Incidence of sexual abuse within health care is estimated to rival levels found within the church and other major institutions, but people who are sexually abused by doctors and other health care workers within the context of health care are faced with many unique barriers that are not present in other settings. Some of the barriers include difficulties distinguishing what constitutes sexual abuse, a decreased ability to prevent sexual abuse from occurring, and a lack of support and justice for instances when sexual abuse has taken place.
Recognizing sexual abuse
Recognizing sexual abuse within the context of health care can be difficult. It can be difficult to distinguish between health care and sexual abuse when routine examinations involve genitals and other sexual areas of the body. But it is the very nature of these exams that places doctors and other health care workers in a privileged and unique position to disguise sexual abuse as something else. For example, doctors are able to perform exams such as vaginal/rectal/breast exams when they are medically unnecessary, and to then defend their actions by claiming they were being “thorough”, or that they were done for the woman’s own good. And it can be very difficult to prove otherwise except in rare instances. For example, Dr. Stanley Chung was brought before the College of Physicians and Surgeons on allegations of frequent and unnecessary rectal and vaginal exams on women, some of whom were virgins.
It can also be difficult to determine when the line from appropriate behavior to inappropriate behavior during an examination has been crossed, especially if the sexual act is subtle. For instance when the doctor’s hand brushes against a breast as if by accident, or the doctor’s fingers linger a bit too long inside the vagina during a bimanual exam. In these instances the woman only has her hunches and instincts to support her suspicions. In other cases it is fairly obvious when the line has been crossed, such as instances where it is obvious that exams are not medically necessary. For example, a commenter on this site stated: “When I was thirteen my mom suspected I might have a kidney infection and took me in to see a urologist. He told me to cross my arms over my head, held my arms down, removed the paper shield and did a breast exam on me while I was fighting against him.” April 4, 2013 at 4:23 pm Clearly a thirteen year old girl would be considered as not being at risk of breast cancer. Another example is the court case of Wasserman versus Ms. Gugel:
Ms. Gugel alleges the doctor took her into an examination room and sexually assaulted her upon the conclusion of his “consultation only” appointment. The doctor claims the alleged sexual assault was actually part of a legitimate medical examination, even though he had already examined her the previous day . . . The doctor also contends the alleged sexual assault was part of a legitimate examination despite his not wearing examination gloves, his smelling his finger after using it to touch Ms. Gugel’s vulva and inserting it into her vagina, and his subsequent sexually harassing phone calls to Ms. Gugel, which were recorded.
Preventing sexual abuse within the context of health care can be difficult. Many women have the reasonable expectation they will be able to trust their health care providers and sexual abuse is not something that is likely to be on a woman’s radar. However, even when distrust of a health care provider is present, the lack of informed consent involving intimate examinations provides little opportunity for a woman to avoid them. In fact, the current situation in women’s health allows for coercion to the point of bullying and the withholding of medications and other health services when women wish to decline pelvic exams/pap tests/STD testing. The power imbalance that is already present in the doctor/patient relationship becomes even more pronounced when a woman feels pressured into invasive exams or is unaware she has the right to say ‘no’, and the opportunity to prevent sexual abuse becomes extremely remote. In addition, the coercion that is the norm in women’s health care allows increased opportunity for predatory behavior and sexual abuse on the part of doctors and other health care providers.
Lack of support and justice
The effects from having been sexually abused by someone in a position of trust can be devastating. Dr. Gerald Monk, a professor at San Diego State University, states “Patients can feel especially violated in the context of health care. Not only do patients anticipate being safe and secure, they expect to be healed. Following an adverse medical event, a patient may experience a lifetime of heartbreaking anguish and suffering.“ Juan Mendez in his work with the Human Rights Association compares some unnecessary medical procedures to torture and states, “medical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is state involvement and specific intent, it is torture.“
Some women who have been sexually abused by a doctor are not even sure what to call it, and in fact sexual abuse when committed by doctors is assigned special terminology and renamed as “medical misconduct”. When some women attempt to seek help they are often met with a white wall of silence and discover that denial and persistent altercation of the facts are prevalent. Sanda Rogers, University of Ontario law faculty, in her discussion of failed promise of reform regarding sexual abuse by health care professionals, states: “Patients report abuse. The evidence is there, as is the evidence that abuse is seriously under reported. The legislation provides the health disciplines with the tools necessary to respond to the abuse perpetrated by some members. Instead, the College of Physicians and Surgeons and other Colleges, have failed to ensure that complainants are provided with the support necessary to assist them to survive the process of complaint, investigation and hearing. The drop off rate on complaints by the CPSO, and by other Colleges, is such that almost no complaints and few complaints of sexual misconduct and abuse proceed to a full hearing. Each stage of the process favors the professional and undermines the complainant.” Sanda also states that complainants who were interviewed by the College members found the complaint process “an amplification of an already traumatic experience“.
As a result, doctors and other health care providers are often left free to continue abusing for years even after complaints against them are made. Dr. Alan Cockeram and Dr. George Doodnaught are just two examples of cases where many women filed complaints and they were ignored.
Sexual abuse under the guise of health care presents many barriers and can have devastating effects. Sanda states that “Abuse in the guise of care, enabled by professional status, access and patient vulnerability and dependency, is an insidious and terrible breach of trust and an unconscionable and violent abuse of power and authority“. Women are often placed in positions where they are vulnerable and left with limited resources to protect themselves from sexual abuse by health care providers. The women who have been abused and who find the courage to complain are often led through a process that often only fails them. In addition, women who have been faced with such experiences are left in a place where health care can be viewed as a threat to their personal safety and psychological stability. In other words, these women are left to cope in a society where health care, for them, does not exist.