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Kitchener neurologist charged with 50 counts of sexual assault testifies about breast, pelvic exams

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Warning: This story includes discussion of sexual assault.

A former Kitchener neurologist charged with sexually assaulting dozens of female patients testified about his process and reasoning for conducting breast, pelvic and rectal exams on Thursday morning.

Jeffrey Sloka faces 50 counts of sexual assault alleged to have happened at his private practice office at Grand River Hospital between January 2010 and July 2017.

He has pleaded not guilty to all charges.

Previously during the trial, court heard Sloka allegedly asked female patients, including teenagers, to take off their clothes for physical and skin exams and touched their breasts and genitals. A medical expert called by the Crown testified some of the types of exams Sloka allegedly performed should not done by neurologists.

A neurologist is a medical doctor who diagnoses and treats disorders of the brain and nervous system.

On Tuesday, Sloka’s defence began questioning and that continued Thursday.

BREAST EXAMINATIONS

The defence began Thursday by questioning Sloka about his process for breast exams and when a neurologist might need to complete one.

Sloka said he has a specific method for how he conducts all physical exams.

“We ask the patient for consent and if they consented, we’d move across to the examination room and find a gown and ask them to change into the gown with the opening towards the back and everything off from the waist up,” Sloka said.

He explained the first part would be a visual inspection on the examination table.

“I would observe the architecture of the breasts,” he said, explaining that he would be looking at the surface and comparing both breasts.

He said the visual inspection typically takes around 15 to 20 seconds.

From there, Sloka said the patient would lie down and he’d do a physical examination.

He’d examine one breast at a time, having them lift their arms into a specific position.

“I would begin palpating across the breasts, and again explaining this as I go,” he said.

“What you’re trying to do, moving in a circular motion, is determining if there’s a lump or another abnormality.”

He said then he would look for nipple discharge. He said that was done in most exams to see if there was evidence of cancer or pituitary adenoma.

“I would have the back of my hand on either side of the nipple. I would press down and move in a little bit, to see if there’s’ any discharge expressed,” he said.

He said the entire thing takes approximately five minutes.

PELVIC EXAMINATIONS

“As a neurologist, did you have occasions to perform an internal examination?” the defence asked Sloka.

“Yes,” Sloka replied, explaining there are a couple of reasons why a pelvic exam would be necessary.

He said if a patient is experiencing a change in bladder function, a pelvic examination would be considered to rule out anything from the pelvic area that could be causing the symptoms.

He said he might also conduct a pelvic exam if looking for cancer.

“As part of a general examination, a pelvic examination can be considered,” Sloka said.

The doctor said part of his training involved learning how to complete these exams, and the reasons he would need to do them. He said textbooks explained the types of situations in which internal exams and breast exams could be beneficial.

Sloka said he would receive consent for an internal exam from a patient before moving forward.

He explained a patient would be in a gown and he would provide an extra sheet for them to have over their legs.

“I explain to the patient it might be a little bit cold, it might be a little bit uncomfortable, I want you to tell me right away if there’s any pain or anything is uncomfortable,” he testified.

He said he would complete the exam internally with his right hand and the left would be on the patient’s abdomen to apply pressure to determine and pain or abnormalities.

He would check the cervix, ovaries, and fallopian tubes.

Sloka said the entire pelvic exam would take around 20 to 30 seconds, with the internal portion taking about 15 to 20 seconds.

RECTAL EXAMINATIONS

Sloka said he also sometimes performed rectal exams, proposing them to patients if they reported a change in bowel or bladder function, or if there was any concern there could be a spinal cord issue.

“The examination involves placing one’s gloved finger into the opening and looking for a change in tone, and at the same time if there’s any masses that one can detect with their finger,” Sloka said.

Sloka said he knew why and when to perform these exams based on what he’s read in textbooks.

Again, he said he would gain consent from a patient before proceeding.

RECORD KEEPING

The defence lawyer then switched his questioning, asking Sloka about his record keeping practices in his office.

Sloka said he used paper copies of patient charts and notes, which would be for his benefit as well as for referring physicians.

He said in records he’d include details like the patient’s name, age, gender, an outline of any problems, symptoms, past medical history and current medications.

When it came to examinations he performed, Sloka said he would only put that in his report if an examination resulted in positive findings.

“You might conduct physical examinations but you might not report on them because there were no positive findings?” the defence asked.

“Correct,” Sloka replied.

In some of his handwritten notes, Sloka said there might be more details jotted down than what he would put in the consultation report for another physician.

“Sometimes parts of the scribble notes might not make it in,” he said.

“I also jotted down consent for certain types of examinations.”

Sloka said he created acronyms for himself that he would make in his notes. One example he gave was COPE which meant “consent obtained for pelvic examination.”

He said he tried to jot that down in every instance, but didn’t always consistently keep up.

RECORD REVIEW

Sloka said he began reviewing his patient records when he released on bail. He has continued to review them throughout the trial.

Sloka said he remembered patients he had seen multiple times, but some patients he’d only seen once he did not remember them off the top of his head.

He said reviewing their records helped him recall his patients.

PATIENT RECOUNT

On Thursday afternoon, the defence started going through the complainants’ files one by one.

Sloka said for the first patient, he performed a cardiac exam, which is often part of his procedure for certain headaches.

During the complainant’s testimony, she said the doctor told her remove her gown and then he touched her breasts.

“She testified you touched and examined her in the area around the armpit, where she said she had some moles,” the defence said. “Did you conduct that kind of skin exam on her?”

“No,” Sloka replied.

Sloka said he did not ask her to lower her gown, touch her breasts or feel around her armpits.

The second patient testified the doctor felt her chest area during a neck exam, cupping both her breasts at the same time.

Sloka said that did not happen.

More patient testimony was read out to Sloka, describing physical exams and alleged inappropriate touching. He said the exams either did not happen or did not happen in the way the complainants had described.

Defence questioning is expected to resume Friday. The trial is scheduled to continue next week, when cross examination may begin.

If you are a victim of sexual assault, help is available. The Sexual Assault Support Centre of Waterloo Region's 24-hour support line can be reached at 519-741-8633

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