Medical Protection steps in when the police investigate an allegation of sexual assault during a vaginal examination. By Dr Heidi Mounsey, Medicolegal Consultant at Medical Protection.
Dr B was an obstetric and gynaecology registrar covering the labour suite during an overnight on-call shift.
He was asked to urgently attend a patient, Mrs T, who had delivered her baby approximately 30 minutes earlier, and who had ongoing brisk bleeding following the delivery. The midwife reviewing Mrs T was concerned, and sounded the emergency buzzer to summon Dr B to review urgently.
Dr B attended Mrs T and introduced himself prior to taking a brief medical history and seeking verbal consent to examine her, which was granted. Dr B explained that the purpose of the examination would be to try to identify the cause of the bleeding and, if necessary, take steps to stop it.
In the presence of the midwife, Dr B conducted a vaginal examination, removed a number of clots, and applied bimanual compression to stem the bleeding. A junior doctor, Dr F, was present on the labour suite and had also attended upon hearing the emergency buzzer, and they obtained intravenous access while the examination was occurring to allow fluids and additional medication to be administered.
After approximately 15 minutes, the bleeding was controlled and Dr B sought further consent from Mrs T to conduct an examination of her external genitalia and perineum to ensure there were no tears or other sources of bleeding.
No further issues were identified and Dr B, after a brief discussion with Mrs T, left the room with Dr F. Dr B was then bleeped to attend the emergency department and asked Dr F to write in Mrs T’s notes to document the interaction.
Three days later, Dr B was contacted by the hospital’s deputy medical director and informed a patient had made a complaint against him of inappropriate physical contact. Dr B was informed that while the matter was investigated, he was to be excluded from any patient contact, although he was permitted to conduct non patient facing work such as audit. He was requested to provide a written statement to the hospital.
The following day, Dr B was contacted by a police officer requesting to interview him in relation to an allegation of sexual assault made by Mrs T. Mrs T alleged that during Dr B’s examination he had repeatedly rubbed her clitoris.
How did Medical Protection assist?
Dr B contacted Medical Protection for advice and was assigned a medicolegal consultant (MLC) who instructed a solicitor and arranged for a conference with Dr B to discuss the matter in detail. Dr B initially stated this was completely unnecessary as he felt it was obvious the patient had misinterpreted the examination and the requirement for it. He felt that the police would simply close the matter without the need for him to be further involved, and wanted to know whether he could sue the patient for defamation. The MLC explained to Dr B that allegations such as this are usually taken extremely seriously by the police and the hospital, and the consequences of not responding in a robust and detailed matter may mean that he was faced with a criminal charge and the consequences of this.
At the conference, Dr B explained the circumstances and the conduct of his examination to the MLC and the instructed solicitor. He was clear that at no point had he deliberately touched the patient’s clitoris nor was there any sexual motivation for the examination he had conducted. He did state that there would have been a possibility he inadvertently made contact with the patient’s clitoris during the examination and management of her bleeding, but if that had occurred it would have been accidental and very fleeting.
The patient’s notes were reviewed and it was observed that Dr F had made only a very brief entry in relation to the discussion with the patient and the examinations performed, without making it clear why Dr B’s intervention had been necessary and that consent had been verbally obtained from the patient. However, Dr B had a good memory of his interaction with the patient, primarily because the allegations had arisen so quickly after the consultation.
On behalf of Dr B, the instructed solicitor drafted a statement for the police incorporating a detailed description of Dr B’s examination, elicited by thorough questioning from the medicolegal consultant.
The statement was submitted to the police, and although the police still arranged to interview Dr B about the matter, this was purely to confirm that Dr B agreed the contents of the statement were true.
The police closed the matter with no further action and the hospital, on being informed that the police were taking no further action, conducted their own investigation, which also closed with no findings against Dr B. He was permitted to return to work with no restrictions imposed on his practice.
Learning points
- The documentation in this case by Dr F on Dr B’s behalf was poor, and had the allegations arisen some time later it is likely Dr B would have had little recollection of the case and would not have easily been able to rely on the medical records. If the task of documenting a consultation is delegated, it is prudent for the clinician conducting the examination to ensure they subsequently review the notes to confirm all the relevant information has been included.
- Allegations such as this must be taken seriously, even if the clinician feels that they are unfounded.
- Involve Medical Protection at an early stage (even if it felt that there is no substance to the allegations) to ensure the first statement provided is of a high quality – this can help resolve the matter more rapidly and reduce the need for additional questioning by the police.