As lawsuits mount against the University of Southern California and a former gynecologist who worked at the school, so do the outrage and demand for answers.
Mixed into the conversation is this: If nurses or medical assistants serving as chaperones witnessed Dr. George Tyndall inappropriately touching and treating students, as some have claimed, what's the point of chaperones?
USC and a former gynecologist there face lawsuits about claims of inappropriate behavior
If witnesses were in the exam room serving as chaperones, what's the point of chaperones, some wonder
A recent investigation by the Los Angeles Times revealed decades of allegations of inappropriate behavior by Tyndall. A 2016 USC investigation led to a suspension with pay, the Times reported, but he did not leave the university until June 2017, after he signed separation papers and agreed to retire.
The more than 20 former and current USC employees interviewed, and numerous complaint documents reviewed, included accounts from chaperones who were in the exam rooms, the paper reported.
One lawsuit filed Monday on behalf of four former students calls Tyndall a "serial sexual predator" and backs the contention that chaperones were aware of what was happening.
A chaperone was there and "deliberately looked away" when Tyndall penetrated Jane Doe 1's vagina "with his entire hand, up to his wrist ... without a glove," the complaint reads.
A chaperone was there and "took no action to prevent or report Tyndall's sexual abuse" when Jane Doe 2 was told to strip naked, was groped and asked "whether or not she had ever swallowed semen before," the documents say.
They also say that because a chaperone was there, Jane Doe 3 "trusted that Tyndall had provided her with legitimate medical treatment" when he repeatedly penetrated her with his ungloved fingers and refused to do the Pap smear that prompted her appointment in the first place.
And while the USC-sanctioned doctor groped Jane Doe 4, "spread her naked buttocks cheeks" and asked about her "willingness to engage in oral and anal sex," the complaint says that the mere presence of the chaperone had helped her ignore that she was "sexually assaulted" -- until stories about Tyndall's alleged actions gained national publicity.
'The ethical obligation'
Students and staff members, including chaperones, reportedly filed complaints about the doctor over the course of many years. Why those alarms didn't amount to meaningful action will be a subject for courtroom arguments.
But what about those nurses and medical assistants who reportedly served as chaperones and their responsibility? What does the Tyndall story mean when it comes to them?
Nurses have an obligation "to promote, advocate for and protect the rights, health and safety of the patient," said Liz Stokes, director of the American Nurses Association's Center for Ethics and Human Rights. And that obligation "transcends into chaperoning, as well."
Though not familiar with the details of the Tyndall case and unable to know how many of the chaperones working with Tyndall were in fact nurses, Stokes said the association's code of ethics requires that nurses "take appropriate actions" when the interests of patients are in jeopardy. "With the ethical obligation to do no harm," nurses must report wrongdoing, including unsafe practices.
Speaking up can be difficult and uncomfortable, she said, but that's where seeking advice from other staff members and supervisors comes in. And, she added, nurses -- like any health care provider -- have the authority to file complaints with licensing boards.
USC filed a complaint about Tyndall with the Medical Board of California in March, after he wrote a letter requesting his reinstatement at the university.
'No foolproof methods'
The use of chaperones during gynecological exams is not law, but it is recommended by the American College of Obstetricians and Gynecologists, the leading professional membership organization.
"A chaperone should, at the very least, be offered," said Dr. Sigal Klipstein, a former chairwoman of the organization's ethics committee. And if a chaperone isn't offered, she said, patients need to feel empowered to ask for one.
The practice started at a time when most gynecologists were men, she said, and chaperones stepped in "to make women feel comfortable and protected."
Now, irrespective of a gynecologist's gender, she said, the practice is still recommended.
Teenage girls often want their mothers in the room, but even then, Klipstein said, it's best to also have "an unbiased observer."
Chaperones exist not just for the patients, she explained; they are also there to protect physicians who might be slapped with false accusations. It is in the interest of both parties -- the patient and the doctor -- to have a bystander and witness present.
If that bystander in the corner sees something inappropriate, she has a responsibility to speak up, Klipstein said.
"We would expect that that would happen," she said before reflecting on news reports about Tyndall, which seemed to be "a breakdown in the system."
Though there are "no foolproof methods," the system in place usually works, Klipstein said. Ob/gyns explain what they're doing to put patients at ease, while chaperones stand by to help patients feel safe and protected.
Gynecological exams are crucial in preventing disease, diagnosing cervical cancer and protecting reproductive health. For that reason, the allegations against Tyndall -- and the reported inaction of chaperones in his exam room -- leave her concerned.
"I would hate for this situation to make women uncomfortable to go to the gynecologist," she said. "It's so important."
'My heart breaks for them'
Cate Guggino understands the gravity of what went on in Tyndall's examination room and offers a uniquely qualified perspective.
Guggino, a women's health nurse practitioner, was a patient of Tyndall's 16 years ago, and she wrote about her experiences in an opinion piece for the Los Angeles Times this week. She said that, as she read the paper's investigation, "my blood ran cold."
She remembered how he asked her to undress while standing just behind a thin curtain. She recalled how he pushed his fingers inside her, causing her pain. She flashed back to his question "I thought you said you weren't a virgin?" and how he told her -- incorrectly -- "your hymen is still intact."
She reflects on that moment today with "trained eyes" and a fuller understanding of female genital anatomy. What he pushed his fingers against that day, when she was a 25-year-old theater student, was not her hymen; it was her G spot, she wrote.
"I am writing this as a victim, yes, but also as a women's healthcare provider who spends her days making sure women have a safe, comfortable and respectful experience during a pelvic exam," she wrote. "What happened in my case -- and I can only speculate happened in so many other cases like mine -- was not normal and was not acceptable."
CNN reached out to Guggino to learn whether there was a chaperone in the exam room that day, to see what she -- given her work -- might say about this matter.
She couldn't recall whether there was a chaperone, but she gathers that there were for some students, based on reports.
"If there were chaperones present at exams that recognized that something was wrong and felt that they had the means to effectively and safely report that but chose to say nothing, I have a huge problem with that," she wrote in an email response.
"However," she added, "if chaperones present at exams recognized that something was wrong and felt they did not have the means and/or safety to report that, then my heart breaks for them because, albeit in a very different way, they were just as much victims of Tyndall's actions and the USC administration's inaction as I and my fellow students were."
That chaperones stayed silent may be attributed to the "significant power differential" that exists, she said, "between doctors/administrators and nurses/medical assistants/clinic staff." Those who did speak out showed "incredible courage."
Guggino also had a message to relay to women who, like her, might have been violated by Tyndall.
"For the victims who feel the chaperone's presence -- and silence -- legitimized the treatment they received I would say first that I hear them, that I understand," she said. "I would also gently encourage them to consider the larger system the chaperones were operating within, while recognizing the feelings about this are deeply personal."
What she sees when she thinks back to her time at USC and the continued tenure of Tyndall is "an incredibly broken system."
CNN attempts to reach Tyndall for comment have gone unanswered.
A spokesman for USC referred questions to a resource page set up for student health center patients, which includes details about a hotline for Tyndall-related complaints and concerns.
The page also includes a message outlining the university's efforts to improve oversight and practices, which started "unrelated to the Tyndall investigation, in early 2016" with the appointment of a task force and led to the hiring of a new chief health director for the student health center.
As a result, "over the past year the health center staff has received extensive training on reporting," the page says. "This training will be ongoing with intensive sessions scheduled this summer and fall to ensure that any concerning behavior is quickly reported and addressed."
In sharing her own story, and seeing the reports shared by others, Guggino hopes this moment will help fix the system on campuses -- not just at USC but across the board -- so young women feel safe and protected.
And maybe this discussion could be a turning point.
"Addressing the issues that have come up around chaperones may be a great place to begin," she said.