KANSAS CITY, Mo. — Imagine being unconscious for a surgery or undergoing a procedure and, without your consent, a doctor-in-training practices an intimate test using your body.
Pelvic and prostate exams are an important part of basic health care — your doctor checking that your reproductive organs are healthy. These exams are also an important part of medical students' training.
However, sometimes the line gets blurry.
Pelvic exams performed on unconscious people without consent remains a gray area that is raising ethical concerns and prompting legislative action. The practice is legal in Kansas and Missouri.
As a warning, this story may be triggering for those who have experienced sexual trauma.
Ashley Weitz remembers being heavily sedated in the emergency room.
"I woke up, there was a bright light (and) he just kind of said, 'I'm almost finished,'" Weitz said.
She recalls thinking, "Finished with what? What is my doctor doing?"
"I don’t remember being put into stirrups," Weitz said. "I don’t remember having my clothing removed."
Weitz's emergency department report said she went to the hospital for nausea, vomiting and a rapid heartbeat — not symptoms she thought would require her doctor to perform a pelvic exam.
"I know that I didn’t consent and I know we didn’t talk about it, because I woke up in the middle of the test screaming," Weitz said.
Through her haze, she saw the emergency-room doctor bagging swabs from the exam.
She and her doctor had already talked about her sexual history and, because she insisted there would be no way she could have a sexually transmitted infection, she did not think a pelvic test would be the next diagnostic step in figuring out what was wrong.
Weitz was 23 years old at the time and struggled to understand what happened.
"I just kind of put it in a corner and went, 'OK, well, because I have a history of abuse and assault, then that must be why this feels like such a violation,'" she said.
Weitz said years later she fully realized it was a violation. Even now, after more than 10 years, she still gets a bit shaken when discussing the experience.
Weitz opened up about the trauma to KSHB 41 News to shine a light on pelvic exams performed without consent.
"I just wanted to be asked," she said.
The KSHB 41 I-Team discovered Weitz isn’t alone.
Pelvic exams usually happen when patients are awake and fully aware that their doctor is going to examine the most private areas of their body.
However, an investigation discovered that medical students have performed pelvic and prostate exams on patients who are under anesthesia without their explicit consent. And it’s often done solely for students’ educational benefit.
It's a practice that has taken place for decades.
A 2005 survey revealed that most medical students at the University of Oklahoma had done pelvic exams on anesthetized women and most of the students didn't think the women gave consent first.
In a 2012 article, a fourth-year medical student said he performed them “for three weeks, four to five times a day.”
Just recently, the I-Team talked to a doctor who trained at a local hospital who recalls an incident several years back when medical students did a pelvic test on a woman with an ovarian tumor. The doctor doesn’t remember if they got consent. The doctor also said he remembers it was a contentious course in school and in residency.
Baltimore pediatrician Ari Silver-Isenstadt said it remains a common practice.
"This kind of thing still happens," Silver-Isenstadt said.
He has spoken out against the practice for years.
"I don’t think having students learn pelvic exams is wrong," Silver-Isenstadt said. "I think not getting explicit consent and cooperation and not making sure everything is on the up-and-up is wrong."
It’s a practice he saw 25 years ago as a medical student.
"It sort of became obvious, the problem was that the woman wasn’t being asked for her consent to participate in my medical education," Silver-Isenstadt said.
During his OBGYN rotation, Silver-Isenstadt found ways to avoid participating in exams on unconscious patients.
"I learned when those kinds of things happened and I wouldn’t show up and never had to do it," Silver-Isenstadt said.
Changing the medical establishment's teaching practices overall may be more difficult to overcome, he said. Some students may feel uncomfortable telling their instructor, the attending physician, no.
"That was highly difficult," Silver-Isenstadt said. "That was challenging."
Eventually, he met with the dean of the school and they let him research the course in 2003.
The research found that students became desensitized about whether consent was important. He also found that patients were willing to participate in students’ education if asked.
That's the key missing piece in Silver-Isenstadt's view — asking.
"It actually would enhance medical-student education because it would reenforce to medical students that the patient has the ultimate autonomy over their own body, and we don’t do things to them for our own benefit," Silver-Isenstadt said.
To be clear, Silver-Isenstadt said pelvic exams performed on unconscious people without consent don’t happen in every surgery or even most surgeries — for example, knee surgery.
"This is, in my experience, exclusively in the context of gynecological surgery," he said.
Silver-Isenstadt encouraged patients to always ask who will be in the room during their procedure and speak up if they don’t want a medical student practicing pelvic exams on their body.
"It’s OK if you say no, because there are plenty of people who are willing to say yes, and it won’t have any impact on your care," he said.
The University of Kansas Health Care system said med students don't have a role in patient care; they are only there to observe and learn. However, residents (who are still doctors-in-training) are allowed to have a role in patient care under the the supervision of the attending physician.
At many hospitals, like KU Health System, patients sign a form acknowledging medical students can or will be involved in their care, but it may not clearly state that a med student could perform certain exams for training purposes alone.
Silver-Isenstadt said many hospitals have policies about getting consent before performing such exams, but he’s panic they don’t enforce them all the time.
Meanwhile, patients who want to see this practice banned nationwide, like Weitz, said that's the problem.
"And that’s part of the trauma is not knowing," Weitz said.
For survivors like Weitz, who has lived with the feeling that her body wasn’t her own, requiring explicit consent is vital. Without it, she said that feeling of uncertainty and violation can cast a shadow on patient care.
"Wait a minute, is that something that could have happened to me?" Weitz said. "And the reality is that it absolutely is and can be."
KSHB 41 reached out to the major medical associations and they all oppose performing these intimate exams under anesthesia without prior, informed consent.
The American Medical Association said they also oppose “blanket bans on student participation” in these cases.
Currently, 21 states have banned pelvic exams without consent. Missouri and Kansas are not among those states.
KSHB 41 spoke with local lawmakers — including Sen. Lauren Arthur, a Democrat from Clay County — about efforts to end the practice.
"I was shocked," Arthur said. "I had no idea that this was a common practice."
How could someone find out if this happened to them? Again, that's part of the problem: A patients likely wouldn’t know because such pelvic exams aren’t done for the patient’s care and aren’t noted in their charts.
Weitz said she’s lucky she actually has that ER note, which many people do not have.
Despite this issue, the people KSHB talked to for this story stress that you should still regularly to the doctor and build trust with your provider. But, remember that you have a say in every part of your care.
Editor's note: The I-Team will have a second part to this reports, which highlights the legislative actions in Kansas and Missouri. That story will Tuesday, Oct. 4.