Mr. B, a 33-year-old Guyanese construction worker, was rushed to an emergency department (ED) with a head injury caused by falling debris at the construction site where he was working.

Ms. H, a 39-year-old nurse practitioner, and a female ED physician, Dr. L, rushed to examine the head wound. The wound was deep and required 8 stitches, but the clinicians were more concerned about potential spinal damage that may have resulted from the injury. 


As Dr. L stepped out to sign some paperwork, Ms. H told the patient that they were going to perform a rectal exam to make sure that he did not have any injury to his spine. The patient immediately became upset and told Ms. H that he did not want a rectal exam. Ms. H tried again to explain the necessity of the exam.


“It will only take a minute and it doesn’t hurt,” she reassured the patient. “It’s very important. We need to make sure that your spine wasn’t injured in the accident.”


The patient just repeated, “No, no!”


Unsure of what to do, Ms. H went out to speak to Dr. L. The physician agreed that a rectal exam was essential, and she also explained this to the patient, who continued moaning, “No.” 


“We just need to do it,” Dr. L told Ms. H. “Call over Dr. M to help, and an orderly.”


The clinicians held down Mr. B as Dr. L conducted a physical exam of the patient’s lower spine to check for spinal-cord injury. When the physician began to attempt a rectal exam, the patient shouted, “No! Please stop!” He tried to free himself from Ms. H and the other clinicians who were restraining him. He became frantic, pleading for the practitioners to stop the exam. 


As Dr. L placed her hand at the patient’s rectal area, Mr. B managed to get free and lashed out violently at Dr. M, the male physician who was attempting to restrain his arms. Orderlies and other hospital staff rushed in to assist, and the patient was sedated and a breathing tube inserted. 


The police were called, and when Mr. B regained consciousness, he was arrested and arraigned on a charge of criminal assault against Dr. M. Mr. B hired an attorney, who was able to get the criminal case against him dismissed. Mr. B then filed a civil suit against the hospital for assault and battery. 


The case eventually went to trial. Both sides agreed that Mr. B had been told that a rectal exam was essential to rule out spinal-cord injury, but after that, their stories differed.


Mr. B testified that although he had clearly refused the exam, he was held down and subdued, and he felt Dr. L’s finger enter his rectum before being sedated. Dr. L testified that she put her finger near the area but never was able to conduct the exam. 


Mr. B testified that while flailing, he had accidently “slapped” Dr. M, who was holding his arms. Dr. M testified that Mr. B was belligerent and had punched rather than slapped him. Ms. H testified that she had explained the necessity of the procedure, describing the chaotic scene that followed.


Both sides called expert witnesses. Mr. B brought in a neurologist and psychiatrist who testified that although a rectal exam is part of routine ED procedure, Mr. B had clearly refused the exam, and he did not exhibit other signs that might have indicated spinal damage. The psychiatrist testified that the experience had left Mr. B suffering from extreme anxiety, agitation, and depression. The defense called an emergency-medicine specialist who testified that a rectal exam is an important part of advanced life support for trauma patients.


In his closing argument, Mr. B’s attorney claimed that even if, as Dr. L had testified, the rectal exam had not actually been carried out, the decision to restrain his client and insert a breathing tube amounted to assault and battery. 


After only a brief deliberation, the jury returned with a verdict for the hospital, finding that the incident did not rise to the level of assault and battery.