MODIFY USA GYMNASTICS RULES AND POLICIES WITH SIGNATURES

Above C.A.R.E. (Child Abuse Recognition Education) Certification 2009; The purpose of C.A.R.E. was to train M.D.s visit doctors’ offices and train the doctors and their staff how to recognize Child Abuse.

Child Athlete Abuse Syndrome (CAAS), which includes Child Athlete Sexual Abuse, is as old as sport itself.

More and more children are participating in Sports, Recreation and Exercise (SRE).

Recently there have been more and more victims come forward and claim that they were sexually abused as children.

State and Federal legislative actions have been passed to address the Child Athlete Sexual Abuse tragedies.

Recently, a ‘well-known, highly respected’ physician, according to sources, was sentenced to 175 years in prison for molesting young female gymnasts.

In 2014 a doctor was arrested for Failure to Report Child Abuse. Other children were abused after the Doctor had treated some of the abused Athletes. His inaction resulted in additional Athlete Abuse injuries, because he did not report. He was complicit. [Doctor arrested after allegedly failing to report child abuse, July 22, 2014, KTSM News Channel 9 El Paso, Las Cruces, Juarez]

The failure to Report Child Athlete Sexual Abuse is an ongoing, chronic problem. Please see below in this report ‘Why Victims Don’t Report’ their own victim-self or victim-teammate Child Athlete Sexual Abuse.

Laws for Reporting Child Abuse, includig Child Athlete Abuse, have been on the books since passage of the Child Abuse Prevention and Treatment Act of 1974 (CAPTA), most recetnely reauathorized in 2010.

“The new Coach Perpetrator ICD-10 Code T07.53 makes the legal relationship of the Coach to the Athlete “crystal clear” for all the entities in crisis to see.

Retired Secretary Condoleezza Rice said,  “Sports are not nations unto their own, immune from outside interference by the justice system. No one is above the law”.

SRE have portrayed themselves the ‘final word’ concerning abnormal abusive behaviors and Athletes, Parents and the Athletlic Community have believed them.

For the 1st time, the USA GYMNASTICS® 2017 – 2018 Women’s Program Rules and Policies Manuel, Governing Competitors and Competitions sanctioned by the National Women’s Program Committee VERSION 1 8/1/2017 has stated differently. Child Athlete Gymnastics Sexual Abuse must be reported to legal aurhtorities 1st, before Gymnastics.

The Policy is as ‘clear as a bell’, ‘crystal clear’. Before this, Child Athletes, Parents and the entire Athletic Community were mislead and confused.

Upfront, Children and Adult Athletes, team members, Parents and adults should not hesitate to report Child Athlete Sexual Abuse because of the following accomodations.

· All states allow the public to anonymously report suspicions of Child Maltreatment, Sexual Abuse, Neglect and Children’s Human Rights Violations to a toll-free, central phone number. 1

· Callers may choose to remain anonymous—and are not assigned numerical identification—without providing a reason for the need to be anonymous. 2

· It is important to note, however, that all states are required to preserve the confidentiality of all child maltreatment reports, except in certain limited circumstances: see Disclosure of Confidential Records: http://www.childwelfare.gov/systemwide/laws_policies/statutes/confide…

· Confidentiality is different from anonymity, but likewise offers privacy and allows for protecting the information from public view, including protecting the identity of the reporter from the person suspected offender.  [Catholic University Law Review, Volume 64, Issue 1, Fall 2014, Article 6, 2-12-2015, Abolish Anonymous Reporting to Child Abuse Hotlines by Dale Margolin Cecka]  [Child Welfare Information Gateway is a service of the Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.]

· Childhelp is the National Child Abuse Hotline. 7 days a week, 24 hours a day, toll-free number, 1.800.4-A-CHILD (1.800.422.4453).

Everyone must ‘Break The Cycle of Silence’ and confront Child Maltreatment, Sexual Abuse, Neglect and Children’s Human Rights Violations head-on.  [Breaking the cycle of silence: a nurse’s view by Murphy PA. Trends Health Care Law Ethics. 1993 Spring;8 (2):37, 26. PMID: 8499698 Indexed for MEDLINE]

Children’s safety is much more important than anyone’s emotional struggles, distressing conflicts, shame, guilt, embarrassment and fear of repercussions, which any victim or other party may have to face.

We must Save Our Children, (SOC) from falling through the cracks of life because of Adverse Childhood Experiences (ACEs).  [Reaching and Teaching Children Who Hurt: Strategies for Your Classroom by Susan Craig Ph.D]  [Falling Through the Cracks, January, 1996 by Lesley Choyce]

“Even though children are only one third of our population, Children are all of our future.” 2.

Children require a special immeasureable category of love; the love for a Child is an endless faucet, which never runs dry. [Mark 10:14}  if we Save Our Children, we will invest-in and save our future,  1. [Children’s Rights and the Developing Law, by Jane Fortin – Law – 2009 – 804 pages]  2. [Select Panel for the Promotion of Child Health, 1981]

The best way to prevent Child Maltreatment, Sexual Abuse, Neglect and Children’s Human Rights Violations is with Deterrence i.e. instilling doubt or fear of the consequences.

  • Child Maltreatment, Sexual Abuse, Neglect and Children’s Human Rights Violations should initiate a Report
  • whidh should identify the suspected offender
  • followed by an investigation
  • and detention of offenders  [Child Maltreatment: An Introduction by Cindy Lou Miller-Perrin, Robin D. Perrin, SAGE, 2007 – Psychology – 475 pages]

A Report is a call for an investigation into suspected Child Maltreatment, Sexual Abuse, Neglect and Human Rights violations.  For immediate and long term resuts, consistent Reporting is the almighty way to nip offenders in the bud.

“”> LANSING, Mich., Jan 24, 2018 (Reuters) – Disgraced long-time USA Gymnastics team doctor Larry Nassar was sentenced on Wednesday to up to 175 years in prison for molesting young female gymnasts, following days of wrenching testimony from about 160 of his victims, including Olympic medalists.

“I’ve just signed your death warrant,” Ingham County Circuit Court Judge told Nassar in imposing the penalty, after delivering a searing rebuke of his years of abuse.

Nassar, 54, pleaded guilty in November to seven counts of first-degree sex assault in Ingham County, as well as three additional charges in Eaton County, where he will be sentenced next week. He is already serving a 60-year sentence in federal prison for child pornography convictions.

Before the sentence was announced, Nassar apologized to his victims, telling them, “I will carry your words with me for the rest of my days.<“”  [Ex-USA Gymnastics doctor sentenced to 175 years for sexual abuse, by STEVE FRIESS, Jan 24th 2018]

“Since allegations against Nassar were made public in 2016, many women have told variations of the same story. They tried to speak up. They told their parents, their coaches, university officials, other doctors. But those who had the power to stop Nassar never did anything. For years, the abuse continued.

“A woman identified only as Amanda, for instance, told NBC News that when she went to see Nassar for hip and back pain in 2014, he touched her breast and tried to put his fingers inside her vagina. She complained to another doctor, who contacted university officials. They investigated but took no action. Nassar stayed at Michigan State.Young women reported Larry Nassar for decades. No one took them seriously — until now. [Young women reported Larry Nassar for decades. No one took them seriously, until now. by Anna North  Jan 25, 2018 Vox]

The following is an example of law enforcement, parents, Athletes and other’s confusion between the Doctor’s alleged conventional medical care and the patient’s alleged Child Athlete Sexual Abuse, when the doctor claimed he was acting according to proper medical guidelines, diagnoses and procedures and the patient claimed he crossed the line and was not.

The police report this website reporter found was by Brianne Randall-Gay, a 16-year-old soccer and tennis player at the time in 2004. She said that she filed a police report to Meridian Township Michigan police that Nassar touched her bare breast and put his hand between her legs during treatment for back pain, but the Police do not pursue charges against Nassar.

Her “second visit with Dr. Nassar, who was treating her for scoliosis, according to a police report.

Nassar massaged her buttocks with his elbow and said, “I bet people at physical therapy don’t do this.” He also rubbed her breasts, cupped her vagina and tried to penetrate it but could not because she was wearing a tampon, the report said.

Randall told an investigator she was “scared” and “uncomfortable” during the examination and that “it freaked her out.” She filed the police report after telling her mother what happened during that second visit. She allegied that he molested her during a 2004 doctor visit. She even had a rape kit examination performed, which was apparently negative for intercourse, but did not prove she was not molested. [Larry Nassar: A trail of sexual abuse, The Detroit News Jan. 17, 2018]

When an investigator interviewed Nassar, the doctor admitted touching Randall in her vaginal area, saying it is a medical technique known as the “sacrotuberous ligament release,” the police report said. He said the technique “has been published in medical journals and training tapes,” and provided police a PowerPoint presentation detailing the procedure.

  • {{{ In quest of the “most correct, honorable, trustworthy medico-professional procedure”
  • “and maximum respect of the rights of the patient to self-determination, independence and autonomy,”
  • legal actions regarding medical responsibility
  • and with the culture and traditions of our country, the USA,
  • and our tradition, which has always been inspired by good common sense, both medical and human,
  • Doctors should always weigh in their mind newly discovered medical and surgical procedures
  • against their formal extensive training, collegues opinions, continuing education, peer reviewed medical journal research and other reports and results following implementation of the new procedure in their own hands
  • and apply the principle of Informed Consent, aimed at lawful health assistance to all patients. }}}

The rape kit was negative and the Doctor’s Michigan State reputation and Power Point were positive evidence for the procedure. The Meridian Twsp Police were not the Michigan Board of Medical Liscensure, where the claim should have been further referred.

Many reporters, including this reporter concluded the judge, unfortunately posed as both judge and advocate tainting the judicial proceedings. She was not impartial, as her black robe was supposed to portray. Her antics and theater corrupted the legal matter at hand, unnecessary, because Nassar was overwhelmingly guilty, based on the facts and laws of the case, assuming Nassar had crossed over from convenional medicine to quackery, lacking expert medical testimony on his behalf.

“In the USA due process rights and presumption of innocence rights, until proved guilty, are fundamental underpinnings of the right to a fair trial.”

The Child Abuse Prevention and Treatment Act, CAPTA, became law January 31, 1974. The Act also created two types of federal grant programs: basic grants to states to support new prevention, assessment, investigation, prosecution, and treatment activities, including reporting abuse. Douglas J. Besharov, the first director of National Center on Child Abuse and Neglect (NCCAN) in 1975, explained to Congress the implementation actions that NCCAN were taking. [40 Years Ago: Child Abuse Prevention and Treatment Act Passed, Oct 14, 2014 NLIHC]

Although all 50 states have had Child Abuse reporting laws since 1974, no mention of failure to report was found in Nassar news reports, even though Failure to Report is a crime. People who fail to report are sometimes complicit, as in the 2014 report above, a doctor who was arrested for Failure to Report Child Abuse.

Child Abuse Reporting should be a point of emphasis during every trial concerning Child Maltreatment, Sexual Abuse, Neglect and Children’s Human Rights Violations .

While these rules of law appear ‘harsh’, rules of law are the main deterrent to horrific crimes. Repeated Failure to Report is equivalent to chronic, repeated failed deterrence. Basketballers can’t score a basket without the ball.

All the rules and policies must be published overtly, wide open and clear as a bell, so one day the rules and policies for gymnastics participation may be standard public policy. All the facts of the case, or lack thereof, laws of the case, ethical conduct and dignity for the law the case must be followed, the beauty of our USA legal system. (Please see this website for the definition of CAAS)

The Indianapolis Star conducted its own investigation and conclusions. “”> Because the organization prizes competitive success above all else, according to the Indy Star, it allows suspected abusers to keep working with gymnasts even while those individuals are under investigation. It allegedly subjects victims who come forward to a “long, arduous, painful” reporting process, in the words of one victim, that seems to blame the gymnasts rather than the accused.

“We do our very best to treat each athlete with respect, dignity, care and support throughout the process of reporting and handling of abuse, including respecting his or her right to privacy,” Paul Parilla, USA Gymnastics Board of Directors Chairman, said in the statement. “USA Gymnastics policies mandate that when anyone affiliated with USA Gymnastics or member clubs suspect potential abuse, the appropriate authorities should be notified.”

USA Gymnastics members are individuals, organizations and clubs/businesses, which are collectively referred to as “Members” and individually as a “Member” (individual Athlete).

The organization’s policies regarding sexual abuse stress education as a preventative measure, noting that its complaint process is separate from law enforcement’s reporting process. USA Gymnastics urges “those affected” to notify child services or the authorities, according to a policy overview a USA Gymnastics spokesperson provided to Mic. But according to the Star, much of the problem comes from the fact that the organization isn’t “setting strict ground rules and enforcing them.”

It has, however, hired former federal prosecutor Deborah Daniels to review and evaluate their sexual misconduct procedures.

“Nothing is more important to the leadership of USA Gymnastics than protecting the young people who learn and train at gymnastics facilities around the country,”

Parilla’s statement read. “Keeping young people safe requires sustained vigilance by everyone — coaches, athletes, parents, administrators and officials.”

[‘IndyStar’ investigation finds 368 gymnasts alleged sexual abuse in past 20 years by Claire Lampen  Dec. 15, 2016]

The key question is ‘how can hundreds of female gymnastic participants in the same activity, often in the same buildings, with the same coaches, doctors, assistants and others, turn the same blind eye, cover-up and fail to report a monumental catastrophy, then show-up to testify publically in the Nassar trial years later?

Are fame, fortune, notoriety, rewards and gold medals more precious than Athlete Safety? This too, seems a ‘harsh’ question.

Readers must remember these USA gymnasts are just kids.

The failure for adult and children amateur athletes to report might be due to the victim’s feeling, emotions, family, relationships, time, who, what, when, where, psychodynamics and other factors. The failures are multifactorial. The following are many of the factors:

• Adult and Child Athletes and SRE Participants are susceptible and vulnerable to abnormal Coaching Behaviors.
• An enormous Power Gap exists between a Coach and Athletes and Participants.
• Zabernism is the misuse of power by an authority such as a coach, doctor, trainer, or any other authority.

• Bullying is another form of zabernism. Coaches, doctors, trainers and others have misused their authority and endangerd athletes with physical, emotional and sexual injuries.
• Youth and Children have a reliance and dependency on Adult authoritarians.
• Because of the Child Victims’ age, innocence, smaller physical size, immaturity, inability to defend themselves, fear, guilt and shame after Child Sexual Abuse and the Power Gap they seldom self-Report SRE Child Athlete Abuse, especially Sexual Abuse.

• Athletes often manifest the ‘Code of Silence’ and ‘take one for the team’
• Some participants feel that no one out there really cares
• Fear repercussions, have shame, guilt, embarrassment
• Feel somehow responsible, perpetrator betrayal
• Become terrified, threatened
• Anticipates gift and reward termination for misconduct with the Coach
• Adults disbelieve the child, child fears potential punishment
• Deeply respects the perpetrator, has been ‘groomed to love’ the perpetrator
• Fears the legal process and/or is demonized as a ‘trouble maker’
• Feels unworthy and themselves might be “publically prosecuted”

[see ‘Why Victims Don’t Report’ link: http://www.cappaa.com/why-victims-dont-report-abuse-2]

Watchfulness, observation and vigilance concerning Child Athlete Sexual Abuse remains a malfunctioning disorder. Child Athlete Sexual Abuse Syndrome is a widespread epidemic and out of control, because the key problem, Failure To Report, is continually overlooked accidently or on purpose.

Modification of the in depth 134 pages of USA Gymnastics Policies and Procedures is a solution to the proliferating epidemic. Everyone should understand their complete role in gymnastic participation. Everyone should focus on the following specific section of the Policies and Porcedures.

The USA Gymnastics Rules and Policy Manuel should highlight Part II. C. 2. and denote that parents, guardians and legal age members must read and sign below the highlighted section of the manual, emphasizing its importance and clearly stating that Athletes will not be able to compete as members, unless the sections have been signed accordingly.

Part II. Reporting, Jurisdiction and Processing Complaints.

A. Reporting Suspected Abuse to Legal Authorities.

1. USA Gymnastics will report suspected child abuse or neglect (including Sexual Misconduct) to the proper authorities in all instances and without exception, unless it is aware that authorities have already beennotified.

2. Covered Adults must report suspected child abuse or neglect (including Sexual Misconduct) to the appropriate legal authorities, which is separate from notification to the Center, USA Gymnastics, or a Member Club as outlined belowpage 18.

For state-by-state reporting information, see below {{{www.childwelfare.gov.}}} which, as referenced, is part of USA Gynastics Rules and Policies.

{{{ How to Report Suspected Child Maltreatment www.childwelfare.gov.

If you suspect a child is being abused or neglected, or if you are a child who is being maltreated, contact your local child protective services office or law enforcement agency so professionals can assess the situation. Many States have a toll-free number to call to report suspected child abuse or neglect. To find out where to call, consult the Information Gateway publication, State Child Abuse and Neglect Reporting Numbers.

Anyone can report suspected child abuse or neglect. Reporting abuse or neglect can protect a child and get help for a family it may even save a child’s life. In some States, any person who suspects child abuse or neglect is required to report. To see how your State addresses this issue, read the Information Gateway publication, Mandatory Reporters of Child Abuse and Neglect.

Child Welfare Information Gateway is not a hotline for reporting suspected Child Maltreatment, Sexual Abuse, Neglect and Children’s Human Rights Violations and it is not equipped to accept reports of this nature. Information Gateway is not equipped to offer crisis counseling. As a service of the Children’s Bureau in the U.S. Department of Health and Human Services, Information Gateway does not have the authority to intervene or advise in personal situations.

Childhelp® is a national organization that provides crisis assistance and other counseling and referral services. The Childhelp National Child Abuse Hotline is staffed 24 hours a day, 7 days a week, with professional crisis counselors who have access to a database of 55,000 emergency, social service, and support resources. All calls are anonymous. Contact them at 1.800.4.A.CHILD (1.800.422.4453).

“If you need help with personal or family situations, you may wish to visit our resources on Where to Find Help.

“This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. [U.S. Depart of Health & Human Services, Administration for Children & Families, Children’s Bureau Child Welfare Information Highway] }}}

B. Reporting Sexual Misconduct. Covered Adults are required to provide notification of conduct of which they become aware that could constitute

(a) Sexual Misconduct,

(b) misconduct that is reasonably related to the underlying allegation of Sexual Misconduct, and

(c) retaliation related to an allegation of Sexual Misconduct as set forth in the Code:

1. Directly to the Center.

2. In the event the disclosure is initially made to USA Gymnastics, USA Gymnastics will forward the 18 Introduction information to the Center.

3. Notification to the Center and/or USA Gymnastics DOES NOT satisfy any legal reporting requirements under state or federal law. Covered Adults are required to report suspected sexual misconduct to legal authorities prior to notifying the Center. page 19.

Covered Adults must sign after reading sentence item 3.

——————————————————————-circle if covered adult

C. Reporting Other Safe Sport Misconduct. Members of USA Gymnastics are required to provide notification of conduct by a Covered Individual that could constitute Other Safe Sport Misconduct:

1. Directly to USA Gymnastics.

2. Sentence a: Notification to USA Gymnastics DOES NOT satisfy any legal reporting requirements under state or federal law.

Sentence b: If the suspected conduct may also be criminal, persons are required to report to legal authorities prior to notifying USA Gymnastics.

Minor members’ Parents and Guardians and legal age members must sign after reading sentence a. and b. of item 2.

—————————————————————-circle if parent, guardian, or legal age member

[USA GYMNASTICS® 2017 – 2018 Women’s Program Rules and Policies Governing Competitors and Competitions sanctioned by the National Women’s Program Committee VERSION 1 8/1/2017]

Every USA Gymnastics participant member should be issued a hard copy of the USA Gymnastic Rules and Policies for signature and issued free internet access to the Rules and Policies for future reference.

Parents, who are permanent caretakers of USAG minor-age participant members, or guardians, who are temporary substitute caretakers of USAG minor-age participant members, signatures or legal-age USAG participant members’ signatures will insure that responsible participant parties have read and signed with knowledge and understanding their requirement to report Child Athlete Sexual Abuse Syndrome in USA Gymnastics.

The hard copies of the signed Rules and Policies should be returned to USAG and become part of each member’s permanent record for safe keeping. This is a cruical step in the promotion of USA Gymnastic Athletes’ Safety.

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There are many research publications on Pudendal Neuropathy and the Sacrotuberous ligament. Additional references and reports:

LANSING, Mich. (WILX) – The last victim to give a statement Tuesday in the Dr. Larry Nassar trial, was from Lindsey Schuett, she was abused by Larry Nassar at the age of 16 in 1999. Lindsey said, “I knew immediately that it was abuse.” She said that she had seen the movie “The Hand That Rocks The Cradle” and knew what he did was wrong. She said she cried at night and finally decided to tell her school counselor and her mother. They didn’t report the abuse and Lindsey was taken to see Nassar again. But this time, she screamed when he tried to abuse her again. She screamed and he chastised her, she said, he was stern with her and told her that she wasn’t allowed to refuse treatment.” When he started again, she screamed more and cried out until she could leave. Lindsey ended her statement by saying, “If anyone deserves to never see the light of day again, it is this man.”

“Anna Ludes prepared her statement on a disc that was played in the courtroom. Ludes said she was part of the MSU Rowing Team from 2010-2014 when she saw Nassar for treatment of back pain. Anna was between 18 and 22 years old when she saw Nassar and was assaulted during all four years. When she hurt her back she was devastated and wanted to see the best doctor for her pain so she could continue to row. Anna said that Nassar called the procedure “trigger point treatment,” and she says “I didn’t even know it was abuse at the time.” She said she thought the treatment was weird and added that now she knows his treatment was sexual assault. She said she was so “brainwashed by him that I didn’t know it.” Anna ended her statement by saying, “because of Nassar I have to spend the rest of my life trying to heal and I want nothing more for him then to spend the rest of his life behind bars.” The judge assured her that he would.

The next few statements were read by the court. Brianne Randall was one of those statements. Randall saw Nassar for back pain. After a procedure, she knew it wasn’t right and filed a report with the Meridian Township police, which led to a hospital visit and a sexual assault kit. At the police station, Nassar and Randall’s parents met up and Nassar said it was a “misunderstanding” and no investigation was done. At the end of her statement the judge said, “the defendant became a good liar.”  [Day 1: Survivor: “I knew immediately that it was abuse”, WILX News 10]

______________________________________________________________________________

“At least 14 Michigan State University staffers and representatives were warned about Larry Nassar’s sexual abuse over the course of two decades and allegedly did nothing to stop it, according to an explosive new report from the Detroit News.

“Accusations from eight young women about the former USA Gymnastics and MSU team doctor’s behavior reportedly reached trainers, coaches, an MSU police detective and MSU President Lou Anna Simon, dating back to 1997. Simon learned about the problem in 2014 when a Title IX complaint and a police report were filed against an unidentified doctor.

“I was informed that a sports medicine doctor was under investigation,” Simon told the News on Wednesday after she appeared in court for Nassar’s sentencing hearing. “I told people to play it straight up, and I did not receive a copy of the report. That’s the truth.”

MSU has repeatedly denied covering up Nassar’s behavior in any way.

“Any suggestion that the university covered up Nassar’s horrific conduct is simply false,” MSU spokesperson Jason Cody told HuffPost earlier this month. “Nassar preyed on his victims, changing their lives in terrible ways. As President Simon has said, MSU is truly sorry for the abuse all victims suffered, the pain it caused, and the pain it still causes.”

“According to the Detroit News, the people who were told of Nassar’s abuse include former MSU head gymnastics coach Kathie Klages, current volleyball team trainer Lianna Hadden, current gymnastics team trainer Destiny Teachnor-Hauk, former MSU clinical psychologist Dr. Gary Stollak and officers at the Meridian Township Police Department.  [By Alanna Vagianos, 01/18/2018, Huffington Post]

2004: Brianne Randall-Gay, a 16-year-old soccer and tennis player, she filed a police report reported to Meridian Township police that Nassar touched her bare breast and put his hand between her legs during treatment for back pain, but the Police do not pursue charges against Nassar. alleging that he molested her during a 2004 doctor visit. She had a rape kit done. [Larry Nassar: A trail of sexual abuse, The Detroit News Jan. 17, 2018]

Her “second visit with Dr. Nassar, who was treating her for scoliosis, according to a police report.

Nassar massaged her buttocks with his elbow and said, “I bet people at physical therapy don’t do this.” He also rubbed her breasts, cupped her vagina and tried to penetrate it but could not because she was wearing a tampon, the report said.

Randall told an investigator she was “scared” and “uncomfortable” during the examination and that “it freaked her out.” She filed the police report after telling her mother what happened during that second visit. She also completed a rape kit examination at a hospital.

When an investigator interviewed Nassar, the doctor admitted touching Randall in her vaginal area, saying it is a medical technique known as the “sacrotuberous ligament release,” the police report said. He said the technique “has been published in medical journals and training tapes,” and provided police a PowerPoint presentation detailing the procedure.

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USA Gymnastics’ board steps down in wake of Nassar abuse scandal

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The presentation, titled “The Sacrotuberous Ligament: The Grand Junction,” was written by Nassar and included photos of him performing the procedure.

The investigator then contacted Randall’s mother to tell her he was “closing the case with no prosecution being sought, due to the facts presented … by Dr. Nassar.”

Randall’s mother told the investigator she was concerned about the way Nassar explained the procedure to her daughter and that he was not wearing gloves during the examination.

“Please listen to all children when they report abuse and take action.” Brianne Randall-Gay.  [Brianne Randall’s victim impact statement at Nassar sentencing, Jan 23, 2018 WZZM 13 TV]

“The same police department that declined to take a 17-year-old girl’s concerns about Larry Nassar to prosecutors in 2004 paid for her flight from Seattle to Michigan so she could speak at Nassar’s sentencing hearing Tuesday. Brianne Randall’s complaints prompted one of the first criminal investigations of Nassar in 2004.”  [Police pay for victim’s Seattle flight to testify against Nassar. By Beth LeBlanc, January 24, 2018, Lansing State Journal]

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Brianne Randall, who reported her abuse by disgraced former USA Gymnastics doctor Larry Nassar to police in 2004, will receive a public apology from officials in Michigan for their handling of the case [http://cnn.it/2FwFP62 CNN International]

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The sacrotuberous ligament (great or posterior sacrosciatic ligament) is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends.

The sacrotuberous ligament  runs from the sacrum (the lower transverse sacral tubercles, the inferior margins sacrum and the upper coccyx[1]) to the tuberosity of the ischium. It is a remnant of part of Biceps femoris muscle. The sacrotuberous ligament is attached by its broad base to the posterior superior iliac spine, the posterior sacroiliac ligaments (with which it is partly blended), to the lower transverse sacral tubercles and the lateral margins of the lower sacrum and upper coccyx.

Its oblique fibres descend laterally, converging to form a thick, narrow band that widens again below and is attached to the medial margin of the ischial tuberosity. It then spreads along the ischial ramus as the falciform process, whose concave edge blends with the fascial sheath of the internal pudendal vessels and pudendal nerve. The lowest fibres of gluteus maximus are attached to the posterior surface of the ligament; superficial fibres of the lower part of the ligament continue into the tendon of biceps femoris. The ligament is pierced by the coccygeal branches of the inferior gluteal artery, the perforating cutaneous nerve and filaments of the coccygeal plexus.[2]

Variation[edit]

The membranous falciform process of the sacrotuberous ligament was found to be absent in 13% of cadavers. When present it extends towards the ischioanal fossa travelling along the ischial ramus and fusing with the obturator fascia.

The lower border of the ligament was found to be directly continuous with the tendon of origin of the long head of the Biceps femoris in approximately 50% of subjects.[3] Biceps femoris could therefore act to stabilise the sacroiliac joint via the sacrotuberous ligament.

Function

The sacrotuberous ligament contains the coccygeal branch of the inferior gluteal artery.

Clinical significance[edit]

If the pudendal nerve becomes entrapped between this ligament and the sacrospinous ligament causing perineal pain, the sacrotuberous ligament is surgically severed to relieve the pain.

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ICD-10-PCS Procedure Code 015C

Pudendal Nerve

ICD-10-PCS Procedure Code 018C

Pudendal Nerve

ICD-10-PCS Procedure Code 019C

Pudendal Nerve

ICD-10-PCS Procedure Code 01BC

Pudendal Nerve

ICD-10-PCS Procedure Code 01CC

Pudendal Nerve

ICD-10-PCS Procedure Code 01DC

Pudendal Nerve

ICD-10-PCS Procedure Code 01NC

Pudendal Nerve

ICD-10-PCS Procedure Code 01QC

Pudendal Nerve

ICD-10-PCS Procedure Code 01RC

Pudendal Nerve

ICD-10-PCS Procedure Code 01SC

Pudendal Nerve

ICD-10-PCS Procedure Code 01UC

Pudendal Nerve

ICD-10-PCS Procedure Code 01XC

Pudendal Nerve

ICD-10-PCS Procedure Code 015C0ZZ [convert to ICD-9-CM]

Destruction of Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 015C3ZZ [convert to ICD-9-CM]

Destruction of Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 018C0ZZ [convert to ICD-9-CM]

Division of Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 018C3ZZ [convert to ICD-9-CM]

Division of Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 019C0ZZ [convert to ICD-9-CM]

Drainage of Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 019C3ZZ [convert to ICD-9-CM]

Drainage of Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 01BC0ZZ [convert to ICD-9-CM]

Excision of Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 01BC3ZZ [convert to ICD-9-CM]

Excision of Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 01DC0ZZ [convert to ICD-9-CM]

Extraction of Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 01DC3ZZ [convert to ICD-9-CM]

Extraction of Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 01NC0ZZ [convert to ICD-9-CM]

Release Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 01NC3ZZ [convert to ICD-9-CM]

Release Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 01QC0ZZ [convert to ICD-9-CM]

Repair Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 01QC3ZZ [convert to ICD-9-CM]

Repair Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 01SC0ZZ [convert to ICD-9-CM]

Reposition Pudendal Nerve, Open Approach

ICD-10-PCS Procedure Code 01SC3ZZ [convert to ICD-9-CM]

Reposition Pudendal Nerve, Percutaneous Approach

ICD-10-PCS Procedure Code 01XC0ZB [convert to ICD-9-CM]

Transfer Pudendal Nerve to Lumbar Nerve, Open Approach

ICD-10-PCS Procedure Code 01XC0ZC [convert to ICD-9-CM]

Transfer Pudendal Nerve to Perineal Nerve, Open Approach

 

The following code(s) above G58.8 contain annotation back-references

that may be applicable to G58.8:

G00-G99

Diseases of the nervous system

G50-G59

Nerve, nerve root and plexus disorders

Approximate Synonyms

Left femoral nerve palsy

Left femoral nerve paralysis

Motor polyneuropathy

Neuralgia iliohypogastric nerve

Neuralgia, pudendal

Neuropathy (nerve damage), multifocal motor

Neuropathy (nerve damage), phrenic

Paralysis of phrenic nerve

Phrenic nerve disorder

Phrenic nerve lesion

Right femoral nerve palsy

Right femoral nerve paralysis

ICD-10-CM G58.8 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):

073 Cranial and peripheral nerve disorders with mcc

074 Cranial and peripheral nerve disorders without mcc

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What is pudendal neuralgia?

“Pudendal neuralgia is a rare problem with the pudendal nerve that can affect both men and women. The pudendal nerve runs through your pelvic region, including your genitals, urethraanus, and perineum. Your perineum is the area between your anus and genitals. The condition is also known as pudendal neuropathy, pudendal nerve entrapment, cyclist’s syndrome, pudendal canal syndrome, or Alcock’s syndrome.

“Pudendal neuralgia can cause pain, especially when you sit. Men with pudendal neuralgia may have pain in the buttocks, scrotumpenis, and perineum. Women with pudendal neuralgia may have pain in their buttocks, vulva, urethra, and perineum.  [Pudendal Neuralgia – Overview WebMD]

References[edit]

This article incorporates text in the public domain from page 309 of the 20th edition of Gray’s Anatomy (1918)

Marios Loukas, Robert G Louis Jr, Barry Hallner, Ankmalika A Gupta and Dorothy White. (2006) “Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome” Surg Radiol Anat 28(2): 163-169

Gray’s anatomy, 40 edition.

Vleeming, A., R. Stoeckart, et al. (1989). “The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint.” Clinical Biomechanics 4(4): 200-203.

[Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency. Pain Physician.  2009; 12(3):633-8 MedLine Abstract by Rhame EE; Levey KA; Gharibo CG]

“Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendal nerve, often aggravated with sitting. Current therapies include medication management, nerve blocks, decompression surgery, and neuromodulation. The ideal management for PN has not been determined. We present a case of a female with 1.5 years of sharp, burning pain of the left gluteal and perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliac joint, epidural, and piriformis injections did not improve her pain. She had tried physical therapy, occupational therapy, massage, and acupuncture but the pain persisted. Medication treatment with oxycodone-acetaminophen, extended release morphine sulfate, amitriptyline, and gabapentin provided only minor relief and she had failed other multianalgesic therapy. She had been unable to work at her desk job for over a year. She had a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that provided pain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF) of the left pudendal nerve in hopes of achieving a longer duration and improved pain relief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds for a duration of 120 seconds at 42 degrees Celsius. After the procedure she reported tolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned. At 5 months follow-up she felt motivated to return to work. One and a half years after the procedure the patient is only taking oxycodone-acetaminophen for pain relief and still has good sitting tolerance. There were no procedure-related complications. To our knowledge PRF for the treatment of PN has not been reported elsewhere in the literature. PRF is a relatively new procedure and is felt to be safer than continuous radiofrequency. Current literature suggests that PRF delivers an electromagnetic field, which modifies neuro-cellular function with minimal cellular destruction. We conclude that PRF of the pudendal nerve offers promise as a potential treatment of PN that is refractory to conservative therapy.”

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Pudendal Neuralgia, Waseem Khoder, MD, Douglass Hale, MD, FACOG, FACSCorrespondence information about the author MD, FACOG, FACS Douglass HaleEmail the author MD, FACOG, FACS Douglass Hale

, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Indiana University School of Medicine, 1633 North Capitol Avenue, Suite 436, Indianapolis, IN 46202, USA

[Pudendal Neuralgia Khoder, Waseem et al. Obstetrics and Gynecology Clinics , Volume 41 , Issue 3 , 443 – 452]

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This case features a 14-year-old female gymnast with reports of burning, stinging, shooting, pain and numbness in the pelvis

https://www.nervemed.com/case-study-14-year-old-female-with-pelvic-pain/

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“”> Brianne Randall-Gay, the woman whose assault complaint against Larry Nassar was dismissed without charges being filed in 2004, accepted an apology years later, this past Thursday from a Michigan police chief who said, “We wish we had this one back.

Brianne Randall-Gay was 17 when she told Meridian Township police that Nassar had molested her with ungloved hands when she sought help for her back.

Officers, however, closed the case after the Michigan State University sports doctor offered an aggressive defense and insisted he was using a legitimate medical technique.

Police didn’t seek an outside opinion on Nassar’s technical explanation.

“It should have been passed on to another expert and it wasn’t,” said police Chief Dave Hall, who called that misstep the “downfall” of the investigation.

Randall-Gay, who participated in the news conference by video from Washington state, said the public apology eases her pain but doesn’t “erase the pain I’ve suffered” since 2004.

“I felt like my complaint was ignored. I felt like I was ignored,” she recalled.

Nassar, who also was a doctor for the U.S. women’s Olympic gymnastics team, subsequently assaulted many more girls after 2004, penetrating them with his hands, according to authorities. He was sentenced last week to 40 to 175 years in prison and faces another long sentence next week.

At least 265 women and girls have said they were assaulted in Michigan and elsewhere, some going back to the 1990s.

Hall and township Manager Frank Walsh reached out to Randall-Gay weeks ago and paid for her to travel to Michigan to testify as a victim at Nassar’s sentencing. She said she cried when she received their call. The officer who had handled her complaint, Sgt. Andrew McCready, apologized in private.

“We were deceived. We wish we had this one back,” Hall said.

In the old police report released Wednesday, Randall-Gay and her mother told investigators that they had visited Nassar to discuss treatment for scoliosis, a curvature of the spine. He sent her to physical therapy but saw her again, this time alone.

She told police that Nassar had removed her underwear, forcibly cupped her genitals with his hand and rubbed her breasts — all without gloves.

“She thought it was ‘weird’ and it ‘freaked her out,'” the police report says.

Nassar told police he applied pressure to the “perineum,” using a formal word for an area between the legs, and said it was done to manipulate a ligament, according to the report.

He provided a paper version of a PowerPoint presentation about the ligament procedure, titled “The Grand Junction.” The case was closed.

Nassar presented officers with a “stack of medical journals this high,” Walsh told reporters Thursday, raising his arm. “He duped us.”

“We can’t undo what happened in 2004. We can only be better because of it, and we’re going to take all the steps necessary to make that happen,” Walsh said. <””  Please read the entire article  [Nassar victim who complained in 2004 gets apology from Michigan police chief by Mike Householder and Ed White, Feb 1, 2018, AP, Chicago Tribune]

______________________________________________________________________________________

Research Abstract:  “”>The principle of informed consent, aimed at the lawfulness of health assistance, tends to reflect the concept of autonomy and of decisional autodetermination of the person requiring and requesting medical and/or surgical interventions. This legal formula, over the last few years, has gained not only considerable space but also importance in the doctrinal elaboration and approaches, as well as juridical interpretations, thereby influencing the everyday activities of the medical profession. Informed consent is still the object of continuous explorations, not only asfar as concerns the already confirmed theoretical profile but, instead, the ambiguous practical and consequential aspect…….

The expression informed consent has simply been transposed in Italian and roughly translated in an ambiguous fashion into “consenso informato” when, on the contrary, it should be referred to as “informazione per il consenso” “information for consensus” not only to respect the concept but, surely, for a more correct deciphering and a more precise interpretation related to the numerous concepts it presupposes and implies.

Information and consent may be compared to the two sides of the same coin. These are the two important pillars that coincide and are joined giving weight to the medical responsibility, as far as concerns consent to the health intervention:

  1. on the one hand, having obtained consent, following correct and sincere information interpreted and deciphered as an important phase and an essential indicator of correct, scrupulous medico-professional procedure
  2. and, on the other, the consensus itself conceived as a duty aiming at the maximum respect of the rights to auto-determination, independence and autonomy of the patient, as a person.

At the beginning of the Nineties, as we have seen, we were made aware of a series of legal actions regarding medical responsibility which was greatly conditioned by the Anglosaxon influence which initially induced many Italian magistrates and forensic physicians to adopt an extremely rigid attitude with no attempt to comply, in any way, with the culture and traditions of our country and our tradition which has always been inspired by good common sense, both medical and human. The American experience has been very rapidly adopted, by some, without a profound, complete and necessary historical and evolutional analysis aimed at those intertwined principles that have been motifs that have gradually led to the legal references in those emblematic cases referred to, the conclusions of which continue to attract a great deal of attention.  “”< [The origin of informed consent Mallardi VActa Otorhinolaryngol Ital. 2005 Oct; 25 (5): 312-27]

____________________________________________________________________

Research Abstract::  “”> The distinction between clinical practice and surgical research may seem trivial, but this distinction can become a complex issue when innovative surgeries are substituted for standard care without patient knowledge. Neither the novelty nor the risk of a new surgical procedure adequately defines surgical research. Some institutions tacitly allow the use of new surgical procedures in series of patients without informing individuals that they are participating in a scientific study, as long as no written protocol or hypothesis exists. Institutions can justify this practice by viewing human research in narrow terms as an activity outlined in a formal protocol. Application of limited definitions, however, erodes patients’ rights and risks losing public confidence in how biomedical research is conducted. I propose an operational definition of human research also be recognized.

Enforcing more rigid and less ambiguous guidelines of human research may curtail enrolment into some studies, but it will also protect patients from being used as subjects without their knowledge.  [When is surgery research? Towards an operational definition of human research by C. Margo, J Med Ethics. 2001 Feb; 27(1): 40–43]

________________________________________________________________

Research Abstract::  “”>  Biomedical research still does not have clear, written, agreed-upon underlying values (for a number of possible reasons that are discussed), and a variety of new pressures are making it necessary to formulate such principles. Toward that goal, this essay first traces the development of the underlying principles that have been formulated in the sphere of human subjects research, from the ancient Hippocratic injunction of do no harm to the three principles identified in 1979 by the National Commission for Protection of Human Subjects of Biomedical and Behavioral Research: respect for persons; beneficence; and justice. Using these principles as a pattern, the following “candidate principles” are proposed for biomedical research to stimulate discussion and the development of consensus among biomedical scientists: honesty of scientists (which encompasses the essential values of integrity, objectivity, verifiability, and truthfulness); respect for others (including respect for research subjects–both humans and other animals–colleagues, and the environment); scholarly competence (which is related to the processes of obtaining and passing on knowledge); and stewardship of resources (involving obligations to protect society from the problems intertwined with scientific advances). Guiding principles of this type must be articulated so they can be transmitted to upcoming scientists, who then can productively and responsibly help shape the future of the research enterprise.  [Toward a statement of the principles underlying responsible conduct in biomedical research. Bulger RE, Acad Med. 1994 Feb;69(2):102-7.]

__________________________________________________________________________________

Nassar victim who complained in 2004 gets apology from Michigan police chief:  “”> Brianne Randall-Gay, the woman whose assault complaint against Larry Nassar was dismissed without charges being filed in 2004, accepted an apology years later, this past Thursday from a Michigan police chief who said, “We wish we had this one back.”

Brianne Randall-Gay was 17 when she told Meridian Township police that Nassar had molested her with ungloved hands when she sought help for her back.

Officers, however, closed the case after the Michigan State University sports doctor offered an aggressive defense and insisted he was using a legitimate medical technique.

Police didn’t seek an outside opinion on Nassar’s technical explanation.

“It should have been passed on to another expert and it wasn’t,” said police Chief Dave Hall, who called that misstep the “downfall” of the investigation.

Randall-Gay, who participated in the news conference by video from Washington state, said the public apology eases her pain but doesn’t “erase the pain I’ve suffered” since 2004.

“I felt like my complaint was ignored. I felt like I was ignored,” she recalled.

Nassar, who also was a doctor for the U.S. women’s Olympic gymnastics team, subsequently assaulted many more girls after 2004, penetrating them with his hands, according to authorities. He was sentenced last week to 40 to 175 years in prison and faces another long sentence next week.

At least 265 women and girls have said they were assaulted in Michigan and elsewhere, some going back to the 1990s.

Hall and township Manager Frank Walsh reached out to Randall-Gay weeks ago and paid for her to travel to Michigan to testify as a victim at Nassar’s sentencing. She said she cried when she received their call. The officer who had handled her complaint, Sgt. Andrew McCready, apologized in private.

“We were deceived. We wish we had this one back,” Hall said.

Meridian Township is next to Michigan State in the Lansing area. In the old police report released Wednesday, Randall-Gay and her mother told investigators that they had visited Nassar to discuss treatment for scoliosis, a curvature of the spine. He sent her to physical therapy but saw her again, this time alone.

She told police that Nassar had removed her underwear, forcibly cupped her genitals with his hand and rubbed her breasts — all without gloves.

“She thought it was ‘weird’ and it ‘freaked her out,'” the police report says.

Nassar told police he applied pressure to the “perineum,” using a formal word for an area between the legs, and said it was done to manipulate a ligament, according to the report.

He provided a paper version of a PowerPoint presentation about the ligament procedure, titled “The Grand Junction.” The case was closed.

Nassar presented officers with a “stack of medical journals this high,” Walsh told reporters Thursday, raising his arm. “He duped us.”

Outside the Nassar matter, the department now is taking a fresh look at any sexual misconduct complaints filed since 2000 to determine if they were handled properly. The chief also will personally review any new cases.

“We can’t undo what happened in 2004. We can only be better because of it, and we’re going to take all the steps necessary to make that happen,” Walsh said. <””  [Nassar victim who complained in 2004 gets apology from Michigan police chief by Mike Householder and Ed White, Feb 1, 2018, AP, Chicago Tribune]

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