consent – Missouri House of Representatives Newsroom

Ban of invasive medical exams without consent sent to governor

The legislature has voted to ensure that Missouri patients can no longer have invasive medical examinations performed while they’re unconscious and without prior knowledge or consent.

*Representative Hannah Kelly (Photo: Tim Bommel, Missouri House Communications)*

Legislators were told that medical students and residents have been allowed and even directed to perform anal, prostate, or pelvic examinations on unconscious patients as part of their instruction, sometimes without those patients’ consent.

House Bill 402 contains several provisions regarding healthcare. One of those would specify that such exams on unconscious patients may only be conducted when that patient or their authorized representative has given consent; the examination is necessary for medical purposes; or when such an exam is necessary to gather evidence of a sexual assault. The legislature voted last week to send HB 402 to Governor Mike Parson (R) for his action.

Representative Hannah Kelly (R-Mountain Grove) sponsored that provision. She told House Communications, “The patient has the right to know what’s going on.”

She said her first concern regarding that issue was for survivors of sexual assault, some of whom she knows personally.

“If you talk to sexual assault survivors, often times they’re very hesitant, especially if they’re younger, to go seek healthcare and to have confidence to get the proper healthcare that they need. This was brought to me out of the concern that we make it abundantly clear in statute that if you’re going to put somebody under anesthesia in regards to any kind of female exam that they have full disclosure of what’s happening before you go under,” said Kelly. “I think anybody likes that, right? But especially if you’re a sexual assault survivor that’s something that is of utmost importance to make sure that you’re getting what you need from your healthcare provider because you’re hesitant, because you’re not secure and you’re not feeling confident of the process.”

The patient examination issue was an important one for legislators in both parties, and as a standalone bill, was voted out of the House 157-0.

Representative Patty Lewis (D-Kansas City) was glad to see it achieve final passage this year.

*Representative Patty Lewis (Photo: Tim Bommel, Missouri House Representatives)*

“I’m a nurse by background. I worked in academic, teaching hospitals. I worked with residents and med students all the time and when I first learned about this issue I was shocked. I couldn’t believe that intimate examinations were happening to people without their consent.”

Lewis noted that this passage shouldn’t hamper students’ abilities to learn. She said they have other chances to receive instruction in such examinations.

“If you go to one of the academic facilities you can opt in to have the med students or residents be part of your care team, or opt out if you don’t want to.”

Any health care provider who violates the new section of law, or any supervisor of a student or trainee who violates it, would be subject to discipline by their licensing board.

Kelly, meanwhile, encourages Missourians to ask questions of their healthcare providers and to makes sure they are made fully aware of what will happen if and when they are put under anesthesia.

The House voted 120-31 to send HB 402 to Governor Parson, who can now sign it into law, veto it, or allow it to become law without his action.

House votes to bar invasive patient exams without consent

The Missouri House has voted unanimously to end the practice of performing certain invasive medical exams on patients who are unconscious and have not given consent.

Legislators learned that in Missouri and elsewhere, medical students and residents in teaching hospitals are allowed and even instructed to perform anal, prostate, or pelvic exams on unconscious patients as part of their instruction.

“That’s a really bad practice because it’s not a good way of teaching students, but it’s also incredibly traumatic and harmful for that patient, to know that they could have been violated while they were unconscious,” said Matthew Huffman with the Missouri Coalition against Domestic and Sexual Violence.

Representative Hannah Kelly (R-Mountain Grove) agrees and she sponsors House Bill 283, which would require informed consent from the patient or someone authorized to make decisions for them, unless the exam is deemed necessary for diagnostic purposes, or for the collection of evidence when a crime is suspected and the patient cannot give consent for medical reasons. If an exam is performed the patient would have to be notified.

“This bill is aimed at making sure that those who are survivors of trauma don’t have to experience further trauma as they go seek healthcare from their provider,” said Kelly. “I want to make sure that sexual assault survivors can confidently walk into their doctor’s office and know that they are empowered to be in control of the process and that there are no surprises. I have seen firsthand how important that is to strengthen the individual.”

Huffman explained that this issue is particularly important for the people his organization works to protect.

“The harm a survivor may feel is retriggering for the simple fact that we know survivors of sexual violence have felt a loss of their own bodily autonomy, and it can be retriggering to find out that someone performed an exam on you while you were unconscious without you being able to give specific consent.”

Kelly said she has seen what Huffman is talking about through her daughter, who has given Kelly permission to speak publicly about her experience and encouraged her to pursue related policy.

“She is someone who has dealt with the unfortunate situation of being a victim of sexual assault … we all need healthcare, right? Someone who is a victim of assault, that’s a paramount kind of subconscious concern is, ‘Okay, am I going to be safe? Am I going to be in control of this situation?’”

Both Kelly and Huffman say whether this bill becomes law this year, they hope it will help call attention to what has been happening to some patients and what people can do now. They encourage people to ask questions when visiting a medical practitioner.

“I would hope that an individual who might … feel like they’re not getting full disclosure or they feel like they have questions, I hope he or she will raise their hand and say, ‘I have some questions. What are we going to do here today? There’s not going to be any surprises, right? Walk me through what’s going to happen once I go under anesthesia,” said Kelly. “That’s what I would hope, is that people feel empowered to hold up their hand and say, ‘Hey, make sure that I understand what’s happening here, please.’”

Huffman said what is as important as anything about this proposal, which has come up for several years now but has yet to reach the governor, is that it’s made people aware that these incidents are happening.

*Representative Patty Lewis (Photo: Tim Bommel, Missouri House Communications)*

“As soon as we started talking to people about it, everyone’s jaw immediately drops open [as if to say] how is this a thing that could even still be occurring and why have I never heard about it? So that’s why we really wanted to bring a lot of attention to the issue because once people know that it’s a thing they absolutely want to make sure that it’s no longer a practice that can happen.”

Representative Patty Lewis (D-Kansas City) was one of the legislators who expressed the surprise Huffman references, when HB 283 reached the House Floor.

“Last year was when I was first made aware of this practice, and I worked in academic, teaching hospitals and wasn’t aware that was going on. Quite frankly I was shocked … is this really, really happening?”

Huffman said what is not known is how often such instances are occurring, largely because they aren’t always reported.

“For anyone who has experienced this, they become aware of it after the fact, and that can be a really traumatic thing to want to speak openly about.”

HB 283 was sent to the Senate on a 157-0 vote and awaits action in that chamber. A similar measure has been advancing through the Senate.

Production note: some of Rep. Kelly’s audio was overmodulated and not fit for air, so it is quoted here but not linked.

Bill would add info on consent, violence, & harassment to sex education in Missouri high schools

A Missouri representative is proposing that high school students learn about sexual harassment, violence, and consent as part of sexual education. Her legislation will be heard Tuesday night by the House Committee on Children and Families.

Representative Holly Rehder (photo; Tim Bommel, Missouri House Communications)

Sikeston Republican Holly Rehder said the idea behind House Bill 2234 was brought to her by students at the University of Missouri who said they wish they had received such an education. They believe teaching high school students about those subjects could prevent situations that can cause life-changing harm, and Rehder agrees.

“What was so fascinating to me was you have these college students – two girls, is who initially brought it to me – that said, ‘We wish we would’ve had this,’” said Rehder. “’We don’t know how they were in high school or what their reputation is back home and then we all get lumped in together and we’re at a party, or we’re at an event, or walking to the car, or whatever … you need to know how to speak up for yourself, set those boundaries, and you also need to know how to not cross them.’”

Numerous cases have put sexual harassment, sexual violence, and consent in the public spotlight. One of those is the case of long-time USA Gymnastics team doctor Larry Nassar. He was sentenced late last month to up to 175 years in prison for abusing young female gymnasts. At least one of the women who gave a victim impact statement before his sentencing has written a letter in support of HB 2234.

Amanda Thomashow tells lawmakers she realized many of those Nassar assaulted didn’t know they were being abused, at least not at first, and trusted the doctor.

She writes, “more than anything I keep coming back to one particular question: How can we prevent such a tragedy from happening ever again? I have repeated this question in my head, over and over, searching for a way to save others from similar evils. I know there are many answers and I know there is no easy solution when it comes to sexual assault. However, I also know one thing with absolute certainty; we must add consent and sexual violence to basic sexual education curriculum. We need to equip young people with knowledge to protect and empower them, and House Bill 2234 does just that.”

HB 2234 would expand Missouri law on what must be included in sex education materials so that they cover sexual harassment, sexual violence, and consent. It would also seek to define those terms in relation to sex education.

It would define “consent” as, “a freely given agreement to the conduct at issue by a competent person. An expression of lack of consent through words or conduct means there is no consent. Lack of verbal or physical resistance or submission resulting from the use of force, threat of force, or placing another person in fear does not constitute consent. A current or previous dating or social or sexual relationship by itself or the manner of dress of the person involved with the accused in the conduct at issue shall not constitute consent.”

HB 2234 defines “sexual harassment” as, “uninvited and unwelcome verbal or physical behavior of a sexual nature, especially by a person in authority toward a subordinate,” and defines “sexual violence” as, “causing or attempting to cause another to engage involuntarily in any sexual act by force, threat of force, duress, or without that person’s consent.”

Missouri school districts are not required to have sexual education as part of their curriculum. The bill would require that these new areas be included for those that do.

Rehder said she looks at the issue not just as a legislator but as a mother of three.

“I think that’s the prism that we need to look at it through – what would we want for our children? What do we want them to know and be prepared for before they go into college,” said Rehder. “Or not college – before they go into the workplace and you have people over you. I think that these are just very important things to know before you’re thrown out into the world.”

The hearing on HB 2234 is Tuesday at 5 p.m. in House Hearing Room 7 in the Missouri State Capitol basement.

Additional audio:

Representative Rehder said she wants students to learn how to protect themselves and to respect others:

“I want them to know some clear cut signals and how to make those clear cut signals. I think it makes a lot of sense. I think it’s a small – doesn’t cost the state anything but could do a world of good.”