Over the past decade, the issue of sexual misconduct liability (SML) in clinical settings has received growing attention, fueled by the frequency and severity of associated claims and substantial settlement amounts. Claims of misconduct can encompass a broad scope of liability and may arise from employees, patients, independent contractors, or visitors. Similarly, the alleged perpetrator could be a practitioner, healthcare staff member, supervisor, or other professional personnel.
Most professional liability insurance policies typically exclude coverage for practitioner-patient sexual misconduct, as such behavior is not classified as medical malpractice. These incidents can lead to civil and criminal legal proceedings, disciplinary actions by licensing boards, and potential imprisonment. The financial impact of such claims can also be substantial, given many are high-severity, high-profile cases.
Healthcare involves close physical contact and a high degree of vulnerability, creating opportunities for abuse, which can be heightened by the trust and confidence patients often place in healthcare professionals. Instances of sexual abuse can occur when medical staff have the opportunity to convince their patients or their caregivers that certain procedures are necessary or take advantage of a patient’s inability to consent. Because healthcare providers may see many patients and often work across multiple facilities, the potential scope of abuse and the number of victims can be sizable.
Research shows that offenders need three things to abuse: 1) access to a vulnerable individual; 2) privacy to be able to offend without detection; and 3) control to manipulate the individual and the community.¹ Sexual abuse by a healthcare provider can include inappropriate touching during an exam, unnecessary genital or rectal exams, groping, sexual comments, forced exposure, photographing patients, or using medical authority to make a patient submit to conduct that was not medically necessary.
Sexual abuse is not confined to a specific specialty or healthcare setting, nor is it limited to physicians or other allied professional practitioners. Nursing and ancillary staff also pose a risk of committing sexual abuse.
Claims Involving Healthcare Sexual Misconduct
- 2024 in Virginia: Civil trial in Richmond Circuit Court awarded three women $300 million in damages. The physician, who taught at Virginia Commonwealth University for 20 years, was accused of inappropriately touching the women during femoral pulse exams.²
- 2025 in New York: A New York court ordered that a pediatrician pay $1.6 billion to over 100 women who accused him of sexually abusing them as children during routine medical visits over decades.³
- 2026 in New York: Weill Cornell Medicine was ordered to pay $1 billion to settle civil claims of patients who were sexually abused by a former assistant professor and urologist who worked at Weill Cornell from 2003 to 2019. The physician often conducted exams alone on male patients as young as 13 years old and was also sentenced to life in prison.4
Managing Sexual Misconduct Liability
The occurrence of sexual misconduct by providers inflicts lasting harm on patients, undermines public trust, damages both organizational and personal reputations, and can permanently jeopardize or end medical careers. Implementing communication strategies, consistently using chaperones, and maintaining documentation practices that safeguard both patients and providers can help establish effective policies to prevent actual or perceived boundary violations.
To strengthen patient protection, California Assembly Bill 849: Health Providers: Medical Safety Chaperone Act, will go into effect on January 1, 2027. The law mandates the presence of a medical chaperone during ultrasound or similar imaging procedures involving sensitive areas, including genitalia, breasts, or rectum. This law requires providers performing sensitive examinations to inform patients that a medical chaperone will be available upon request to assist with or observe the examination.5 Providers have the right to refuse to perform a sensitive exam without a medical chaperone if the provider determines that one must be present. The use or refusal of a medical chaperone must be documented in the medical record.
Policies and Protocols for Use of Chaperones During Examinations
Examinations or procedures involving sensitive areas may be a distressing experience for some patients. Chaperones may provide patients with comfort, dignity, and safety during these examinations or procedures. They may help the patient understand the procedure, answer questions, or ease anxiety for patients who are uncomfortable due to their cultural or religious backgrounds. Chaperones may also assist with dressing and undressing patients, setting up medical equipment or supplies, ensuring continued consent, and protecting the provider if the patient becomes violent or aggressive.6
Physicians should develop a policy that describes who can serve as a chaperone, when chaperones should be present, how they are to be proposed or requested, and what to do when a patient declines.
A trained member of the healthcare team (MA, RN, LVN, technician) who acts as an impartial observer during an examination, treatment, or procedure may serve as a formal chaperone. A parent, guardian, or caregiver present at the patient’s request does not replace the requirement for a formal chaperone during sensitive exams.7
A key component of a successful chaperone policy is ensuring training for those who will serve as chaperones for sensitive exams and the healthcare providers. Training for both chaperones and providers should include review of expectations for each role, improve communication between the team, suggest neutral terms for intervention in the case of patient distress or chaperone discomfort, and set expectations for provider behavior and the procedure.8
Training should occur upon hire and be renewed regularly with knowledge/skill competency to include cultural sensitivity and trauma-informed practices. Key components for chaperone training include:
- Ensuring patient comfort and dignity while maintaining privacy.
- Informing the patient that the chaperone will be present if a sensitive exam is performed, or for any other exam as requested by the patient or provider.
- Positioning of chaperone during exam to visualize point of contact during the exam or procedure.
- Assisting patient with undressing/dressing before and after exam.
- Review how chaperone may intervene or stop an exam if they are concerned about patient distress or inappropriate steps during the exam.
- Documenting the chaperone’s presence during the exam or the patient’s declination of a chaperone.
Key components for provider training include:
- Proper communication with patients about why the sensitive exam is needed.
- Proper communication before and during a sensitive exam to explain what to expect from the exam and what will happen during the procedure.
- Documentation of patient education provided.
- Documentation if the patient declines any part
of exam. - Documentation of chaperone presence (including chaperone’s name) or declination of chaperone use.
- Chaperone communication to signal the need to pause an exam due to obscured view or patient discomfort.
- Importance for providers to minimize the amount of sensitive information asked and shared in front of the chaperone to protect patient confidentiality.
Patient Education
Prior to the exam, it is important to educate the patient about why the examination is needed, what the exam entails, the purpose and availability of a chaperone, and the patient’s ability to decline or stop any portion of the exam. Patient education may be provided using a variety of educational resources or materials, including an explanation from the chaperone or provider, in-room postings or written materials, and web-based written information or videos.9
Key patient education elements:
- Information about the practice’s chaperone policy, including when chaperones are mandatory or available upon request, and when a chaperone may be declined by the patient, including the consequences for declining a chaperone, e.g. exam or procedure may be rescheduled or canceled.
- Information outlining the components of a sensitive exam, the role of the chaperone, and how to report concerns about inappropriate exams.
- Verbal explanation of the planned examination by a provider.
- Education on the patient’s right to request clarity on the exam, express discomfort, or to terminate an exam at any point.
- The ability of the patient to request the gender of a chaperone.
Information should be provided to patients through an informed discussion between the provider and the patient.6
Documentation Requirements
Document in the medical record the use of a chaperone or the patient’s decision to decline a chaperone. Include:
- Name of the chaperone, date, and time of the exam or procedure (example; “Sensitive portions of the exam were chaperoned by [Name, title]”).
- Patient’s informed consent regarding the presence of the chaperone, or their refusal (example; “Patient declined chaperone”).
- If the patient declines a chaperone, document any actions taken, e.g., providing patient education, rescheduling or cancelling the procedure, referring the patient to another provider, or proceeding to perform the exam without a chaperone.
- If a chaperone is not available, document their unavailability, offer to reschedule the exam, and the patient’s decision.
- Document the patient’s gender preference and whether it was accommodated. If not, note the reason and the patient’s acceptance or an alternative.
Physician and Patient Communication During Sensitive Examinations
Clearly define appropriate and inappropriate interactions between healthcare personnel and their patients. Always maintain clinical and respectful language, avoiding personal remarks or humor. Casual or lighthearted comments regarding a patient’s body during sensitive examinations are frequently considered unprofessional and inappropriate. Although these remarks may be intended to alleviate tension, they have the potential to compromise patient dignity and erode patient trust.
Healthcare providers must prioritize maintaining professional boundaries and fostering a respectful clinical environment to minimize the risk of sexual misconduct liability. By establishing clear policies and expectations, providing ongoing education and training, and promptly addressing concerns or allegations of inappropriate conduct, healthcare providers can help safeguard patients, maintain professional boundaries, and mitigate the risk of sexual misconduct liability. 
Deborah Kichler, RN, MSHCA, is a Senior Risk Management and Patient Safety Specialist. Questions or comments related to this article should be directed to DKichler@CAPphysicians.com
References:
¹Praesidium. “First, Do No Harm” Part II: Know the “How” and Manage Access. https://www.praesidium.com/insights/blog/first-do-no-harm-second-know-t…;
²Survivor Rights. “Dr. Daniel Davidow Trial: Jury Awards $300 Million to Women Who Claimed Sexual Abuse at Cumberland Hospital.” September 28, 2024. https://survivorsrights.com/dr-daniel-davidow-lawsuit/
3CBS News. “New York pediatrician accused of sex abuse ordered to pay $1.6 billion to 104 women, including priest in Las Vegas.” April 9, 2025. https://www.cbsnews.com/news/ny-pediatrician-stuart-copperman-accused-s…
4The Cornell Daily Sun. “Weill Cornell Settles Sexual Abuse Claims for Over $1 Billion, Announces $30 Million Patient Safety Initiatives.” August 3, 2026. https://www.cornellsun.com/article/2026/08/z0dczq2glgbv
5 Assembly Bill No. 849 Legislative Counsel’s Digest, Chapter 442. An act to add Sections 1234.1, 1264.1, and 124441 to the Health and Safety Code, relating to health providers. https://bit.ly/ab-849
6ECRI. “Providing Chaperones During Sensitive Examinations and Procedures.” August 26, 2024.
7American College Health Association (ACHA). “Best Practices for Sensitive Exams. American. October 2019. https://www.acha.org/wp-content/uploads/2024/06/ACHA_Best_Practices_for…
8Ibid.
9Ibid.