UK legislation is clear; performing internal / pelvic examinations on an unconscious woman is sexual assault. The Sexual Offences Act 2003 Part 1 Sexual Offences Section 2 Assault by penetration reads:
(1)A person (A in this instance the medical student) commits an offence if—
(a)he intentionally penetrates the vagina or anus of another person (B in this instance the female patient) with a part of his body or anything else,
(b) the penetration is sexual,
(c)B does not consent to the penetration, and
(d)A does not reasonably believe that B consents.
(2)Whether a belief is reasonable is to be determined having regard to all the circumstances, including any steps A has taken to ascertain whether B consents.
(3)Sections 75 and 76 apply to an offence under this section.
(4)A person guilty of an offence under this section is liable, on conviction on indictment, to imprisonment for life.
Read it here www.legislation.gov.uk/ukpga/2003/42/part/1
If women patients are not aware and so do not consent to medical students inserting their hands into their vagina and anus to practice pelvic examinations, they have been sexual assaulted with the willing collusion, co-operation, enablement and encouragement of every NHS employee and others present in that operating theatre and the theatre suite. This amounts to Joint Enterprise. Read the CPS Guidance here www.cps.gov.uk/sexual-offences
So are women patients still being subjected to Sexual Assault by Penetration in UK NHS hospitals? Yes. NHS researchers have published recent studies on exactly this practice.
In December 2018 Armitage & Cahill at St Michaels Hospital University of Bristol reported that “Undergraduate medical students often struggle to gain satisfactory competence levels in intimate examination” and asked “What factors increase the likelihood of a woman allowing a student to perform an intimate examination?” The report concluded that “Women's willingness to agree to vaginal examination is influenced by several student-related factors, some modifiable.”
Read it here www.ncbi.nlm.nih.gov/pubmed/29385938
If Bristol women are still saying NO in 2018, just exactly how do medical students practice “intimate examinations” without it becoming Sexual Assault by Penetration?
In 2013 Carson-Stevens et al at Cardiff and Bangor Universities published “Framing patient consent for student involvement in pelvic examination” in the BMJ Journal of Medical Ethics. He reports that, “Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. In the absence of a clear ethical model, coercion appears likely.
Read it here jme.bmj.com/content/39/11/676 & last modified on 8 January 2020 here orca.cf.ac.uk/110181/
In 2011 Rees & Monrouxe at the University of Dundee College of Medicine, Dentistry and Nursing reported on “medical students' explanations of their behaviour when instructed to observe or perform intimate examinations or procedures without valid patient consent.” “112 involved dilemmas associated with intimate examinations. Of these, 63% (n=71) described dilemmas which came about because students were instructed to observe or perform intimate examinations or procedures without valid consent. A total of 82% (n=58) involved students complying with instructions... Despite clear policies at each school, students in all schools observed or performed intimate examinations or procedures without having gained valid consent from the patient.”
Read it here www.ncbi.nlm.nih.gov/pubmed/21251051 & www.researchgate.net/publication/49770695_Medical_students_learning_intimate_examinations_without_valid_consent_A_multicentre_study
In 2009 Martyn & O’Connor at University Hospital Galway reported that, “The teaching of pelvic examinations to medical students is a challenge faced by most Obstetricians and Gynaecologists. It is an embarrassing and potentially painful procedure for the woman while she is awake. Elective gynaecological procedures under general anaesthesia are often seen as an ideal opportunity to teach pelvic examinations with least disturbance to the patient”... and that “In our audit we found that 26% of women did not consent to a pelvic examination by a student while asleep.” Read it here www.ncbi.nlm.nih.gov/pubmed/20108806
In 2018 my partner had elective surgery under general anaesthetic at Nottingham City Hospital. She was forced to have male students present during her surgery who were there to practice pelvic examinations on her. She found this out from an NHS employee at the Trust when she met the employee by chance in 2019. In 2019 I visited my GP on an unrelated matter and agreed to a medical student from the University of Nottingham medical school being present. I asked that medical student about my partner’s experience. They replied that medical students are in operating theatres all the time, that patients are not informed, cannot consent and that medical students names are routinely NOT included on the theatre record of those present, and if someone enters the operating theatre AFTER the patient is anaesthetized, the name of that person is never entered onto the theatre record either. Because of the WHO Sign In, everyone in that operating theatre knows that a student is present and why they are present. Is this how patient consent is circumnavigated at Nottingham City Hospital? If so, and my partner’s experience is valid, women having elective surgery at Nottingham City Hospital are not protected from Sexual Assault by medical students.
The Sexual Assault by Penetration of women elective surgical patients in NHS hospital operating theatres has been perpetrated by NHS employees for decades. There is no evidence that it is not happening today. In Manchester a couple of hundred men were sexually assaulted using amnesiac “date-rape” drugs, and Greater Manchester Police set up special telephone hotlines staffed with specially trained counsellors following huge resource commitment to investigate and prosecute ONE offender; thousands of women elective patients are sexually assaulted by NHS medical students in NHS hospitals, and everyone concerned just looks the other way.
This issue, MumsNetters, demands your immediate and ongoing focus. No-one else is going to protect women having elective surgery in NHS hospitals from routine Sexual Assault.