Chaperones, Trust, and the Cost of Silence

The Safety Ledger - The $750 million Hadden settlement shows what can happen when institutions ignore a basic safeguard—never let a patient be examined alone.

Hospitals train for emergencies, but the worst harm can occur in the most ordinary setting: a patient in an exam room with a trusted doctor. The recent $750 million settlement involving New York Columbia and NewYork-Presbyterian—the largest to date in the Robert Hadden case—should make every institution stop and ask what went wrong. More than 800 women were violated over nearly two decades while hospital leaders ignored repeated warnings. This was not a failure of medicine, but of accountability. The system failed patients.

One lesson stands out: every hospital must have a clear, mandatory policy requiring a chaperone during all sensitive examinations. That means a second trained staff member—typically a nurse or medical assistant—present during sensitive examinations, breast, pelvic, rectal, or genital exams, for both male and female clinicians. A chaperone protects the patient, the physician, and the institution. Their presence ensures transparency, provides emotional comfort, and deters misconduct or misinterpretation.

Here are some cases:

• Former Obstetrician/Gynecologist Robert Hadden Sentenced To 20 Years In Prison For Sexually Abusing Numerous Patients

• Army gynecologist took secret videos of patients during intimate exams, lawsuit says

• “Doctors & Sex Abuse” investigation

• The Atlanta Journal‑Constitution “Doctors & Sex Abuse” investigation – https://doctors.ajc.com/impact/ Doctors & Sex Abuse+1

• Review article: Sexual Violation of Patients by Physicians (DuBois et al) –

• Scholarly ethics/regulation discussion: Professional Codes, Public Regulations, and the Rebuilding of Judgment Following Physicians’ Boundary Violations (d’Oronzio)

• Regulatory / professional-body statement: Federation of State Physician Health Programs (FSPHP) “Statement on Sexual Misconduct in the Medical Profession”

• Media summary: ProPublica “Doctors Accused of Sexual Abuse Are Rarely Punished”

• Additional regulatory/discipline analysis: BMJ article “Medical boards often shield doctors guilty of sexual

• Doctor convicted of series of sexual offences

• Johns Hopkins Hospital pays out $190m over doctor tapes

• State Medical Board Temporarily Suspends License

• California prison gynecologist accused of ‘horrific’ abuse of patients in lawsuit

• More than 100 former patients sue OBGYN, Cedars Sinai for alleged sexual abuse

What Is a Medical Chaperone?

A medical chaperone is a trained healthcare staff member—typically a nurse, medical assistant, or technician—who is present during a sensitive physical examination to protect both the patient and the clinician. Sensitive exams include any evaluation or procedure involving the breasts, genitals, rectum, or other intimate areas that may cause embarrassment, discomfort, or vulnerability. The chaperone’s purpose is not merely to observe, but to provide reassurance, help with draping or positioning, and serve as a neutral witness to ensure professional boundaries are maintained. The presence of a chaperone affirms that care is being delivered with respect, transparency, and accountability.

What Counts as a Sensitive Examination

A sensitive examination is any medical encounter that involves exposure or physical contact with private body areas or discussions of intimate bodily functions. This includes breast, pelvic, genital, or rectal examinations; procedures involving transvaginal or transrectal probes; and any situation requiring removal of undergarments or palpation of reproductive organs. Examinations of children, adolescents, or patients with cognitive impairment are also considered sensitive, as are encounters where the patient expresses discomfort or unease, regardless of body area examined. Sensitive exams can occur in obstetrics, gynecology, urology, surgery, primary care, radiology, and emergency settings—anywhere physical intimacy or vulnerability is inherent to the procedure.

Who Qualifies—and Who Does Not

A family member, friend, or partner may offer emotional comfort but is not a substitute for a trained medical chaperone. Chaperones must be hospital-approved personnel who understand confidentiality, documentation, and professional conduct requirements. Their role includes confirming that the examination proceeds appropriately, protecting both the patient and the clinician from misunderstanding or misconduct allegations.

For All Physicians, Regardless of Gender

Chaperones are equally important for male and female clinicians. The need for one does not depend on the physician’s gender or reputation but on the nature of the examination and the patient’s right to privacy and protection. Gender assumptions—that women physicians are “safe” or that men “need supervision”—undermine the ethical purpose of the policy. True professionalism means consistent, gender-neutral protection for every patient, in every exam room.

Why Hospitals resist having a clear Chaperone Requirement

Many physicians still resist chaperones. Some cite efficiency or say “my patients trust me.” Others claim it’s impractical or intrusive. Yet what is truly intrusive is the betrayal of that trust when a patient is left alone and vulnerable.

In every major case of physician sexual abuse—Nassar at Michigan State, Tyndall at USC, Heaps at UCLA, and Hadden at Columbia—the same pattern repeats: no chaperones, poor reporting systems, and administrators who chose denial over documentation.

How policy prevents harm

A consistent chaperone policy creates a culture of visibility. When every clinician and patient knows the rule—no sensitive exam ever without a chaperone—the ambiguity disappears. Staff know when to step in. Patients know what to expect. Hospitals can audit compliance, document exceptions, and investigate complaints with facts instead of silence. It also protects physicians from false allegations by providing a witness and written record.

Elements of an Optimal Chaperone Policy

An effective chaperone policy must clearly define when chaperones are required, who is qualified to serve, and how their presence is documented.

Sensitive examinations include breast, pelvic, genital, and rectal exams; transvaginal or transrectal ultrasound procedures; examinations of children, adolescents, or cognitively impaired patients; and any exam requiring removal of undergarments or touching of private areas.

The policy should mandate a trained chaperone for all such examinations.

When No Means No: Why Hospitals Prohibit Sensitive Exams Without a Chaperone

When a patient explicitly declines the presence of a chaperone, most hospitals now require that the sensitive examination not proceed. At first glance, this may seem to contradict patient autonomy. In reality, it reflects a deeper ethical balance between respect, safety, and professional integrity.

The Ethical Foundation

Sensitive examinations—such as pelvic, rectal, or breast exams—require exceptional care. They involve intimate contact that places both the patient and the clinician in a position of vulnerability. Chaperones exist not only to protect patients from potential misconduct but also to protect clinicians from false or misinterpreted allegations. The rule that no exam may proceed without a chaperone if one is offered and declined is not a bureaucratic barrier; it is a safeguard grounded in ethical and legal prudence.

Respecting Autonomy Within Boundaries

Patient autonomy is central to ethical medicine, but autonomy does not mean that every patient preference must be honored if it compromises safety or professional standards. When a patient declines a chaperone, it may reflect personal comfort, cultural beliefs, or a desire for privacy. However, the clinician’s duty of care includes ensuring transparency, preventing misinterpretation, and maintaining institutional integrity. By declining to perform the exam under these conditions, the clinician communicates: “Your autonomy is respected, and our shared safety matters equally.”

Institutional Duty and Consistency

Hospitals bear the responsibility for setting consistent standards of care. Allowing one provider to proceed without a chaperone while others do not creates inconsistency and risk. A “no chaperone, no exam” rule removes ambiguity. It standardizes practice across the institution, reduces medico-legal exposure, and ensures that professional conduct is uniformly upheld. This protects not only the patient and the physician but also the hospital’s moral and legal credibility.

Documentation and Communication

When a patient declines a chaperone, documentation must be clear: the offer was made, the refusal recorded, and the patient informed that the exam cannot proceed without one. Communication should remain calm and respectful, emphasizing that this policy protects all involved. Most patients, once the reasoning is explained, understand that this rule is not about distrust but about maintaining professionalism and dignity.

Why This Policy Matters

This approach signals that intimate examinations are never casual or negotiable. They occur only when consent, privacy, and professionalism align. In a time of heightened awareness about sexual misconduct and professional boundaries, such policies help rebuild trust in medical institutions that have, in some cases, failed to prevent harm.

A “no chaperone, no exam” rule is therefore not a denial of care but a declaration of values: that safety, respect, and accountability are inseparable from medical professionalism.

It must also include staff training on communication and professional boundaries, patient education materials explaining their right to a chaperone, and confidential reporting channels for any concerns. Compliance should be monitored regularly by hospital leadership.

A strong chaperone policy treats this safeguard not as an optional courtesy, but as a core standard of patient safety, ethics, and trust.

The ethical foundation

The ethical principle is clear: power must never go unchecked. Medicine is built on asymmetric trust. Patients consent to intimate examinations because they believe the physician’s duty outweighs any personal risk. That moral balance collapses the moment oversight disappears. The principle of nonmaleficence (“do no harm”) demands structural safeguards, not just individual virtue. As ethicist Frank Chervenak has long argued, professional responsibility must be institutionalized—it cannot depend solely on personal ethics or good intentions.

What hospitals should do now

1. Adopt and enforce a written chaperone policy for all sensitive exams, without exceptions for “trusted providers.”

2. Inform patients that if they decline a chaperone the examination cannot proceed.

3. Train staff on how to explain chaperone presence to patients with empathy and transparency.

4. Document chaperone attendance by both the clinician and the chaperone in the medical record for each relevant encounter.

5. Offer patients the option of a same-gender chaperone when possible.

6. Audit compliance as part of routine quality and safety reviews.

Hospitals should also establish private, independent reporting channels for staff or patients who feel uncomfortable, with mandatory investigation and whistleblower protection. Without clear systems, misconduct remains invisible until it becomes a public scandal.

Extending the Policy to Private Practice

This policy must also apply to all doctors and midwives in private practice. Sensitive examinations in solo or small-group settings carry equal, if not greater, risk of misunderstanding or allegations. Private practitioners should adopt the same “no chaperone, no exam” rule to align with professional norms and patient safety standards. Doing so affirms that ethical boundaries and transparency are universal obligations, not limited to hospital-based care. Patients deserve consistent protection regardless of where they receive care.

Insurance and Liability Requirements

Medical liability insurers and malpractice carriers should include the presence of a chaperone—or documentation of a declined and deferred exam—as a condition of coverage.

Such a requirement would establish a uniform standard of practice, reinforce risk management principles, and encourage consistent documentation. Insurers are in a strong position to promote safer practices by aligning their policies with ethical expectations.

The Columbia case as warning

The Hadden case revealed that institutional knowledge existed for years—letters, complaints, and administrative awareness as far back as 1994. Yet nothing changed. The absence of a chaperone policy meant that hundreds of women were examined alone, their accounts minimized or ignored. What could have been a single investigation instead became a billion-dollar reckoning.

The ethical message

A chaperone is not just a procedural safeguard—it is a symbol of respect. It reminds both doctor and patient that medicine is accountable to moral law, not personal power. Hospitals that fail to adopt such policies are not only negligent; they are complicit. As this case shows, the cost of silence is measured not only in dollars, but in destroyed trust.

Major U.S. Hospitals and Health Systems with Public Chaperone Policies

1. Yale Health (affiliated with Yale New Haven Health): Yale Health’s published policy states that “a medical chaperone is required during all sensitive portions of a visit.” Sensitive visits include any examination, treatment, or procedure involving the genitals, rectum, or breast. This is one of the clearest mandatory policies in the country.
   Status: Mandatory
   Source: Yale Health Chaperone Policy

2. Vanderbilt University Medical Center: Vanderbilt’s Medical Chaperone Policy requires a trained chaperone to be present for all sensitive examinations or procedures unless the patient explicitly declines. This policy defines sensitive exams and outlines documentation procedures.
   Status: Mandatory unless patient declines
   Source: VUMC Chaperone Policy (PDF)

3. Michigan Medicine (University of Michigan Health): Michigan Medicine’s patient guide notes that “a chaperone may be provided to help protect and enhance a patient’s comfort, safety, privacy, and dignity during sensitive examinations or procedures.” Patients are informed that they may request a chaperone at any time.
   Status: Offered or provided when indicated
   Source: Michigan Medicine Chaperone Policy

4. Michigan State University Health Care: MSU Health Care provides chaperones during all sensitive examinations and procedures, and patients may also request one for any encounter.
   Status: Provided for sensitive exams and available on request
   Source: MSU Health Care Chaperone Policy

5. St. Peter’s Health (New York): St. Peter’s Health states that a “medical chaperone is required during the sensitive portions of a visit.” Patients can request a chaperone during any visit for any reason, but the policy mandates one during specific types of exams.
   Status: Mandatory for sensitive portions, available on request otherwise
   Source: St. Peter’s Health Chaperone Policy

6. Yale New Haven Health (system-wide): This system aligns with Yale Health’s policy requiring a chaperone during all sensitive portions of a visit, with identical definitions of sensitive examinations.
   Status: Mandatory
   Source: Yale Health Chaperone Policy

7. St. Charles Health System (Oregon): Following Oregon’s state-wide rule, St. Charles requires providers to offer a trained medical chaperone for sensitive exams. Adult patients can opt out but must sign a declination.
   Status: Required offer; opt-out allowed
   Source: St. Charles Health System News Release

8. University of Florida Health: The Florida Academic Health Patient Safety Organization policy outlines that chaperones should assist during medical examinations or procedures to ensure patient safety and dignity. This serves as a state-wide template for Florida hospitals.
   Status: Template policy—recommended or available
   Source: University of Florida FAH PSO Guidelines (PDF)

9. Johns Hopkins Medicine: Johns Hopkins includes in its patient rights that every patient may “ask for and be provided a chaperone during exams, tests, or procedures.” This is a patient-rights–based model rather than a mandatory rule but is clearly institutionalized.
   Status: Available on request (institutionally recognized right)
   Source: Johns Hopkins Patient Rights

10. Kaiser Permanente: Kaiser Permanente’s member rights documents specify that patients may request a staff chaperone during medical appointments or tests. Some regional facilities make chaperones standard practice for sensitive exams.
    Status: Offered by default or on request, varies by region
    Source: Kaiser Permanente Member Rights

11. Huntington Health (Cedars-Sinai affiliate): Huntington Health describes a formal Medical Chaperone Program and defines chaperones as present for all exams exposing the genital, rectal, or breast areas.
    Status: Mandatory for defined sensitive exams
    Source: Huntington Health Chaperone Program

12. Mass General Brigham (Boston): Mass General Brigham notes that its practice is “to have a clinical chaperone present for sensitive exams or procedures.”
    Status: Routine practice / expected standard
    Source: Mass General Brigham Patient Rights

13. Cleveland Clinic:Cleveland Clinic’s patient rights statement includes the explicit right “to have a medical chaperone with you during sensitive or intimate exams.”
    Status: Available by right, standard practice in sensitive exams
    Source: Cleveland Clinic Patient Rights

14. Mayo Clinic / Mayo Clinic Health System: Mayo Clinic specifies that patients may request a chaperone for any exam, and staff may also require one during sensitive procedures.
    Status: Offered and encouraged
    Source: Mayo Clinic Patient Rights

15. UCLA Health: UCLA Health mandates that “a medical chaperone will be provided for all sensitive exams and procedures,” defining which types of exams qualify.
    Status: Mandatory
    Source: UCLA Health Chaperone Policy

16. NYU Langone Health: NYU Langone offers chaperones for intimate or sensitive exams across all sites, and staff are trained to explain the policy to patients.
    Status: Offered by default, standard in OB/GYN
    Source: NYU Langone Health Patient Rights

Key Takeaway

The strongest policies—such as those at Yale Health, Vanderbilt, UCLA, and St. Peter’s—require a chaperone’s presence for all sensitive exams. And the strongest policies include language that the examination cannot proceed if the patient declines.
Hospitals with weaker frameworks merely allow a chaperone “upon request,” leaving safety dependent on patient initiative or clinician discretion.

Some hospitals currently do not post a system-wide chaperone policy on its public patient-rights pages, though some affiliate hospitals mention merely “offering” chaperones. A formal, visible, mandatory policy would strengthen patient protection and institutional defense.

Reflection:
The first step to restoring integrity in medicine is not technology or litigation—it is presence. One witness in the room can mean the difference between safety and suffering.

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