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Thursday, May 31, 2012

Oklahoma Hospital Refuses Services, Emergency Contraception to Rape Victim

Posted by on Thu, May 31, 2012 at 1:39 PM

In depressing rape-related news*, this is what happens when state legislatures allow doctors to weasel out of doing their goddamn jobs, via conscience clauses:

Imagine being the victim of a sexual assault, or a parent who learns their daughter was sexually assaulted. You arrive at a hospital, looking for assistance — someone to do a physical exam, tests, collect evidence, offer emergency contraception so the rape isn't compounded by pregnancy.

Imagine being turned away.

This is what happened to a young woman who arrived at Integris Canadian Valley Hospital with her mother. There, the doctor that met with her told her that the hospital was unable to examine her or provide emergency contraception due to a lack of Sexual Assault Nurse Examiners (SANE). The specially trained nurses are rotated from hospital to hospital, and there were none at the hospital that the victim chose.

Hospital spokes-people argued that the doctor made the right call, and that SANE nurses were specially trained to collect and preserve evidence without "re-traumatizing" the victim. However, the real question is whether the doctor behaved ethically when she refused to provide emergency contraception, which is much more effective the sooner it is taken after unprotected sexual intercourse.

As the article points out, there's no sane case for a doctor refusing treatment and emergency contraception to a rape victim. And how is forcing a woman to stagger from hospital to hospital in search of a doctor or nurse who believes in doing their goddamn jobs and providing basic, judgment-free medical care (again, to RAPE VICTIMS) not "re-traumatizing"?

Sad hat tip to Cynthia.

*And yes, in case you're wondering, I am the life of every party.


Comments (25) RSS

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ryanayr 1
Obviously these idiots care more about their oaths to an imaginary fairytale than their Hippocratic oaths.
Posted by ryanayr on May 31, 2012 at 1:51 PM · Report this
camlux 2
Oklahoma = Yemen. The Taliban are the same. The place is just spelled slightly differently.
Posted by camlux on May 31, 2012 at 2:00 PM · Report this
Vince 3
Sue, sue, sue them for malfeasance and negligence!
Posted by Vince on May 31, 2012 at 2:04 PM · Report this
Unfortunately when you go to an ER they can - and in fact are supposed to - turn you away if you need the services of a specialist and they don't have one at the hospital. This is why most hospitals with ERs don't have OB/GYNS and why hospitals with OB/GYNS often don't have ERs. It gives ERs an "out" on the law that does not allow them to refuse care to a patient. It helps to prevent malpractice suits from high-risk patients which, in turn, allows the ER to stay open. ERs are huge money sink holes for hospitals. Generally speaking without being able to move out the high risk patients most hospitals wouldn't be able to sustain ERs. It unfortunately ties the hands of ER staff, quite often in ways they are unhappy with.
I'm not suggesting that this means the doc couldn't have given EC to this patient. Just that this is why the patient wasn't treated. As soon as a pregnant woman goes to the ER with a pregnancy related condition and they don't have an OB/GYN on staff they put her in an ambulance and have her taken to a hospital with an OB/GYN. It's the same principal. Not good for the patient but it's how the system works. It's not as if the doctor said "I think you're a dirty slut and I won't touch you". The doctor said "We have a protocol for this and we are unequipped to handle it" which is different. Same effect for the patient but it doesn't reflect back on the doctor.
Posted by moosefan on May 31, 2012 at 2:06 PM · Report this
@3, You can't. The patient needed specialist care and they were unable to provide that care. They are within their rights to say we can't do anything for you. That's how ERs work.
Posted by moosefan on May 31, 2012 at 2:08 PM · Report this
Look, if the Lord chooses to gift you the blessing of a child, should you really be picky about the details? Now, get back in the kitchen, woman.
Posted by tiktok on May 31, 2012 at 2:10 PM · Report this
The INTEGRIS Canadian Valley Hospital Emergency Department personnel wanted to ensure that the patient was examined and treated appropriately for rape as coordinated through the SANE program. The Emergency Department staff confirmed that a specially trained Sexual Assault Nurse Examiner (SANE) was on call and available at INTEGRIS Baptist Medical Center. The patient was told that she should go to that ER for treatment. The YWCA SANE program is a collaboration between the YWCA, Metro Area Law Enforcement, Oklahoma County District Attorney's Office, and three medical centers: Midwest Regional, INTEGRIS Southwest and INTEGRIS Baptist. While YWCA Hospital Advocates provide emotional support for victims, specially trained Volunteer Sexual Assault Nurse Examiners perform forensic examinations following sexual assault or rape. SANE's are specially trained to properly collect, preserve and document evidence of sexual assault; all without re-traumatizing the victim during the extensive exams.
Posted by The Rest of the Story on May 31, 2012 at 2:10 PM · Report this
For everyone screaming about how awful this all is you should read the comment @7. The situation is pretty much exactly as I thought: You need specialist care that we cannot provide. Here is where you can get that specialist care, go there. It is in no way about exercising a "conscience clause" or doctors being insensitive jerks. It's about getting the patient the proper care which could not be given where she was.
They'd do the same to someone with a spinal chord injury in need of surgery if they didn't have a neurosurgeon on staff. And no one would scream about who horrible it was of them to find a neurosurgeon and send you off to them at another hospital. This is how ERs work in this country.
Posted by moosefan on May 31, 2012 at 2:19 PM · Report this
the mother was especially frantic because this is the fourth time her daughter has been "raped" this month.....
Posted by morningafterpill on May 31, 2012 at 2:21 PM · Report this
Cienna Madrid 10
@4, I can understand and appreciate the need for medical specialists, especially when criminal evidence must be collected. But from what I can tell, Yukon--the town where this woman was denied care--only has one hospital.

So just how far are rape victims expected to travel in OK to get medical attention? Is 20 miles reasonable? 40?

And, assuming that there's only one hospital in town, why are these nurses such rare birds? Why is there *not at least one medical professional on rotation* competent enough to handle the basic medical needs of a rape victim, let alone dole out EC--something any pharmacist could do?
Posted by Cienna Madrid on May 31, 2012 at 2:28 PM · Report this
@9, you're an asshole of the highest order.
Posted by moosefan on May 31, 2012 at 2:28 PM · Report this
@10/Cienna, The unfortunate thing (well, one of many unfortunate things about how it works) is that distance and time are considered inconsequential in the face of specialist/no specialist. My father, an ER doc, used an example for an ER in rural PA that he used to work in: A pregnant woman (from upwards of 40 miles away) comes into the ER in labor. She is assessed and, since the hospital does not have an OB/GYN on staff, she is put into an ambulance and taken to the nearest hospital with an OB/GYN on staff. This is approximately another 20 miles and probably another hour. At the second hospital she is seen by an OB/GYN and fully assessed. It is determined that her labor is problematic/the baby is in distress will need neonatal intensive care which is not provided at hospital #2. So the patient is again put into an ambulance and taken to a hospital in downtown Pittsburgh for specialist care. Approximately another 50-60 miles and 2 hours. So a pregnant woman in labor in dire need of care may not see the doctor she needs for 4 or 5 hours after she initially sought medical treatment.
It's awful and it's sad and it can lead to serious issues for the patients. However, it is how things are done. I know my dad has to turn away patients that he would like to see admitted because the hospital doesn't have the staff to care for them. One of the only times in my life that I've seen him cry was because he told parents of an infant that their child was incredibly sick and he'd given the infant meds to let her sleep but they needed to take their baby to Children's Hospital. He gave them referral paperwork. He did everything he was supposed to. The parents took their child home, never sought further treatment and the baby died. And my Dad came home from work shattered. Wishing he'd realized that they wouldn't take their baby. Wishing he'd somehow intuited that they wouldn't and that he'd called for an ambulance and not trusted them with the life of their child. But he could not have had the child admitted to the hospital he was working in, that was never an option.
Posted by moosefan on May 31, 2012 at 2:43 PM · Report this
I've been wondering about this for a while. Has anyone put together some website, some listing of all the businesses, ranging from pharmacies to hospitals, I suppose, that refuse to provide contraception of some type or another?

I imagine something like this would, presumably, be able to save some people some suffering and misery and simultaneously have the capacity to hit such businesses in the wallet with (omfg I'm losing my mind again, what's that word that means a good deal of people refuse to purchase the products or services of a certain business; it's not embargo; oh this is going to drive me insane, well whatever *that* is and I'm sure the rest of you know what I'm talking about).
Posted by Central Scrutinizer on May 31, 2012 at 2:50 PM · Report this

Yukon is a suburb of Oklahoma City.
The hospital with the SANE was 4 miles away.
you stupid cunt.
Posted by too bad your mom's abortion failed on May 31, 2012 at 2:52 PM · Report this

thank you.
Posted by we strive to be the best. on May 31, 2012 at 2:53 PM · Report this
@10 Cienna, Yukon is basically a small suburb of Oklahoma City and the hospital she went to is part of a first-class medical system that, it looks like, was doing exactly what they should be doing to ensure she got appropriate care. Also, everyone in Oklahoma travels at least 20 miles to do anything - that's just a short car ride in Oklahoma miles.
Posted by Ex-Okie on May 31, 2012 at 2:59 PM · Report this
venomlash 17
Posted by venomlash on May 31, 2012 at 4:34 PM · Report this

I think there are a number of doctors (myself included) who would argue that examining and trying to treat a sexual assault victim without a SANE rises negligence and could easily be considered malpractice.

As others have pointed out, the referral hospital was not 20 or 40 miles away, but significantly closer. But even if it wasn't, lots of people travel significantly more than 40 miles for injuries and assaults more life-threatening than those described. We do not have hospitals on every corner. There are plenty of towns which no longer have a single physician, let alone a gynecologist or other specialists. That's just how it is.

As to your question to why there isn't one trained individual on call, the answer is because it costs money to train and maintain a SANE. Clearly it would be nice if there were, just like it would be nice to have universal healthcare. These are good ideas, but railing against the hospital for not providing them is myopic.

In terms of the EC, I agree completely.
Posted by RGW on May 31, 2012 at 5:06 PM · Report this
Can these Doctors not be sued personally for HIPAA-cratic Oath violation?

I think that going after the Doctor, Pharmacist personally might discourage shit like this.
Posted by axiom on May 31, 2012 at 6:24 PM · Report this
I am an ER physician and have done sexual assault exams, though I am not SANE/SAFE trained. This was a few years ago when there were very few SAFE examiners at all and there was no other option. In more recent years, trained assault examiners actually get furious with us if we even talk with the patient first, much less do the exam. Much of this anger is due to their concern about compromising a legal case in case there is even a small difference in charting (e.g. "patient states she was attacked at approximately 6 PM" and "patient says she was raped 1 hour prior to arrival"). They don't want us to do a piecemeal treatment before sending the patient to them - they want to be involved from start to finish.

A second issue is that sexual assault exams take a LONG TIME. Often an hour and a half or more. Most often, this exam is forensic in nature - you're trying to gather evidence for a legal case, not save the patient from imminent death. If a rape victim isn't in immediate danger of death, and you're a single-coverage doctor in an ER full of patients who may have acutely life-threatening conditions...well, the patients who could die take precedence. It's very hard to justify blowing off the elderly chest-pain patient or the seizing infant to perform a SANE exam when there's a dedicated examiner at a hospital only a few miles away. The ER doc has to consider their obligation to every patient in that emergency room, not just the one who's the most devastated.

Since you have 72 hours for both emergency contraception and post-exposure HIV prophylaxis, I can see how in some situations a physician might decide that the best approach considering the needs of all the patients would be to divert the rape victim to a hospital with a dedicated examiner instead of performing the exam themselves and (a) messing up the patient's legal case while (b) abandoning their ethical obligation to patients who were sicker.

If this physician threw the patient out without any follow-up or recourse, then that's wrong and unethical. If she sent the patient to another facility that could reasonably see and treat her within 24 hours, then it's possible that a tough decision was made - but not a cruel one. We have no idea what the situation was in that ER that night.
Posted by Yeek on May 31, 2012 at 7:50 PM · Report this
On the other hand, if the patient said she did not want a sexual assault exam and only wanted emergency contraception - well, in that case, referring her to another hospital with a SANE examiner would be pointless (since the patient would refuse that service).
Posted by Yeek on May 31, 2012 at 8:00 PM · Report this
So I assume no database has been established to catalog the abuses of a woman's right to sexual self-determination. Thanks assholes.
Posted by Central Scrutinizer on May 31, 2012 at 10:19 PM · Report this
Those arguing the woman couldn't be given emergency contraception because there wasn't a SANE nurse there: bullshit. A SANE nurse does exams. They don't provide medication - or at least they're not the only ones who can do so. The doctor could have very easily handed her a pill before either A, calling a SANE nurse, who in fact travels from hospital to hospital, 24hrs a day - or before sending her to a different hospital. Or at least that's how it works in Massachusetts, where this shit is taken at least a little seriously.

This isn't a reason not to provide contraception. It's just an excuse.
Posted by NateMan on June 1, 2012 at 3:01 AM · Report this
@ 23 - I agree with you IF the patient said she didn't want a SANE/SAFE exam or if she stated that she absolutely wasn't going to go to another hospital. In those circumstances you do the best you can.

Although SANE/SAFE nurses don't give out medication, they always want to be consulted before that decision is made. They have a very long pro-con list they go through with every patient regarding PEP benefits and risks. So, if the patient indicated that she was promptly going to another hospital with a SANE/SAFE examiner, then its a defensible decision.

In cases where the patient is too distraught to decide, I just say to hell with the SAFE/SANE examiner and give them the emergency contraception. I've gotten a few very angry phone calls about that, but too bad. If the patient then decides that she does want the SAFE exam, and is willing to put up with a second ER bill, I send them on their way. Rarely, if the ER I'm working in is not busy (almost never), I will offer to do the forensic exam myself.

Posted by Keey on June 1, 2012 at 6:54 AM · Report this
And yes, I'm the same person as Yeek (different computers, registration problems, etc. etc.)
Posted by Keey on June 1, 2012 at 7:12 AM · Report this

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