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AP examines patient consent before pelvic exams; states, med schools split on legislation

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When a woman undergoes gynecological surgery, what happens when she’s under anesthesia? In teaching hospitals, it’s common practice for medical students to give patients a pelvic exam as part of their training. Whether the patients have given consent for that exam is not clear, and in the #MeToo era, the question has drawn the interest of state lawmakers.

The issue also captured the attention of our staff. New York photo editor Jenny Kane spotted a story online about a bill on the issue making its way through the New York legislature and passed the tip to the State Government Team. A quick search revealed that the issue also was being debated in other states. In one of them, Rhode Island, reporter Jennifer McDermott started digging into the legislative angles while Seattle-based Health and Science Team reporter Carla Johnson started examining the medical side of the issue.

McDermott and Johnson faced several obstacles in reporting the story,including a struggle to define the controversy,because a patient under anesthesia doesn’t know what’s happening to her. Through sources and social media,Johnson found medical students who described their experiences in the surgical rooms. Many had performed pelvic exams on anesthetized women and some expressed qualms about whether the patients had been fully informed. Only one medical student agreed to be quoted by name and,luckily,she was willing to be photographed.

Doctors,too,were skittish about talking,but Johnson learned that Tufts Medical Center was rewriting its consent forms because of the ethical concerns of medical students. However,some medical schools,including Yale and the top teaching hospital in Utah, said the bills were unnecessary – either because they said their consent was adequate or because they didn’t want the state legislating their training procedures.

That conflict was the point of lawmakers introducing the legislation and gave the reporters the peg for their story:

Bills introduced in roughly a dozen states this year would require that women undergoing gynecological surgeries give explicit approval to a pelvic exam beforehand. It’s a step that some medical experts say is an unnecessary intrusion into patient care.

Despite the legislation,McDermott had a hard time getting lawmakers to talk because they were dealing with other priorities as their legislative sessions wrapped up. She persisted and got most of the major players,while also tracking the legislation in a dozen states and updating the story as bills cleared legislative hurdles. Especially key was the contribution of Brian Witte,the statehouse reporter in Maryland. He pressed the governor’s office, getting the timely news kernel that Gov. Larry Hogan was indeed going to sign the pelvic exam consent bill a day after the AP story moved.

While not all the pelvic exam consent bills passed this year,the story’s play showed how widely the topic resonated. It won play on at least 35 front pages,including with the Denver Post and Charlotte Observer. Online play was equally impressive,with nearly 20,000 page views.

It also resonated on a personal level. A few days after the story ran,McDermott received an email from a woman who described being pressured into signing a consent form as she was wheeled into a surgical breast biopsy. Afterward,she was sure she had been subject to a pelvic exam. She wrote,“I hope your article will help women have more information and control of their own bodies and not be taken advantage of in such vulnerable situations. I think this clearly speaks to the fact that it’s not just for pelvic exams but anytime women are under sedation. I hope I’m wrong,but I feel pretty sure this happened to me. Thank you for your hard work and bringing this to light and hopefully changes to this appalling practice.”

For their teamwork,execution and sensitive handling of a complex topic,McDermott, Johnson and Kane win AP’s Best of the Week award.

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