ANNAPOLIS– In July, a resident at a facility for female juvenile offenders reported that the sole physician offering gynecological procedures made a comparison between the size of his finger and a penis during an examination, according to a report released this week.
The report by the Juvenile Justice Monitoring Unit, which evaluates facilities under the jurisdiction of the Department of Juvenile Services, quotes the youth’s statement about the July examination at the Thomas J.S. Waxter Children’s Center, the only state-run facility for both detained and high security girls.
“Do you get penis this size? (referring to his finger) Girl you need to get new meat with the body you got,” the girl reported the doctor said to her during the exam.
In its written response to the report, the Department of Juvenile Services said that it reviewed the complaint and consulted with its medical director and with the Department of Health and Mental Hygiene.
DJS found that “it was common practice for a practitioner in preparation for or during a pelvic examination to compare the size of the speculum or gloved finger to other objects including a penis, especially if the patient is sexually active … The gynecologist was attempting to educate the patient about the pelvic examination and trying to reduce concerns that the bimanual portion of the examination that requires use of gloved fingers should not hurt.”
The DJS written response also states that a nurse chaperone was present during the examination and the “nurse chaperone did not corroborate the verbal statement made by the youth and did not believe that comments made by the gynecologist to the patient were inappropriate. The nurse did confirm that the gynecologist made a comparison between the size of his finger which would be used in the examination to the size of a penis.”
In an emailed response, Dr. Paula Braverman, a Cincinnati gynecologist and member of the American Academy of Pediatrics, wrote that she is not “aware of published references or guidelines that specifically address that particular comparison.”
Braverman, who co-authored an article for the journal of the American Academy of Pediatrics titled “Gynecologic Examination for Adolescents in the Pediatric Office Setting,” said in an email:
“We advocate discussing the steps of the exam and reassuring the patient that nothing will be done without informing her first … Examples of explaining the bimanual exam include describing that one to two gloved fingers with lubrication will be used and that the purpose of the exam is to determine whether there is any abnormality of the uterus or ovaries. Patients should be reassured that the practitioner will proceed slowly to minimize discomfort. When an adolescent uses tampons, it is sometimes helpful to explain the insertion of the gloved fingers is similar to insertion of a tampon.”
The doctor in question, who is not named in the report because of privacy laws, continues to work at Waxter. Since the incident, girls have been refusing gynecological appointments with him, the report states. The report also states that a similar complaint about the doctor was made in March 2007, “but that allegation was not sustained.”
Jay Cleary, director of communications for the Department of Juvenile Services, said the doctor’s “lapse in judgment is correctable.”
“That doctor has worked with DJS for 15 years, during which he has never been the subject of any lawsuit,” Cleary said. “Whatever perceptions the girls had of that doctor are no longer there. The girls are getting the appropriate level of care and treatment.”
The official from the Department of Health and Mental Hygiene who was consulted by DJS could not be reached for comment. Officials at the American Congress of Obstetricians and Gynecologists also could not be reached for comment.
Advocates argue that beyond the recent incident, a gynecologist at a youth facility should always be female.
Sonia Kumar, an attorney with the American Civil Liberties Union of Maryland who has worked with girls at Waxter, said the situation highlights the disconnect between the department’s statements about being committed to providing trauma-informed care for girls and its willingness to do so. It further demonstrates that DJS is not accountable to girls and their families, she said.
“Has headquarters even tried explaining its decision to girls in the facility? From their perspective, this is just more proof that adults can’t or won’t protect you,” Kumar said. “A judge says you are going to Waxter so you’ll be safe. Instead, you feel violated in the facility. When you tell the adults in charge, nothing happens. It’s unacceptable.”
In 1989, the Supreme Court ruled that incarcerated people must be provided with adequate medical care, but the current situation at Waxter is denying this right to its residents, the monitoring unit’s report states.
“In the current situation at Waxter, girls undoubtedly need the special services provided by a gynecologist,” the report states. “When girls routinely refuse to be examined by the doctor because of his behavior, and no alternative is available, then these girls are effectively denied necessary medical care.”
The department has been criticized for its management of Waxter multiple times. This spring, legislation was introduced in the General Assembly to shut down the facility, but it failed in committee.
A May facility report by the Monitoring Unit also recommended that Waxter be closed.
The new report and the DJS response, both of which include information about other juvenile justice facilities in the state, can be accessed at: http://www.oag.state.md.us/JJMU/index.htm