Child sexual abuse in a medical context

If your child is at a teaching hospital, consider how often it’s okay for doctors to come in and show your child’s body to others.

Child abuse (illustrative) (photo credit: INGIMAGE)
Child abuse (illustrative)
(photo credit: INGIMAGE)
Many of us automatically view the medical professionals we turn to in times of need as infallible and trustworthy. They are rightly held in the highest esteem for their specialist training, challenging work and ability to save lives.
However, people are increasingly recognizing the need to be mindful of child safety, even when it comes to visits to a doctor or dentist as well as when children are hospitalized.
“Even though we’re currently facing a crisis of child sexual abuse in Israel, when it comes to cases of sexual abuse by medical professionals, we’re actively involved in fewer than 20 cases a year,” says abuse expert Debbie Gross, founder and manager of Tahel, the crisis center for religious women and children.
“Many more cases go unreported, partly due to the doubt that plagues patients (or their parents) if what they experienced was abuse or a necessary part of the procedure, or simply out of fear that they won’t be believed.”
“Parents need to make sure that they are aware,” says Gross.
“In the doctor’s room, they have final say and need not acquiesce to anything that they are uncomfortable with. They can change to a different practitioner at any point.”
According to Gross, even when an attitude of respect is appropriate, parents need not hand over trust unequivocally – even when the medical professionals come highly recommended, wear a kippa, or go out of their way to help (there are many reasons people may forgo caution).
“Always trust your intuition.”
Fortunately, there is burgeoning consciousness in all sectors of Israeli society, due in part to the tireless work of Tahel. In addition to spearheading a recent revolutionary conference in Jerusalem confronting violence and abuse in the Orthodox community, Tahel offers a national 24-hour crisis hotline; personal support and advocacy; professional training to rabbis, teachers and educators; policy design and implementation for communities, schools and synagogues; as well as abuse prevention workshops.
Choosing a medical professional
When choosing a doctor or dentist, Gross advises selecting someone you can have an open relationship with.
“Discuss with the professional upfront what their philosophy is on the parent being in the room during the check-up and treatment,” says Gross.
This varies according to the age and gender of the child and the procedure involved, but Gross recommends remaining in the room, even if separated by a screen for privacy.
Another question is how to respond when circumstances arise in which the physician does not want the parent in the room, for example when a child is difficult to treat with the parent in the room. In such cases, Gross advises ensuring that there is an assistant or technician with the child at all times.
Gross suggests showing up early to get a feel for how the practitioner works.
“Keep watch!” Apart from the yihud issue (the religious prohibition on being alone with a member of the opposite sex), “the rules protect both sides,” says Gross.
Long-standing Jerusalem-based dentist Dr. Ari Greenspan agrees.
“It’s not a good idea for any practitioner to treat someone alone, for the sake of the patient as well as the practitioner,” says Greenspan.
“In difficult-to-treat cases, it may be necessary to tell the child that if they don’t cooperate, the parent will need to leave the room. It is a difficult dance between what the practitioner feels is right for the patient and what the parent wants. Though it is the parent’s right to insist on being in the room, the practitioner has the right to say they cannot treat the child under the circumstances.”
In such cases, Gross suggests that the parent keep watch that the door is left open for full transparency, to make sure the technician remains in the room, and so the practitioner knows the parent can walk by at any time.
“Dentists also have an important role in observing and identifying abuse,” says Greenspan. “Signs may be apparent in the mouth, as well as on the head, face and neck. Also, since dentists see patients for many years, they may notice behavioral or other changes.”
Red flags
According to Gross, worrisome behaviors from a practitioner include coming too close unnecessarily, and tickling or poking without asking permission from the child or parent first.
“There are ways other than touching to communicate and make a child feel more comfortable. By the time a child is seven years old, there should be no touching without asking for permission.”
Gross cautions against a doctor who asks the child to totally undress when it is not a complete physical or who touches unrelated body parts without explaining. Other warning signs include the practitioner asking the child inappropriate personal questions, or using sexual language around the child or parent.
“It would ring warning bells for me if the doctor insists that the parent need not accompany their child, or if they offer to drive the child home if the parent makes the last appointment,” warns Gross.
“These are serious boundary issues.”
According to Gross, many cases of sexual abuse, rape and molestation take place in hospitals, either by doctors or by people pretending to be doctors.
“No woman or child should be left alone in a hospital during the day or overnight,” insists Gross.
“There should always be an adult in the room. Always accompany your child to the bathroom.”
Gross advises trusting your feelings in a situation, and in cases where a child may be required to have an exam without you in the room, e.g. an X ray, make sure to accompany the child right to the door.
“A predator would more likely to wait for a child whose parent is not waiting right outside.”
If your child is at a teaching hospital, consider how often it’s okay for doctors to come in and show your child’s body to others.
Educating ourselves and our children
Getting informed, educating our children and being involved in their lives is something we can do to keep our children safe. Studies show that predators prey on children who know them well, who are naïve or are going through a crisis and don’t have a strong support system in place.
“Make sure not to send children (even 17-year-olds) alone to the doctor or with just a sibling, even if the sibling is 17 years old,” suggests Gross.
“Always accompany your children – especially if they will be under anesthesia.”
Cultivate a close relationship with your children. Get in the habit of having them share their day with you. Ask targeted questions and teach your child they can discuss anything with you – even if it’s uncomfortable or you’re not going to like it.
Before chatting to them directly (and regularly) in an age appropriate way – from around age three – you can talk about general safety, e.g. crossing the road and fire safety.
“The conversation should be light, loving and caring,” says Gross.
Rabbi Yakov Horowitz, founder and director of Project YES (Youth Enrichment Services) in America and author of respected child safety book Let’s Stay Safe, advises teaching your child about personal space (“my body is mine”).
Their body is private; nobody is allowed to touch them and “take” from them in that way, just like nobody is allowed to take their backpack or their snack. At a very young age train your children by encouraging privacy.
“While messages like sharing are important, these can be troubling in the arena of child safety,” says Horowitz.
“Find a balance where your children know what’s theirs so that this awareness extends to their body.
“Share with your children that certain touching is not good, and specifically define the difference between good and bad touch. Tell your children that nobody has the right to touch them on the parts of their body covered by a bathing suit. List exceptions to the rule carefully, e.g. mom, dad and grandma while cleaning you, or during a doctor’s exam with mom or dad in the room.
Don’t make overly broad statements about family members or doctors.
“Teach them that no adult is allowed to tell them to keep a secret from their parents. Nobody should make them feel uncomfortable and they can say ‘no’ – even to an adult,” says Horowitz.
“Take what your children share with you seriously.”
Tahel’s workshops teach that most people are nice, but that there may be some who aren’t (you can’t always tell from the outside) and that’s why there are safety rules: say no, run away and tell an adult.
What to do if you have a suspicion about a practitioner?
1. If you have no evidence and just a feeling something is off, trust your instinct and stop using the practitioner immediately.
2. Consider mentioning something to the office staff and gauging their reaction.
3. Consider lodging a confidential complaint with the clinic or boards that the practitioner belongs to for inappropriate conduct. This can provide important feedback for the doctor himself and for the health clinic.
4. Contact Tahel to discuss the matter with Gross and her team in confidence.
In many cases, Gross will suggest approaching the doctor or dentist in confidence to put safety measures in place, such as working together with the professional’s authority figure (e.g., rabbi) or staff to prevent abuse.
What to do if you absolutely know sexual abuse has happened?
Since abuse can mean different things to different people, it is advisable to interface with a responsible, sagacious person that one trusts and is widely trusted for his or her capacity to pass judgment. They can help you make a balanced decision before exposing what you consider abuse.
1. If you know for sure that child sexual abuse has occurred, this should be reported to law enforcement and a social worker immediately.
2. You should contact the medical board in your state or region.
3. If friends approach you regarding your experience with the physician, relay your experience without embellishing or downplaying what happened. If you know people who use the same physician, consider discussing the laws of slander with a responsible halachic authority to know when and how to publicize such information. It is important to be concerned about protecting any potential victims as well as not to harm anyone’s reputation or practice unnecessarily. Jewish law offers clear guidelines how to navigate through such situations.
4. You can call Tahel to get advice, advocacy and support and remain anonymous. If you need to go to the police, Tahel will accompany you.
When it comes to your practitioner, be proactive and bring up concerns with the practitioner himself.
“Share on this subject with people you know,” counsels Gross.
“You can organize a community awareness event where parents and others can learn about building a safer community for their children.”
The hope is that as our awareness grows, and as we become more empowered, situations where abuse once may have happened will be prevented. 
Contact the Tahel 24-hour hotline: (02) 673-0002.