Women Veterans subjected to "medical rape" at OHSU/PDX V.A.
Women in the V.A. health care system are being subjected to "medical rape". So, just how many times are we supposed to be raped for our country and suffer further abuse when we speak out?
Open Letter to:
Frank Van Cleave,
House Committee on Veterans' Affairs
This is as much information as I have to date. Please accept it as a response to Dr. James Tuchschmidt's response letter dated March 12, 2008 sent to Mr. DeFazio's office.
In response to Dr. James Tuchschmidt's claim that they were unaware of my need for male absence during the June and December procedures:
When I was diagnosed w/breast cancer, I strongly expressed my resistance to having men around as I went through this type of surgery. While the V.A. is very male dominated environment, OHSU did not have that feel. I had requested OHSU take charge of my care, but the V.A. refused to refer. I requested OHSU accept me as a patient under Champ VA (my husband is a service connected veteran), but they insisted I go back to the V.A., saying I would have the same care and physicians there I would get at OHSU. I had signed papers at OHSU stating that I did not want students participating in procedures. I did not want to go to the V.A. and told Nancy Sloan it was for two reasons; first too many men around at a time when I am not going to want any men around, and second for such medical care, I needed to know I was in the hands of a good surgeon and in a clean safe environment. I told her that I was very insecure that the V.A. could meet these needs. Nancy Sloan, assured me that I would be safe, and all my needs cared for; so, I asked for Dr. Karen Kwong, a name I had been given by Joan at OHSU. James Tuchschmidt is right, this is not in the records, not the ones I was given. However, I was very upset and made quite a fuss about my fears of male presence as staff and patients. (I have found what is put in and left out of V.A. medical records is selective and at times more reflective of a physician's attitude or legal concerns than an actual account of events.) Even given the V.A.'s alleged failure to note this conversation and these concerns; Tuchschmidt's argument that they did not know better, in light of discovered deception, does not hold water. I was told by Dr. Kwong going into surgery how unusual an "all female team" was in surgery. Either she was not telling me the truth; or something changed. Either way she certainly knowingly lied after the fact, a clear indication that she was well aware of my objection to male presence and participation in such a surgery. In fact, I am fairly sure I wrote "no males" on the consent form signed on 6-15-07. If they did not know I did wanted only women, then why did Dr. Kwong claim we were going in with "an all female team"? Why did she lie to me after the fact, but before the colonoscopy and thus, before my complaint? If she did not know I would find this objectionable prior to surgery, then at the point I asked about the man introducing himself to my husband (who has no legal say in the matter if my incapacitation is medically induced, such as with sedation), she would still have no knowledge of such objection. In the absence of such knowledge, one might expect a lie regarding student participation, (not that this is acceptable) but Dr. Kwong lied about male presence during the procedure all together. She lied again when I questioned her May 13th, 08. Then she stated that when I said "no men" they knew I, as most women who make it a point to request such an exclusion, "mean it" so there were "no men in the room". I told her I knew from the records Ronald Gshwend and Jeffery Hoke were in the room, she claimed no, "they kicked all the men out". This is not true. Ronald Gshwend was involved in prep before the first and between surgeries, he also verified the count. How can they think it would be ok to have him in prep, after the fuss I made? Also, Jeffery Hoke came in to replace another one of the women anesthesiologist and was there during and after the masectomy. He is the anesthesia nurse that took charge right before the masetcomy and taking notes throughout, so there is no way he left the room. He was also in charge of my care after surgery while still sedated. While the V.A. claims that a curtain does not provide the sort of privacy necessary for inappropriate conduct this is a stupid statement, plus I DID NOT WANT MEN AROUND AND MADE THAT CLEAR. Why was I sedated so early? If it were all women I would not have found it humiliating as Kwong suggests is their reason for extending anesthesia time by administering prior to prep. There is only one reason I can think of for her to lie, one reason why men only appear after I am drugged, and one reason for a discrepancy between records I am given and those available to V.A. staff; Dr. Kwong, and the staff, was well aware I did not want men participating in this surgery. I was sedated before prep, it would seem, so men could get involved against my expressed will from prep onward. Rather than accommodate those needs, they merely conspired to violate my civil rights and commit medical battery.
The V.A. claims the right to keep things from you if they think knowledge it is not good for your health. (This was posted on the wall regarding patients rights and responsibilities). This sort of secrecy provides the space for and encourages the rationalization of keeping practitioners and/or practices that you may find objectionable hidden rather than respecting a patients autonomy, dignity, civil rights, and privacy. It is a way to overcome objections to what some patients may recognize as increased risks. Prolonging anesthesia, which carries many risks including the facilitation of cancer growth, to enable student training is one such example. 1. If they know what they are doing can cause harm, increase risks, or that a patient would find it objectionable, they should not do it anyway, hide that fact, and then just hope no one heard the tree fall in the forest. The tree still fell, the harm is still done. In fact they create what feminist philosophers of sex call a "rape culture". The relationship between the patient and care providers in the OHSU/PDX VA has become an adversarial one; the environment hostile, one in which the patient's dignity, humanity, autonomy, and rights are treated as something to be challenged and overcome in the interest of education, profits (including kickbacks), and other provider self interests.
How this all went down:
As requested, I was assigned and had gotten to know and trust Dr. Karen Kwong. I researched her experience, liked her calm cool disposition, and the idea of small steady hands. I was comfortable with her. I also requested and was assigned a female OBJYN to do a bilateral oopherctomy at the same time. I had talked with the OBJYN surgeon and liked her as well. The day after the surgery a female resident came in to introduce herself as having assisted with the concurrent bilateral oophorectomy stating that I likely did not remember her as I was drugged; but that she had talked to me right before surgery. She was right; I did not remember her. It did not bother me; she was female, which is the criteria I had requested, and I was told she was supervised by the young woman to whom I had spoken. I did not realize it at the time; but in retrospect this was the first hint I had that I was not being allowed the right of "informed consent" in terms of who would be touching and cutting on my body while I was unconscious. While I was aware PDX VA was a teaching facility for OHSU; I also assumed I would be introduced to all people including students that would be involved in surgical, invasive, and/or intimate procedures in advance. While observation (from a different viewing room, not the same room where I would be subject to a greater risk of infection) was something I did not assume I had control over (but should), student participation, student intimate exams, and broadcasts I assumed would require specific consent. Stupid me, I thought I had rights. Still, like I said, I did not find the OBJYN female residents participation particularly objectionable, and had I been asked would have consented to her participation in this surgery, so at this time I thought nothing of her visit. I liked her. No males came by as did she and introduced themselves as participants.
A few days after the surgery, my husband told me that a man had come by, claimed he had spoken with me (if he did I was drugged at the time; I have no memory of him), said he would be sitting "second chair". It took us quite some time to figure out who this man was. He did not look at his face, and did not get a good look at his name tag (he did not have on his glasses). He did see that the man's name tag, and introduction claimed he was the "Chief of something". As I had requested women, and had been told going into surgery that I had an "all female team", I asked Dr. Kwong about this mystery man at my follow-up appointment. She gave me the "dear in headlights" look that I have come to know as a leading indicator that a lie is coming. She denied the presence of a male surgeon. Not accepting Dr. Kwong's first response that there were no males, I asked Dr. Kwong if this male who spoke to my husband could have been a male student. She looked at my chart on the computer screen and denied that any male physicians or students were in the room, and stated that she performed the mastectomy. According to the records I was given upon request, Dr. Shabnam Chaugle did the surgery and Dr. Kwong supervised. I would not have consented to a resident performing the mastectomy. I was more worried about the mastectomy than the oophorectomy in terms of surgical expertise because of the cancer. I wonder if this had not been a teaching project would I be suffering less nerve damage pain. (Identification of and avoiding damage to nerves is one thing students are graded on when doing a mastectomy.) I selected Dr. Kwong based on both gender and risk assessment. My consent was not transferable to another surgeon. Still, Shabnam being a woman, given good pain management (it took eight months to get to any sort of viable pain management as pain meds cause my already troubled G.I. serious problems), I would have accepted this and moved on, save I knew men were in that room and I was being lied to about that fact; this I found very threatening. If they were willing to lie to me about male participation in the surgery, what else might they lie about? Very recently, I was told that another set of records maintained at the V.A., but not provided to me, indicate Gregory Adams, was the surgeon, and Donald McConnell the attending. I looked these names up and found that McConnell is Chief of General Surgery, and Adams a urology student. I tried to access these records but thus far have been denied.
Before I had reviewed the records they do allow me to see, but after my husband had told me about the male surgeon and Kwong had denied the same, I went in for a colonoscopy. I had postponed the colonoscopy until a while after the mastectomy due to a widening recognition of the fact that trauma (including surgery) can increase the growth rate of cancer. 2 The G.I. clinic was well aware of my concerns as I had stated my reasons for postponement. This alone would suggest it would be proper to ask about any trainee participation at the time of making the appointment. On the contrary, again such plans to involve students were intentionally concealed. When I was ready, I asked for and again was assigned a female physician. I was told I would have Dr. Collins. I told Dr. Collins I did not want men involved. Being concerned, I very specifically told her that I suspected I had been lied to by Dr. Kwong and did not want such a thing to happen again. She assured me "no men". After I had been made very ill with an overdose of the laxative, after the I.V. was in, after something was injected into the I.V. to "help me relax", after I was stripped, after I was stretched out in the procedure room (which I now realize was also a teaching room and likely more than one student was invited in after I was fully sedated), Dr. Collins came in with Dr. Mitchal Schreiner and Donald Miller, a nursing assistant they called a "tech", and a female nurse to attend to anesthesia. Dr. Collins introduced Mitchal as her fellow and he shoved a consent form in my face to sign. I was not asked! I was told he would be doing the colonoscopy. I have since learned this is a strategy systematically and intentionally employed to overcome potential or expressed objection. It was dark (or at least seemed like it was through the fog of medication), I was lying down, and I had been throwing up from being overdosed with a third bottle of Sodium Phosphate. (Which I am now convinced I was given because Dr. Collins did not want to wait long enough to allow my system plagued by a recently proven slow motility to work. She had the results of the gastric empty test at the top of the records as the most recent procedure.) When Dr. Collins brought in the men, she quickly stood to the side where I could not even see her to object. I was forced to face the men if I wanted to object to their presence. I was shocked, embarrassed, and humiliated and did not have the physical strength to throw Dr. Schreiner out. I signed. I was not "compliant" and there was no "misunderstanding"; I was lied to, manipulated, drugged, humiliated, and battered. Dr. Collins had plenty of opportunity before the procedure room, to tell me about these men; she could have told me when she had me in a room to insist I need a third bottle of Sodium Phosphate. At that time, I could have and would have left. I was not given that choice. Rather than be honest, she hid the men from view and knowledge. I was also lied to by the tech about the role he would play. The tech introduced himself, said he was there to collect any polyps and take them to the lab. He said he realized I was not comfortable and would remain on the outside of the door. Then he went to the door, but remained in the room. He also participated in the procedure; he had his hands on the tube in my rectum, and likely had his hands on me. This is battery.
Latter, Dr. Collins claims she explained JACHO to me. She did not. I did not hear about JACHO until I read it in the notes. I am not convinced JACHO requires both the tech and the fellow, unless Dr. Collins did not stick around or was teaching a group of students gathered in the room rather than tending to my care. Also, there are many female fellows in the G.I. department. I see no reason why I could not have been provided all females. Or better yet, be informed that a student would be performing the procedure when I made the appointment; in which case I would have postponed the procedure and done it latter elsewhere. If I had no right to have such a request honored, and/or they had no intentions of honoring this request, I should have been told at a time when I could still negotiate terms (like have a family member present), reject the situation and seek care elsewhere, or even simply give myself more time to recover emotionally from the June surgery. But I was not asked, nor informed of Dr. Collins intentions until all efforts had been made to place me in a position from which I would not feel free to object. By the time Dr. Collins introduced the male resident I already felt drowsy and week, clumsy and the room seemed dark. Given the female resident who stated she had introduced herself while I was drugged in June, given the male who introduced himself to my husband claiming to have spoken to me before surgery in June, and given my memory of what was done prior to the colonoscopy in December, it seems consent for student or other potentially offensive (to the patient) participation is being sought after patients are drugged. In my opinion the consent fails under these conditions and thus this once again, as in the first incident in June, rises to the level of sexual harassment and battery.
Many women experience non-consensual penitration of any sort, including by physicians, as and act of violence. Read what the following woman has to say:
The attached article about doctors parading med students into the OR to practice pelvic exams on anesthetized women without their knowledge or consent is without a doubt one of the most horrifying things I have ever read. I've had three gynecological surgeries under general anesthesia, the most recent less than two weeks ago. The idea that my doctors may have brought packs of complete strangers in to take turns jacking me open with a speculum and then cramming their fingers up me while I was out almost knocked me off my feet. It's been five days since I read this on CNN.com and I have not been able to stop crying and shaking. I've never felt so betrayed in my life. I'm horrified for myself and all the women who have been assaulted in this way by people they thought they could trust, their doctors. This is nothing less than medical rape. Violating a woman without her knowledge or consent while she's completely helpless is practically the dictionary definition of sexual assault. This reprehensible practice is no different than a guy dropping a roofie into a woman's drink at a bar and then having sex with her while she's unconscious. It is rape under general anesthesia. This is the most disgusting, despicable violation of patient trust I've ever heard of. If you can't trust your doctor, who can you trust? Women having gynecological surgery are not "pelvic exam dummies", they are human beings who have the right to privacy and the right to be treated with dignity and respect, and they deserve to be able to trust their doctors. Given our litigation-happy society, this is something I rarely say, but I hope women start suing and I hope they win millions. I have my post-op follow up with my GYN on Monday and if I find out she did this to me, I'm going to have a lawyer in about 30 seconds flat. Even if it didn't happen, I will never again trust a physician to have my best interests at heart. I will never again allow myself to be put under general anesthesia without a friend, family member or someone else I trust to be an advocate for ME in the room. I no longer trust a doctor to behave in that capacity. http://www.cnn.com/2003/HEALTH/03/11/pelvic.exams.ap/index.html
I have read many accounts of such violence against patients, how the patients object and some physicians/students rationalize this practice, while other physicians/students refuse to practice in this fashion. One doctor, who happens to be a personal friend, told me about her own training through practices of "medical rape", how much she regretted that something that turned out to be so harmful to the patient had been done for her own benefit, and how she had been used as a front to get uninformed consent for a parade of male students who were subsequently brought in to follow her exam with a multitude of exams, the first of which was not medically indicated. I also read one account by a patient being forced who said the male student found it so distasteful he refused and left the room. Of course women are not alone. Male patients are abused as well. One man did not go all the way under, and suffered the trauma of 8 students practicing unauthorized rectal exams prior to a colonoscopy. I have read dialogues on medical chat boards between lawyers, whose practice is to defend physicians, trying to tell them not to do this, and physicians responses. Some listen, but others attack personally and without reason to a point where at least one attorney was contemplating crossing over to the other side. The most interesting, however was a male physician/patient who complained when he had told a student 'NO" and yet following the attending's orders the student plunged his finger up the good Doctors rectum before he knew what hit him. This physician/victim agreed, the act of unconsentual penitration is a form of violence, a form of violence that some have come to call, "medical rape". This is why it should only be done in emergencies, not as a means of overcoming the inconvenience of consent or personal rights. There are many professionals who agree and some medical students have even risked their careers in refusing to do unauthorized exams. Therefore, in good company, I maintain the act of anyone male or female examining our cutting on intimate parts of my body and to whom I did not give explicit and specific informed consent to be providing such care, has committed patient battery. Consent to surgery is specific for the surgery and procedures necessary to such surgery by a particular provider, not carte blanche consent to any and all procedures or surgeries any physician may want to perform, including practice exams by any practitioner. 3. In cases where my request for female practitioners is also violated w/o reasonable prior consult and consent it is also a case of sexual harassment. Given this is occurring in a government facility; such actions are a violation of my civil rights.
After the colonoscopy, my rectum hurt more than it should. I took a mirror and looked, it was badly bruised. I called Dr. Collins who had no medical explanation for the physical trauma. She stated that there were no problems with the procedure and no reason for the bruising and pain. I found this very alarming. I asked her had I not made myself clear that I did not want men involved. She said I had, and that she was sorry. I asked her why the "tech" did not leave the room as he said he would. She said she did not know why he did not step outside the door, but that she also heard him say that he would not stay inside the room. I knew I could no longer talk to her without losing it; I thanked her for her apology and hung up. I was angry that after telling Dr. Collins I did not want men, she did what she wanted anyway. I was angry that I had been lied to by Dr. Collins before the procedure. I hate being lied to as it takes away my freedom. I cannot make free choices; I cannot protect myself if I am being manipulated by lies and the concealing of information. Now it was obvious to me I was being abused for the sake of training, and I was still not being told the whole truth about who was doing what to me once they put me under anesthesia. After researching practices at OHSU/PDX V.A., it is reasonable to suspect that Dr. Schreiner was likely not the only male trainee in attendance that day, not the only male who performed a rectal exam, and he was certainly not the only male involved in the procedure.
After the gastric empty study and colonoscopy, I expected a follow-up appointment in the G.I., but had to ask for one. I thought I would be going back to the Dr. Knigge who ordered the test, but the appointment was made with Dr. Collins. I accepted; I wanted to tell her to her face how I felt about what she did. At this appointment Dr. Collins seemed to have no answers to my questions. Honestly one would think she was not there. She acted like she was either not there, or was working hard to bite her tongue regarding the source of the physical trauma. She said that sometimes a physician will forget to uncurl the tube before pulling it out; but did not say this happened, and she said the bruising pattern would have been different. After this appointment, Dr. Collins wrote in my notes that she had informed me that the male tech would be involved in the procedure. This is a lie. She said nothing about the tech. (This was my first indication that he had been involved beyond polyp delivery to lab.) She introduced the fellow, told me he would be doing the procedure, and then the "tech" Mr. Miller introduced himself, and said he would be outside the door only to retrieve and deliver polyps to the lab. Dr. Collins did not introduce this man, nor did she say anything to me about Mr. Miller. In spite of saying he would leave, he remained in the room and participated in the procedure. Was this 'tech" even qualified to have his hands on the tube? Did he commit the error Dr. Collins described? In 2004 a colonoscopy plus upper G.I. (w/three folks involved) took 20 minutes in Roseburg for both procedures. It took four people over twice as long to do this colonoscopy as it did three people to do two procedures, a colonoscopy and upper G.I. in 2004, and in 04 there were more polyps removed. Why should an uneventful colonoscopy in PDX take 45 minutes? Was my health being risked for the sake of training multiple students? More students seem to have been involved in the June surgery than I had been informed of before or after the surgery, and physical symptoms support this suspicion. A physical exam by another physician revealed fissures and a "butter fly shaped" infection that seemed to be concentrated on only one side of my rectum. This "infection" was very painful, itchy, and took it's own good time getting better.
After the colonoscopy, I decided I should take a closer look at my medical records. This is when I found Dr. Shabnam Chaugle, was named as the surgeon for the mastectomy, and noticed all the men that had been involved in my care while I was under anesthesia in June. Dr. Kwong had straight up lied. In spite of her reassurance there were no men, "on the team", there were men all over me. The records I was given upon request name who was involved in prep before each surgery, and the surgical count named Ronald Gschwend, and one Jeffery Hoke who replaced a female anesthesiologist just before the mastectomy and was in charge of my care after the surgery while I was still under the influence of sedation. While not in the records I was given, according to a person with insider access to V.A. records, a Gregory Adams was listed as the surgeon in the records accessed, and Donald McConnell as the attending. I will try again to access these records, but would not be surprised if the records are changed. Still, McConnell explains the mystery "Chief of something" who spoke to my husband, so I am convinced the source was not misreading the records. Dr. Kwong has since claimed this was a "chief resident" who thought he would be doing the surgery with her, but because I said, "no males" he was not there. This story is not very strong in light of the fact that I had indicated no males on the 15th, and he claimed to have "talked" to me when he talked to my husband. Dr. Chaugle has refused to return my calls asking her to confirm the, "no male" story Dr. Kwong tells. She did call Dr. Kwong to express concerns. As a result of these deceptions on two different occasions, I now have no confidence in male or female physicians. The V.A. web site claims that women do not use the V.A. due to ignorance of availability. Women do not use the V.A. due to fear of this sort abuse. In a recent news article Jan Buchanan, a women's veterans program manager for the VA's Puget Sound Region said, "A lot of women are reluctant to come into a hospital," said . "It seems too military to them... They fear they might see their perpetrator." No, we are more afraid of finding a new one. The V.A. preferences male vets and thus seem to have a lot of male nurses, CNAs, etc... some are downright creepy. Many women veterans myself included have suffered prior sexual abuse by medical professionals in military hospitals. We move on with our lives, but have learned to be careful of male doctors, nurses, etc... ; then the V.A. subjects us to conditions that are not only offensive and intolerable (male care under anesthesia) but risks triggering PTSD symptoms, and places women in danger of repeated sexual assault. These events have left me incapable of thinking about having to once again go under anesthesia, have grossly intensified the mental trauma associated w/the mastectomy, and more.
It was obvious they had made no effort to consider my expressed need for females, for dignity, autonomy, privacy, and security. I would NOT have consented to male participation had I been told. I DO NOT WANT MEN AROUND ME WHILE I AM UNDER ANESTHESIA. Furthermore, I was much more worried about the mastectomy than the oophorectomy. Had anyone bothered to ask; I would have said yes to the two OBGYN physicians, and only those two WOMEN. If asked, I may have approved of two more female students performing practice exams prior to sedation, no more than two, not while under sedation, and no men. NO MEN!!! Not observing, not participating. I absolutely did not want men around me while I was having my breast severed from my body, having GYN surgery, and certainly did not want them participating in the process. The V.A. knew this and rather than respect me, my autonomy, my rights, they lied. They made no attempt to limit male participation, only to hide such participation. This is a perfect triangle of abuse; the perpetrators, the silent partners, and the victims.
Not only is this a failure of "informed consent", and a case of battery, as the V.A. is a federal institution, it is a violation of my civil rights. Dr. Kwong had a duty to inform me that she would not be performing the surgery. The consent forms (signed in advance, though I now suspect they have other forms they have you sign after you are drugged) make it sound like the "resident" is getting the consent for the physician to do the surgery. In my case, a woman was the resident who attained the consent, Michelle Ellis. Michelle is the resident I thought would be assisting Dr. Kwong and helping with post surgical care. I did read the forms (presented as consent on the 16th two days before surgery), and the consent form being a bit obscure asked questions. (It would take an attorney for a patient to know they were signing a consent for anyone to do the surgery and for multiple unnecessary intimate exams, and then they would argue over what such general language really means.) I asked Michelle Ellis, and again I was told Dr. Kwong was doing the surgery. She said the clause I was asking about only referred to students assisting Dr. Kwong, and she rattled off a few of the sorts of things they might do; none of which included cutting or exams. This is the point at which I think I wrote 'NO MALES" on the consent form. This misrepresentation violates the patient's right to rely without reservation on the belief that her doctor will act only to protect her body, dignity, and safety, and not expose her to unnecessary risks without her knowledge and consent. If Michelle is present in O.R. she is there as a unidentified student. As students are not listed in the records to which I have access, I have no idea how many male students, staff, may have been in attendance during these procedures. I only know there were men present and participating, some are listed in the medical records I was provided and some are not. I have managed to secure anesthesia notes that prove Jeffery Hoke was there through the mastectomy and took charge of my care after.
Given the prevalence of this practice of not telling patients that the surgeon they think will be operating is only supervising (which may or may not mean they are in attendance), of failing to introduce patients to residents, students, or trainees, who will be performing exams and/or procedures, given what I have learned about teaching hospital practices in general, and OHSU/PDX practices in particular, given an infection in my pelvis after the first surgery, and the trauma and infection in my rectum after the colonoscopy, there is reason to suspect that teams of students, were not only observing but performing unauthorized exams such as breast, pelvic, and rectal exams while I was under anesthesia. This sort of bait and switch and mass participation, unrestrained by informed consent and empowered patient control, has not served my medical or psychological health. Furthermore, it places women at greater risk of sexual misconduct while under anesthesia by establishing a culture in which women's autonomy is meaningless, in which women are not self determining subjects, but objects to be subjected to the will and interests of others, all while women are the most vulnerable, completely incapable of defending themselves. To leave a woman under anesthesia in the care of a male is endangerment. To engage in such practices and then leave a woman under anesthesia in the care of a male or men, well that is downright stupid and abusive. 4.
It is hard enough for a woman to go through a mastectomy, some may not mind male participation, but for others, to have unwanted males involved is stressful, even scary, to do so without informing the patient well ahead of time and in an appropriate fashion is abusive, violent, and harmful. I cannot say I did not know this was a teaching facility; but I certainly did not know they would not inform me of, even conceal the extent of, student and/or male participation, that they would violate my autonomy and civil rights. All autonomy, all dignity, all subjectivity was stolen. I am very upset that a woman in this day and age with all the female practitioners cannot go through a mastectomy, oopherectomy, or colonoscopy without the security and peace of mind knowing that men will have access while she is under anesthesia. I have been assured (by the patient advocate) no man in the V.A. would take advantage in a situation where a woman had been dosed with a date rape drug or other anesthesia, where he could expect to get away with it and no one would know. Excuse me if I do not buy the B.S. This is exactly what these Doctors seem to be doing, taking advantage while patients are under anesthesia, to substitute patient informed consent, patient autonomy with their own will and intesrests. My requests for male absence during these procedures was not unreasonable. Statistics for rape are horrific. 10% of males admit that they find extreme violence (with little sexual content) against women erotic (A good reason not to want males present during a mastectomy.), and half find rape erotic (a good reason to oppose practice exams while under anesthesia or male involvement in intimate exams, many of these men must find this "medical rape" errotic.) 60% of male college students asked said they would rape if they knew they could get away with it, and the Military culture is known for being abusive of women from recruitment to the V.A. 5 (All good reasons not to want males providing care while under anesthesia.) Male physicians are also not somehow divinely above other males. I have read, but have not been able to verify the research source that, male physicians are twice as likely to sexually assault a woman than the general population of men. If true, access within a rape culture is likely the reason why. I have had two women in the V.A. system ask me, "do you really think that if you are left with two men, they might conspire to do something and neither tell?:" The answer is definitively YES. Only 50 % of male and 58% of female physicians agree that all suspected cases of sexual impropriety committed by other physicians should be reported. 6
While patient advocacy compared my opposition to male involvement in such procedures to racism, the analogy is not a valid one. Asians do not go about systematically abusing and raping white men. Asian care providers are not members of a population that is a real and current threat to any other demographic; male care providers are members of a population that remain a threat to women. Women are sexually assaulted by male care providers every day. Within the military culture the chances of abuse are even higher.
* A 2003 report financed by the Department of Defense revealed that nearly one-third of a nationwide sample of female veterans seeking health care through the VA said they experienced rape or attempted rape during their service. Of that group, 37 percent said they were raped multiple times, and 14 percent reported they were gang raped. 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.
link to www.dissidentvoice.org
Yet the PDX VA staff and OHSU faculty involved did not consider my feelings enough to talk with me, introduce, and try and negotiate student involvement. They simply sedated me and did as they pleased. These instances of concealment and blatant disregard for my very clearly expressed feelings regarding males participating in my care amount not only to sexual harassment, medical battery, and a violation of my civil rights, but, given stats above, also endangerment. I had a right to exclude men from a surgery the likes of a mastectomy and oophorectomy, and procedures the likes of a colonoscopy. If OHSU/PDX V.A. could not or did not want to respect that, I should have been told right away, by Nancy Sloan. At that point I could have freely chosen to seek care elsewhere, chose alternative care, tried to negotiation something I would be comfortable with at the V.A. (Such as family member presence by my side at all times during anesthesia, meeting all students to be present and limiting the number of males.), or even exercise my right to refuse care all together. In fact I had asked OHSU (where I had refused student participation) about Champ VA coverage and was left thinking that I would have to cover 30% of the total bill, not just the $500 cap that is my current understanding of my costs. It was my understanding that this is why they refused to treat me and sent me back to PDX VA. As they accept Champ VA one would assume they have agreed to the fee schedules, and thus the only reason I can see for sending me to PDX VA is to gain greater student access with less legal risks. (I found out that OHSU is sued on average of 23 times a year, and earn more than they get.)
These physicians have caused me grave psychological trauma and inflicted unnecessary pain and suffering. This is a breach of Dr. Kwong's and Dr Collin's fiduciary duty in relationship to me and my health care. The entire V.A. staff and especially the physicians had a duty to do all that was necessary and reasonable to ensure I made it through this tragedy with as little physical and mental health risk as possible. If that was not their top priority, if my dignity, autonomy, health, was to be subordinate to education or the whims of Chief of Surgery, they should have informed me that their primary interest was their own, allowing me to seek more patient friendly care elsewhere. This breach of the special doctor-patient relationship in favor of other interests has lead to a complete and total loss of trust in medical professionals and has caused me much, pain, distress, humiliation, and may have resulted in a sexual assault w/resulting STD. Hear me out.
After the bruising went away, the pain subsided a bit then came back worse. I went for an STD screen (western Blot), it came back positive for Herpes 2. I was told this was a good test (Western Blot) and the chances of a false positive were very low. My partner with whom I have been in a monogamous relationship for 20 years, subsequently tested negative. I had a pap done in Feb of 07. I was told by a man in Pathology that "I did not have HSV then, and I do not have it now." If not exposed by Feb of 07, the most likely exposure came from the V.A., through improperly sterilized temperature controlled equipment, or sadly sexual assault while under anesthesia.
While Dr. Dryden claims I was attended to by the female nurse until I became "alert"; this is insufficient to ensure a lack of opportunity. "Alert" does not imply recall. My first memory is back with my husband both times after anesthesia, in June and December. I did not remember transport, which does not occur until you are "alert", according to charts. The medical records provide evidence that at times males have been involved in pre-surgical prep, intimate exams and procedures, and after care while still under anesthesia. I have discovered this much in spite of efforts to hide male involvement. Odds are there has been further male involvement which I have been unable to uncover.
The "flag" referred to by the V.A., according to Dr. Collins, supposedly states "don't even ask". After much research, I am now well aware of the "don't ask, don't tell" training practices used by OHSU faculty on "public" patients. This seems to be exactly the practice Dr. Kwong/Dr. McConnell employed when he stepped in with Dr. Adams, and Kwong lied before and after surgery about who was present and involved. I have every reason to believe that I will be lied to and my requests ignored should I once again find myself anesthetized by PDX V.A. I can have no confidence in what I am being told by people who I know as a matter of practice mislead, misinform, obscure truth, and outright lie, all to manipulate patients, by people willing to secure UNINFORMED consent after administering mind and/or mood altering drugs.
Under these conditions of deception and prioritizing physician education over patient health and safety, how can I even have confidence that I had cancer? OHSU/PDX VA needs to train students, OHSU faculty at PDX VA have demonstrated that teaching is their priority over and above veterans' health and well being; OHSU is in control of both imaging and pathology upon which diagnosis is based. Pathology is not an exact science, and OHSU has a strong incentive to diagnose female veterans with breast cancer as they can train students on us without the risk and liability they suffer at OHSU. In September of 2007 I rec'd a letter from Nancy Sloan telling me my mammography at OHSU had turned out OK. I called her to let her know that was not so good as I had a mastectomy. She checked it out and said that it was the MRI of the right breast the letter referred to, but the letter did not say MRI it said mammography. I would have, and did at the time, just assumed this was an innocent error; but now, I realize I can never assume innocence concerning OHSU/PDX VA. (I checked the stats. Female Veterans are twice as likely to be diagnosed with breast cancer as women in the general population. Why? Are they just twice as likely to be diagnosed? Or, have they suffered some Military specific exposure, in which case breast cancer should be recognized as a service connected condition?)
As OHSU expands it teaching operations to all Oregon V.A. facilities, as all V.A.s across the country become teaching outlets, abuse will also expand. As the V.A. allows teaching institutions access to all V.A. facilities, as all Veterans suffer a heavier burden of training medical students. If nothing is done to protect them, female vets will be super exploited. Being in short supply relative to the demand for training opportunities in female specific care, women will suffer a greater number of practice exams and a greater number of student errors. In the absence of informed consent as a limiting or controlling factor female veterans who seek V.A. care will suffer a greater risk of battery.
While some physicians claim that unauthorized exams and ghost surgeries are necessary to education as no one would consent to student care; research indicates this is simply not the case. Research shows that 87% of patients when asked will allow student participation in their care. In one study only 12.5% of women and 15% of men declined any medical student participation. 6 Most will want to negotiate numbers, such as limiting the number of students who can perform pelvic or rectal exams; some (about 50% of the women) will want to negotiate gender specification for intimate procedures. Most will want information about the level of supervision and student participation. This is a patients right, and research indicates time after time patients prove to be amazingly generous. Patients have proven to have more confidence in the students than the students do in themselves, and when included in the process as a subject rather than an object patients can offer highly constructive feedback. It is not necessary to teaching residents in a surgical setting to employ sexual harassment, deception, manipulation and even a form of battery some, including this patient, have come to call, "medical rape". In terms of practice exams (which require a high volume of student training), if there are not enough willing patients, such exams can be performed on paid subjects, called "standard patients" just as models are paid in art classes. There is no excuse for gang banging an anesthetized patient with numerous students. Medical schools may need to expand their pool of patients served and be more willing to ask every patient (not just the "public" patient) to participate, spreading the burden out over a reasonable number of FULLY informed consenting patients. In cases of surgery, the physician and student may have to take some time with the patient. The student may have to take the time to get to know the patient and provide some amount of care for the patient prior to surgery. In the end this has to be the patients free, (not a coerced, manipulated, and selectively informed even misinformed) choice.
What needs to be done:
I want full and complete disclosure as to who was present during, who performed exams, and who participated in these procedures. I had a pap February of 2007. The slides are on file at PDX VA. Per instructions for me to, "go through proper channels", my physician Dr. Margaret Philhower, ND, PC has requested these slides. She sent a copy and I faxed a copy to PDX VA myself, called and was told the request has been sent to pathology. I want these slides surrendered for an independent test for HSV DNA and antigens. If this test is negative indicating I had not been exposed prior to February of 07, I would like for all staff involved in my care while under anesthesia be tested for Herpes 2, as well as the patient the colonoscopy equipment was used on prior to me. I would like video of relevant hallways, recovery room, and O.R. while I was in their care to be reviewed to ensure that all who had access are identified and tested. Those who test positive should be tested further for the particular strain, which could be subsequently evaluated for a match with my infection. If a match is found, the means of infection may need to be investigated. If sexual assault is indicated, I want full cooperation from the V.A. in seeking all evidence and information required for an effective prosecution. Either way, if this bait and switch and inclusion of male residents was Donald McConnall's call, and as Chief of General surgery one would assume it was his call, he should be forced into retirement for violating my civil rights, patient battery, sexual harassment, and (as I was left in the care of at least one male while under anesthesia) endangerment. He should also be charged criminally. By stepping in and taking over this surgery, knowing full well I did not want him and other men involved, this man has proven his willingness to, perhaps even passion for, committing female patient battery. He should be removed as Chief of General Surgery at PDXVA. The man is 66 years old. It is time he retire and a younger person pave the way for a new way of doing things for a new wave of female veterans many who have suffered greater military sexual abuse that my own generation. Given all the deception (which they like to call a "missunderstanding"); I cannot know for sure who all may have been involved in any of these procedures.
I would like policy regarding informed consent be changed. I have enclosed a copy of The American Medical Student Association's, "Principles Regarding Patient Rights", as well as, a "Draft of Proposed Legislation Concerning Informed Consent and Medical Accountability", by Eileen Marie Wayne, M.S. 8 ALL consent forms should be presented at least 48 hours before surgery, and ALL participants and any student exams revealed and explained verbally and in writing at that time. The patient should be sent home with copies of these forms to read and a number provided should they have questions. The goal should be full disclosure, not tricking, manipulating, or deceiving a patient. When a woman indicates in any way she is not comfortable with males participating in her care, staff should immediately ask questions necessary to record in detail patients limitations on male participation and then those limits should be respected save an unforeseen emergency. If undesirable male participation will be hard to avoid, or in a particular case not in the patients best interest (as would be the case that a particular staff member is the only one well trained on a particular procedure) the patient should be informed, introduced to the male and honestly told in full the extent of his expected participation and why she is better off in his care. While a heads up and explanation by a female ahead of time would have been nice, one man who performed my pre-surgical sentinel node mapping, either sensitive to my discomfort, or to women's discomfort in general, informed me that he was on the team that invented the procedure being done, had done it on hundreds perhaps thousands of women. He was good, professional, and had an excellent "bed-side manor", he was not severing my breast from my chest, or poking around orifices, and most important, I was not under sedation. Not a problem. Though I do not think this should be assumed for all women. Some women will need ALL female care providers and the V.A. has a responsibility to provide such for women who have suffered MST, just as person with their leg blown off should be provided a prosthesis. When this is not possible a woman should remain by her side for assurance and comfort.
What I am personally opposed to, is not being able to control male participation, from restrictions to prohibitions depending on the care being provided, whether or not I will be sedated, and the hit I get off those participating when introduced. I am opposed to being lied to by my medical providers, confidence in whom is of utmost importance. This is a reasonable request being made by a reasonable woman.
According to the, "Principles Regarding Patients' Rights", published by the American Medical Student Association, www.amsa.org/about/ppp/pr.cfm, Patients have the right to choose whether, how, and under what conditions to participate in training of medical students. However, "in many cases permission is sought at the last moment, making it difficult to refuse." It seems, in some cases a "better to ask forgiveness rather than to ask permission" strategy is employed. In others a "don't ask, don't tell" policy is used. The AMSA suggests a patient, should be told when the appointment is made and given all information necessary for consent to be informed including status, experience level, supervision level, and sex. 9
1. (see http://www3.interscience.wiley.com/cgi-bin/abstract/112721174/ABSTRACT?CRETRY=1&SRETRY=0 )
2. link to books.google.com
3. NON-CONSENSUAL PELVIC EXAMINATIONS
"Using tort law to secure patient dignity" Assoc of trial lawyers of America. http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1060&context=fac_pubs
Autonomy Suspended: Using female patients to teach intimate exams without their knowledge or consent by Robin Fretwell Wilson, http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1009&context=fac_pubs
Are Med Students Practicing on You?, By: Suz Redfearn, Mens Heatlh10. http://www.entrepreneur.com/tradejournals/article/87455710.html
5. About 10% of the population of male students are sexually aroused by"very extreme violence" with "a great deal of blood and gore" that "has very little of the sexual element"(Malamuth 1985, p.95)
356 male students were asked: "If you could be assured that no one would know and that you could in no way be punished for engaging in the following acts, how likely, if at all, would you be to commit such acts?" (Briere and Malamuth, 1983). Among the sexual acts listed were "forcing a female to do something she really didn't want to do" and "rape" (Briere and Malamuth, 1983). Sixty percent of the sample indicated that under the right circumstances, there was some likelihood that they would rape, use force, or do both. (Other research has shown this 60% figure to be amazingly consistent.)
"Some people dismiss the findings from these studies as "merely attitudinal." But this conclusion is incorrect. Malamuth has found that male subjects' self-reported likelihood of raping is correlated with physiological measures of sexual arousal by rape depictions. Clearly, erections cannot be considered attitudes. More specifically, the male students who say they might rape a woman if they could get away with it are significantly more likely than other male students to be sexually aroused by portrayals of rape. Indeed, these males were more sexually aroused by depictions of rape than by mutually consenting depictions. And when asked if they would find committing a rape sexually arousing, they said yes (Donnerstein, 1983, p. 7). They were also more likely than the other male subjects to admit to having used actual physical force to obtain sex with a woman. These latter data were self-reported, but because they refer to actual behavior they too cannot be dismissed as merely attitudinal."
Rape Nation, By Kari Lydersen, for AlterNet, July 2, 2004.
7. Arrogance, Abuse, Fraud, and Medical Malpractice: How Some Physicians Beg for Lawsuits
8. Draft of proposed legislation concerning informed consent and medical accountability
9. Principles regarding patients' rights.
Health is harmed when rights are violated.
VA uses unsupervised residents and other practices that would not be accepted elsewhereBy JOAN MAZZOLINI, THE PLAIN DEALER Cleveland, Ohio Sunday, January 28, 2001
Cc: Peter DeFazio
House Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, D.C. 20515
or fax your letter to: (202) 225-2034
or call: (202) 225-9756
Other interesting links and notes
However, patients were likely to express a preference when a genital or rectal examination was involved. Weyrauch et al2 found that when men expressed a preference for physician sex, almost all requested a male. Heaton and Marquez3 found that 39% studied would request a male physician, 12% indicated that they would refuse a female physician, and 2% stated that they would request a female physician for a genital examination.
Physicians are in the position to deliver health care information that is valued by adolescents.23 When adolescents are satisfied with their physician, they keep appointments more consistently.24 The recommended frequency of genital examinations for male adolescents will be attained more easily when physicians are sensitive to sex preference.25 Based on these preliminary findings, sensitivity to the physician sex preference of male adolescents may be an important factor of a successful health care interaction. Future studies should investigate how the ethnicity of male adolescents and fear of a same or opposite sex examiner moderates clinic attendance.
Female physicians experience intense sexual harassment to the point of some pointing to this as a reason for high suicide rates amoung female physicians. http://womensenews.org/article.cfm/dyn/aid/2167/
link to www.washingtonpost.com
Hospitals ignore such behavior
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