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"We could collect our $350 from the state and move on," Rauth-Farley says, "but I need a reason to believe something's happened to the kid. Then we'll examine. The child doesn't necessarily have to disclose something. Sometimes it's instinct, but I do go on something. . . . Not that the exam is traumatic, it's just not fun."
Each child who does get a physical exam undergoes a 90-minute drill: It's a checkup that ends with an examination of the genitals using a device called the colposcope. A series of magnifying glasses, the colposcope doesn't touch the subject, but allows the trained observer to better determine if abuse has or hasn't occurred. If evidence emerges and the police don't know about it yet, Rauth-Farley is mandated by law to report it.
She says most doctors are untrained in how to analyze sexual abuse, often with grave repercussions. She describes how, time and again, an emergency-room doctor or a family practitioner will tell a parent that a child has been abused, solely because of a hymenal tear.
"That's not necessarily true," Rauth-Farley says. "Too many doctors don't know a hymen from a head, or that the myth about 'busting the cherry' is just that, a myth. Even then, a perfectly normal exam can still be consistent with sexual abuse, depending. We doctors don't always have answers . . ."
The doctor tells a story of an 8-year-old girl whose minister father took her to the ER at St. Joe's. The child was bleeding badly from her vagina, and was too traumatized to talk.
"It looked for all intents and purposes that she had been raped," Rauth-Farley recalls. "They took her to the operating room, with the dad in the waiting room. Everyone was treating him like crap, very accusatory. As it turned out, I was thoroughly embarrassed by how they treated this man. They called me down there, and I spoke to the dad. He said they were coming back from church and his daughter was on her bike, that's all he knew."
She says she asked the police to check the little girl's bicycle. They discovered the child had impaled herself on a bracket that attaches to a reflector behind the seat.
Almost in passing, Rauth-Farley says prepubescent females may not be able to distinguish vaginal from labial penetration if it's momentary. In the audience, assistant public defender Candace Kent takes careful note. The attorney has a client accused of sticking his finger in his step-granddaughter's privates. Rauth-Farley is listed as a prosecution witness.
A month later, the case comes to trial. Rauth-Farley walks briskly to the witness stand in a Maricopa County courtroom. She's toting a black purse, and is dressed in a white pleated dress and red jacket, looking sharp and professional.
Waiting in the lobby minutes earlier, Rauth-Farley realized that the prosecutor accidentally had handed her a report from another case. A less experienced hand may have panicked, considering that the doctor hadn't looked at the correct file in more than a year.
Instead, Rauth-Farley chuckled, then mused, "Would have looked real good, talking about the wrong girl on the stand. Oh, well. Didn't happen. No problem."
The prosecutor leads Rauth-Farley through her resume--undergraduate, graduate and medical school degrees from Creighton University in Omaha, Nebraska, residency at the University of Nebraska-Omaha, a pediatrician for 16 years, at St. Joseph's Hospital since 1989.
She makes eye contact with the jurors, and is serious but relaxed on the stand.
This case is a tough one for the prosecution: When the little girl was 5, she told her mother that grandpa had stuck his finger into her vagina. He says he may have accidentally touched her genitals briefly when she was sitting on his lap.
Rauth-Farley tells jurors that the girl's exam showed no signs of injury. She says she saw signs of redness outside the child's labia, but that it wasn't a significant finding.
Candace Kent asks the doctor, "The bottom line with a history of touching, you wouldn't expect to find any physical signs?"
"And if the touching is momentary and accidental, you're not going to find any physical signs?"
Kent asks Rauth-Farley to recall what she'd said at the Bar meeting in April. The doctor sticks to her earlier comment, that prepubescent girls sometimes mistake touching as penetration.
As she leaves the courtroom, Rauth-Farley passes a little blond girl engulfed by family members. It's the alleged victim.
The doctor turns to a young resident at St. Joe's who watched her testify.
"I have to tell the jury what I found," Rauth-Farley tells him, turning her testimony into a teaching lesson, "and I can't be evasive. That's not right. I have to tell it like I see it. Do I think the little girl is telling the truth? Sure. But it's not my job to sort that out."
The defendant is acquitted on one charge, with the jury deadlocked on the other. Prosecutors say they plan to retry the man on the remaining count.
Kay once told me that there's never a day that she doesn't want to take a child home with her.
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