Missouri lawmakers overwhelmingly support banning pelvic exams on unconscious patients

Under current Missouri law, there is no prohibition on doctors or medical school students performing pelvic, prostate or anal exams on unconscious patients without consent. 

A pair of bills that have received unanimous support in both the House and Senate seek to change that. 

On Thursday, The Senate voted 33-0 in support of legislation sponsored by Democratic state Sen. Lauren Arthur that would prohibit health care providers from performing these exams on patients under anesthesia without first receiving explicit, informed consent. 

A similar bill, sponsored by Republican Rep. Hannah Kelly, cleared the Missouri House last week 157-0. 

Both bills need approval from the other chamber to go to the governor’s desk.

“I’ve heard from Missourians who’ve learned only after the fact that they’ve been subjected to these exams,” Arthur said. “And understandably, they feel very violated. And for those with a history of sexual abuse, they were particularly traumatized.”

These sorts of exams on anesthetized patients are legal in 29 states and are thought to be helpful for medical students. But the lack of consent has inspired several state legislatures to consider bans in recent years. Similar bills have failed to get traction in Missouri for the last three years. 

Matthew Huffman, chief public affairs officer for Missouri Coalition Against Domestic and Sexual Violence, said someone who goes in for a surgery at a medical school could have a procedure performed without their knowledge for teaching purposes instead of for a medically necessary reason. 

“Without informed consent,” he said during a February committee hearing, “we’re really talking about sexual assault.”

It’s unclear how often this is happening in Missouri, said Victoria Pickering, director of advocacy with the Metropolitan Organization to Counter Sexual Assault.

“My hope is that it is rare,” she said. “But it is currently legal, and I have worked with survivors who have experienced this and found out only after the fact. 

“One of these exams taking place is one too many.”

A health care provider who violates the prohibition, or who supervises a student or trainee who violates the prohibition, would be subject to disciplinary action by the state licensing board. Exceptions to the prohibition include if a person authorized to make health care decisions for the patient gives approval, the exam is necessary for diagnostic or treatment purposes or a court orders the exam.

In 2019, the Association of Professors of Gynecology and Obstetrics stated that students should only perform pelvic exams under anesthesia when the exam is directly supervised, explicitly consented to, directly related to the procedure and only performed by a student who is part of the care team.

A 2022 survey of 305 medical students who had completed an OB-GYN rotation found that 84% had performed at least one pelvic exam on a patient under anesthesia. Of those students, 67% said they “never or rarely” saw anyone explain to the patient that a pelvic exam may be performed while under anesthesia. 

“The intent of this bill,” Kelly said, “is to protect patients’ rights when they are under anesthesia or in a state of unconsciousness.”