Brandon doctor censured for improper genital exam

Hey there, time traveller!
This article was published 30/05/2023 (831 days ago), so information in it may no longer be current.

A longtime Brandon pediatrician has been reprimanded by Manitoba’s physician watchdog after he administered a genital exam on an adolescent patient without gloves, proper draping and obtaining consent.

Dr. Emmett Elves was issued a formal censure by the College of Physicians and Surgeons of Manitoba earlier this month, after it found he “failed to meet the standard of the profession” and “displayed a lack of judgment” relating to a 12-year-old boy’s appointment in 2022.

Elves, who has been practising since the 1970s, has apologized to the patient and plans to retire in June, according to a discipline decision posted on the college’s website.

The censure comes one month after a Free Press investigation revealed six Manitoba physicians — including Elves — have chaperone conditions on their licences, meaning they require someone else present when conducting sensitive exams.

Little to no information is public about why those conditions are required, though in Elves’s case, it is now clear why the conditions were in place and approximately for how long.

The college’s discipline decision states in the summer of 2022, the boy and his mother (neither of whom are identified) sought care from Elves after the boy fainted the night before. During the visit, Elves took down the patient’s history and conducted part of an examination while the boy was sitting on the exam table, then directed him to lay down.

According to statements from the patient (named Patient A in the decision) and his mother, Elves asked the boy if he knew how to check for testicular cancer. When he said no, Elves said he would show him, though he did not “specifically” ask for permission, nor was he wearing gloves.

“Dr. Elves then lifted the waistbands of Patient A’s sweatpants and underwear,” reads the censure decision. “As Dr. Elves did this, Patient A states that Dr. Elves said ‘We’re gonna say hello.’ While keeping Patient A’s waistbands away from his body with Dr. Elves’s right hand, Dr. Elves proceeded to examine Patient A’s testicles with his left hand.”

The decision states Elves was trying to explain how to conduct the testicle exam, but the patient said he was stunned and couldn’t process what the doctor was saying.

Both the patient and his mother said they were “shocked and confused by the approach.”

After the examination, Elves made a comment about knowing patients who died of testicular cancer. He did not document the testicular exam in his notes.

During the college’s investigation, Elves acknowledged he didn’t wear gloves but said he had washed his hands beforehand.

Elves said he asked the patient if he was doing testicular self-examination, telling him he was “a stage of life where it was something he should be doing regularly.” The patient said “uh-huh,” which the doctor took to mean he understood an examination would then take place and why it was needed.

In his response to the complaint, Elves said: “I am very sorry that (Patient A and his parent) felt I did not adequately explain the reasons for performing a genital examination, and that I did not obtain (Patient A’s) consent to do it. It was my impression he understood I was going to do the examination and the reasons for it.”

At some point after the college received the complaint, Elves agreed to sign a voluntary undertaking imposing conditions on his practice, which were posted on his physician profile.

The conditions, which remain in place until he retires, require Elves to have another adult in the room when conducting genital exams, to explain to the patient and/or their parent why the exam is needed and to obtain their consent, to ensure adequate draping is provided and to post a sign in his office indicating the chaperone requirement.

Elves has agreed to stop practising medicine as of June 30, and sign an undertaking to never again practice in Manitoba or any other jurisdiction. He was also ordered to pay the college $4,000 to cover the cost of the investigation.

The college considered mitigating factors in its decision to censure Elves rather than refer the case to its inquiry committee, which handles serious cases and ones doctors refute.

The factors include: his willingness to co-operate with the college’s investigation; his agreement to having the chaperone requirement imposed; the fact testicular self-examination is important for adolescent male patients to understand; the fact he will soon be retiring; and his “willingness to acknowledge his conduct and avoid a contested hearing that would have required Patient A to testify.”

Elves was previously censured in 2014 for two matters, one in which an infant died days after birth following an incorrect diagnosis, and another in which a baby required a life-saving liver transplant which may have been avoided had their condition been diagnosed sooner.

The Free Press spoke Tuesday with a receptionist at Elves’s Brandon Clinic office and requested comment from the doctor, but did not hear back by deadline.

katrina.clarke@freepress.mb.ca