No more medical rapes please!

Generally the Doctors are told that ‘comfort of the survivor and allaying her apprehension is of paramount importance’, ‘survivor must be counselled’ and made aware of importance of medical examination. Under Point 9.4 it is stated: “Although it is conceded that ‘per vaginal’, ‘per speculum’ ’bimanual examination’ may not be necessary in all the cases, physicians examining such cases ultimately have a duty to do all in the best interests of their patients, only they have to be judicious and take informed consent before they perform these procedures Rape is the most heinous crime and more inhuman than murder.

Instead of developing a strong working system to arrest the rapes and quickly adjudicate rape prosecutions, individuals occupying important legal positions are talking nonsense about what causes rape, culture, dress of women etc. The criminal rape is unfortunately followed by ‘medical rape’. Some of the doctors gain vicarious pleasure by conducting finger tests among the rape victims without understanding or explaining the need. The issue before me (as CIC) was whether the State is ready to impose total ban on this ‘medical rape’.

The representatives of Family and Welfare Department of GNCTD told me that Per Vagina test (inserting one or two fingers into vagina to study the injuries etc) cannot be totally banned and an ‘advisory’ was circulated among doctors advising not to resort to this test on victims of rape except for essential medico-legal reasons. This makes that complete ban on PV test is not possible because it is advisable in view of legal and medical necessities. In response to my order to explain whether the Government imposed ban on PV test for protecting privacy of rape survivors they gave above explanation.

Yogesh Kumar sought to know whether PV test (aka two finger test) on rape victims is banned or not. The PIO, Dr Lily Gangmei (Directorate of Health Services), stated that an advisory was issued on 28.5.2014 to the doctors, in general, dissuading them from PV test when not medically needed. The First Appellate Authority has ordered the Director of DHS on April 15, 2014 to provide the information within 20 days. The Advisory document was made available to Medical Superintendent (Nursing Homes) Dr R N Das on May 12, 2014, which he should have forwarded to the PIO to be given to the applicant. It was not done.

Only after I ordered it on January 21, 2015, Das sent on February 11, 2015, a copy of advisory on tests to be conducted on rape victims to the PIO. It is clear that Dr R N Das has given this report to the PIO ten months after the order of FAO dated 15.4.2014. It is sad to note that, while the Advisory note was handed over to Dr R N Das on 12.5.2014, he chose to share it with the PIO only on February 11, 2015. I considered that Das has obstructed the information though he has it under his control and directed him to show the cause why maximum penalty cannot be imposed on him.

Expert gynecologist Dr Puneeta Mahajan appeared before my Commission’s hearing and tried to remove misconception among the general public and media about Per Vaginal test. She pointed out the First paragraph of the advisory which stated: “It is evident from the media reports that a misconception exists in the minds of the general public, legal experts and the judicial courts that ‘finger test’ is conducted by doctors to judge if the rape victim is habituated to sexual intercourse”.

Third paragraph says: “What has been alluded to as ‘Finger Test by the doctor on a rape victim’ in the media and legal circles is simply the ‘per vaginal examination’ done by the doctor examining the victim by inserting one finger or two fingers in the vagina of victim. It is unfortunate that the term ‘finger test’ has gained considerable coinage”. Under point 3.3, the advisory has clarified that PV examination is done for the purposes of evaluating condition of genital organs, document injuries, possible infection to institute therapeutic measures and to collect samples, and not to judge if the woman under examination is habituated to sexual intercourse.

In point 3.6, the advisory quotes WHO guidelines and stated “...PV examination should be performed only if medically indicates certain circumstances (listed)”.Under point 3.10, the advisory stated the examination should be conducted for medical reasons only and never to judge the habituation of the survivor to sexual intercourse (as being wrongly perceived in the media). The Advisory instructs doctors: to refrain from recording how many fingers can or cannot be inserted during these gynaecological examinations, doctors should refrain from comments both verbal and written like ‘rape has occurred/not occurred or likely/unlikely’, etc.

Generally the Doctors are told that ‘comfort of the survivor and allaying her apprehension is of paramount importance’, ‘survivor must be counselled’ and made aware of importance of medical examination. Under Point 9.4 it is stated: “Although it is conceded that ‘per vaginal’, ‘per speculum’ ’bimanual examination’ may not be necessary in all the cases, physicians examining such cases ultimately have a duty to do all in the best interests of their patients, only they have to be judicious and take informed consent before they perform these procedures.

The Advisory has finally concluded that it cannot be recommended that physicians be made to function under the constraint of a complete ban of these essential steps of internal examination of a sexual assault survivor, which may not only prove detrimental to her health but also result in injustice. The Advisory was prepared by Dr Gita Radhakrishnan, Director-Professor & HOD Obstetrics and Gynaecology, University College of Medical Sciences, Dr Amita Saxena, HOD, Obstetrics and Gynaecology & MS, Lal Bahadur Shastri Hospital, Dr Sreenivas, Associate Professor Forensic Medicine, Maulana Azad Medical College. Dr Puneeta Mahajan stated that in some cases the tests were necessary to achieve conviction of rape accused and also for the purpose of treatment to the victim.

I think that doctors should be thoroughly educated about their conduct during the conduct of this test, only if essential. First this advisory, redrafted in simple language, should be provided to victims and their family elders so that they prevent misuse. Then it should be shared with NGOs to remove misuse and apprehensions about the test, among the media, legal experts and general public. It is the duty of the doctor to explain the victims and the concerned. Doctors who are endowed with power because of their knowledge of medicine should use this power with wisdom and discretion.There should be no medical apes at all.