Colorado embraces broad law requiring patient consent for pelvic exams while sedated

Colorado medical providers will need to get patients’ prior consent before medical students can perform pelvic exams on them while they are unconscious for a procedure under a bill signed into law

ByJESSE BEDAYN Associated Press/Report for America
May 25, 2023, 1:19 PM
Colorado Pelvic Exams
FILE - A lone cyclist passes by Colorado's State Capitol building, Friday, Jan. 15, 2021, in Denver. Colorado passed a law Thursday, May 25, 2023, requiring that patients give informed consent for medical students to perform pelvic exams on them while they are unconscious. (AP Photo/David Zalubowski, File)
The Associated Press

DENVER -- Colorado medical providers will need to get patients' prior consent before medical students can perform pelvic exams on them while they are unconscious for a procedure under a bill signed into law Thursday.

In signing off on the law in her capacity as acting governor, Lt. Gov. Dianne Primavera put Colorado with at least 20 other states that have consent laws on the books. But Colorado's goes far beyond other states' because it requires that the medical students be named ahead of time and meet the patient — a step one bioethicist is concerned might impede students' chances to learn.

Proponents of the law, which had bipartisan support, say every aspect protects patients from feeling violated and, in certain cases, retraumatized after surviving sexual assault. They hope it will set the standard for states that have weaker consent laws or none at all.

“Learning of a non-consensual intimate exam is traumatic, forcing patients to relive some of the worst moments of their life. We’re putting an end to this unethical practice,” Democratic state Rep. Lorena Garcia, who co-sponsored the bill, said in a statement.

The goal is to ensure that a patient is fully aware of, and agrees to, having students replicate breast, pelvic, prostate or rectal exams that can involve the insertion of fingers or devices inside someone's vagina or anus.

It's difficult to quantify how often students perform such exams without informed consent, in part because patients might never know that they were practiced on and students might be afraid to raise concerns to their superiors.

Typically, patients fill out a number of forms giving broad consent for procedures that might be medically necessary while they are sedated, including for students to participate in their care.

For such procedures to take place under Colorado’s new law, patients would have to sign a consent form that explains what will happen and will include the names of any students who might take part.

Kayte Spector-Bagdady, a clinical ethicist who co-authored a 2019 recommendation by the Association of Professors of Gynecology and Obstetrics, worried that determining which students can and cannot be involved prior to the procedure could limit learning opportunities.

Schedules, especially in a hospital setting, can change rapidly, Spector-Bagdady argued. If the named students aren't available, the Colorado law wouldn't allow others to step in and learn. Those educational opportunities are critical for future doctors to be proficient in treating women, she said.

Elizabeth Newman, public policy director at the Colorado Coalition Against Sexual Assault who supports the law, said naming the students and having them meet the patient are integral components of complete, informed consent and ensure that students learn the rules governing the consent process.

There are certain caveats, including that licensed practitioners can perform exams in emergency situations in which getting consent ahead of time isn't possible. The law includes whistleblower protections for medical students, and doctors and hospitals could face liability if they violate the consent rules.

Those who have opposed the bills and laws across the U.S. say they're examples of government unnecessarily meddling in patient and provider trust, and that guidance should come from medical associations.

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Bedayn is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.