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.

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.

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.