Process for physical exams outlined by ex-Kitchener neurologist Jeffrey Sloka at trial

Warning: This story contains some graphic details.

Ex-Kitchener neurologist Jeffrey Sloka took the stand for a third time Thursday at the Waterloo Region Courthouse, where he outlined the processes for medical breast, pelvic and rectal exams that he'd performed during his practice. 

He told the court that he would obtain consent prior to each of the examinations where patients would be in gowns in various stages of undress.  

Sloka is facing 50 counts of sexual assault in connection to incidents dating back to 2010. The alleged victims, who were patients seeking treatment, ranged in age from their teens to their 50s.

• Read more about this trial

There were instances where Sloka thought breast exams were appropriate, such as if someone had a breast lump and they were concerned about it or if he had prescribed birth control pills, explaining that these exams are required by the pharmaceutical company. He said that he wanted to ensure users were tumour free.

Sloka told the court that if his patient consented to an exam, they'd get into the gown with the opening at the back and their clothes removed from the waist up. He said that he started the exam with a visual inspection for about 15 to 20 seconds, and then the exam would proceed with the patient lying down on an exam bench. 

Sloka said that he would examine one breast at a time, and only one side of the gown would be down to minimize exposure. With two fingers, he'd apply pressure to the breast, move his fingers in circular fashion, then he'd move fingers to a nearby location and repeat the process until he had covered the entire breast area.

After that, he said that he would put a hand on either side of the nipple and press it, looking for obvious discharge. He'd also inspect the armpit closest to that breast, looking for signs of cancer spread, using his fingers.

He'd repeat the process on the other breast. He said that the entire exam took about five minutes, give or take.

It's alleged Sloka asked patients to undress so he could perform a physical or skin examination during neurological exams in his practice. It's also alleged he touched his patients' breasts. In some instances, it is alleged he inserted his fingers into the patients.  

Sloka has pleaded not guilty to all counts.

Internal pelvic exams

On Thursday, Sloka said that he'd propose internal pelvic exams if there was a "change in bladder" to rule out anything in the pelvis that could be causing the symptoms. He'd also do them when looking for cancer, he said. Sloka said that he learned when to do them as part of his training from "textbooks and guidelines." 

For an internal pelvic exam, Sloka said that he'd have a discussion about the exam and rationale with the patient and obtain consent. The patient would be in a gown with everything off from the waist down, and he'd grab an extra linen for draping.

During the exam, the patient would be lying flat on their back with their legs in what Sloka described as a frog leg position. He started with an inspection looking for abnormalities on the outside of the pelvic area or for abnormal discharge. 

Sloka said that he used both hands, which were gloved, to assist with the examination, with one of them inspecting the inside of the patient, looking for various abnormalities. He said that the total exam would last about 20 to 30 seconds with his fingers inside the vagina for about 15 to 20 seconds.   

Rectal exams

Sloka said that he'd propose rectal exams for things like a change in batter function. He said that the patient would be on a bench on their left side, facing the wall with their back toward him, and knees up to provide access to the region.

With a gloved hand, Sloka said that he'd lubricate a finger, and use it to enter the anus, then enter further, and move the finger around looking for abnormalities. He said the exam would last five to 10 seconds.

When testifying late last year, neurologist Dr. Vera Bril — who was qualified in September as an expert — explained that it's typically not within the purview of neurologists to do sensitive exams, looking at areas such as breasts, the rectum or the vagina.   

"Neurologists don't do breast exams and they don't do vaginals," Bril had told the court.

However, when Sloka was testifying on Wednesday, he countered some earlier testimony provided by Bril, who had objected to skin exams for a specific neurological condition of the skin. Bril had suggested genetic testing instead, but Sloka said that this sort of testing isn't 100 per cent accurate.

Sloka had a primary practice at Grand River Hospital but also had privileges at Guelph General Hospital and St. Mary's General Hospital in Kitchener.

Sloka was put under restrictions in September 2017 due to the accusations. He was then stripped of his licence in May 2019 and arrested four months later in September.     

Police announced multiple sets of charges against Sloka and by June 17, he faced 76 allegations in connection with separate sexual assaults against women in Waterloo region. However, 26 were withdrawn at the request of the Crown.  

Sloka is expected to return to the stand on Friday for a fourth day of testimony.

Read more about this trial and events leading up to it through CBC's coverage here: 

• Kitchener neurologist faces hearing over sexual abuse accusations
• Former Kitchener neurologist stripped of licence after patients sexually assaulted
• Former Kitchener, Ont., neurologist charged with 34 counts of sexual assault
• Former Kitchener neurologist faces new sexual assault charges
• Woman sues former Kitchener neurologist accused of sexually assaulting 63 patients
• Waterloo Regional Police lay 8 more sexual assault charges on former neurologist
• Trial of former Kitchener neurologist opens with summary of years of alleged sexual assaults
• Trial of ex-Kitchener neurologist continues as expert outlines standards for exams
• Intimate exams were 'not necessary', says expert at trial of ex-Kitchener neurologist
• Ex-Kitchener neurologist Sloka documented breast exams on patients, says Crown
• Ex-Kitchener neurologist Jeffrey Sloka testifies in sexual assault trial
• Ex-Kitchener neurologist Jeffrey Sloka outlines process for different examinations at trial