KANSAS CITY, Mo. — Doctors-in-training performing intimate exams on anesthetized or unconscious patients without their knowledge and without their consent — it's a little known practice in medicine the KSHB 41 I-Team discovered is legal in a majority of states, including Missouri and Kansas.
Learning how to do a pelvic and prostate exam is part of medical students' education and ongoing training. These exams are also an extremely important part of a person's basic care.
However, ethical lines blur when a person's body is viewed as a teaching tool.
You probably won't go in for knee surgery and end up getting a pelvic exam while you're under.
But abdominal surgery? Gynecological surgery? It could happen.
The problem is, there's no way to know exactly how often it happens. The I-Team found out it's a common practice and you might not ever know it happened.
In part one of this story, the I-Team explains more about this complicated issue and how failing to get consent can negatively impact patient trust.
For part two, KSHB talked to local lawmakers who want to fix this issue and ensure patients’ rights are always protected.
Kansas and Missouri don't have anything set-in-stone in the laws about this.
"I was shocked. I had no idea that this was a common practice," Missouri Sen. Lauren Arthur said.
Arthur is one of the local lawmakers who want to find a legislative cure.
"I had a visceral reaction to it," Arthur said, which is what made her want to jump into action.
Arthur introduced a bill last year that would require healthcare providers, including students, to get explicit consent from patients before doing pelvic, prostate or rectal exams on them while they are unconscious.
Arthur’s bill had a couple exceptions, like when an exam is necessary for treatment or diagnosis or if a court orders one to collect evidence.
"These are important procedures," Arthur said. "I don't want to create any stigma around them, but under all circumstances, they should only be performed if a patient has given explicit, informed consent.
Arthur's bill died in committee.
In 2020, Missouri state representative Shamed Dogan filed a similar bill. It didn’t pass, but made it to a hearing, with more than a dozen people testifying in support, saying a woman’s body, or anyone’s body, shouldn’t be used as a mere teaching tool.
Ashley Weitz was one of those who submitted written testimony in support of the bill.
"I was shocked to learn this wasn't an anomaly, and my experience was a product of a way of educating that is not only antiquated, not only is it harmful, but it's unnecessary," Weitz said.
It’s personal to her.
"I woke up in the middle of the exam screaming," Weitz said.
A doctor performed a pelvic exam she didn’t consent to while she was heavily sedated in a Utah emergency room 15-years-ago.
As a sexual assault survivor, the experience traumatized her so much that she’s gone without necessary healthcare.
But she found her voice to help pass bills in Utah and in other states that would ban what happened to her.
"I just wanted to be asked," Weitz said.
MOCSA, the Metropolitan Organization to Counter Sexual Assault, also advocated for the Missouri bill.
The organization work with survivors of sexual abuse and trauma, like Weitz, who they say could face irreparable harm.
"Having something done to their body, or worrying that something may have been done to their body can be tremendously impactful and can cause anxiety and stress, re-traumatization and flashbacks," said Victoria Pickering, MOCSA's director of advocacy.
Kansas representative Rui Xu is also trying to stop this practice. He says patients likely understand medical students could be involved in their care, especially at teaching hospitals. But this, he says, is different.
"A pelvic exam is an extra level of invasion, in my opinion, so that should require an extra level of consent that did not seem like has been happening and certainly not written into statute," Xu said.
Xu filed a bill in 2020 – his first act as a freshman lawmaker. It died too.
He thinks he knows why.
"The medical society tends to have a little more lobbying force in Kansas," Xu said. " In the super minority, we don't get much opportunity to get hearings on our bills in the first place, let alone something with opposition."
Xu and Arthur plan to re-file their bills in January.
"I think with the right forces, with you guys shining a light on this, potentially maybe we can change more hearts and eventually get this passed," Xu said.
The Kansas Medical Association declined to tell the KSHB 41 I-Team why it opposed Xu’s bill, but did provide us with a statement.
“Should Representative Xu introduce a similar bill next legislative session, we will read the language of the bill before taking a position on it, if any," it said in a statement.
A tip to take away: Pay attention to hospital consent forms. They may not mention anything about med students and doctors-in-training practicing pelvic exams.
You have the right as a patient to ask your doctor who will be in the room for your surgery or procedure. You also have the right to tell them you do not want any doctors-in-training to do pelvic exams on your body as practice.
In some hospitals, med students don't play a direct role in patient care.
However, these pelvic exams are not done for patient care; they're often done solely so that the medical student or the doctor-in-training can learn.
We reached out to national medical associations, who say doctors need to get prior, informed consent before performing an exam the patient wouldn't be expecting.
The lawmakers we talked to believe it should be a law, even if hospitals have policies in place.