”, 24.

Regardless of awards and even if insurance companies refuse to insure repeat offenders, this does not seem to slow down the abuse. Awards are not proportional to the injury, nor large enough relative to income achieved through such abuses to discourage the practices. In spite of lawsuits, sanctions, and payouts, patient abuse remains profitable. 25

Research and empirical evidence has done little to change attitudes. Research indicates that listening to and respecting patient wishes in conjunction with honesty and early confession and apology for error reduces litigation. A few hospitals that have revamped policies and practices in response to this research have reduced malpractice payouts by 85% 26 Unfortunately, such evidence fails to persuade physician attitudes, who claim they have, “No time to listen and talk to patients.” 27.

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What is to be done?

When patients’ health and well-being are no longer the top priority of physicians the system is no longer trust worthy and should be radically reconstructed to once again serve the interests of equal protection and security of ALL patients. Piecemeal socialization or V.A. type medical care within an overarching for profit system only tends to subject the poor who do manage to access medical care to the sort of abuses described above.

I heard a wise person suggest that if all the Physicians and other medical staff who worked at the V.A. had to use the V.A. themselves for medical care, things would change. Likewise, only in a one-payer system that treats ALL citizens who seek medical care the same, will some of us not be subjected to such abuse in the interest of others. Only in a one-payer system will physicians and other medical staff find their interests in common with the patient’s interest.

What can we as patients needing care do in the meantime?

1. Demand a single payer system,

2. While seeking the bulk of your health care on the margins outside of the mainstream of large corporate medicine. There are many ailments that can be effectively treated by Chinese Physicians and naturopathic doctors.

3. Demand family member presence while under anesthesia.

4. Read all consent documents, and do not be afraid to alter those documents or bring your own for the physician to sign.

5. Ask if trainees will be involved in your care at the time you make an appointment. Record the conversation.

6. Be ready to refuse care or be turned away and find care elsewhere.

7. Lobby your state and federal representatives for greater protective legislation. Add a clause to consent forms in facilities such as the V.A. regarding adherence to state regulations they are not otherwise obligated to follow.

8. Be suspicious of Physicians who make multiple referrals, use coercive tactics to convince you to do things, respond to every concern you may express with another scan, MRI, or other test, seem to have more patients than can be properly cared for without many residents and trainees helping out, lie to you even once.

9. Educate yourself and become wise about how you access medical care before you discover you have been abused. Remember, no medical care, or delayed medical care can, in many cases, be better than bad medical care.

10. Be a skeptic. Expect your Doctor to lie to you. Remember their Hippocratic Oath has more to do with P.R. propaganda than having any real meaning to many physicians.

11. When you find a Doctor has abused you; let the rest of us know. Post flyers, post adds, get the word out about that Doctor. Start an Abusive Doctor boycott list web site in your area. As we boycott those physicians and seek care with more ethical practitioners incentives may shift a bit.

- MC Kean

1. The following two articles represent a very small fraction of the propaganda concerning lawsuits and medical malpractice.

A Confederacy of Boobs, by Michael Fumento Reason, October 1995

Medical Malpractice Suits Are Dividing the Nation!, by Marcel Votlucka , The Stony Brook Press, December 8, 2005

2. Study Casts Doubt on Claims That the Medical Malpractice System Is Plagued By Frivolous Lawsuits, Harvard School of Public Health, May 10, 2006

3. Too Many Malpractice Suits, Or Not Enough?, By Solange De Santis, ConsumerAffairs.Com, October 18, 2004

Also see,

Medical Malpractice in TX: is one of many articles, facts, and research published by, Public Citizen, regarding lawsuit propaganda.

The Medical Malpractice Myth: Forget tort reform. The Democrats have a better diagnosis, by Ezra Klein, Slate, Tuesday, July 11, 2006

4. Prescription Drug Scams, by Dean Baker, Thruthout, June 29, 2006

Drug Trials Hide Conflicts for Doctors , by KURT EICHENWALD and GINA KOLATA, May 16, 1999

Insurers Pay Doctors to Switch to Generics, by Joe Mantone, The Wall Street Journal Health Blog, Jan 24, 2008.

Med-tech perks for doctors questioned, by JANET MOORE, Star Tribune, Feb 28, 2008

Is Something Rotten in the State of Radiology?, by Leonard Berlin, MD, FACR, Imaging Economics, March 2007

5. Profit-Seekers, by Payne Hertz, Wednesday, August 29, 2007

Also see,

Needless Surgery, Reprinted from Consumer Reports on Health (March 1998)
© 1998 Consumers Union*

To Go Under the Knife--or Not?, by Kate Murphy, Business Week, July 7 2003

 

Health Department Fines Parkway Hospital $32,000 for Performing Unnecessary Surgeries on Patients from Leben Home, state of New York Department of Health, 7/16/01

Blue Cross and Blue Shield Plans File $30 Million Lawsuit Alleging "Rent a Patient" Fraud in Southern California, Summary by Blue Cross Blue Shield Association, BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

Laparoscopic Cholecystectomy Atrocity, Elizabeth Eugenia James-LaBozetta

Central Ohio Patient's-rights Service (C.O.P.S.) and Citizens for Medical Safety

 

6. High Rate of Failure Estimated for Silicone Breast Implants, by GARDINER HARRIS, New York Times, Published: April 7, 2005

7. Breast surgery accelerates recurrences in some women., Heatlh Facts, Nov 5, 200

Trauma-associated growth of suspected dormant micrometastasis

, Nagi S El Saghir,1 Ihab I Elhajj,1 Fady B Geara,2 and Mukbil H Hourani3 BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

 

STRESS HORMONES MAY PLAY NEW ROLE IN SPEEDING UP CANCER GROWTH, Cancer Research, Nov. 1, 2006 republished OHSU Research News

 

Tumor dormancy: not so sleepy after all, by Cliff Murray, Nature Medicine, 1, 117 - 118 (1995)

 

Does surgery unfavorably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases?,European Journal of Cancer, Volume 41, Issue 4, Pages 508-515 M. Baum, R. Demicheli, W. Hrushesky, M. Retsky

Wounding from Biopsy and Breast cancer progression, Ritsky etal, The Lancet, Vol 357, March 31, 2001

HOW SCIENTIFIC ARE ORTHODOX CANCER TREATMENTS?

, by Walter Last

 

8. Top 10 Reasons to Be Glad You Have Breast Cancer, by PJ Hamel
Monday, May 7, 2007

Breast Cancer Sells, by Lucinda Marshall, AlterNet. Posted October 24, 2007.

9. Are Med Students Practicing on You?, By: Suz Redfearn, Mens Heatlh

 

10.VA uses unsupervised residents and other practices that would not be accepted elsewhereBy JOAN MAZZOLINI, THE PLAIN DEALER Cleveland, Ohio Sunday, January 28, 2001

11. Not Rape, but Still Not Right: Hospitals Should Get Clearer
Consent Before Med Students Probe Anesthetized Women,
Evan Schulz, LEGAL TIMES, Mar. 17, 2003, 54;

Also see,

Using tort law to secure patient dignity, by
JOHN DUNCAN
Independent
ROBIN FRETWELL WILSON
Washington and Lee University - School of Law
DAN LUGINBILL
Ness, Jett & Tanner, LLC
MATTHEW RICHARDSON
Wyche, Burgess, Freeman & Parham, PA

U of Maryland Legal Studies Paper No. 2004-24

Training Intrusive and Needs Patient Consent, Activists Say, WASH. POST, May 10,
2003, at A1; Darin L. Passer, Medical Students Respect Their Patients, THE STATE,
July 19, 2003

Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?, by Melissa Waters, Concurring Opinions, July 24, 2007

12. V.A. Malpractice info website.

13. Don't Ask, Don't Tell: A Change in Medical Student Attitudes After Obstetrics/Gynecology Clerkships Toward Seeking Consent for Pelvic Examinations on an Anesthetized Patient, Peter Ubel 188 AM. J. OBSTETRICS & GYNECOLOGY 575 (2003).

14.Informed consent in public hospitals, by SP Kalantri, Indian Journal of Medical Ethics, Oct - Dec 2000

 

15. “Nearly half of doctors in a recent survey admit to witnessing a serious medical error but not reporting it.” How Professional Is Your Doctor?, Tara Parker Pope, The New York Times, December 3, 2007,

16. V.A. Malpractice info website.

17. Rape Nation, By Kari Lydersen, for AlterNet, July 2, 2004.

18. Gregoire pledges to reform health-care licensing, by Michael J. Berens, Seattle Times staff reporter April 30, 2006

19. The Problem of Health Care Fraud, National Health Care Anti Fraud Association

20. Phoenix Doctor's Picture Taking Latest Sad Tale of Medical Malpractice, |by Parker Waichman Alonso LLP

Also see,

Public Citizen Releases Database With Names of 1,112 "Questionable Doctors" in Pennsylvania, Oct. 29, 2003

Also see,

The story of Dr. John York and the Calif. Board of Medical Quality Assurance, by Al Schallau

Bad doctors get slapped on the wrist

, by Janet Kornblum, USA Today, Aug, 30, 2006

21. NON-CONSENSUAL PELVIC EXAMINATIONS, By: John Kasprak, Senior Attorney, ORL Research Report, June 22, 2004

22. First State Law in Nation Protecting Women From Unauthorized Pelvic Exams Takes Effect January 1st, Office of Assemblywoman Sally J. Lieber, Dec 19, 2003

23. Pelvic exams on unconscious women? More hospitals say no

, A.P. March 11, 2003

Using tort law to secure patient dignity: often used as teaching tools for medical students, unauthorized pelvic exams erode patient rights. Litigation can reinstate them., Duncan, John ; Luginbill, Dan ; Richardson, Matthew ; Wilson, Robin Fretwell , Trial, OCT 1, 2004

24. Medical-malpractice battle gets personal, By Laura Parker, USA TODAY, June 13, 2004

Also see,

How Malpractice Suits Keep My Profession Honest, by Bernard Sussman, Washington Post, April 24, 2005; Page B02

Doctors Take the Offensive. More-Aggressive Tack Used to Cut Frivolous Malpractice Claims, By RACHEL EMMA SILVERMAN Staff Reporter of THE WALL STREET JOURNAL March 23, 2004

The Medical Malpractice Myth, by Tom Baker, University Of Chicago Press, December 1, 2005

 

2.0.CO;2-D">Law and the Life Sciences: Doctors Sue Lawyers: Malpractice inside out, George J. Annas The Hastings Center Report, Vol. 7, No. 5 (Oct., 1977), pp. 15-16
doi:10.2307/3560717

25. Lax oversight favors doctors over patients: Doctors keep licenses despite lawsuits, sexual assaults, even patient deaths, , By GINA BARTON, JOURNAL SENTINEL WATCHDOG REPORT, : Jan. 26, 2008

 

26. Listening and talking to patients. A remedy for malpractice suits?, G W Lester and S G Smith University of Saint Thomas, Houston, Texas. 1993 and,

Apology a tool to avoid malpractice suits, By Lindsey Tanner, A.P., The Boston Globe, Nov. 12, 2004

27. “No time to listen and talk to patients.” by A W Wirtzer (al. Lester 268, or Western Journal of Medicine, June, 1993 pg 639)

 

   

 

Images - http://www.albany.com/wellness-blog/Medical-Malpractice-Lawsuits.jpg


Student Doc tells of Medical Rape - "Anesthetized women look so vulnerable.

"Anesthetized women look so vulnerable."[119]

I am all gloved up, fifth in line. At Tufts, medical students - particularly male students - practice pelvic exams on anesthetized women without their consent and without their knowledge. Women come in for surgery and, once they're asleep, we all gather around; line forms to the left.

In the medical ethics literature this practice has been called, "an outrageous assault upon the dignity and autonomy of the patient...."[120] "The practice shows a lack of respect for these patients as persons, revealing a moral insensitivity and a misuse of power."[121] "It is just another example of the way in which physicians abuse their power and have shown themselves unwilling to police themselves in matters of ethics, especially with regard to female patients."[122]

We learn more than examination skills. Taking advantage of the woman's vulnerability - as she lay naked on a table unconscious - we learn that patients are tools to exploit for our education.

It all started on the first day when the clerkship director described that we were to gain valuable experience doing pelvic exams on women in the operating room. I asked him if the women knew what we were doing. Are the women asked permission? "No," he said. And not only no, he described that he was, "ethically comfortable with that." I did some reading.

Massachusetts state law reads: "Every patient... has the right... to refuse to be examined... by students... and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic."[123] Yes, the right to refuse, but what if the patient doesn't even know? Was the director's attitude what-she-doesn't-know-can't-hurt-her? The confrontation continued.

He countered, "These women sign off that right to refuse on their surgical consent form." Having long learned a healthy skepticism about the pronouncements of authority, I got a copy of the form. The only mention of students reads as follows: "I am aware that occasionally there may be visiting surgeons/ healthcare professionals/ students observing techniques." Observing? We were going to be doing a lot more than observing. I went back to talk to him.

"Women are smart," he told me. "They know that when it says a student observes, that the student will be participating in the procedures." My eyes widened. And anyway, I was told, "Most women wouldn't mind." My jaw dropped. And, "Why are you so sensitive?"

I was just stunned, a stranger in a strange land. I was reminded of the summer I spent in Louisiana, where I had a debate with an orthopedic surgeon over whether or not the abolishment of slavery was really a good thing. "Now just think about it," I was admonished. What do you even say? How do you even respond?

So if the patients already secretly know and wouldn't mind regardless, then surely the course director wouldn't mind me wasting my breath to ask the women permission. (For that matter, he shouldn't mind a quick letter to the Boston Globe either.) No, I was told initially, I am not to ask women permission to use them - their bodies - for our education. I shouldn't let them know. Why? "We would just confuse the patients," he said. "You don't ask permission for male genital exams, do you?" I was asked. "We don't get them to sign permission for every little detail?"

John M. Smith, in Women and Doctors writes, "Many doctors regularly abuse women as a result of underlying prejudice and self-deception."[124] The whole situation reminds me of a famous James Thurber cartoon. A male doctor is leering over the headboard of a hospital bed at a female patient. Caption: "You're not my patient, you're my meat."[125]

"It is grossly unjust to exploit the vulnerable."[126]

Maybe the women wouldn't mind not being asked. After all, he is a doctor. I went back to the library. Sixty-nine women were asked in a British survey whether they thought permission should be specifically sought for students doing pelvic exams in the operating room. One hundred percent said yes; they all thought that specific permission should be sought.[127] A Swedish study found that 90% of gynecologic patients "would feel aggrieved if they discovered that they had participated in [any kind of] clinical training without first having been informed or given the opportunity of declining."[128] And of course, "Express consent does not mean a signature on a piece of paper... [it means] the patient must understand the general nature of the procedure - that is, that she is being used for teaching."[129]

I brought this to the director's attention. I gave him a copy of the British study. He dismissed it; how could I possibly extrapolate data from a British low income clinic to our population? Again, speechless. Even if the data were two orders of magnitude off and only one out of a hundred would mind not being asked, shouldn't that be enough?

The practice may even put the school and hospital in legal jeopardy - battery, professional misconduct, perhaps even aggravated sexual assault. Maybe I should just walk out of the OR and call the police. As written in a British Sunday Times article, "There is nothing to stop a woman bringing a legal action of assault. The only reason no one has done it is because they don't know what's going on."[130] The attending assured me they had thought of that too. "It's been past the risk analysis committee," he told me as he patted my shoulder, "there's nothing to worry about." At that point I gave up.

Appendix 49 offers some perspective on this outrageous practice.

Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women

Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women

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From the now defunct Non-Con web site

Posted by Jill—Unnecesarean

Public health reporter André Picard published an editorial yesterday in the Canadian newspaper, The Globe and Mail, imploring the medical community to end the practice of performing vaginal exams on anesthetized women without their consent. The article about physician Sara Wainberg’s research and personal accounts of the practice has ignited comment storms, debate and outrage.

Pelvic examinations performed routinely in teaching hospitals on uninformed, anesthetized women prepped for unrelated surgeries is not breaking news. The topic bubbles up to the surface every few years, incites a media frenzy, then simmers back down into what Picard calls “one of those dirty little secrets of medicine” and again drops from the public eye.

The story is that the practice of digitally raping anesthetized female and male patients without their consent continues.

One of many articles on the ethics of performing pelvic exams on anesthetized women was written by Robin Fretwell Wilson, a professor of law at the University of South Carolina School of Law, who testified before the Federal Trade Commission and Department of Justice Hearing on June 10, 2003. In her article, Unauthorized Practice: Teaching Pelvic Examination on Women Under Anesthesia that appeared in the Journal of the American Medical Women’s Association in 2003, Wilson cites study after study showing that the practice is routine.

In February, Ubel et al reported that 90% of medical students at four Philadelphia-area medical schools performed pelvic examinations on anesthetized patients for educational purposes during their obstetrics/gynecology rotation. Although trumpeted as proof that physicians are lax in securing permission, the study was not clear on the matter of consent. Caldicott et al reported in January that 53% of students at a single English medical school performed pelvic or rectal examinations on anesthetized patients. Students acted without any written or oral consent in 24% of the exams.

Research in the United States, Canada, and Great Britain has shown that the unauthorized use of women is not confined to 1 or 2 medical schools. Using anesthetized patients before surgery to teach abnormal anatomy “has long been practiced.” Women are also used to teach normal anatomy. As late as 1992, Beckmann found that 37.3% of US and Canadian medical schools reported using anesthetized patients to teach pelvic exams.

Other data in Wilson’s article:

[In 2002], nearly half of Canadian medical students (47%) at the University of Toronto reported “pressure to act unethically” and named as the leading culprit the collision between medical education and patient care. Many were asked to perform pelvic examinations without consent.

Ninety-four percent of Oxford Medical School graduates learned to perform digital rectal examinations using male and female patients, many of whom were anesthetized.

Only 37.5% of teaching hospitals “inform patients that students would be involved in their care.”

Forty-two percent of US students are not forthright about their status when doing pelvic exams on conscious women.

Five percent of obstetrics/gynecology department chairs tell students to introduce themselves as doctors and just proceed.

 

Some states in the U.S. ban the practice of digitally violating anesthetized female patients. California Governor Gray Davis signed AB 663 into law during the first half of the 2003-04 legislative session which makes the performance of pelvic examinations on anesthetized or unconscious women without consent by doctors and medical students a misdemeanor and ground for the loss of their medical license.

The glaring limitation in the bill is, as Wilson wrote, ”[no] woman can enforce her own interests in being asked if she never knows an exam has taken place” and therefore the bill “suffers from the same limitations as existing causes of action for battery and the failure to secure informed consent.” While AB 663 increases the sanctions for unauthorized exams, Wilson argues that it does nothing to remedy the underlying pressures that have fostered the use of patients as teaching tools without permission.

Ironically, under the subheading “Exaggerated Fear of Refusal,” Wilson cites multiples showing that women will consent to pelvic examinations for educational purposes, even while anesthetized or during birth.

Dr. Ari Silver-Isenstadt, co-author of the aforementioned study about Philadelphia-area medical schools appeared on ABC’s Good Morning America show on June 10, 2004 to discuss the study. He told ABC that the study was based on his own experiences in medical school when “[he] was asked to participate in some of these educational experiences and [he] felt very uncomfortable…”

Naturally, many patients take issue with the idea that their anesthetized bodies will be probed without their expressed consent and knowledge.

One such patient was Zahara Heckscher, who was interviewed by the Washington Post in May 2003. According to the article, Heckscher was preparing to have an ovarian cyst removed at George Washington University Hospital and asked her surgeon if medical students would be practicing pelvic exams on her while she was unconscious.

Shocked when she received a “yes” answer, Heckscher “wrote a note on her consent form forbidding anyone other than her attending physician to perform a pelvic exam on her while she was under anesthesia.”

Not all doctors agree that patients at a teaching hospital should complain about the practice.

Former ACOG president, Dr. Thomas Purdon, expressed concern “that an important quality evaluation that’s been a mainstay of evaluation in the operating room for more than 50 years is getting sensationalized,” according to OB/GYN News.

“It’s a crucial teaching point to see how a procedure is done, what the pathology is, and to tie that to the pelvic exam,” said Dr. Purdon of the Arizona Health Sciences Center in Tucson.

Purdon also argued that this type of treatment is implicit.

In Dr. Purdon’s view, patients who get treated at a teaching hospital “should already know that it’s not just one single doctor who’s taking care of them.”

Purdon expressed frustration that people who go to university centers for care are “pick[ing] apart” something so important.

Although the practice of performing pelvic exams on paid volunteers has gained popularity in some institutions over the last 15 years, physicians are never going to get enough paid volunteers to adequately teach students, he said.

As an educator, “it’s frustrating for me that people who want to go to university centers for the latest treatments and technology pick apart something that’s an area of importance,” he said.

It’s common in a teaching situation for a medical student, one or two residents, and a faculty person to compose a surgical team. It’s not as if 12 medical students are in the operating room examining the anesthetized patient, he said.

Activist Michael Greger, MD, told the Washington Post that the voluntary guideline of having one or two students perform the exam is widely ignored. Said Greger, “If they have five medical students on an OB-GYN rotation, they aren’t going to let one do it and not the other four.”

Bioethicist and medical historian, Jacob Appel, analyzed the recent court-ordered hospitalization of then pregnant woman Samantha Burton for the Huffington Post in his article, “Medical Kidnapping: Rogue Obstetricians vs. Pregnant Women,” in which he stated:

Preventing a competent pregnant woman from leaving the hospital under these circumstances is no less egregious than compelling her to have an abortion. Forcing additional intrusive care upon her, such as unwanted vaginal exams or cervical assessments, is legally-sanctioned digital rape.

As André Picard wrote, “the problem is the result of a failure to communicate. It is also a striking example of a lingering bit of paternalism that is still all-too-present in medical culture – this notion that “we do the surgery and the details are none of your business.”

With sufficient evidence that the majority of women would consent to a pelvic exam if asked, the practice of medical students manually raping anesthetized women in the name of education is a pitiful relic of medical culture. Were it not for the many brave medical and nursing students over the years who spoke out against the practice of culturally-sanctioned digital rape in the operating room and in labor and delivery under the guise of frequent unnecessary cervical checks, this would remain a dirty little secret.

If a Tree Falls: If a Patient is Assaulted Under Anesthesia - MCKean

If a Tree Falls:

If a Patient is Assaulted Under Anesthesia

Few patients realize American medicine has a long history and extensive current practice of violating anesthetized patients rights. This is done in a multitude of ways. Oneis Ghost surgeries, where a patient is told one person will be performing the procedure, but the operation is literally subcontracted out (with kickback and all) to another surgeon and the surgeon you thought was operating has moved on to a higher paying patient/procedure. Other times your surgery is handed over to interns and residents to whom you have never been introduced. The physician the patient was told would be performing the procedure may be merely supervising, or may have moved on to the next case and only be available by phone in the case of an emergency. Once under anesthesia for surgery or colonoscopies physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. 1. 

Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions and intimate practice exams for the sake of education rather than patient health. Other times patients are given “conscious sedation” (date rape drugs) to obtain drug facilitated signatures on consent forms allowing the switch, when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. “Gurney consenting” is a method often used on patients who staff has reason to think will not consent to substitutions, video tapping, many spectators, or multiple pelvic exams by teams of students lined up 8 and even 12 deep…, adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern.

As patients, we are lead to believe that patients have rights, and physicians respect our rights as a matter of practice and oath. We are further lead to believe that there are laws protecting these rights, and physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical “professionals”. The World Medical Association Declaration of Helsinki 2000 declared that, “The well-being of the human subject be given the highest priority and accorded precedence over the interests of science and society.“ This is not medical education and research as it is practice, more propaganda than reflective of practice. Many common practices among practitioners, hospitals, drug companies, imaging companies, and labs prove this declaration hollow.
In addition to these Ghost surgeries, and gang bang intimate student exams, kickback driven medicine, unnecessary surgeries and other harmful procedures, are all common practices that prove the WMA declaration to be no more than propaganda. An overwhelming number of physicians get kickbacks and other economic incentives from pharmaceutical companies, not only for being willing to prescribe a drug, or implant a devise, but also for research. Often, physicians also get kickbacks from other Physicians, hospitals, and imaging facilities to which they refer patients. Physicians even get kickbacks for implant devises. Influenced by a greed for these kickbacks, many physicians prescribe medications and procedures they know are NOT the most effective response to your medical condition or may not even be indicated in your case, but you have become part of a side effects study. 2. In one study one third of the Doctors interviewed, “admitted they would order unnecessary MRI scans and 25% referred patients to an imaging center where they had a financial interest.” 3.

Physicians promote unnecessary surgeries and other risky procedures, often failing to tell a patient of less radical alternatives, to disclose and even mislead patients about risks, and encourage a patient to elect procedures that are not good for their health. “While it is difficult to distinguish "necessary" from "unnecessary" surgeries, some estimates put the latter at 2.5 million a year, resulting in 11,600 deaths a year as well as severe pain and disability for many of the survivors.” 4. Breast implants are just one example. Implants are never permanent. Most will require another surgery within five years, virtually 100% fail within 10 years. 5. Reconstruction after a mastectomy requires multiple surgeries (including one on the healthy breast), and thus provides a whole string of opportunities for surgeons to make big bucks. For women with cancer this is particularly cruel even murderous as evidence indicates that physical trauma the like of multiple surgeries can encourage the spread of cancer. 6. Surgeons virtually never reveal this trauma induced cancer growth risk. Even women’s magazines have described new “perky” breasts, and perhaps even a tummy tuck, as a couple among ten reasons to “be glad you have breast cancer.” 7. While plastic surgeons claim options for such reconstruction are, “essential to women’s self-esteem“, there are less dangerous roads to dealing with self-esteem issues, patients are not well informed of risks, and surgeons literally peddle reconstruction.
 

This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern. One would think we would hear from our better, more ethical physicians, if such violations were common, that medical boards would act to remedy the situation. It is harder to understand the silence of more ethical less greedy physicians, or nurses for that matter. There is, however, one violation practiced by physicians historically and today that provides us with an insight, a perspective, from which to think of these violations by many physicians, and silence by others, that leads us to a deeper understanding of how medical culture is literally constructed one generation after another to an end conductive of such patient abuse. Unnecessary exams and tests are harmful to patient health, medical radiation cumulative and a proven source of cancer, medications often dangerous. Currently, however, I want to address a practice that physicians claim carries NO risk of harm to patients, serves only to benefit ALL members of society, and are willing to VIOLENTLY defend the practice over all claims to patient autonomy, all reasonable notions of informed consent. I chose this practice because I think it ultimately is very informative and insightful perspective to take a look at in terms of medical staff attitudes towards patients and patient’s rights. This is the practice of “medical rape”.
Manifest in various forms, medical rape is essentially a non-consensual, non-emergency, intimate exam (pelvic, breast, or rectal) or procedure. Students are inducted into the culture of disrespect for patient autonomy, dignity, privacy, and yes, even health, through medical rape in the form of lines of students, interns and residents, six, eight, or more (many reports have been in the double digits), performing practice pelvic, rectal, and breast exams on manipulated young clinic patients or uninformed sedated patients waiting for surgery. Many intersexuals are traumatized by medical staff forcing apart their legs for gangs of students to inspect their genitals.
Now medical culture resists “medical procedures” being referred to as “rape”, regardless of lack of consent, use of chemical force and restraint, lies and manipulation, and the employment of methods they are very well aware patients would not tolerate were they informed. My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected non-consensual non-emergency, non-medically indicated pelvic exams, and more. If we are to understand this medical culture of patient violation, it is insightful to approach the subject from the direction of historical practice, in conjunction with the rationalizations of apologists that refer to themselves as medial ethicists. This is a sort of “People’s History” of Allopathic Medicine. With no intent to go into the detail Howard Zenn has in his books, I want to take a critical look at medical practices as they relate to violations of patient’s autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, the philosophical and pragmatic weaknesses of such rationalizations, and what needs to be done to ensure patient autonomy, dignity, and rights are respected.

The History:

We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,…; from it’s inception allopathic or “western” medical “advancements” to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 8

At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, “allopathic medicine” (which became what we now know as “western medicine”), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued patients who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving.

Opportunistic philosophers (linked to eugenics) and emerging pharmaceutical companies offered the allopath the American Medical Association (A.M.A.), an organization that would seek the elimination of competition and control over medical education and the market, ensuring the high income of the allopathic doctor. The objective of the AMA, was to eliminate patient choice, “to secure a government-enforced medical monopoly and high incomes for mainstream doctors.” 9. The A.M.A. lumped ALL sorts of medical care, including midwifery, in with snake oil salesmen, and lobbied for legislation eliminating their competition. Alternatives were all but eliminated from for- profit medical care. The poor, however, sustained medical care in the form of the old women and men passing on home remedies and basic medical knowledge.

One might assume the poor simply could not afford the allopath, or lived more remote lives, and both are true, but the situation was not so simple. While profit driven medical care was reserved for the privileged, patients with money and social status have not only the ability to pay the bill, but also the means to retaliate should the physician deviate from a professional standard of care and the patient suffer. This made the physicians paying customers risky research subjects. Physicians learned early on to treat privileged white males (those who can afford to pay for their medical care and lawyer fees) with more respect.

In the late 1700s a Mr. Slater sued a Dr. Stapleton and Dr. Baker for re-breaking a poorly healed bone. The court found in favor of Mr. Slater because the defendants acted, “contrary to known standard of care and did so without the informed consent of the subject.” Although, the treatment turned out to set a new standard of care in the end, the courts decision did not turn on the success of the experiment, but on the lack of informed consent, that the patient, "...may take courage and put himself in such a situation as to enable him to undergo the operation". 10. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)

Physicians not eager to give up their God like position to treat people as less that full subjects; but, also wanting to make money without being sued, learned to treat the more privileged according to the standard of care, and experiment on those less likely to sue. While being offered little in terms of medical care (medicine administered in their interest), these subjugated groups served as a resource for human lab rats upon which to test this or that drug, treatment, or procedure. Financial and other coercive means were employed in some cases, others downright deception. Informed consent, in any meaningful sense of the word, was rarely sought. Thus, the poor had more than simple economic inability to pay keeping them from seeking medical care from “outsiders”, and in particular from the allopath. 11.

With the advent of surgery; however, physicians needed more than lab rats, they needed living cadavers. While drafted soldiers may “volunteer” to be lab rats in order to avoid being sent to kill others, and many patients can unknowingly be injected with this or that, surgical experimentation presents the problem of being impossible to hide from the patient. Given the extreme nature of surgery and the very high infection rate at the time, (rendering surgery a very risky proposition), it was virtually impossible to acquire “consent“.

The allopath turned to non-free peoples as a resource for breathing cadavers. Subjects with absolutely no freedom to object, slaves, poor mental health patients, and prisoners of war became prime targets for some of the most vial forms of human exploitation. Dr J Marion Sims,(1813-1884) the “father of modern Gynecology”, and the first physician to have a statue erected in his honor in the United States, provides a particularly atrocious, if not unique, example. Doctor Sims avoided the problem of a scarcity in “voluntary” subjects by using African American slave women. The problem of patient autonomy and the need for consent was avoided, and not thinking of the women as human subjects, Dr. Sims operated on his slave and Irish female subjects without anesthesia, something he dare not do to women of privilege. The condition for which Sims sought a cure, …, was largely caused within the slave population by malnourishment and/or pregnancies at a young age, such that the pelvic was underdeveloped leading to prolonged obstructed labors. Dr. Sims not only did not do anything to help the condition of these women, he used them, and their unborn. Most of the women used in his experiments died, many after suffering for weeks. When slave owners refused him further access to their property, he purchased slaves, the first a seventeen year old slave girl he called Anarcha for $500 upon which he performed over 30 operations within a few months in spite of the fact that his own records indicate she was cured after the 13th surgery. There is no reason to assume the slaves he purchased (particularly given the price) were always afflicted prior to Sims’ experiments. Anarcha’s condition (several vaginal tears) was the result of a three-day labor, and then a rough forceps (another of Sims’ inventions) assisted delivery by Dr. Sims, an experimental procedure in which he had no previous experience, using an experimental tool still controversial to this day. While you can read modern apologists who insinuate that these procedures may have been voluntary, these women were slaves, anesthesia was not used (until post surgery so Sims would not have to listen to their moans), and the number of surgeries performed on single subjects were in the double digits. People were asked to hold the women down, most of who after a couple of times could no longer stomach the task, nor Dr. Sims. 12. There is every reason to assume the bulk of these women did not “volunteer” and the girl(s) he purchased most certainly did not.

Apologists also argue that without this sort of violence and abuse the achievements of Sims would never have been enjoyed by millions of women today. This is an obvious logical fallacy as there is no reason to assume that similar (perhaps less violent) procedures would not have been developed by other physicians. More than logical fallacy, historical evidence refutes the claim. In fact, Sims was not the first to repair vesicovaginal fistulas successfully. Twenty-five years before Sims' experiments (from 1845 to 1849) , Montague Gosset in England had used silver wire in a fistula repair, and the use of lead shot to hold wire sutures in place was also known. In 1836, John Peter Mettauer in Virginia and, in 1839, George Hayward in Massachusetts succeeded in closing fistulas. 13. Thus, there is no reason to assume that only Sims could have copied and published these achievements. There is no reason to assume such advancements require such violations of human autonomy. Many contemporaries made medical advances without the use of captive patients. Ephraim McDowell of Kentucky, who in 1809 performed the first successful abdominal operation, and Crawford Long of Georgia, who in 1842 used ether as an anesthetic for the first time, to name just two, both used informed, free, white patients.

Many medical anti-ethicists, as they can only descriptively be called, argue that Sims must be judge by the standards of his time, not ours. However, many speculate Sims left the South due to significant criticism. His colleagues at a Woman’s Hospital Sims help found were so critical of Sims’ unethical experimentation that they voted to ban his cancer surgeries and limit the number of spectators in attendance at surgeries. Eventually, his colleagues so feared for the lives of patients at the hospital they invited Dr. Sims to leave the Hospital. His brother-in-law, also a physician, pleaded with Sims to give up his surgeries. James Simpson of Edinburgh, pointedly remarked in critic of Sr. Sims, "I took occasion to make an extensive series of experiments ... [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform." 14. Nor was Sims a Calvinistic practitioner who did not believe in anesthesia, as he did give his victims chloroform post surgery, if only so he did not have to listen to their moans from the pain.

Given Sims experiments (as he brutally carried them out) would not have been possible had his subjects not been slaves, given such abuse was not necessary for the “advancement of women’s medicine”, given the criticism of his own contemporaries, and given both slavery and non-consensual experimental procedures have come under mass social critic and legal restraint one might find it hard to understand why contemporary medical ethicists might defend Sims’ experiments. Still, many physicians are irrationally emphatic about in their defense of Dr. Sims, arguing the end justified his means. I am convinced, and evidence suggest, they do so not because their argument is well supported by reason or evidence, but because they feel they have a vested interest in opposition to patient autonomy and the ethic against violating informed consent; they have a vested interest in treating the rich and subjecting the poor to violent abuses against patient autonomy, dignity, and health. Contemporary acts of medical violence are rationalized in the same manor Sims’ experiments employing medical rape of the slave women has been rationalized and re-rationalized by some physicians and medical (anti) ethicists. The fact that in spite of criticism in his own day, today Physicians’ rewrite history not only in overwhelming defense, but worship of Dr. Sims is very telling. In fact, to this day people are often reduced to captive patients, not as much through slavery as through force, physical and chemical.
MCKean

To be Continued: To be Continued: In the next chapter I will talk about current practice. We will also address physician justifications for violations of Kant's moral imperative, their fiduciary duties, and Hippocratic oath. Finally we will propose legislation to address these violations and an opportunity for you to act.

1... Not Rape, but Still Not Right: Hospitals Should Get Clearer
Consent Before Med Students Probe Anesthetized Women,
Evan Schulz, LEGAL TIMES, Mar. 17, 2003, 54;

Also see,

 

..Using tort law to secure patient dignity, by
JOHN DUNCAN
Independent
ROBIN FRETWELL WILSON
Washington and Lee University - School of Law
DAN LUGINBILL
Ness, Jett & Tanner, LLC
MATTHEW RICHARDSON
Wyche, Burgess, Freeman & Parham, PA

 

U of Maryland Legal Studies Paper No. 2004-24

 

Training Intrusive and Needs Patient Consent, Activists Say, WASH. POST, May 10,
2003, at A1; Darin L. Passer, Medical Students Respect Their Patients, THE STATE,
July 19, 2003

 

Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?, by Melissa Waters, Concurring Opinions, July 24, 2007

2.

Prescription Drug Scams, by Dean Baker, Thruthout, June 29, 2006

 

Drug Trials Hide Conflicts for Doctors , by KURT EICHENWALD and GINA KOLATA, May 16, 1999

 

Insurers Pay Doctors to Switch to Generics, by Joe Mantone, The Wall Street Journal Health Blog, Jan 24, 2008.

 

Med-tech perks for doctors questioned, by JANET MOORE, Star Tribune, Feb 28, 2008

 

Is Something Rotten in the State of Radiology?, by Leonard Berlin, MD, FACR, Imaging Economics, March 2007

3.

Phoenix Doctor's Picture Taking Latest Sad Tale of Medical Malpractice, |by Parker Waichman Alonso LLP

4.

Profit-Seekers, by Payne Hertz, Wednesday, August 29, 2007

Also see,

 

Needless Surgery, Reprinted from Consumer Reports on Health (March 1998)
© 1998 Consumers Union*

 

To Go Under the Knife--or Not?, by Kate Murphy, Business Week, July 7 2003

 

 

Health Department Fines Parkway Hospital $32,000 for Performing Unnecessary Surgeries on Patients from Leben Home, state of New York Department of Health, 7/16/01

 

Blue Cross and Blue Shield Plans File $30 Million Lawsuit Alleging "Rent a Patient" Fraud in Southern California, Summary by Blue Cross Blue Shield Association, BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

 

Laparoscopic Cholecystectomy Atrocity, Elizabeth Eugenia James-LaBozetta

Central Ohio Patient's-rights Service (C.O.P.S.) and

Citizens for Medical Safety

 

5.

High Rate of Failure Estimated for Silicone Breast Implants, by GARDINER HARRIS, New York Times, Published: April 7, 2005

6.

Breast surgery accelerates recurrences in some women., Heatlh Facts, Nov 5, 200

 

Trauma-associated growth of suspected dormant micrometastasis, Nagi S El Saghir,1 Ihab I Elhajj,1 Fady B Geara,2 and Mukbil H Hourani3 BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

 

 

 

STRESS HORMONES MAY PLAY NEW ROLE IN SPEEDING UP CANCER GROWTH, Cancer Research, Nov. 1, 2006 republished OHSU Research News

 

 

Tumor dormancy: not so sleepy after all, by Cliff Murray, Nature Medicine, 1, 117 - 118 (1995)

 

 

Does surgery unfavorably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases?,European Journal of Cancer, Volume 41, Issue 4, Pages 508-515 M. Baum, R. Demicheli, W. Hrushesky, M. Retsky

Wounding from Biopsy and Breast cancer progression,

Ritsky etal, The Lancet, Vol 357, March 31, 2001

 

HOW SCIENTIFIC ARE ORTHODOX CANCER TREATMENTS?, by Walter Last

 

7.

Top 10 Reasons to Be Glad You Have Breast Cancer, by  PJ Hamel
Monday, May 7, 2007

8.

Vaccines and Medical Experiments on Children, Minorities, Woman and Inmates (1845 - 2007), Friday, December 14, 2007 by: Mike Adams, Natural News Editor
BITTER PILL : Disseminating Truth And Fighting Tyranny

 

http://www.homersbitterpill.com/2008/12/human-medical-experimentation-in-united.html

 

Race, Health Care and the Law Speaking Truth to Power! Basis of Distrust

 

http://academic.udayton.edu/health/05bioethics/slavery02.htm

 

Human medical experimentation in the United States: The shocking true history of modern medicine and psychiatry (1833-1965)

 

Toxins in the Bodies of Newborns Lead to a Contaminated Generation

9/9/2008 - (NaturalNews)

 

Hepatitis B Vaccine: Good for 'Newborn' Prostitutes and Drug Users, but Who Else? 7/11/2008 - (NaturalNews)

9.

AMA’s stated purpose

10.

(Slater v Baker and Stapleton (1797) 95 English Reports 860.)

11.

http://jme.bmj.com/cgi/content/full/34/3/180#B12

 

http://jme.bmj.com/cgi/content/abstract/32/6/346

http://jme.bmj.com/cgi/content/full/34/3/180 .. B19

 

http://shm.oxfordjournals.org/cgi/content/abstract/20/2/223

http://jme.bmj.com/cgi/content/full/34/3/180 .. B18

 

http://www.naturalnews.com/022383.html

12.

(James Marion Sims: some speculations and a new position Caroline M de Costa MJA 2003; 178 (12): 660-663)

McGregor DM. Sexual surgery and the origins of gynecology: J. Marion Sims, his hospital, and his patients. New York, Garland Publishing, 1989:47.)

13.

Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132:878-884.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.

14.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.)  

 

 

If a Tree Falls

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Original Content at http://www.opednews.com/articles/If-a-Tree-Falls--If-a-Pat-by-MC-Kean-091122-423.html


November 23, 2009

If a Tree Falls: If a Patient is Assaulted Under Anesthesia

By MC Kean

Few patients realize American medicine has a long history and extensive current practice of violating anesthetized patients rights. This is done in a multitude of ways. One is Ghost surgeries, where a patient is told one person will be performing the procedure, but the operation is handed over to interns and residents to whom you have never been introduced once you are under anesthesia. The physician the patient was told would be performing the procedure may be merely supervising, or may have moved on to the next case and only be available by phone in the case of an emergency.

Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions. Other times patients are given “conscious sedation” (date rape drugs) to obtain drug facilitated signatures on consent forms when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. This is a method often used on patients who staff has reason to think will not consent to substitutions, video taping, or multiple pelvic exams", adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician.

Once under anesthesia for surgery or colonoscopes physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern.

We are convinced that in the western world the average medical patient has established rights to dignity, privacy, and self-determination, that physicians are trained to respect and protect these rights, and any physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical “professionals”. It is an understanding come by via propaganda and is not reflective of reality. So, what is real?

My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected to forced rape exams, non-consensual non-emergency, often even non-medically indicated pelvic exams, and more. This is a sort of “People's History” of Allopathic Medicine. With no intent to go into the detail Howard Zinn has in his books, I want to take a critical look at medical practices as they relate to violations of patient's autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, and what needs to be done to ensure patient autonomy, dignity, and rights are respected.

I. The History:

We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,"; from it's inception allopathic or “western” medical “advancements” to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 1

At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, “allopathic medicine” (which became what we now know as “western medicine”), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued any patient who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving.

Opportunistic philosophers (linked to eugenics) and emerging pharmaceutical companies offered the allopath the American Medical Association (A.M.A.), an organization that would seek the elimination of competition and control over medical education and the market, ensuring the high income of the allopathic doctor. The objective of the AMA, was to eliminate patient choice, “to secure a government-enforced medical monopoly and high incomes for mainstream doctors.” 2. The A.M.A. lumped ALL sorts of medical care, including midwifery, in with snake oil salesmen, and lobbied for legislation eliminating their competition. Alternatives were all but eliminated from for-profit medical care. The poor, however, sustained medical care in the form of the old women and men passing on home remedies and basic medical knowledge.

One might assume the poor simply could not afford the allopath, or lived more remote lives, and both are true, but the situation was not so simple. While profit driven medical care was reserved for the privileged, patients with money and social status have not only the ability to pay the bill, but also the means to retaliate should the physician deviate from a professional standard of care and the patient suffer. This made the physicians paying customers risky research subjects. Physicians learned early on to treat privileged white males (those who can afford to pay for their medical care and lawyer fees) with more respect.

In the late 1700s a Mr.Slater sued a Dr. Stapleton and Dr. Baker for re-breaking a poorly healed bone. The court found in favor of Mr. Slater because the defendants acted, “contrary to known standard of care and did so without the informed consent of the subject.” Although, the treatment turned out to set a new standard of care in the end, the courts decision did not turn on the success of the experiment, but on the lack of informed consent, that the patient, "...may take courage and put himself in such a situation as to enable him to undergo the operation". 3. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)

Physicians not eager to give up their Godlike position to treat people as less that full subjects; but, also wanting to make money without being sued, learned to treat the more privileged according to the standard of care, and experiment on those less likely to sue. While being offered little in terms of medical care (medicine administered in their interest), these subjugated groups served as a resource for human lab rats upon which to test this or that drug, treatment, or procedure. Financial and other coercive means were employed in some cases, others downright deception. Informed consent, in any meaningful sense of the word, was rarely sought. Thus, the poor had more than simple economic inability to pay keeping them from seeking medical care from “outsiders”, and in particular from the allopath. 4.

With the advent of surgery; however, physicians needed more than lab rats, they needed living cadavers. While drafted soldiers may “volunteer” to be lab rats in order to avoid being sent to kill others, and many patients can unknowingly be injected with this or that, surgical experimentation presents the problem of being impossible to hide from the patient. Given the extreme nature of surgery and the very high infection rate at the time, (rendering surgery a very risky proposition), it was virtually impossible to acquire “consent“.

The allopath turned to non-free peoples as a resource for breathing cadavers. Subjects with absolutely no freedom to object, slaves, poor mental health patients, and prisoners of war became prime targets for some of the most vial forms of human exploitation. Dr J Marion Sims,(1813-1884) the “father of modern Gynecology”, and the first physician to have a statue erected in his honor in the United States, provides a particularly atrocious, if not unique, example. Doctor Sims avoided the problem of a scarcity in “voluntary” subjects by using African American slave women. The problem of patient autonomy and the need for consent was avoided, and not thinking of the women as human subjects, Dr. Sims operated on his slave and Irish female subjects without anesthesia, something he dare not do to women of privilege. The condition for which Sims sought a cure, " was largely caused within the slave population by malnourishment and/or pregnancies at a young age, such that the pelvic was underdeveloped leading to prolonged obstructed labors. Dr. Sims not only did not do anything to help the condition of these women, he used them, and their unborn. Most of the women used in his experiments died, many after suffering for weeks. When slave owners refused him further access to their property, he purchased slaves, the first a seventeen year old slave girl he called Anarcha for $500 upon which he performed over 30 operations within a few months in spite of the fact that his own records indicate she was cured after the 13th surgery. There is no reason to assume the slaves he purchased (particularly given the price) were always afflicted prior to Sims' experiments. Anarcha's condition (several vaginal tears) was the result of a three-day labor, and then a rough forceps (another of Sims' inventions) assisted delivery by Dr. Sims, an experimental procedure in which he had no previous experience, using an experimental tool still controversial to this day. While you can read modern apologists who insinuate that these procedures may have been voluntary, these women were slaves, anesthesia was not used (until post surgery so Sims would not have to listen to their moans), and the number of surgeries performed on single subjects were in the double digits. People were asked to hold the women down, most of who after a couple of times could no longer stomach the task, nor Dr. Sims. 5 There is every reason to assume the bulk of these women did not “volunteer” and the girl(s) he purchased most certainly did not.

Apologists also argue that without this sort of violence and abuse the achievements of Sims would never have been enjoyed by millions of women today. This is an obvious logical fallacy as there is no reason to assume that similar (perhaps less violent) procedures would not have been developed by other physicians. More than logical fallacy, historical evidence refutes the claim. In fact, Sims was not the first to repair vesicovaginal fistulas successfully. Twenty-five years before Sims' experiments (from 1845 to 1849) Montague Gosset in England had used silver wire in a fistula repair, and the use of lead shot to hold wire sutures in place was also known. In 1836, John Peter Mettauer in Virginia and, in 1839, George Hayward in Massachusetts succeeded in closing fistulas. 6. Thus, there is no reason to assume that only Sims could have copied and published these achievements. There is no reason to assume such advancements require such violations of human autonomy. Many contemporaries made medical advances without the use of captive patients. Ephraim McDowell of Kentucky, who in 1809 performed the first successful abdominal operation, and Crawford Long of Georgia, who in 1842 used ether as an anesthetic for the first time, to name just two, both used informed, free, white patients.

Many medical anti-ethicists, as they can only descriptively be called, argue that Sims must be judge by the standards of his time, not ours. However, many speculate Sims left the South due to significant criticism. His colleagues at a Woman's Hospital Sims help found were so critical of Sims' unethical experimentation that they voted to ban his cancer surgeries and limit the number of spectators in attendance at surgeries. Eventually, his colleagues so feared for the lives of patients at the hospital they invited Dr. Sims to leave the Hospital. His brother-in-law, also a physician, pleaded with Sims to give up his surgeries. James Simpson of Edinburgh, pointedly remarked in critic of Sr. Sims, "I took occasion to make an extensive series of experiments ... [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform." 7. Nor was Sims a Calvinistic practitioner who did not believe in anesthesia, as he did give his victims chloroform post surgery, if only so he did not have to listen to their moans from the pain.

Given Sims experiments (as he brutally carried them out) would not have been possible had his subjects not been slaves, given such abuse was not necessary for the “advancement of women's medicine”, given the criticism of his own contemporaries, and given both slavery and non-consensual experimental procedures have come under mass social critic and legal restraint one might find it hard to understand why contemporary medical ethicists might defend Sims' experiments. Still, many physicians are irrationally emphatic about in their defense of Dr. Sims, arguing the end justified his means. I am convinced, and evidence suggest, they do so not because their argument is well supported by reason or evidence, but because they feel they have a vested interest in opposition to patient autonomy and the ethic against violating informed consent, they have a vested interest in treating the rich and subjecting the poor to violent abuses against patient autonomy, dignity, and health.

To be Continued: In the next chapter I will talk about current practice. We will also address physician justifications for violations of Kant's moral imperative, their fiduciary duties, and Hippocratic oath. Finally we will propose legislation to address these violations and an opportunity for you to act.

1.

Vaccines and Medical Experiments on Children, Minorities, Woman and Inmates (1845 - 2007), Friday, December 14, 2007 by: Mike Adams, Natural News Editor


BITTER PILL : Disseminating Truth And Fighting Tyranny

http://www.homersbitterpill.com/2008/12/human-medical-experimentation-in-united.html

Race, Health Care and the Law Speaking Truth to Power! Basis of Distrust

http://academic.udayton.edu/health/05bioethics/slavery02.htm

Human medical experimentation in the United States: The shocking true history of modern medicine and psychiatry (1833-1965)

Toxins in the Bodies of Newborns Lead to a Contaminated Generation

9/9/2008 - (NaturalNews)

Hepatitis B Vaccine: Good for 'Newborn' Prostitutes and Drug Users, but Who Else? 7/11/2008 - (NaturalNews)

2.

AMA's stated purpose

3.

(Slater v Baker and Stapleton (1797) 95 English Reports 860.)

4.

http://jme.bmj.com/cgi/content/full/34/3/180#B12

http://jme.bmj.com/cgi/content/abstract/32/6/346

http://jme.bmj.com/cgi/content/full/34/3/180 \ B19

http://shm.oxfordjournals.org/cgi/content/abstract/20/2/223

http://jme.bmj.com/cgi/content/full/34/3/180 \ B18

http://www.naturalnews.com/022383.html

5.

(James Marion Sims: some speculations and a new position Caroline M de Costa MJA 2003; 178 (12): 660-663)

McGregor DM. Sexual surgery and the origins of gynecology: J. Marion Sims, his hospital, and his patients. New York, Garland Publishing, 1989:47.)

6.

Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132:878-884.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.

7.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.)

 

 





Author's Bio: Just one citizen struggling to regain American Democracy. I am a bit of a intellectual jack of all trades master of none. I have studied, economics, sociology, philosophy, womens studies, and political science at a graduate level.

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TEACHING RAPE:

Medical parishioners validate and perpetuate rape culture.
If you are an Oregonian woman in need of medical care that requires anesthesia beware. We all heard about the recent incident with the anesthesiologist in the dentist’s office, but few realize that you are more likely to suffer sexual assault while under anesthesia in Oregon than if you had the same procedure in 42 other states. Women have been lead to believe they are protected while under anesthesia. This is not the case. You will be told that law requires a “nurse” be with you while under anesthesia, they rarely tell you that “Nurse” can be a male, even if the patient is a female. They do not tell you that Oregon allows Drs to bring in male students and resident trainees to watch and participate in procedures while a patient is unconscious, often without her knowledge before or after.
Students have described as many as five and six students lining up to do pelvic exams on a single anesthetized patient. If Drs bother to tell patients at all about a student they often bring in a student after a patient has been prepped for a procedure, introduce the student and shove a consent form in your face. Now at this time when you are naked, perhaps even in many cases partly sedated, Drs acknowledge that 100% of the time patients do not feel free to read what they are signing or object, regardless of previously expressed preferences. Drs. admit the fear that a patient will say NO, or a patient having already said, NO is the very reason they trump patients will by last moment introductions or fail to introduce all together. Thus, Drs. admit to subjecting women to touching and exams by people, they have in many cases never even been introduced. Yet, research indicates that if women are asked ahead of time, before the introduction, and the number of students is limited, most will not object. Some will; but then should that not be our right? Not only do such practices expose patients to risks they have not given informed consent for Drs. to subject them to, risks resulting from prolonged anesthesia, multiple penetrations beyond medical necessity for the patients health, and risks of error by inexperienced trainees, but also subject them to the increased risks of sexual assault while under anesthesia. Now the first three seem rather obvious, but the latter? How can that be? Well, think about it. These students and all the medical personnel from tech to nurse watch as women are violated, listen as Drs. rationalize that women have a duty, and students have a right to access women’s bodies against their will and/or knowledge. Take the student’s quote below who was subjected to an ethical Dr. during OBGYN rotations and complained, “at what point do the patient's wishes get trumped by the need to train students?" One might just as well ask, “At what point do the woman’s wishes get trumped by the need for sex?” Now one will argue that education is not sex, but let us look closer. The message that is being relayed, being taught, culturally reinforced is that men's needs/desires are trump women's right to control what happens to their own bodies. Women’s will is irrelevant in light of the desires and needs of men, in this case male students and Drs. to learn, to educate, and to practice medicine as they see fit. While all patients suffer the risk of student error and prolonged anesthesia from teaching situations, and therefore should enjoy a civil right to informed consent prior to prep and prior to student presence. In many cases like the one above women, patients are in addition suffering the risks of psychological trauma from rape and/or the fear of rape. In Oregon, it seems that risk is higher than 42 other states. There is a connection between the resistance of the medical professionals to relinquish the privileges they find in a rape culture and the violation of women under anesthesia. What privileges? Access to women’s bodies against their knowledge and/or will. OHSU is just one example. In spite of all their “woman centered” propaganda. OHSU is teaching it’s medical students to rape patients. How? By teaching them that they have a right to access women’s bodies in spite of women’s expressed will against or ignorance of that access. Such practices can and do lead to rape. http://www.ncvli.org/objects/Oregon.v.Burleson.pdf

Are Portland V.A. patients being used and abused for the sake of training OHSU residents?

The media has focused on vets access to medical care, and claimed the quality of care is just fine. I beg to differ. While the quality of health care is generally poor in America, Vets have literally become the lab rats and breathing cadavers of the U.S. health care system. It has been conventional wisdom that vets may improve their odds of quality care if a V.A. medical facility is joined at the hip to a teaching facility such as is the case with OHSU and PDX VA. Reality is much different than most people would ever dream. I was reminded of a story told to me by an old C.N.A. who used to work a V.A./teaching hospital. This resident happened to mention that he had not “done a hernia”, the surgeon promptly began going about raising the gowns of old men until he found a hernia (a small one that did not require surgery and the man was very old), and ordered the prep and “trained” that young resident proper. The most present lesson? Poor elderly V.A. patients are little more than a cadaver. What occurred above is patient abuse pure and simple. So why did he feel so free to do what he did? The odds of him suffering any repercussions are relatively low when the patient is a V.A. patient. OHSU is sued by the public on average of 23 times a year for malpractice. At this point in my research, under the umbrella of the V.A. they seem to have suffered none. While this sort of risking harm for the sake of teaching puts all vets at risk, women Vets, may find themselves not only put at risk of physical harm, not only physically assaulted in the name of “teaching” OHSU residents at the PDX V.A., but also at risk of having ones stated gender preferences violated in the most vial ways. Many women, history of assault or not, prefer female doctors in certain situations—OBJYN, surgical procedures such as mastectomies or colonoscopies. Given the historically evident risk of assault women face while under sedation, this is a time when more than the gender of the physician, but the gender of the nurse may be relevant. In the case of GYN surgery such as an oophorectomy a women may not want men present at all. Here is one story that illustrates my point as told through a couple of letters to PDX VA Chief of staff. V.A. Medical Center, PDX Chief of Staff Dr. John Dryden P.O. Box 1034 Portland, OR 97207 I have some concerns regarding my care at the Portland V.A. While both my husband and I have repeatedly expressed to several staff members from bottom up, (from C.N.A. to DR) that I am not comfortable with men being involved in my care if that care involves exposure of sensitive areas, I am not evidently being heard or understood clearly. I have been in O.R. a couple of times in the last year. I am not at ease with being unconscious generally, and very uncomfortable with the presence of men during unconsciousness and/or procedures the likes of these two events. The first event was a mastectomy/bilateral oophorectomy on June 18th ‘07, the second was a colonoscopy on Dec. 12th ‘07. I had done my best both times to ensure I was not only in the care of a woman, but women, that is that not only the surgeon, but also the entire “team” was female. Both times I asked and understood that not only was the person performing the surgery, but also all in the room would be women. Neither time did this turn out to be the case. In the first case, this may be due to a difference in understanding the term “team” in conjunction with a failure upon the part of the V.A. policy to respond fully to the needs of many women who might specifically request female Doctors. In spite of asking and being told that we were going into the O.R. with, “an all female team”, in the case of the mastectomy/bilateral oophorectomy a male Ronald J Gschwend was involved on the prep team and support staff during the surgery; according to the record he seems to be in the room during the entire prep and all three operations. Given the exposure in such a prep and surgeries, I am not happy with this situation for two reasons. One being unconscious, I cannot KNOW that I was never in the room alone with him at any time before, between, or after surgeries, and secondly the overwhelming eroticization even comodification of violence against women in this culture ensures that I can never be assured that such procedures as a mastectomy that comes at a very high price for me will not be an erotic experience for a male. For both these reasons, I am upset about Ronald’s presence. I am also not happy with the fact that a Jeffery J. Hoke seemed to be in charge of my care in POCU for well over an hour while I was still under the influence of sedation. I awoke in a Room to find no women around (there did not seem to be a woman on the ward that night) and men in charge of my care. My husband was there so I said nothing at the time (did not seem to care until latter when the sedative had worn completely off.) My husband did at that time warn the male nurse that I would not like this once sedation wore off. It seems to me if a woman makes gender specific requests; there is good reason to assume a need for this gender specificity to apply from the top all the way down unless the patient indicates otherwise. It appears to me that a Dr. Shabnam Chaugle MD is listed as the surgeon and Dr. Kwan as attending on the mastectomy. (Kwan has assured me she did the operation, but according to the records, this is not the case.) I do not remember being introduced to any Dr. Chaugle but based on a Google, this person was a Resident at OHSU, who is now in California. It also appears that Dr. Chaugle is a woman, but I am not sure this info is accurate. My husband told me that a male in scrubs introduced himself as assisting; but after reviewing the medical records, I have come to the conclusion this must have been Dr. Chaugle or perhaps Dr. Galic, and that, he was simply mistaken about her gender. I find this sort of bait and switch to a relatively inexperience resident at the last minute a problem itself when a procedure is blown (in case of the mastectomy and oophorectomy it certainly was not), if gender is also switched in the process, as occurred with my colonoscopy on Dec. 12th. , it is even more complicated. Again as in the case of the first surgery, I requested a woman when I made the appointment, was introduced to Dr. Judith Collins, and told this would be the woman doing the procedure, asked and was again assured it was an all female team. Again this turned out not to be the case. After I was prepped and in the O.R. room a young male, Dr. Mitchal A. Shreiner was introduced to me, and I was told he would do the procedure. Dr. Collins told me in the phone conversation I had with her latter about the issue she did indeed understand that I wanted all women present. She did apologized for bringing Dr. Shreiner’s in when she was well aware that I did not want a man present. In addition, however, and perhaps more of a concern to me is how in both cases (June 18th and Dec 12th) men were involved in my care on a lower level. On 12/12 there was also a male “tech” that introduced himself, identified his job as transport of any tissue to lab, and said he would be on the “other side of the door unless needed” and then preceded to remain in the room the entire time. During my phone conversation with Dr. Collins, she confirmed that I heard him correctly, that he said he would be on the outside of the door unless and until needed and could not account for why he remained in the room. When I looked at him like what the hell are you still doing here, rather than asking him to leave, Dr. Collins tried to reassure me by blocking his view with her body, but that only lasted for a short while until she had to “step away”. I am very upset that he stayed in the room and this issue I would like to be addressed. Why did this man lie? Why did he stay in the room? He obviously knew I did not want him there, yet he lied to get consent for one thing and did another. I am not sure this tech’s behavior legally amounts to sexual harassment, but from my standpoint this is at least a case of sexual harassment. Being introduced literally seconds before the procedure, I did not feel I had the power or time to object. (I did display behavior that was evidence of my discomfort, however, including trying to cover up when left in his full view. That is the last thing I remember before being rushed out the door to go home. I cannot even remember being given the post op instructions, but then neither does my husband.) I see no reason for his being there. The attending nurse could have easily handed any tissue that needed transport (his stated purpose for being there) out the door. WHY DID HE STAY??? The next day I noticed signs of much more physical trauma than I expected—excessive bruising in the area (a deep blue circle all the way around my anal cavity extending out about an inch beyond the opening, and continues into the canal), as well as, pain both in the local area and lower abdomen. A few days latter I talked with a breast cancer friend I call when I need understanding. She had just had a colonoscopy a couple of weeks earlier and she said she had no such trauma immediately concluding I was assaulted. Now, I do not know this to be true; however, given no other explanation I do not know what else to think. Dr. Collins could think of no reason why there should be such trauma from the procedure. However, it is logically unavoidable that either: Dr. Collins not having done a preliminary exam is unaware of some condition that may have caused this and likely should have also then eliminated me as a good person for Resident training. (Which in my opinion any patient currently suffering chronic pain is not a good candidate for training risking the infliction of further suffering.) or, Dr. Shreiner needs to fail that procedure, be taught better on a couple of cadavers and then try again on a living human. Dr. Collins insists he did just fine. He certainly seemed to be doing ok as I went under; but something went wrong somewhere, or, I was assaulted while under sedition. Dr. Collins assured me that it is PDX policy to have a female nurse present the entire time a woman is under sedation, but I am not confident that protocol is consistently followed, nor that Dr. Collins would know if it were not. While I was told that the female nurse who was supposed to be there the whole time would call and assure me that she did indeed follow that protocol, I have received no such call. I would like to talk with her. I do not know her name, and again as in the case of the tech, I was unable to find it in the records. (This indicates to me other people could have been involved including men and their names would not necessarily show up on my records.) Again, I do not know why the extent of the physical trauma. It is my lack of ability to KNOW what occurred in conjunction with knowing things did not occur, as they should have that concerns me. (I was traumatized when I did not go under during a colonoscopy four years ago, but to go under and wake up harmed is worse.) I certainly think an investigation is warranted. Why did this man stay in the room? Who had any contact with me before I was returned to my husband? What are the professional and criminal histories of these people? Did opportunity present itself? Why am I so badly bruised? I want to know did the resident under Cr. Collins supervision (or lack of supervision if she left the room), botch this colonoscopy or was I assaulted? Elatedly, unless Dr. Collins can KNOW beyond a shadow of a doubt that nothing occurred and in the absence of any explanation for the level of physical trauma, it seems to me I now need to be tested for STDs before returning to active relations with my partner. Thus, I would like an investigation into whether or not Dr. Collins or you can GUARANTEE no need for concern, and inform me of the results. Did both Dr. Shreiner and the “tech” leave the room before or with Dr. Collins? Did Dr. Collins leave the room while either male was still in the room? Did either of them return to the room? Was I ever left alone or in care of a man or men during or after the procedure? What is the history and character of this nurse? What is her name? I would like to talk with her. WHAT HAPPENED???? Why am I hurt??? I understand that I am writing a male Dr. concerning this issue, which guarantees you will not be able to understand this on the level I would like and may even find my preferences sexist and certainly inconvenient for male colleagues, perhaps even staffing. From my perspective, given not only my personal experience, but the experience of many women in the world and nation wide, in conjunction with the fact that Oregon has a higher instance of sexual offenses against women under sedation in medical care than 40 other states, indicating a lack of sufficient law and/or monitoring to guarantee women’s safety; it is essential to my security to never be left alone in the care of a male while under the influence of anesthesia. I understand that such sex specific criteria will not guarantee the absence of an inappropriate event (women abuse and silently allow abuse); it will certainly decrease the odds. In addition to the unexplained physical trauma, or should I say even in the absence of this physical trauma, I would continue to feel distressed over the presence of male “techs” during these procedures. If the general population of breast cancer patients feel anything like I do, cancer itself leaves one a bit out of control of ones life and even body. In this case, it seems to me, a lack of sensitivity training and adequate policy or enforcement has exacerbated this feeling (rather not just a feeling but actual reality of lack of control). Doctors are in a habit it seems of bringing Residents in at the last moment. (I am starting to suspect this is because if they give us time to think we will not consent, either to a student or a male.) As stated before, I suspect it may well be that pushing the limits of my tolerance for men in such situations benefits education and keeps from complicating staffing; but it has taken an emotional/psychological toll on me that is not acceptable. If a woman expresses a preference for female Doctors in general or in relation to a specific procedure, it should be assumed she has a reason for such a preference. More questions need to be asked to see how deep that sensitivity goes and how best to accommodate the patients medical needs in a way that will allow her to get the care she needs without unnecessary psychological discomfort. The way it is being done, (ask nothing just bring the men in at the last moment; if she does not assert herself enough to throw them out, she must not mean it when she claims she does not want men present or involved), not only is it similar to rationalizations for sexual assault, it lends itself to an attitude that is conductive to assault, a hostile environment if you will. It amounts to an attitude of people as objects rather than free subjects, giving staff the idea that stated preferences do not matter if she does not yell or stop her feet (or if you think she will not remember doing so) keep going. Also, some of us experience this lack of consideration of our expressed preferences while under sedation as sexual assault, and repeated requests by staff to include men while in the men’s presence as sexual harassment. It is a problem when Doctors feel more compelled to take you into a private room to talk you into a procedure they think you may resist (this has occurred several times) but do not seek the same sort of meaningful informed and expressed consent when they bring in a male and/or student knowing you may be resistant. I am either, never told men will be present and may or may not find out from my charts, or men are brought in at the last minute, after prep after in the O.R. when it is much harder to protest, and drugs may have been administered, “to help you relax”. At this point, it seems to me, women’s expressed limitations regarding male participation are being intentionally pushed, even ignored. From the perspective of a sensitive woman and patient, I would suggest that policy change to something akin to: ALL women who are to undergo a procedure requiring the exposure and or invasion of sensitive areas (breasts, vagina, anus), are asked what their comfort level is; a. Ok w/ specified procedure(s) performed by males b. Not ok w/a. but ok w/ male support staff being present during procedure, involved in prep, or post op care. c. Not ok with male presence of any kind during specified procedure, prep, or post op. I have been assured it is policy not to leave women alone w/any males while under the influence of anesthesia, regardless of perceived or expressed patient comfort level. If this is the case, make sure it is strictly enforced. If it is not the case, it should be. 2. Only in an emergency effecting patient health should such gender preferences as described and reported by patient be violated. Please do not tell me to go to, “patient advocacy”; I called them and was told that due to the nature of my complaint I needed to write this to letter to the “Chief of Staff”. Beyond the requests made above, what do I want? While the above events are the most disturbing I have experience of late, they are not isolated. I was open to some exceptions (male students who I was introduced to ahead of time, had a chance to talk with and then asked to approve or not by the female supervising Doctor after the male student has left, so I can speak frankly about how I feel concerning his participation). However, given the fact that if I am asked at all I am not being asked ahead of time (before prep, before the administration of any medications even a mild tranquilizer, before being taken to the procedure room), and given the fact that when I ask and am assured of an all female team up to moments before the procedure, yet can have no confidence that this will indeed be the case, I not only want the flag in my chart as Dr. Collins suggested, but I want a member of my family present at all such procedures including O.R. I realize this is unconventional, but at this point, after so many lies, and now there is this unexplained physical trauma, I have no trust of your staff male or female from C.N.A. to Dr. I would also like the name of the tech on 12/12. I remember his face, but I want to know his name and have it put in my charts that he is never to be involved in my care in any way what so ever in the future. I feel very strongly about this. Education, staffing, there was absolutely NO valid reason for him to stay in the room. He was getting off on doing so; he could, so he did. If I had the power, I would fire him. (As an old labor activist, I do not say this lightly.) I would applaud your doing so, but doubt I will see this satisfaction unless I am not the first to complain. He lied, and did so intentionally and smoothly; at the very least I would like a write up on the event in his personal file. Then, in case such behavior is repeated on his part, there will be a record in his personnel file making the pattern evident. I would like a min-by-min account of what occurred 12/12 during and after the procedure. I would like to know what medications where administered and when. (The records on 12/12 seem incomplete from the exclusion of this tech’s name to the absence of notes on prep complications and a bad decision to administer a third bottle of fleet.) If there is any sort of recording of the procedure, I would like to hear it. I DO NOT want you to withhold any information you may discover for any reason, including that such knowledge may negatively affect my health physically or psychologically. (If you have been following the recent case in PDX you will know that a higher court has now overturned the lower court declaring that patients do have a right to know if they have been assaulted, in spite of perceived psychological/physical harm.) In addition, given this administrations use of Verichips, and expressed desire to expand that use, I would also like to know if any kind of chip was placed during either procedure above. Aside from the obvious problems with such a practice, these chips have been proven to cause cancer. I would like a referral to a private physician of my choosing to do a follow up exam to check for physical damage. (I am still suffering abdominal cramping and canal discomfort, and spotting.) Dr. Collins volunteered, but at this point, I would like an independent examination. Unless you can guarantee it is not necessary, I would like the same to be done in terms of testing for and STDs. I cannot afford to pay for this myself, and it seems to me outside/third party care only makes sense in terms of these two requests. The V.A. should pay for this, and I should still be able to choose my own Dr. or clinic. While in the V.A. health care system I have received both the best and the worst of care. In many ways the V.A. system is the best American health care has to offer. If my experience of late is any indication, however, much work still needs to be done in terms of women’s health and safety. I am looking forward to hearing from you. After another encounter w/Dr. Collins and reading updated notes in her medical records, this woman writes another letter before she hears back regarding the first. That letter follows. V.A. Medical Center, PDX 1/22/08 Chief of Staff Dr. John Dryden P.O. Box 1034 Portland, OR 97207 Dr. Dryden, This is a follow up to a letter I sent to you (forgot to date but) you rec’d on 1/9/08 I would like to make an addition to my complaint referred to above. I am not sure why my follow up was with Dr. Collins rather than Kingge other than this gave her an opportunity make misleading notes to out and out lies in my chart in an attempt to cover her own back side, an attempt that ends up providing further evidence of her incompetence and raise more questions regarding her medical ethics and what happened on 12/12. First are the conflicting notes. While the notes I previously obtained on 12/13 stated that both prep and procedure where “uneventful”, and claims of “no complications” were made in notes by Dr. Schreiner, and verbally by Dr. Collins in phone conversations and at the appointment on the 16th,” in the notes following that appointment Collins now claims, the procedure was “quite difficult from prep onward”. She does not elaborate. The failure to elaborate may be because the difficulties were a direct result of Dr. Collins’ incompetence. Indications of incompetence: The prep was problematic because of Dr. Collins not allowing enough time for the laxative to work. It seems to me the low digestive motility indicated more time be allotted; but instead she insisted that I needed a third dose as I had previously thrown up some of the a.m. dose. I told her I did not throw it all up and felt what I had thrown up was due to consuming too much already; but she insisted I needed a second a.m. dose indicating that it would be a shame to have to start over again another day. Not wanting to go through the prep again, and living 5 hours from Portland, against my better judgment, I acquiesced and WAS OVERDOSED. 10 min or so after the last dose, I really started throwing up. This may account for some of the difficulty in OR if I continued to heave during the procedure, but I have never been told this was the case. Also, I told them not to put a tube down my throat as I had a serious gag reflex problem; if they did so, knowing my own history, I have every reason to believe this would have further complicated things. It certainly did the last colonoscopy that was done four years ago concurrently w/a UGI. The procedure was 45 min long. This is unacceptable!!! Why was a procedure that should have lasted 20 –30 min tops going on for another 15 min? When I asked Dr. Collins about this, she once again said the procedure was uneventful and indicated that I should find comfort in the fact that is was thorough. This is in reference to locating cancer; but if this can be achieved for the mass of cases in 20-30 min, being thorough cannot explain 45 min. What, is everyone else getting a cursory exam? An exam this long for the sake of training is patient abuse. Most of your staff members seem to be able to read charts. The pain clinic seems very good. What is wrong with Collins and her fellow? After repeatedly telling these people I am not using pain medication because of an impaction, their conclusions continue to hypothesize pain medication use as a factor. Furthermore, Dr. Collins seems to think the GI issues are recent, starting A.I. use. This is simply not the case and she should know this if she had read my chart. I do not like medications and for the last 10 years have not taken medications until recently, but this condition has been consistently present and progressive over that same time. Unless it has something to do with a past medication such as Serizon, which I have previously inquired about and was told there is no relation, it is not likely med related. Also, indicating an unwillingness or inability to effectively read charts she stated in these same notes that I never had a UGI, which I did four years ago. Indications that Dr. Collins is not an ethical practitioner: The notes Dr. Collins put in my charts on 1/16 do not reflect the facts, not even as she knows them. Dr. Collins knows that I never gave permission for the male tech to be in the room save to receive tissue samples if needed. She admitted this over the phone and stated she did not understand why he stayed in the room. As I stated before, his stated purpose was transportation of tissue and he promised to remain on the other side of the door until needed. Dr. Collins knows this and what she was willing to admit to me over the phone is not reflected in her notes; in fact she provides conflicting statements. I never gave permission for him to participate in the procedure, “suctioning” or other wise. Dr. Collins knows this, and has previously admitted to this understanding, yet now Dr. Collins’ states I did consent to him being in the room and his participation. I assume this is to cover her butt, and thus he did indeed participate in the procedure. Why was he needed for this if there were two Drs. and a nurse in the room? From what orifice was he suctioning, and why was the nurse not doing this? Why is a “tech” doing this? He was not even scrubbed. If there were extenuating circumstances that indicated he be used in such a capacity for which he is not qualified it seems such circumstances warrant a note in the chart and a post op explanation to me. Dr. Collins claims she informed me that, “JECHO requires a tech” she did not and if she had bothered to talk with me in that sort of detail, I would have rejected the male tech. If she had asked if a “trainee” could do the procedure, I would have said no regardless of gender. I was hustled pure and simple, and in the most vile way—kin to rape. Again, Dr. Collins knew I did not want men involved and set things up so I would know as little as possible and know it as late as possible. This is not ethical. Dr. Collins had many opportunities (including when I expressly asked, and when she had me in a room to talk me into an overdose) to ask about her “trainee” (he was introduced only as an MD to me, not as a “trainee”, another of Collins’ lies), and failed to do so until I was in the OR. While she states in my chart I was “OK” with these men being in the room; she admitted over the phone that she was well aware that I was not “OK” with it, (as I had asked for women and expressly confirmed less than 20 min prior to the procedure that this would be the case), at the time and apologized for moving forward in spite of this understanding. Furthermore, this “request” concerning Dr. Schreiner did not come in the form of a question, but in the form of an introduction and the statement that he would be doing the procedure while shoving a paper to sign in my face. Laying down prepped for procedure is not a time when a patient feels they have the leisure to object, let alone to sit up ask for light and some glasses to read a document. I was never told a tube would be put down my throat; and had told them when they asked about a feeding tube that this would cause an ongoing gage reflex. The only reason I can see for this late request concerning the men, and the misrepresentation of the techs participation, is manipulation. If this does not break the letter of the law, it certainly breaks the spirit of the law concerning consent. Was a tube put down my throat? Did this still unnamed tech participate in the procedure? If so why? There were more mistakes made than the overdose and disrespectful manipulation and lies regarding the men here. Either Dr. Collins did not honestly attend the entire procedure, or she knows more than she is telling or entering in my charts, as the physical trauma remains unexplained. She seemed to present a hypothesis at the last appointment about the tub being curled when pulled out causing a descending colon. I did not understand what she was talking about; but my husband explained it latter. If this happened, who had a hold of the tube at the time? Why was I not told? At this point, it has become evident to me that Dr. Collins is a very poor physician. She does not read or interpret charts well, she does not listen to patents nor respect their perspective or feelings, and she is not good at making decisions. Furthermore, she is willing to lie to cover her mistakes, as well as what appears to be abuse of Vets for the sake of training her fellows. Certainly in the sea of evidence indicating incompetence the probability of the physical trauma resulting from said incompetence rises. However, such incompetence in a team can also lead to assault and thus this remains to be ruled out. She ignored my request men not be present and did what she wanted to do, and did it after she overdose me making me sick. She employed the threat of having to do it all again if I did not go along with her plan. Given the fact that I was lied to about the nature of the techs role, if he was involved in the procedure, I call that RAPE. If he was not involved, it remains a case of serious sexual harassment and perhaps medical malpractice. Your V.A. advocate (or so called “patient” advocate) assured me that it is only the sort of men that I would associate with that would rape; certainly no man she knew at home or at the V.A. This woman seems to think the real problem is that as I am not a Christian who associates with Christian men (FYI 70% of Christian men report “sex addictions”), thus undermining my faith in the goodness of men. She is ignorant, insulting, offensive, and certainly, no “patient” advocate. She gave indications of bigotry and internalized sexism. She actually reminded me of what is referred to as a “silent partner” with all her claims of the goodness and innocence of men. Furthermore, I am sick of people indicating that only a “victim” would object to men in such intimate care. This is not true. Many young women raised by feminist are taught to avoid male practitioners to keep from being victims. I have heard more than one female practitioner inform me that she would insist upon women in such cases, not because she had been assaulted, but because she knew the men of which she was speaking on a personal enough level not to trust them. Also, why is it your staff seems to feel such freedom to dump their religious B.S. on patients; from this “advocate” to an oncologist insisting that whatever happens is “gods will” or part of “gods plan”? I find this highly offensive. Has the V.A. deteriorated as much as active military health care where Army Doctors are willing to hand rape kits over to perps.? Has the V.A. been infiltrated by crazy fundamentalist Christians as has reportedly much of the military? Which reminds me I do expect an answer to the verichip question. While I have no intentions of a civil law suite, (I find them a bit restrictive if one wants honest dialogue and quick change); a lack of appropriate response to my concerns could change my mind. I will have these questions answered to my satisfaction one way or another. This includes a detailed account of the procedure as it was performed and every persons role in the room, (if it was taped I want access), a min-by-min account of all events and complications, all involved and in what way, including an explanation of the physical trauma. In spite of what your staff seems to want me to believe, effects have causes. I expect full disclosure. If criminal behavior is indicated I expect charges be filed and V.A. support in prosecution. I would also like to know what the qualifications/ training this “tech” has assisting in colonoscopy procedures. If policy violation is evident, then I expect an administrative response. To the extent that policy is at fault, I expect reform. My expectations are not unreasonable. BTW, while Dr. Collins seems to minimalize the harm she has done, not only am I waking up every morning with this first on my mind each and every day, not only can I not watch a movie because I cannot keep these thoughts from creeping into my head and disrupting the flow of the movie, not only am I avoiding all including my family to keep from dumping this crap on them, but I STILL HURT!!! Yet the only follow up I have been offered is w/ Dr. Collins. If G.I. has anything constructive to offer, I am desperate enough to return for Dr. Knigge. In terms of a follow up exam regarding any harm that may have resulted from the colonoscopy, I want this follow up fee based and I want to pick the Dr. so there are no conflicts of interests. Patients Name This same patient has been inspired because of the above experiences to do a little research on how the above story may fit into teaching practices in general and the attitudes these practices foster towards women. Perhaps one of the most interesting finds is a web site where student Drs. chat. http://forums.studentdoctor.net/showthread.php?t=82833 On this board, a question is posed. “From some personal experience and hearing stories from others, there seems to be a trend where male students are often being asked to leave during a Gyn visit. This seems unfair, especially to those of us interested in ObGyn. At what point do the patient's wishes get trumped by the need to train students?” Of course the answer to this is at all points. Part of the lessons that need to be learned are those relating to respecting patients; yet many of these young students are being taught a different lesson. This is one student’s response, for example. “this is the case at many schools, particularly if you rotate through a private hospital. If you are interested in obgyn (why??), try to rotate through a county or city hospital.” One could also assume V.A. The comments go on to include a detailed explanation of how to manipulate women. “have found that it really depends on the attitude of the attending (or the nurse) who presents the option of a student to the patient. On my FP rotation I was introduced to the patients as a medical student working with the physician, by the attending. It was said in a manner that implied this was the norm and was expected. He tells them this right on the spot, while I was already in the room. I was not turned down a single time. I am sure that some women would have declined if asked in a subtler manner….On the other hand my OB rotation and a few other electives, nurses would first ask a patient. I did not directly hear, but can guess that it was phrased something like " You don't want a medical student examining you, do you?” Or at least with that connotation.” “If it was a CLINIC patient, who almost by definition was either... A) Coming in for free care (of course they're uninsured!!!) B) "No Ingles..." (& can't bring someone who does!!) C) On welfare with 3 kids by 3 different "baby-daddy"s D) All of the above (more than 90% of the time) I didn't even bother to ask. It is MY education, after all....” “Well, actually...for me MALPRACTICE is a trivial issue...errr...actually it's a NON-issue as I am Navy HPSP with every intention of making Navy Medicine a career. I already have 6 years active duty...only 14 more 'till retirement  Not only will I NEVER have to worry about malpractice insurance, I also don't have to worry about student loans  Go Navy!” What these young men, and educators of both genders do not realize it the heyday of doing as you will with women are over. This is pointed out by one responded who pointed to an ACOG news release, "The issue of physician gender is also an important criterion for women," Dr. Miller said. According to the Gallup survey, about half (47%) of the women surveyed prefer a female ob/gyn, while 15% state a preference for a male ob/gyn, and 37% say they have no preference." click here to read the whole article. Just to show how strong some women feel about that preference, here are some of the women’s statements at that same chat. “Males aren’t welcome into ob/gyn.... thats the bottom line” “The patient's wishes NEVER get trumped by the need to train students. It's my cervix, thank you, and as long as I am conscious I get to choose who sees it.” “I had a pelvic done this week and the (male) physician came in, then the MALE nurse came in. I said: hey, why are you here, it's supposed to be a FEMALE in here with me. The male nurse got nasty and said: no, it's only supposed to be a "nurse." Silly me, I forgot I was in Utah, home of the MORMONS.  So even tho it was a teaching hospital and you'd think they were actually living in the 21st century, they apparently are not. Women are definitely second class citizens here, and the doctors are still men - for the most part. I was really very angry - they were incredibly patronizing and insulting towards me and it was clear that I had no rights in their eyes.” “You are the one who don't got it pal. Male gyno will continue to exist, but not abundantly. Like it or not gender is the issue here. No male doctor likes to think he one day won't have such access to a woman's body, but the fact is he is not, and don't you forget that. You got it.” Women are starting to stand up and state, “It is our bodies and you boys have no rights to access, no matter what you may think. Push us more and see if we do not push back. If you do not understand that, you have no business in OBJYN, or medicine for that matter.” The rape culture and what other men have done and do to women will have it’s impact. This is not only going to affect your training, but your practice. DEAL WITH IT!!! While not in the majority, there were very mature intelligent responses. Here is a mature response from a man that is suited for medicine. “In the end, figured that each women could choose their own providers (and in my case observer) - Although I was really attracted to OB/Gyn I could feel the limitations as a male - In the end, my interest (and eventual application) to ENT told me that my practice would eventually be limited to just north of the clavicle. I just appreciated a side of medicine I would never see again. And loved every minute of it.” The point to all this is to pose the question is OHSU doing to V.A. patients what it cannot get away with doing to OHSU patients? It is this V.A. patient’s opinion that yes, indeed they are abusing V.A. female patients, not necessarily in OBJYN, but certainly by one Dr. Collins in G.I. If such things as described in the letters and the Residents comments by residents above are common practice at the PDX VA, then the very attitude that serves as a underpinning of this Rape culture, the very attitude that founds the sexual assault of female vets, that is the attitude that men have a right to access women’s bodies over their objections, is shared by their medical providers.

OHSU linked to RAPE and Tourture

I have known about the rape (subjecting sedated patients to teams of residents, interns and students performing pelvic, rectal, and breast exams without the patients being informed and consenting) of OHSU/PDX VA patients under sedation for some time. At first I thought this was strictly for the sake of education, but then I discovered some things that made me question. This story is one. Was this, medical rape, in some cases, done for the sake of punishment, torture, research. here is the story by Michael Munk Wed, Jun 17, 2009 Joseph Matarazzo retired from OHSU in June 2007. From 1957 to !996, he = was head of the Department of Medical Psychology and then Professor of = Behavioral Neuroscience until retirement to emeritus status. A former = APA president, both he and his wife, Dr Ruth Matarazzo, received = Presidential Citation at the 2007 convention of the American = Psychological Association. He was a member of the Spokane torture = consulting firm Mitchell Jensen's board and a CIA professional standards = board.=20 From Jane Mayer's interview with CIA director Panetta = http://www.newyorker.com/reporting/2009/06/22/090622fa_fact_mayer?current= Page=3Dall "In April, Panetta fired all the C.I.A.'s contract interrogators, = including the former military psychologists who appear to have designed = the most brutal interrogation techniques: James Mitchell and Bruce = Jessen. The two men, who ran a consulting company, Mitchell, Jessen & = Associates, had recommended that interrogators apply to detainees = theories of "learned helplessness" that were based on experiments with = abused dogs. The firm's principals reportedly billed the agency a = thousand dollars a day for their services. "We saved some money in the = deal, too!" Panetta said. (Remarkably, a month after Obama took office = the C.I.A. had signed a fresh contract with the firm.)=20 According to ProPublica, the investigative reporting group, Mitchell and = Jessen's firm, which in 2007 had a hundred and twenty people on its = staff, recently closed its offices, in Spokane, Washington. One employee = was Deuce Martinez, a former C.I.A. interrogator in the black-site = program; Joseph Matarazzo, a former president of the American = Psychological Association, was on the company's board. (According to = Kirk Hubbard, the former head of the C.I.A.'s research and analysis = division, Matarazzo served on an agency professional-standards board = during the time the interrogation program was set up, but was not = consulted about the interrogations.)=20 Lawsuits against abusive contractors remain a possibility, and any one = of them could expose a line of authorizations leading directly up the = chain of command at the C.I.A., and into the Bush White House. George = Brent Mickum IV, a lawyer representing Abu Zubaydah, a C.I.A. prisoner = who was repeatedly waterboarded, said, "I'd like to sue Mitchell and = Jessen in a minute." (Mitchell was an adviser on Zubaydah's = interrogation.) After Zubaydah was waterboarded, his lawyers say, his = mental state deteriorated, and he has since been prescribed the = antipsychotic drug Haldol.=20 visit my website www.michaelmunk.com

FGM and Child Molestation in American Medicine

Scandal explodes over doctor's 'clitoroplasty.'
 
 
 When most of us think of female genital mutilation, we probably think of faraway places. Well, peel off those blinders. In 1997, our very own Department of Health and Human Services estimated that 168,000 girls and women living in the United States had been or were at risk of being subjected to some form of the abhorrent practice known as female genital mutilation (FGM).


Not only is FGM being practiced relatively widely in the United States, it's happening in the most hallowed halls of American medical science. In fact, the head of the pediatric urology department at Cornell University's New York Presbyterian Hospital -- which is often ranked among the top 10 hospitals in the country -- has been operating on young girls who suffer from what he (and likely the girls' guardians) have decided is "clitorimegaly," or oversized clitorises.

In order to relieve these girls from what seems like little more than a cosmestic issue, Dr. Dix P. Poppas cuts out parts of the clitoris' shaft, saving the glans, or tip, for reattachment. Poppas triumphantly calls the procedure -- rebranded a clitoroplasty -- a "nerve sparing" one unlike the FGMs practiced in other countries.

How does the good doctor know that nerves have been spared? Well, Poppas and his nurse practitioner developed a series of sensory followup tests involving Q-tips, their fingernails and vibrators. But don't worry, a family member was always present in the room. As the resulting journal article notes, management of such situations requires a "compassionate and multidisciplinary approach."

Activists Alice Dreger and Ellen K. Feder, a professor of medical humanities and bioethics and a professor of philosophy, respectively, have been railing against the practice of FGM -- of any kind -- for a decade. They are part of the majority medical view that questions the very basis of clitoroplasties. (The American Academy of Pediatrics disturbingly stated in May that it only had an issue with "all types of female genital cutting that pose risks of physical or psychological harm" -- as if any kind of clitoral mutilation did not necessarily entail such harm. The AAP recanted the shocking affront to women's physical and mental health only a few weeks later.)

"We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm," Dreger and Feder wrote in an article lambasting Poppas' study.

These procedures seem motivated mostly by an obsession with having "normal" genitalia -- and normal kids. The fact that cosmetic genital surgery is on the rise is one sign of this. And given that only one of every 2,000 infants is born with genital ambiguity, parents faced with an "abnormal" clitoris are not likely to have ever seen one before and may react with trepidation. Will my kid be a lesbian? Will my little girl want to become a boy? We know children are all unique, like snowflakes, but when it comes to vaginas, sexual orientation and gender identity, it seems we'd prefer cookie-cutter, please.

So parents go to Dr. Poppas who mirrors their fears and offers a medical procedure that Cornell's Web site recommends "because female patients are able to undergo a more natural psychological and sexual development." What parent would withhold such treatment, recommended by a top-notch pediatrician and hospital?

Poppas cuts off parts of the perfectly healthy, albeit-larger-than-we'd-like clitoris, the only organ in either sex whose only known function is sexual pleasure.

Although Poppas boasts of the "nerve sparing" nature of his procedure, a study in the Lancet showed some women who underwent other nerve-sparing surgeries "had the worst possible score for orgasm difficulties." Not to mention the fact that simply preserving the glans may not be enough, given that many women find more pleasure is derived from the shaft than the tip, which can be overly sensitive.

The horrors of clitoroplasties aside, Poppas' particular brand of FGM adds an extra layer of psychological damage. When Dreger told Ken Zucker, a child psychologist about how Poppas used a vibrator to test a little girl's clitoral sensation, he said: "Applying a vibrator to a six-year-old girl's surgically feminized clitoris is developmentally inappropriate."

Dreger and Feder write:

[The study's authors] describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”

Of course it's inappropriate. And lest that is not obvious on its own, transgendered adults have long been vocal about how genital displays in medical exams were among the most traumatic experiences of their entire lives.

In this case, as sex columnist Dan Savage writes, "These post-op visits with the doctor and his vibrator do the girls no good -- what can the doctor do if a girl reports no sensation? reassemble her clit? -- and retaining sensation isn't proof that these girls will grow up to be healthy, sexually functional adults."

The sad irony is that maintaining these girls as healthy, sexually functional, happy adults is the cause of all these problems in the first place. Parents and the doctors who legitimize their fears need to know that reconstructing a clitoris -- or any other ambiguous genitalia -- to meet "normal" standards does nothing to change what may be behind the differences to begin with. You can't "fix" your kid's genetic and hormonal makeup -- you can only cover it up, and such efforts can have tragic psychological and physiological results.

The least we can do is give every kid a chance to figure out who he or she is and what he or she wants when he or she is old enough to do make that call -- and to accept them as they are throughout the entire process.

After Cutting Little Girls' Clitorises, Ivy League Doctor Tests Handiwork With a Vibrator

Scandal explodes over doctor's 'clitoroplasty.'
 
 
 
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When most of us think of female genital mutilation, we probably think of faraway places. Well, peel off those blinders. In 1997, our very own Department of Health and Human Services estimated that 168,000 girls and women living in the United States had been or were at risk of being subjected to some form of the abhorrent practice known as female genital mutilation (FGM).

Not only is FGM being practiced relatively widely in the United States, it's happening in the most hallowed halls of American medical science. In fact, the head of the pediatric urology department at Cornell University's New York Presbyterian Hospital -- which is often ranked among the top 10 hospitals in the country -- has been operating on young girls who suffer from what he (and likely the girls' guardians) have decided is "clitorimegaly," or oversized clitorises.

In order to relieve these girls from what seems like little more than a cosmestic issue, Dr. Dix P. Poppas cuts out parts of the clitoris' shaft, saving the glans, or tip, for reattachment. Poppas triumphantly calls the procedure -- rebranded a clitoroplasty -- a "nerve sparing" one unlike the FGMs practiced in other countries.

How does the good doctor know that nerves have been spared? Well, Poppas and his nurse practitioner developed a series of sensory followup tests involving Q-tips, their fingernails and vibrators. But don't worry, a family member was always present in the room. As the resulting journal article notes, management of such situations requires a "compassionate and multidisciplinary approach."

Activists Alice Dreger and Ellen K. Feder, a professor of medical humanities and bioethics and a professor of philosophy, respectively, have been railing against the practice of FGM -- of any kind -- for a decade. They are part of the majority medical view that questions the very basis of clitoroplasties. (The American Academy of Pediatrics disturbingly stated in May that it only had an issue with "all types of female genital cutting that pose risks of physical or psychological harm" -- as if any kind of clitoral mutilation did not necessarily entail such harm. The AAP recanted the shocking affront to women's physical and mental health only a few weeks later.)

"We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm," Dreger and Feder wrote in an article lambasting Poppas' study.

These procedures seem motivated mostly by an obsession with having "normal" genitalia -- and normal kids. The fact that cosmetic genital surgery is on the rise is one sign of this. And given that only one of every 2,000 infants is born with genital ambiguity, parents faced with an "abnormal" clitoris are not likely to have ever seen one before and may react with trepidation. Will my kid be a lesbian? Will my little girl want to become a boy? We know children are all unique, like snowflakes, but when it comes to vaginas, sexual orientation and gender identity, it seems we'd prefer cookie-cutter, please.

So parents go to Dr. Poppas who mirrors their fears and offers a medical procedure that Cornell's Web site recommends "because female patients are able to undergo a more natural psychological and sexual development." What parent would withhold such treatment, recommended by a top-notch pediatrician and hospital?

Poppas cuts off parts of the perfectly healthy, albeit-larger-than-we'd-like clitoris, the only organ in either sex whose only known function is sexual pleasure.

Although Poppas boasts of the "nerve sparing" nature of his procedure, a study in the Lancet showed some women who underwent other nerve-sparing surgeries "had the worst possible score for orgasm difficulties." Not to mention the fact that simply preserving the glans may not be enough, given that many women find more pleasure is derived from the shaft than the tip, which can be overly sensitive.

The horrors of clitoroplasties aside, Poppas' particular brand of FGM adds an extra layer of psychological damage. When Dreger told Ken Zucker, a child psychologist about how Poppas used a vibrator to test a little girl's clitoral sensation, he said: "Applying a vibrator to a six-year-old girl's surgically feminized clitoris is developmentally inappropriate."

Dreger and Feder write:

[The study's authors] describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”

Of course it's inappropriate. And lest that is not obvious on its own, transgendered adults have long been vocal about how genital displays in medical exams were among the most traumatic experiences of their entire lives.

In this case, as sex columnist Dan Savage writes, "These post-op visits with the doctor and his vibrator do the girls no good -- what can the doctor do if a girl reports no sensation? reassemble her clit? -- and retaining sensation isn't proof that these girls will grow up to be healthy, sexually functional adults."

The sad irony is that maintaining these girls as healthy, sexually functional, happy adults is the cause of all these problems in the first place. Parents and the doctors who legitimize their fears need to know that reconstructing a clitoris -- or any other ambiguous genitalia -- to meet "normal" standards does nothing to change what may be behind the differences to begin with. You can't "fix" your kid's genetic and hormonal makeup -- you can only cover it up, and such efforts can have tragic psychological and physiological results.

The least we can do is give every kid a chance to figure out who he or she is and what he or she wants when he or she is old enough to do make that call -- and to accept them as they are throughout the entire process.

Hell No, I won't go, to the V.A. for health care. - MC Kean

This is plain crazy.  In what is perhaps the develop worlds most socially stratified (unequal) health care system, Veterans suffer the social position of the lab rats and breathing cadavers. 

We are the breathing cadavers upon which over 50% of not only U.S. but foreign medical students trained in U.S. learn their skills.  Most of us are not informed of the status or lack of experience these trainees may have.  Many of these trainees are under supervised.  Veterans who request no trainees will not only be treated poorly, but once sedated, no request will be honored.

Veterans are a very large pool of living lab rats for big pharma.  Veterans are often not told of the experimental nature of drugs and are often given drugs in side effect trials for conditions they do not even have. 

While some may claim well at least vets are getting health care, think again.  The V.A. standard of care is much lower than private care.  Physicians are told not to diagnose conditions the V.A. does not want to treat.   Indicative lab levels indicating treatment are not the same as in private practice.  Labs may indicate a thyroid condition, anemia, or any other number of conditions to a private provider, but the V.A. standards will mean the vet will not even be informed that he or she has a condition that would be treated in the real world of medicine.

Care is not taken to treat, nor is care taken to treat safely.  When a veteran does get care, they are often treated by an unqualified provider and may even be infected due to dirty gear with everything from Hep C to HIV.  One would hope this would be exceptions to the rule, but poor substandard care is the V.A. standard of care.

In short getting health care at the V.A. is an unhealthy even dangerous thing to do.  Below is the overwhelming evidence proving V.A.'s criminal lack of care, and these are just reports over the last two months.

JUNE 2010

VAOIG FAULTS NEW JERSEY VA HOSPITAL IN 13 KEY AREAS (06-16-10)   The East Orange VA hospital has many problems including staff using improper sterilization procedures.



NEW DOCUMENTS DETAIL BAY PINES VA'S 40 VIOLATIONS (06-14-10)   We have a complete list of the violations and the hospital director's instructions to his staff.

DOCTOR: VETERANS HOOKED, NOT HELPED, AT VA HOSPITAL (06-14-10)   "We are told to just continue giving the patients narcotics. Most of them are addicted. Some come to the clinic in active withdrawal."


VAOIG FINDS MULTIPLE PROBLEMS AT CHILLICOTHE VA FACILITY (06-11-10)   Including: Most physicians hired in the last year had not documented competence to support privileges granted.



VAOIG FINDS USUAL VA HOSPITAL PROBLEMS IN SEATTLE (06-10-10)   OIG found that 25% of staff handling reusable medical equipment not trained and noted additional equipment sterilization problems.

VAOIG TESTIMONY: VA SLOW TO IMPLEMENT IG'S RECOMMENDATIONS (06-10-10)   Both political parties lash out at VA for compromising patient safety and wasting taxpayer dollars.



BAY PINES VA ACCREDITATION REPORT NOW AVAILABLE (06-08-10)   The Joint Commission report is available for viewing or download.

TWO VAOIG REPORTS SHOW VA'S HEALTHCARE STAFFING SERVICES PROGRAM IN SHAMBLES (06-08-10)   Program lacks trained contracting officers, proper review, management oversight and wastes money.


EDITORIAL: NO EXCUSE FOR VA TO KEEP BAY PINES REPORT A SECRET (06-07-10)   "Patients and taxpayers are entitled to know precisely where Bay Pines needs to improve ... There is no excuse for the secrecy."


BAY PINES VA HOSPITAL RACKS UP 40 VIOLATIONS (06-04-10)   "I think any hospital that has 40 violations ... has a moral obligation to step forward to reassure patients that their safety is guaranteed."

VAOIG EVALUATION OF VA'S MEDICAL FACILITY QUALITY MANAGEMENT PROGRAMS (06-03-10)   VA's Inspector General found significant weaknesses at Fayetteville, Manila, Honolulu and Marion, Illinois.

VA'S INSPECTOR GENERAL RELEASES SEMIANNUAL REPORT TO CONGRESS (06-02-10)   VAOIG issued 120 reports and identified nearly $673 million in monetary benefits, for a return of $14 for every dollar expended on OIG oversight.


MAY 2010

SHINSEKI'S PROPOSED LEGISLATION COULD NEGATIVELY IMPACT MANY VETERANS (05-28-10)   "Getting rid of the primary basis of appeals and running off the lawyers will surely allow VA to get rid of all those pesky claims on remand."



NRC PRELIM REPORT: 13 VA HOSPITALS IN VIOLATION OF RADIATION USE REGS (05-26-10)   Nuclear Regulatory Commission could strip the VA of its ability to oversee radiation services at all 153 hospitals nationwide.


VA SLOW TO CARE FOR BRAIN INJURED VETERANS (05-24-10)   "They were blowing me off. I feel like things that have to happen, they're dragging their feet on."

VAOIG FINDS CONFUSION AT VA'S ALBUQUERQUE REGIONAL OFFICE (05-21-10)   IG found a 36% claims error rate and untrained Service Center managers.


VAOIG TURNS UP NUMEROUS PROBLEMS AT SAGINAW VA HOSPITAL
(05-21-10)   VA's Inspector General finds ten problem areas including sterilization of equipment.

BUYER, VAOIG BLAST VA FOR LAX DATA SECURITY PROCEDURES (05-21-10)   Until VA fully implements key elements of its information security program, VA's mission critical systems remain at an increased and unnecessary risk of attack or compromise.

HOUSE VETS' SUBCOMM. TO HOLD HEARING ON VA DATA BREACHES
(05-18-10)   The Subcommittee on Oversight and Investigations to hold a webcast hearing on Wednesday, May 19 at 10am Eastern time.


VAOIG FINDS USUAL PROBLEMS AT HOUSTON VA HOSPITAL (05-14-10)   The familiar laundry list includes problems with equipment sterilization and physician credentialing.

VAOIG FINDS VA'S NATIONAL CALL CENTERS NOT PERFORMING WELL
(05-14-10)   VA's IG concluded that any one call placed by a unique caller had just a 49% chance of reaching an agent and getting the correct information.

LAPTOP STOLEN FROM VA CONTRACTOR HAS VETS' PERSONAL INFORMATION (05-14-10)   Data was not encrypted. Rep. Steve Buyer says, "This is an inexcusable abrogation of responsibility that would not be tolerated in any private company."
 

OSHA CITES MINNEAPOLIS VA MEDICAL CENTER FOR MULTIPLE VIOLATIONS (05-13-10)   OSHA found 37 violations, 32 of which were serious and four were repeat violations of safety standards.

PROPOSED VA RULE WOULD LIMIT DRUG REPS' ACCESS TO HEALTH CARE STAFF (05-12-10)   Drug reps would have to make appointments before entering VA facilities and would generally be restricted from areas of patient care.


NPR SPECIAL: DISABLED VETERANS FACE A FACELESS BUREAUCRACY (05-12-10)   Paul Sullivan: "The Department of Veterans Affairs is so complicated, it would drive a normal person insane in three minutes."

VAOIG: VA FAILING TO IMPLEMENT MENTAL HEALTH SERVICES HANDBOOK (05-11-10)   The most commonly identified barriers to implementation were need for additional space, need for additional staff, and recruitment of staff.


CONGRESS AND VIETNAM VETERANS UNHAPPY WITH THE VA (05-10-10)   Rep. Bob Filner: "I am convinced that Vietnam veterans are suffering and dying while VA dithers and vacillates. VA should be ashamed..."

AFTER VETERANS' DEATHS, VA LIMITING SOME SURGERIES
 (05-10-10)   Deaths at Marion, Illinois VA hospital prompt agency to suspend some procedures because of "surgical complexity."

VAOIG: VA'S PHILLY PROSTATE TREATMENT PROGRAM LACKED REVIEW
 (05-10-10)   VA's Inspector General found that the program went four years without a peer review or quality assessment.


GAO: TRAINING FOR VA CLAIMS PROCESSORS MAY NOT BE APPROPRIATE (05-01-10)   Some of the training received was delivered too late, suggesting that regional offices may not always deliver the training needed in a timely manner.

Now, some will claim this is evidence of why universal health care will not work, but they are wrong.  This is why socially stratified health care does not work.  We need everyone, including medical workers to get the same health care. 


I am one of those vets infected with dirty V.A. gear, infected with an STD, an STD that my husband of over two decades does not suffer.  After two colonoscopies, a surgery, several gross violations of my privacy, dignity, autonomy, and informed consent laws, and a STD infection, of course the V.A. claims that I cannot "prove" they are the source of the infection.  Yet, common sense would dictate that given the V.A. track record, they are certainly the most likely source of many veterans infections.  We are supposed to be given service connected compensation when the V.A. does us harm.  I find it interesting that just when all this is coming out about poor, even dangerous V.A. health care, the V.A. seeks to reform claims such that a veteran has not right to appeal or an attorney.

As a female vet, I can attest to the fact that women suffer even more than the men from V.A. “care”.  But, that is not the direction or reason for this post.  
I was inspired to post this, because now, the V.A. wants my husband to get a colonoscopy at the V.A.   His response, “Hell no, I won’t go.”

Vet's took to the streets to get health care.  Now that "health care" has been transformed into something that does us more harm than good.  It is time to hit the streets again.  This time in solidarity with the masses and demand single payer health care, not insurance company windfalls

VA Patients are being killed by substandard care

By JIM SUHR – 6 days ago ST. LOUIS (AP) — Substandard care at a southern Illinois Veterans Affairs hospital may have contributed to 19 deaths over the past two years, a VA official said as he apologized to affected families and pledged reform. The hospital in Marion, Ill., initially drew scrutiny over deaths connected to a single surgeon, but two federal reports found fault with five other doctors. The hospital undertook many surgeries that its staffing or lack of proper surgical expertise made it ill-equipped to handle, and hospital administrators were too slow to respond once problems surfaced, Dr. Michael Kussman, U.S. veterans affairs undersecretary for health, said Monday. "I can't tell you how angry we all are and how frustrated we all are. Nothing angers me more than when we don't do the right thing," Kussman told reporters during a conference call after releasing findings of the VA's investigation and summarizing a separate inspector general's probe. Still, Kussman insisted, "what happened in Marion is an exception to what otherwise is a truly quality health-care system" across the VA. The VA will help affected families file administrative claims under the VA's disability compensation program, he said. Families also could sue. The VA investigation found that at least nine deaths between October 2006 and March last year were "directly attributable" to substandard care at the Marion hospital, which serves veterans from southern Illinois, southwestern Indiana and western Kentucky. Kussman declined to identify those cases by patient or doctor, though Rep. Jerry Costello, an Illinois Democrat, said those nine deaths were linked to two surgeons he did not name. Of an additional 34 cases the VA investigated, 10 patients who died received questionable care that complicated their health, Kussman said. Investigators could not determine whether the care actually caused the deaths. Inpatient surgeries have not been performed at the facility since problems first became public last August. They will remain suspended indefinitely, Kussman said. In pledging reforms, Kussman said the VA has launched an administrative investigatory board to review care problems and matters raised by employee groups. The VA last September also installed interim administrators to replace the Marion VA's director, chief of staff, chief of surgery and an anesthesiologist, moving them to other positions or placing them on leave, Kussman said. The anesthesiologist has since quit, Kussman said. "The previous leadership will not return" to their former jobs, he said. The VA's investigation cited by Kussman covered a two-year span, the VA said. The inspector general's office blamed three deaths on substandard care at the Marion site, but that review covered only the past fiscal year, which ended in October, the VA said. That report was not immediately available Monday. Telephone calls on Monday seeking comment from the Marion VA were directed to spokespeople with the agency's Washington headquarters. Neither Kussman nor the VA investigation's 41 pages of findings named surgeons involved in the deaths, though Kussman acknowledged that much of the criticism has focused on Dr. Jose Veizaga-Mendez. Veizaga-Mendez — identified in Monday's report as "Surgeon A" — resigned from the hospital Aug. 13, three days after a patient from Kentucky bled to death after gallbladder surgery. All inpatient surgeries stopped a short time later. Sen. Dick Durbin, an Illinois Democrat, has said Veizaga-Mendez is linked to 10 patients' deaths at the Marion facility, about 120 miles southeast of St. Louis. Kussman declined to discuss that claim Monday, saying he didn't want to influence additional internal investigations of six of the site's surgeons he said had "at least one episode of substandard care." Veizaga-Mendez and another surgeon no longer practice at the Marion VA. The remaining four surgeons remain on staff but are "only doing minor cases at this time," Kussman said. "We don't think the physicians killed the patients," he said. "We think the physicians were trying to care for the patients and did so in an inadequate way." Costello and fellow Rep. John Shimkus, a Republican from Collinsville, Ill., called Monday's findings "shocking." Durbin said the reports "confirm what many of us in Illinois feared" — that the Marion VA's medical care was substandard and that protocol for protecting patients was ignored. "As the inspectors who reviewed the Marion hospital put it, the quality of care at Marion was 'horrible,'" Durbin said. Veizaga-Mendez's whereabouts are unclear. He has no listed telephone number and has been unreachable for comment. The Marion VA hired Veizaga-Mendez in January 2006 after he practiced in Massachusetts, where he was under investigation for substandard care in 2004 and 2005. The claims include allegations that he botched seven cases, two ending in deaths. Veizaga-Mendez was permanently barred from practicing medicine in Massachusetts last November — a disciplinary move that also requires him to resign other state medical licenses he may hold and withdraw pending license applications. He has also made payouts in two Massachusetts malpractice lawsuits. Hosted by Google Copyright © 2008 The Associated Press. All rights reserved.

When the ranting of a mad man in the lobby makes more sense than the health care providers.

The most telling contrast made itself present to me over the last couple of days. While in the waiting room at the Roseburg V.A. a very irritated man began to rant and rave about the Bush administration and American Corporate fascism. He went on to suggest that something needed to be done or we were all doomed to some great evil empire. Now this man was in no way in a healthy state of mind, yet what he was saying was largely right on target. Bush is most assuredly sadistic. Oil and military industrial profits are the driving force of the ruling politics. Vets are getting the shaft; and the American medical system is in shambles. If we do not do something about this administration we are doomed to a state of fascism. I thought to myself, when the ranting of a mad man reflect the truth of our situation, then what does that say about the current state of affairs? The fact that his ranting rang true to the ear said much more about the truth of the ill state of American politic, than it did this man’s level of mental health. In contrast the day before I was at the PDX V.A. for a colenoscopy where some members of the medical staff appeared to be less able to grasp what needed to be done in the context of the procedure than this mad man did in the context of national/global politics. What I am saying is that in a real way certain members of this medical team appeared to be less competent at thinking than this ranting mad man. My best advise to anyone dealing w/western medicine is DO YOUR HOMEWORK AND TAKE CONTROL OF YOUR CARE!!!!! The mad man may be mentally ill, but the health care professionals may be CRAZY. Weather blunted from overwork or a Corporate directed misseducation, if you let them do anything they want, well you are not likely to start feeling better, and may even die. It seems this week they were hell bent on overdosing me on Sodium Phosphate. After getting fairly sick from the first bottle the night before, upon drinking the second bottle cramping, nausea, and vomiting started, followed shortly by symptoms of dehydration. In spit of the facts that these were symptoms that the enclosed literature had identified as concerns in relation to overdose and dehydration, the medical staff showed no concern of overdose or dehydration. Although I asked several times and explained I felt dehydrated I was told not to drink anything as they claimed that drinking more fluids may interfere with the Phosphate. This is contrary to the homework I did, which suggests you need to drink a lot of extra fluid to assist the process. Giving me more to drink should have been their first response. Had I been confident enough to over rule the “professionals” and just drink some water or 7 up, things would have been fine. That is the lesson of this day, do your homework, and then trust your judgement. The Dr. insisted that what I needed was a third dose of the phosphate. I told her I was concerned about overdosing which can cause kidney failure among other problems. She said, “but you didn't keep the second bottle down". I let her know it did not all come back up and I thought it best to give it a little more time to finish the flush. Without asking me any questions concerning how much came up and how much stayed down, without checking the fluid coming from by body to determine progress, she blindly insisted something else must be done. I consented to an enema, which she suggested, and then dropped, insisting that what I needed was another bottle of Phosphate. At this point I was very thirsty from dehydration, wanted a drink desperately and it became evident that the dehydration would continue until I consented to another dose, or refused further care and left the PDX V.A. without having completed the procedure (one that I agreed with the Drs was a good idea). I went against my best judgment and let them give me another bottle. This time it seemed like it all came back up (at least I hope it all did as this was an obvious overdose). I am convinced that if they had given me more fluids like I asked from the start the prescribed second bottle would have worked just fine with no need for the third. But, this overdose is not the worse of it all, nor the end of their efforts that could have resulted in grave harm. No, after throwing up the third bottle consumed some evidently not so bright nurse with the worse bedside mannor I have every experienced, came and suggested a feeding tub to dump a fourth bottle on my stomach. I told her “NO”, on very clear and certain terms. Yet she continued to go about advocating with the Dr. and other medical staff to shove a tube down my throat. As I went into the bathroom I passed their little pow wow they were having at my expense and in a low voice told them, “they were doing the procedure today, and they were going to do it WITHOUT a feeding tube!!!” This time, without any suggestion on their part, I left the fluid coming out the lower end inthe toilet, so they could see the progress, objective evidence they already should have requested. On my way out of the john, I told them I left them something more substantial upon which to base their opinions, and that things were clearing up quickly now. The Dr. asked me when I was throwing up, while I was drinking in response to the taste, or after it had hit my stomach. I reiterated that it was indeed after a being on my stomach for 15 min. or so that it came back up. She turned her attention back to the group, once again to talk about me rather than to me and finally ruled out the feeding tube with a, “it would not work then anyway.” The subject was finally closed. The decision to move ahead was made, and things worked out just fine within minutes of that decision the fluid finally ran clear. So, while unlike the madman, I will not rant at the V.A. where other people are sick and trying to get care. Like the madman I will rant; but here in writing on this page. Why??? CUZ WHEN THE MADMAN IN THE LOBBY MAKES MORE SENSE THAN THE PROFFESIONALS IN CARE OF YOUR HEALTH IT IS TIME TO SPEAK UP!!!!!

By Lucinda Marshall - Breast Cancer Sells

AlterNet Posted on October 24, 2007, Printed on October 24, 2007 http://www.alternet.org/story/65943/ October means falling leaves, ghosts and goblins, and pink, lots of Pepto-Pink as we observe National Breast Cancer Awareness Month (NBCAM). From Campbell's Soup to Breast Cancer Barbie, it seems as if just about everyone has jumped on the pinkified bandwagon. And although October is also Domestic Violence Awareness Month (DVAM), we'd much rather be aware of breasts, even sick ones, than talk about black eyes and things that aren't supposed to go on behind closed doors. That point is reflected in women's magazines, which devote much more space in their October issues to breast cancer than they do to domestic violence. Of nine publications that I recently found on a grocery store magazine rack, all of which advertised breast cancer articles on the covers of their October issues, only two also contained coverage of Domestic Violence Awareness Month (and mentioned that on their covers).* And, what's worse, of the coverage dedicated to breast cancer, much of it was offensive, superficial, misleading, or flat-out wrong. This year there is even called Beyond Breast Cancer that cheerfully proclaims that there are "10 Good Things About Breast Cancer." Who knew? And just what are the pluses of getting this dreaded disease? According to the bubblegum-colored magazine, one perk is a pair of new boobs that "will face the horizon, not the South Pole.' Better yet, they will be paid for by insurance. Oh, and you get lots of cards and flowers. Meanwhile, both Good Housekeeping and Woman's Day give incorrect information about mammograms. Good Housekeeping claims that "[N]o one disputes that all women 50 and over should be screened annually." Yet physicians in different countries disagree on how often women over 50 should be screened. While doctors in the United States recommend annual mammograms, those in Europe say every two to three years. In Australia, where a study out last year shed significant doubt on the extent to which mammograms save lives, the recommendation is every two years. Interestingly, in some of these countries, the incidence and death rates for breast cancer are actually lower or comparable to the United States. When they're not spewing misinformation, the October issues of the traditional women's magazines are offering overly simplistic information about breast cancer risk factors and tips for preventing it. Woman's World (not to be confused with Good Housekeeping discuss factors you can change, such as smoking, and those you can't, like genetics. Missing is any mention about the purported connection between breast cancer and hormone replacement therapy. Also absent is information on parabens, phthalates and other carcinogenic chemicals, which are disturbingly common in consumer goods from lipstick to lotion. The silence on these subjects mirrors the focus that both the American Cancer Society and Susan G. Komen for the Cure place on the profitable business of curing cancer rather than preventing it, which likely would hurt the bottom line of many of their biggest donors. Consumers are told that shopping will help find a cure -- a message that is not lost on advertisers. Vogue sings the praises of one prolific advertiser, Ralph Lauren, who this year is selling polo shirts with bullseyes above the breast to target breast cancer. The ad shows a group of young, mostly white women wearing skimpy thongs, the polo shirts and nothing else. Subtle, huh? A Pine Sol ad in Essence features motorcycle riders Aj Jemison and Jan Emanuel "driving for the cure," which is awfully hard when your vehicle is spewing cancer-causing exhaust. On top of that, Pine Sol contains 2-butoxyethanol (EGBE), which has been linked to fertility disorders, birth defects and other medical problems. Redbook carries a sparkling wine "Cheers for the Cure" ad. Curiously, their article, "Who Beats Cancer and Who Doesn't," was one of the few risk factor pieces that failed to mention the link between alcohol and breast cancer, something that is highlighted in several of the other magazines. And what if you or someone you love gets breast cancer? Not to worry, the women's magazines are full of inspiring survivor stories. Unfortunately, while most breast cancer victims are over the age of 50, not one of the nine magazines I analyzed focused on those women and the impact the disease has on their lives. Far more typical is a piece in Vogue discussing a very attractive young woman's agonizing choice to have a preventive double mastectomy because she carries the genes that can cause breast cancer. And with the exception of Essence, whose target audience is black, most of the women in these survivor stories are white, even though black women are more likely to die from the disease. Despite most of these magazines having sections on health, family and love, only two of them (Redbook and Essence) had any mention of Domestic Violence Awareness Month. While it is questionable that additional awareness of breast cancer is useful, in the case of domestic violence, more coverage would be helpful. Domestic violence is the most common type of violence experienced by women both globally and in the United States. The Family Violence Prevention Fund reports that one out of every three women worldwide is "beaten, coerced into sex or otherwise abused during her lifetime." Here in the United States, the rate is one in four. In 2005 (the latest year for which statistics are available), 976 women in the United States were killed by by men that they knew. Yet because we tend to see this violence as a private, shameful issue, only 20 percent of rapes and 25 percent of physical assaults against women in this country are reported to the police. Also underreported is the great financial toll domestic violence takes on communities. FVPF estimates that the health-related costs of "rape, physical assault, stalking and homicide committed by intimate partners exceed $5.8 billion each year." About 70 percent of that goes toward direct medical costs; the other 30 accounts for indirect costs such as lost wages. Though lacking in many other details, this month's article in Redbook did attempt to demonstrate how common domestic violence really is, with featured pictures of two women as well as two men who knew a woman who had been affected by domestic violence. And the article in the October issue of Essence, which delves into why black America is "so silent" about the violence that is committed against black women (a number that nearly doubled between 2003 and 2004, according to the Bureau of Justice Statistics), also pinpoints why more coverage in these magazines would be more useful. ""Awareness, or lack thereof, is also a factor, says Rose Pulliam, president of the National Domestic Violence Hotline and the National Teen Dating Abuse Helpline. "We have to find a way to talk about domestic abuse that doesn't demonize our men but creates a way of looking at this as something to discuss openly," she says. What to take away from all this? The bottom line, literally, is that we shrink away from black eyes. Breasts, on the other hand, are highly marketable commodities, as these magazines' advertising and helpful hints about pink products attest. Glamour even uses breast cancer awareness as an opportunity for a little full frontal nudity, featuring young, pretty and oh-so-white survivors with their best come hither looks. This emphasis on youth and whiteness is a true disservice to older women who are far more likely to get this disease and black women who are more likely to die from it. Such irresponsible coverage of breast cancer and blindness to domestic violence suggest that many publications are less concerned with women's health than with making a buck. By tugging at consumers' purse strings instead of promoting their well-being, these magazines fail to serve the women who read them. *The magazines surveyed for this article were: Essence, Redbook, Good Housekeeping, Women’s Day, Women’s World, Ladies Home Journal, Glamour, Vogue and Beyond Breast Cancer. Lucinda Marshall is a feminist artist, writer and activist. She is the Founder of the Feminist Peace Network, www.feministpeacenetwork.org.

Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women - feminizing.com

Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women

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From the now defunct Non-Con web site

Posted by Jill—Unnecesarean

Public health reporter André Picard published an editorial yesterday in the Canadian newspaper, The Globe and Mail, imploring the medical community to end the practice of performing vaginal exams on anesthetized women without their consent. The article about physician Sara Wainberg’s research and personal accounts of the practice has ignited comment storms, debate and outrage.

Pelvic examinations performed routinely in teaching hospitals on uninformed, anesthetized women prepped for unrelated surgeries is not breaking news. The topic bubbles up to the surface every few years, incites a media frenzy, then simmers back down into what Picard calls “one of those dirty little secrets of medicine” and again drops from the public eye.

The story is that the practice of digitally raping anesthetized female and male patients without their consent continues.

One of many articles on the ethics of performing pelvic exams on anesthetized women was written by Robin Fretwell Wilson, a professor of law at the University of South Carolina School of Law, who testified before the Federal Trade Commission and Department of Justice Hearing on June 10, 2003. In her article, Unauthorized Practice: Teaching Pelvic Examination on Women Under Anesthesia that appeared in the Journal of the American Medical Women’s Association in 2003, Wilson cites study after study showing that the practice is routine.

In February, Ubel et al reported that 90% of medical students at four Philadelphia-area medical schools performed pelvic examinations on anesthetized patients for educational purposes during their obstetrics/gynecology rotation. Although trumpeted as proof that physicians are lax in securing permission, the study was not clear on the matter of consent. Caldicott et al reported in January that 53% of students at a single English medical school performed pelvic or rectal examinations on anesthetized patients. Students acted without any written or oral consent in 24% of the exams.

Research in the United States, Canada, and Great Britain has shown that the unauthorized use of women is not confined to 1 or 2 medical schools. Using anesthetized patients before surgery to teach abnormal anatomy “has long been practiced.” Women are also used to teach normal anatomy. As late as 1992, Beckmann found that 37.3% of US and Canadian medical schools reported using anesthetized patients to teach pelvic exams.

Other data in Wilson’s article:

[In 2002], nearly half of Canadian medical students (47%) at the University of Toronto reported “pressure to act unethically” and named as the leading culprit the collision between medical education and patient care. Many were asked to perform pelvic examinations without consent.

Ninety-four percent of Oxford Medical School graduates learned to perform digital rectal examinations using male and female patients, many of whom were anesthetized.

Only 37.5% of teaching hospitals “inform patients that students would be involved in their care.”

Forty-two percent of US students are not forthright about their status when doing pelvic exams on conscious women.

Five percent of obstetrics/gynecology department chairs tell students to introduce themselves as doctors and just proceed.

 

Some states in the U.S. ban the practice of digitally violating anesthetized female patients. California Governor Gray Davis signed AB 663 into law during the first half of the 2003-04 legislative session which makes the performance of pelvic examinations on anesthetized or unconscious women without consent by doctors and medical students a misdemeanor and ground for the loss of their medical license.

The glaring limitation in the bill is, as Wilson wrote, ”[no] woman can enforce her own interests in being asked if she never knows an exam has taken place” and therefore the bill “suffers from the same limitations as existing causes of action for battery and the failure to secure informed consent.” While AB 663 increases the sanctions for unauthorized exams, Wilson argues that it does nothing to remedy the underlying pressures that have fostered the use of patients as teaching tools without permission.

Ironically, under the subheading “Exaggerated Fear of Refusal,” Wilson cites multiples showing that women will consent to pelvic examinations for educational purposes, even while anesthetized or during birth.

Dr. Ari Silver-Isenstadt, co-author of the aforementioned study about Philadelphia-area medical schools appeared on ABC’s Good Morning America show on June 10, 2004 to discuss the study. He told ABC that the study was based on his own experiences in medical school when “[he] was asked to participate in some of these educational experiences and [he] felt very uncomfortable…”

Naturally, many patients take issue with the idea that their anesthetized bodies will be probed without their expressed consent and knowledge.

One such patient was Zahara Heckscher, who was interviewed by the Washington Post in May 2003. According to the article, Heckscher was preparing to have an ovarian cyst removed at George Washington University Hospital and asked her surgeon if medical students would be practicing pelvic exams on her while she was unconscious.

Shocked when she received a “yes” answer, Heckscher “wrote a note on her consent form forbidding anyone other than her attending physician to perform a pelvic exam on her while she was under anesthesia.”

Not all doctors agree that patients at a teaching hospital should complain about the practice.

Former ACOG president, Dr. Thomas Purdon, expressed concern “that an important quality evaluation that’s been a mainstay of evaluation in the operating room for more than 50 years is getting sensationalized,” according to OB/GYN News.

“It’s a crucial teaching point to see how a procedure is done, what the pathology is, and to tie that to the pelvic exam,” said Dr. Purdon of the Arizona Health Sciences Center in Tucson.

Purdon also argued that this type of treatment is implicit.

In Dr. Purdon’s view, patients who get treated at a teaching hospital “should already know that it’s not just one single doctor who’s taking care of them.”

Purdon expressed frustration that people who go to university centers for care are “pick[ing] apart” something so important.

Although the practice of performing pelvic exams on paid volunteers has gained popularity in some institutions over the last 15 years, physicians are never going to get enough paid volunteers to adequately teach students, he said.

As an educator, “it’s frustrating for me that people who want to go to university centers for the latest treatments and technology pick apart something that’s an area of importance,” he said.

It’s common in a teaching situation for a medical student, one or two residents, and a faculty person to compose a surgical team. It’s not as if 12 medical students are in the operating room examining the anesthetized patient, he said.

Activist Michael Greger, MD, told the Washington Post that the voluntary guideline of having one or two students perform the exam is widely ignored. Said Greger, “If they have five medical students on an OB-GYN rotation, they aren’t going to let one do it and not the other four.”

Bioethicist and medical historian, Jacob Appel, analyzed the recent court-ordered hospitalization of then pregnant woman Samantha Burton for the Huffington Post in his article, “Medical Kidnapping: Rogue Obstetricians vs. Pregnant Women,” in which he stated:

Preventing a competent pregnant woman from leaving the hospital under these circumstances is no less egregious than compelling her to have an abortion. Forcing additional intrusive care upon her, such as unwanted vaginal exams or cervical assessments, is legally-sanctioned digital rape.

As André Picard wrote, “the problem is the result of a failure to communicate. It is also a striking example of a lingering bit of paternalism that is still all-too-present in medical culture – this notion that “we do the surgery and the details are none of your business.”

With sufficient evidence that the majority of women would consent to a pelvic exam if asked, the practice of medical students manually raping anesthetized women in the name of education is a pitiful relic of medical culture. Were it not for the many brave medical and nursing students over the years who spoke out against the practice of culturally-sanctioned digital rape in the operating room and in labor and delivery under the guise of frequent unnecessary cervical checks, this would remain a dirty little secret.