Practice of Medicine

Article

Chaperones- Considerations for Reducing Liability:

June 23, 2015

From the Desks of:

Karen Civali, RN, CPHRM; Mary Gregg, MD, FACS, MHA, Chief Medical Officer, SVP; Laura Martinez, BSN, RN, MS, CPHRM, FASHRM,VP Risk Management

Allegations of healthcare sexual impropriety have commanded sensational news headlines and stories, serving as judge and jury over the involved physicians and/or other healthcare workers.

Patient Sues, Claims She Was Raped During Colonoscopy  (Outpatient Surgery March 12, 2015).  A Portland, Ore., woman is suing the clinic that performed her colonoscopy last April for unspecified damages, claiming that she was sexually assaulted while under anesthesia, a charge the clinic vehemently denies…..

Nurse Accused of Sodomy in PACU;  (Outpatient Surgery,  March 10, 2015) Recovering patient emerged from anesthesia to the alleged assault...

Could this happen in your health care setting? 

The American Medical Association’s (AMA) Opinion on the Use of Chaperones states, “From the standpoint of ethics and prudence, the protocol of having chaperones available on a consistent basis is recommended.  The Opinion also states, “A policy that patients are free to make a request for a chaperone should be established in each health care setting.”

The AMA suggests the following tenets be added to any policy concerning the use of chaperones:

Communicate the chaperone protocol to patients by prominent notice and through conversation with the patient.

•     Honor all requests for a chaperone.

•     Provide facilities for undressing, sensitive use of draping, and clear explanations on the

various components of the physical examination.

• Provide chaperones on a consistent basis, particularly for intimate examinations and those that may be construed as such.

• When a chaperone is offered, keep patient inquiries of a sensitive nature to a

minimum. Provide a separate opportunity for a private conversation between the

patient and the physician, in order to protect the patient’s personal health information(PHI).

• Provide an authorized health professional to serve as the chaperone whenever possible.[1]

The American Academy of Pediatrics (AAP) offers the following guidance on the use of chaperones for children and adolescents.

In the medical office setting, the physical examination of an infant, toddler, or child

should always be performed in the presence of a parent or guardian. If a parent or

guardian is unavailable or the parent’s presence will interfere with the physical

examination, such as in a possible case of abuse or parental mental health issues, a

chaperone should be present during the physical examination.”[2]

It is important for health care professionals to recognize the patient who requires too much of the physician's attention or who makes the physician feel uncomfortable, even when sensitive examinations are not taking place.  Do not permit sexual advances by a patient. Strongly consider termination of the patient/physician relationship if this occurs.

The key to avoiding allegations of sexual misconduct is to be able to recognize patient behaviors and patient encounters that have the potential to be misconstrued as a violation of the professional boundary that exists between the health care provider and the patient. The possibility of an allegation of sexual misconduct still exists despite the absence of any inappropriate behavior by the physician, their staff or other health care professionals.

By implementing these recommendations, health care professionals can reduce exposure to such allegations, and maintain a professional relationship with patients.

Consult your state medical board for any state-specific guidelines on the use of chaperones.

MagMutual Risk Management and Patient Safety Consultants invite our policyholders’ questions. If you wish to discuss issues related to this article, or have other questions please call us at 1-800-282-4882, and ask for Risk Management.

 

The information presented in this Advisory is intended as general information of interest to physicians and other healthcare professionals. The recommendations and advice published herein do not reflect or establish a standard of care and do not establish rules for the practice of medicine. The publication of this information is not intended as an offer to insure such conditions or exposures, or to indicate that MAG Mutual Insurance

Company will underwrite such risks for the reader. Our liability is limited to the specific written terms and conditions of actual insurance policies issued.

*Revised December 2014, June 2015

  [1] American Medical Association, Council on Ethical and Judicial Affairs. "Use of Chaperones During Physical Exams." June 1998.

 

 

[2] American Academy of Pediatrics. "Policy Statement - Use of Chaperones During the Physical Examination of a Pediatric Patient." American Academy of Pediatrics (American Academy of Pediatrics), September 2011: 991993.

American Medical Association. Opinion 8.21- Use of chaperones during physical exams. Chicago, IL: American Medical Association, 1998

American Medical Association. Opinion 8.21- Use of chaperones during physical exams. Chicago, IL: American Medical Association, 1998.

American Medical Association, Council on Ethical and Judicial Affairs. "Use of Chaperones During Physical Exams." June 1998

American Academy of Pediatrics. "Policy Statement - Use of Chaperones During the Physical Examination of a Pediatric Patient." American Academy of Pediatrics (American Academy of Pediatrics), September 2011: 991993.

 

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.