The genital examinations administered to three former patients of San Mateo child psychiatrist William Ayres appeared to have "very specific” medical reasons and follow the general consensus of researchers who not only approve of but encourage such methods, a psychotherapist with a medical degree told jurors yesterday.
Dr. Gilbert Kliman took the stand all day in the molestation trial of the former doctor whom prosecutors say inappropriately touched male minor patients under the guise of medical exams.
Ayres, 77, is anticipated to take the stand himself today in his own defense but first defense attorney Doron Weinberg called Kliman to back the argument his client’s accusers — now adults — erroneously believe they were abused as part of routine examinations to rule out physiological problems as a cause of their psychological issues.
Kliman told jurors that while those in his specialty of psychoanalysis take care not to have any physical or even outside contact with a patient, psychiatrists don’t necessarily agree.
"They march to a different drummer,” Kliman said.
Weinberg wants jurors to believe the men’s allegations are due in part to leading police interrogations and media coverage.
Ayres, 77, has pleaded not guilty to 10 counts of lewd and lascivious activity with a child under age 14 stemming from the six men who say he molested them between 1988 and 1996 when they were aged 9 to 13. Last week, those six alleged victims testified as did four patients whose allegations fall outside the statute of limitations. The jury must decide if those statements can be used as evidence.
Kliman, who belongs to the American Academy of Child and Adolescent Psychiatry of which Ayres once was president, differed from prosecution witness, Dr. Lynn Ponton, who told jurors there was little if any reason for the genital exams described by 10 former patients who testified.
Ponton gave jurors a set of her own guidelines for physical examinations of children and red flags that she found in the alleged victim’s medical files. Kliman, who also reviewed the files, disagreed. At one point, he called notes in one patient’s filed a "delightful psychotherapeutic interaction” and praised Ayres’ methods. At another, he said Ponton is a psychoanalyst like himself and likely adheres to the no-contact standard rather than the wider realm of psychiatry which allows — and sometimes proactively supports — the idea of physical and genital exams performed in conjunction with treatment.
Physical abnormalities of the genitals can often signify problems which also carry behavioral issues, such as Klinefelter syndrome in which the testicles are small and undescended and the patient carries an extra X chromosome, he said.
Some researchers believe physical exams provide more comprehensive care and "increase rapport” between doctor and patient, Kliman said.
The number of child psychiatrists have dropped in the past two decades out of fear false memories will create a "day care epidemic,” he said, referencing the notorious McMartin preschool case in which hundreds of children accused their caregivers of sexual abuse only to have the charges dismissed and the allegations later thrown into question.
A "number of concerning studies” showed that kids through the age of 10 significantly "misremember” aspects of physical exams and gave false positive statements that their genitals were touched, Kliman said.
Kliman conceded he’d likely seek parental consent before performing a physical and genital exam on a minor patient but that it isn’t an industry standard.
Walking through the medical and police reports on four former patients who testified, Kliman suggested legitimate reasons for Ayres to have conducted physical exams. Orion B.’s file referenced Klinefelter Syndrome but at age 9 was likely too young for testosterone therapy. Kliman said an exam as part of guiding the boy successfully through puberty in his condition would be "a typical objective.” Scott T., who saw Ayres for bedwetting, could have had a physical cause for the condition such as a dual urinary system or penile malformation — both reasons Kliman said he could have undergone a genital exam. Robert W. had no medical records but testified he asked Ayres about growth of his enlarged left nipple. Kliman said that could be linked to a number of conditions or smoking of too much marijuana. Scott E. told jurors the doctor touched his groin area during an exam after he complained of cramps. The problem was gastrointestinal so an exam in that region is expected and if the doctor’s hands brushed his penis, it would be "probable,” not improper, Kliman said.
Kliman also said discussions about sexual anatomy, including the arousal and elasticity of female genitalia, is not inappropriate with a teenage boy.
"I don’t see anything wrong with that,” he said.
The crux of some debate between Kliman and prosecutor Melissa McKowan is whether in the absence of concrete examination guidelines by the child psychiatric academy if pediatric medicine standards should be used. That policy includes chaperones.
Kliman said no and explained that every region of the nation and every psychiatric department has its own rules. Ayres’ decision to examine patients was made in the midst of "what you are complaining about,” namely a lack of uniformity and a variety of opinions, Kliman told McKowan.
Under cross-examination, Kliman said the medical records of the three patients after 1991 showed medical reasons for each genital examination.
"It wasn’t random at all,” he said.
Yet, he conceded, others didn’t specifically note exams of the boys just details about urine and the presence of public hair.
He also agreed that if the examinations involved masturbation and ejaculation as alleged, Ayres would not be adhering to any academy’s standards.
"Of course it would not be proper for a doctor to rob children of their innocence ...,” Kliman said.
Ayres is free from custody on $750,000 bail. Closing argument are tentatively scheduled for Friday following the prosecution’s rebuttal.
Michelle Durand can be reached by e-mail: firstname.lastname@example.org or by phone: (650) 344-5200 ext. 102.