Students allegedly performed gynecological exams on unconscious patients

Health Ministry appoints 7-member c'tee to probe report that students were told to perform exams without patients' permission.

Health Ministry director-general Prof. Avi Yisraeli has appointed a seven-member committee to look into medical students' involvement in physical examinations in operating theaters, following press reports that 14 unidentified students said they were told to perform gynecological examinations of female patients under anesthesia without the patients' explicit permission. The panel, to be headed by Tel Aviv University's Sackler Medical School deputy dean Prof. Anat Loewenstein, was sparked by front-page "exclusive investigations" that appeared in both Ma'ariv and Yediot Aharonot on Thursday. The Yediot reported that 14 medical students filed complaints with the ministry over the past few weeks, but ministry associate director-general Dr. Boaz Lev denied this, saying no one had heard of the issue until it was discussed at a meeting held with medical school deans at Tel Aviv Sourasky Medical Center on Wednesday. Neither Lev, the deans of the four medical schools, nor the heads of the hospitals queried by The Jerusalem Post knew of any case in which women under anesthesia were examined by medical students called into operating theaters to perform gynecological examinations for teaching purposes without the patients having given their informed consent. The Hebrew dailies did not state what medical schools or hospitals were involved. The Post learned that Ma'ariv started working on the story more than a week ago, but that when Yediot Aharonot learned of it on Wednesday, it hurriedly sent reporters to report on the issue. A directive issued by Yisraeli in July 2005 to all hospital directors and senior health fund officials stated that while medical students must participate in clinic and hospital procedures so they can learn the profession, the patients' rights to privacy and dignity are primary. The heads of all medical units must inform every patient that the institution serves also as an educational facility for students. This must be made known with a large poster in a prominent place or in an information leaflet handed to every patient. The patient must also be informed that he or she has the right to refuse the presence or involvement of medical students in examinations, without the patient's treatment being jeopardized. When students are involved, they must be presented and their status identified before the patient, Yisraeli wrote. A medical student may perform an examination only if the supervising doctor is also present, he added, and the patient may ask that a third party (relative or friend) be present. The number of students in the room at any one time must be minimized. If the patient is a minor, helpless or unconscious, a medical student may perform an authorized examination only when a parent or a member of the medical team is present. The Health Ministry's statement on Thursday said the committee, which includes doctors from two medical schools, the ministry's public complaints commissioner and a lawyer, will look at what is accepted around the world and what medical students are currently doing with patients, and recommend ways to explain to patients what is involved and of getting their consent. One senior gynecologist told the Post that when he learned his specialty, no medical student performed gynecological tests on anesthetized patients in an operating room, rather they were allowed to examine women in outpatient clinics after they gave their specific consent. He knew of no such cases of unauthorized examinations today, and said that if they occurred, it could be considered assault, a violation of the Patients' Rights Law and even "rape." The Israel Medical Association said that as a result of the publicity, its ethics bureau would hold a discussion on examination of patients under anesthesia by students. The Hadassah Medical Organization said it has its own form that it gives to everyone when hospitalized that states clearly its hospitals are teaching institutions and that medical students are part of the examination process, but that they are obliged to preserving the patient's dignity and privacy. The patient is not required to sign the document, which says that a signature allows medical students to participate in procedures before surgery, whether the patient is conscious or not, only if a physician is present. Prof. Ido Perlman, dean of the Technion's Rappaport Medical Faculty, said he has never heard of a case such as that claimed by the newspapers. "If students in any medical school were involved in such cases, they should have complained immediately to the faculties. We have not received any complaints," he said. Prof. Yossi Mekori, dean of TAU's Sackler Medical Faculty, said that "once the patient's explicit consent is given, students who are part of the medical team before the patient is operated on may perform an examination under a doctor's supervision, as part of their medical education. But students who were not involved in the patient's care may not suddenly be invited into the operating room to examine the patient. I have spoken to dozens of our medical students in the last few days, and no one knew of such a case."