Allegation:
Injury due to improper anal cavity search performed in Emergency Department without consent.
The Case:
The patient, a 27 YOM (5’8”, 176 lbs.), presented to the emergency department for an involuntary blood draw pursuant to a warrant. The patient was uncooperative during the blood draw and had to be restrained by security and the officer who brought him in. The blood draw was completed by a nurse, as is hospital practice, and returned a blood alcohol level of .17, more than double the legal limit.
As part of hospital practice, the patient was asked if he had any medical issues that required attention. The patient stated he had a history of lower back pain, herniated disks, laminectomy, and was out of his prescriptions for Neurontin and OxyContin. He also stated he had an episode where he lost control of his bowels, or felt as if he lost control of his bowels, when the police were handcuffing him. A separate encounter was created in the medical record. The records contain a general consent, which was signed by a hospital registration clerk after obtaining verbal consent from the patient who was in police custody and unable to sign.
After requesting medical treatment for lower back pain, the patient was seen by a physician assistant (P.A.). He was cooperative during his exam providing the names of his treating physicians, his medical history, and current medications, as well as answering all questions relating to his complaint. He stated he did not have numbness, tingling, or paresthesia in his legs. However, the episode of incontinence coupled with the patient’s history of back pain was concerning and a rectal exam was necessary to rule out cauda equina syndrome.
The patient was cooperative during the rectal exam. He was able to rotate himself on the bed without problems and there are no indications in the record that show he objected to treatment. The exam was completed. There was good tone. The patient was then examined by the physician in the ED who noted that he was not in significant pain and was ambulatory. The final impression and diagnosis was low back pain versus strain. The patient was discharged into police custody.
One year after the encounter, the patient brought suit in federal court claiming civil rights violations due to an improper cavity search, alleging the rectal exam was requested by the police to search for drugs.
The patient provided no experts regarding the medical care he received. Overall, defense witnesses were supportive of the care provided by the P.A. and physician. Given the patient’s complaints, a rectal exam was indicated to ensure there was no damage to the nerves that would require immediate intervention. At trial, testimony revealed that cavity searches are not performed via physical exam. If foreign objects are suspected, a CT scan or an x-ray will be utilized to determine whether a foreign object is present. This practice is in place to protect the safety of the patient and provider.
Verdict:
At trial, the jury found the PA and physician met the standard of care and entered a unanimous verdict in favor of the defendants.
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