Gerald Tarutis

Chaperones –Recommended Or Required?

Posted by Gerald Tarutis on July 02, 2015

The American Medical Association (AMA) in 1998 adopted Opinion 8.21 which provides for “the protocol of having chaperones available on a consistent basis for patient examinations is recommended.” The Opinion also states that a “policy that patients are free to make a request for a chaperone should be established in each health care setting” and that this “policy should be communicated to patients.” http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion821.page. During the intervening 17 years, the Opinion is not routinely followed and there appears to be a wide disparity on how it is interpreted.

While the AMA statement is not legally binding, in the United Kingdom the General Medical Council (GMC - an independent organization that helps protect patients and sets the standards that doctors are required to follow) has specifically stated when a physician does an “intimate examination, [the physician] should offer the patient the option of having an impartial observer (a chaperone) present wherever possible…whether or not [the physician is] the same gender as the patient.” http://www.gmc-uk.org/guidance/ethical_guidance/21168.asp. This same policy applies to NHS Hospitals and their Emergency Departments.

Meanwhile, seven states (Alabama, Delaware, Georgia, Montana, New Jersey, Ohio & Tennessee) have implemented legal mandates for the presence of medical chaperones during intimate examinations which are generally defined to be “examinations of genitals and rectums in all individuals and/or breasts, if female.” Kay, Amanda, “Policy Review and Analysis of Chaperoning Intimate Medical Examinations Legal Mandates” (2015). Master of Public Health Thesis and Capstone Presentations. http://jdc.jefferson.edu/mphcapstone_presentation/135

Edwin Leap, M.D. recently indicated his opinion that all physicians should utilize chaperones and that the traditional notion that chaperones are only needed for male physicians examining female patients was an outdated and sexist view of the role and purpose of chaperones. http://www.kevinmd.com/blog/2015/04/were-going-to-need-more-medical-chaperones-heres-why.html

In a similar vein, Kristina Giyaur, Esq., recommends that from a legal defensive posture, chaperones should be utilized with all patients because “complaints can now be of a homosexual or transsexual nature, physicians should use chaperones regardless of the patient’s gender or sexual orientation. Moreover, sexual misconduct is no longer defined exclusively as an act of sexual assault” and complaints and lawsuits can arise “based on a wide range of allegations from physical and verbal sexual harassment, suggestive comments, inappropriate comments, and even leering.” http://www.mdrxlaw.com/publications/1-medical-practice-management/7-using-chaperones-to-deter-defend-against-sexual-misconduct-complaints

At this point it remains unclear whether the cost of a chaperone can be billed or is simply a new “overhead” cost and whether the “standard of care” is actually changing or not. The issue is highly charged and will no doubt continue to expand and be subject to much debate.