MPIE Risk Management GEM (Volume II): Chaperones in Ambulatory Care: The Best Defense Against Sexual Abuse Allegations

In the news:

These are just some of the recent headlines showing that sexual abuse allegations against healthcare providers continue to be problematic. They also show that sexual abuse allegations and professional liability concerns for providers have not decreased since the start of the COVID-19 pandemic. One may have assumed these cases would decrease with fewer in-person visits. However, our risk management assessments, consultations, and claims investigations involving sexual abuse suggest otherwise.

There is no fail-safe approach to preventing sexual abuse claims in the medical field. However, using chaperones for all intimate or potentially sensitive exams, procedures, or diagnostic testing is the best way to mitigate the risk of such allegations. The highest risk for allegations of sexual abuse remains associated with intimate exams by physicians. Claims and licensing complaints continue to be filed against allied health professionals providing examinations or therapy near genitals or breasts. Some of the most significant risks arise when a male provider or allied health professional examines or treats an unaccompanied minor female patient. Being aware of this dynamic when scheduling appointments is an essential first step. Automatically scheduling a chaperone for such visits may prevent any potential allegations or misunderstandings.

Before conducting an intimate exam or providing medical care near a potentially sensitive body part, healthcare providers should discuss the nature of the exam or treatment to be provided and include the purpose and role of the chaperone with the patient (or representative). Some patients may be uncomfortable with the presence of a chaperone or not have a thorough understanding of the chaperone’s role.   

Patients have a right to refuse a chaperone. However, it would be highly concerning if refusal continued after discussing the chaperone’s purpose and role. Healthcare providers may also be unwilling to conduct an intimate examination without a chaperone. If the patient continues to refuse the chaperone, in either case, as noted above, it would be in the provider’s best interest to suggest that the patient seeks an alternative provider (so long as the patient’s clinical needs allow this).

A patient may want a family member or companion present during sensitive examinations or procedures. However, such individuals should not serve as the designated chaperone. Instead, the practice should ensure that an appropriately trained staff member act as the chaperone. The designated chaperone should also be of the gender with which the patient feels most comfortable.  

Chaperones provide essential protection for both patients and providers during exams and procedures. They can also provide benefits beyond that function by promoting patient safety and comfort. Their presence may prevent misunderstandings that may lead to future accusations while protecting the patient’s dignity during sensitive exams and procedures.

Clear communication about sensitive issues is also important in reducing allegations of sexual abuse by healthcare providers. Physicians and allied health professionals should precisely explain in detail what the process, procedure, or therapy will entail. The conversation should be exceptionally clear about any hands or equipment that will be placed on or near sensitive body parts. There should also be sufficient opportunity for the patient (or parent or guardian) to ask questions and for the patient to make the provider aware if they are uncomfortable or otherwise apprehensive about the therapy or exam. A separate opportunity for private discussions between the patient and provider should be made available after the exam if a chaperone is used.

Documentation in the medical record of the discussions and who was present in the room should also occur. This should include the name of the person in the chaperone role. Having a written record identifying who was in the room during the exam can also help to protect against accusations or clarify any misunderstandings.

Risk Management Resources and Support
To promote the development and deployment of chaperone policies and procedures, we are sharing (with permission) a sample policy from ECRI. Please review this sample and consider how it may be best incorporated into your practice or enhance your existing policy approach.

MPIE Risk Management also includes a program called “Sexual Abuse Prevention” as part of the core 2022 annual education requirements. Look for more information to be released soon!

If you are an employed provider of a healthcare system and have questions on this subject, please consult your organization’s risk management department for advisement as to system policy or protocol.