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Another patient raped by a paramedic?
by Kevin Pezzi, MD
I excerpted this story from one of my books of ER stories, lopping off another story prefacing it that isn't relevant to the topic of paramedics raping patients, hence the somewhat awkward beginning here.
I should emphasize that these cases (this and this) are the only ones I know about; the vast majority of paramedics are very honorable people doing heroic work. But thinking of the saying, where there is smoke, there's fire, the visible tip of this depraved iceberg is surely not the whole of it.
I don't want to give you any more nightmares about hospital security, but I may have witnessed an eerily similar case. I say “may have” because I don't know if a rape occurred or not. However, the second I saw the man, who I'll call Jim, I suddenly wondered if he had raped the patient in the room he just left.
Jim worked in the ER as a technician [and outside of it as a paramedic], and I'd seen him thousands of times, but never looking the way he did that Saturday night when he darted out of her room flushed and sweating profusely with a glazed look in his eyes but zero eye contact. Jim was normally affable, relaxed, happy, and slow-moving. I'd never seen him move that fast, nor had I ever seen him sweat. The ER air conditioning was on, so the temperature and humidity were perfect for comfort. Furthermore, he had no obvious reason to be in that room, which was situated at the end of a long hall. And, in case you are wondering … no, I had never suspected anyone else of anything similar, although I'd seen innumerable hospital personnel rush out of rooms before. There was something odd about this event that struck me like a hammer.
I couldn't ask the patient, a mid-twenties woman who was in a permanent vegetative state (PVS)—what most people would call “a vegetable” not out of meanness, but because permanent vegetative state can be a mouthful. She hadn't moved in so long that her joints were frozen, so whenever I saw her (this wasn't the first time), she was curled into a ball. Unlike most PVS patients, she had a cute face and a surprisingly attractive body—even more amazing because she could never exercise, obviously. Sans the brain injury, she probably would have been gracing the cover of a fitness magazine.
So did Jim rape her? I don't know. I did not have sufficient evidence to make that allegation, but I had a gut feeling that it did occur. I would have performed a rape examination had I seen any tangible evidence of it, such as him zipping up his pants when I entered the room, but I did not think that I had adequate grounds to proceed. That would necessitate examining not just the patient, but also collecting specimens from Jim, my co-worker, who undoubtedly would have been devastated if my suspicion was false. He might even have successfully sued me, and won millions (not that I have that much to give), if I made the rape accusation with zero proof of it.
Perhaps I should have had a female nurse step into the room while I did a quick check for semen or some other evidence. However, from what I know about numerous legal precedents (none identical to this one, unfortunately), a hunch is not sufficient legal justification or “probable cause” to allege a rape and investigate it. If I thought that a rape occurred, I should do a complete exam, collect the numerous specimens, file a police report, etc. Not a partial exam or “quick look,” because a rape can occur without that showing anything.
This is one of those gray-zone medical dilemmas without a clear-cut solution. Some people might argue for doing the rape exam to protect the patient. Others might argue with equal vehemence that it would be a gross injustice to Jim to proceed without more evidence of wrongdoing. In our crazy legal system, criminals can be freed on a technicality if a court determines that the police proceeded without probable cause. I doubt that any court would say that I had probable cause. Even I doubt that. Yet my hunches are usually correct, and if I had to guess, I'd bet that this one was, too.
UPDATE: This case still bothers me. If I had to do it over, I now lean toward a full investigation, but it is easy to say that in retrospect, not being immersed in a busy ER (as the ER was that day), when the last thing that other patients needed was the doctor distracted by a long rape examination and the ER in turmoil because of the allegation.
This isn't the first time I wished ER doctors were given more legal training, and of course more staff coverage to give docs the luxury of more time to make such decisions by consulting others. It's tragic that many professional athletes (paid significantly more than doctors) often sit on the sidelines just waiting in case they are needed to enter the game, but in every ER I worked in, there was never any ER doctor on-call for backup no matter how busy we were. So if I had to run three codes at the same time, that's what I did.
