Daniella Mohazab didn't know what to expect from her first pelvic exam in 2016. The University of Southern California sophomore, then 19, was startled when her doctor examined her vagina for several minutes without gloves, but assumed it was standard procedure.
It wasn't until two years later, when she read about Dr. George Tyndall's alleged sexual abuse against USC students, that she realized she may have been sexually violated by him as well.
Driven by stories like Mohazab's, California Assembly members Ian Calderon (D-Whittier) and Cottie Petrie-Norris (D-Laguna Beach) have proposed a bill to require doctors to give first-time pelvic exam patients a pamphlet about how the exams are supposed to be conducted, and a phone number should they want to report misconduct to the state medical board. Doctors would face a fine if they did not collect a patient's signature confirming they received the pamphlet.
Mohazab said a pamphlet would have helped her immensely.
"It would give people an answer about what’s right or wrong," said the Los Angeles resident who now works at a tech startup. “I trusted my doctor, and now, years later, I’m dealing with the consequences of that.”
Legislators in Michigan proposed similar legislation last year in response to the scandal involving Dr. Larry Nassar, the former Michigan State University and USA Gymnastics team physician who pleaded guilty to sexually assaulting minors and possession of child pornography. Nassar had sexually abused hundreds of young women and girls under the guise that he was performing physical therapy.
The bill, which failed, would have created a standardized consent form for guardians, outlining basics such as the use of gloves, before a minor could undergo any treatment involving vaginal or anal penetration.
Doctors have pushed back hard on the bills in both states, mostly because of the signature requirements.
Health researchers say these measures are part of a broader national shift in the doctor-patient relationship. The old-school dynamic, in which the doctor is viewed as the ultimate authority, is giving way to another perspective: Physicians can be questioned, and patients have a right to speak up if they feel uncomfortable.
In addition to Tyndall and Nassar, several high-profile sexual misconduct scandals have come to light since 2014, including cases at prestigious universities and hospitals such as UCLA, Johns Hopkins Hospital and the Ohio State University. In all of the cases, the doctors are accused of using their medical authority to victimize hundreds — and in the Johns Hopkins case, thousands — of patients.
"There are unfortunately too many times where we need to protect people from their physicians," Petrie-Norris said.
There's no evidence that informed consent laws prevent sexual assault.
However, these pamphlets might send a strong message to all clinicians — including potential predators — that patients will be on their guard, said Robin Fretwell Wilson, director of the Epstein Health Law and Policy Program at the University of Illinois College of Law.
For almost two decades, Wilson has lobbied states to pass laws banning pelvic exams on anesthetized patients without prior consent — a common practice in teaching hospitals.
"We're really sensitized to this now in the #MeToo era," Wilson said. "It's a time when we can empower patients."
In California, two powerful doctor groups, the California Medical Association and the California Academy of Family Physicians, oppose the bill's signature requirement, saying it would burden doctors with extra paperwork without preventing crime, and could cause a victim to blame herself after the fact for not having stopped the abuse.
The American Congress of Obstetricians and Gynecologists, a national organization, also weighed in on the measure, saying it is generally opposed to any proposal that mandates how doctors communicate with their patients.
The state Assembly has already approved the bill, which is now in the state Senate. Its supporters include the Consumer Attorneys of California and the Medical Board of California.
Dr. Joyce Sutedja, an OB-GYN resident at the University of California-Irvine Medical Center, said she was abused by Tyndall when she was a student. At the California Medical Association's request, she argued against the bill's signature requirement in a state Senate hearing in June, saying it might make victims feel responsible for what had happened to them.
"If I had signed a piece of paper stating that I knew the components of a normal pelvic exam — whether I had actually read the document or not — and the same thing had happened despite my signing the form, it would be near impossible to keep from blaming myself for letting it happen anyway," Sutedja wrote in a letter to lawmakers.
The signature requirement in Michigan's bill led to its demise.
Doctors were worried that minors would decide not to seek sexual health care services because they would need permission from their parents or guardian beforehand, Michigan Rep. Daire Rendon (R-Lake City) said.
But a signature can be empowering for patients, argued Christy Leach, 43, who testified at the same California Senate hearing as Sutedja.
"It forces the predatory doctor to keep his sick notions at bay," she said.
When Leach attended USC, she went to the student health center in 1998 for a sinus infection. During the appointment, Tyndall talked her into her first pelvic exam as well, during which he pushed his ungloved fingers in and out of her vagina for what seemed to her like five minutes. The experience was extremely painful, Leach said, but she had no idea to expect anything different.
When she had a gynecological appointment a few years later with a different doctor, Leach was surprised when the properly conducted pelvic exam was painless and over in seconds. Her trust in her doctors was so strong, however, that she reasoned that Tyndall must have given her a more rigorous exam.
"The human spirit is strong, and wants to believe the best in people," Leach said. "And so I just really thought that this thorough exam must be only every couple of years.”
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.