Clinical Chaperone Policy

Policy:

It is the policy of the UCI Student Health Center to provide and utilize patient chaperones as required for sensitive examinations and procedures, and when requested for non-sensitive examinations and care.

Purpose:

A chaperone's principal responsibility is to protect patients from abuse. But they can also reassure or comfort patients during examinations that they might find embarrassing or distressing. The presence of a chaperone during sensitive examinations may also help protect providers themselves from false allegations of abuse.

The chaperone will:

• be sensitive and respect the patient's dignity and confidentiality
• be familiar with the procedure involved in a routine sensitive examination
• be present for the entire exam and can see what the provider is doing, if practical
• be prepared to raise concerns about a provider's behavior or actions

Medical examinations and clinical procedures involving the breasts, buttocks, or pelvic area (hereby referred to as “sensitive”) are potentially discomforting to the patient.

Therefore, to minimize patient discomfort, when a clinic appointment is requested where it is anticipated a sensitive examination will be medically necessary, the priority will be that the patient be scheduled with a same sex provider.

On occasion, a sensitive examination is not anticipated, but is determined to be medically necessary through further clinical review. This policy applies to these cases as well.

Procedure:

The medical assistant preparing the patient to be seen for a sensitive exam will be responsible for advising the patient of the duties of a chaperone, assessing if a chaperone is requested or declined, documenting the patient’s choice in the Health Record, and assuring that the provider is aware. Notwithstanding the presence of the chaperone, prior to initiating any sensitive examination, all providers must clearly communicate with the patient the need for the exam and describe how it will be performed.

• A same sex clinical chaperone (nurse or medical assistant) is required to be offered by the provider to be present in the exam room, which the patient may choose to decline. If the need for the exam is not urgent, the patient will be offered the option of rescheduling with a provider of choice. If the patient chooses to decline a chaperone, this will be documented in the Health Record for the visit.
• If a same sex chaperone is unavailable, the patient will be offered the options of 1) an opposite sex chaperone, 2) no chaperone, or 3) rescheduling at a different time to a provider of choice. However, under no circumstances will a male provider be permitted to perform a sensitive exam on a female patient un-chaperoned, or with a male chaperone, even if that is the female patient’s request.

• At any time during any examination, sensitive or non-sensitive, whenever a patient expresses or displays any indication of discomfort, the examination should be stopped. Options will be discussed and if the exam is to continue, a clinical chaperone matching the patient’s identified sex should be offered and documented.
• In all circumstances when the provider requests the presence of a clinical chaperone but the patient refuses, the clinical encounter will immediately cease.
• The presence of a clinical chaperone in the exam room should be limited to the duration of the sensitive examination. Conversation between the provider and the clinical chaperone during the sensitive exam should be kept to a minimum and to only when necessary. To preserve confidentiality, provider-patient communication should take place privately after the examination.
• The presence of a chaperone or other alternative offered to the patient should be documented in the medical record. In most cases, a relative or friend of the patient is not an impartial observer, and is therefore not a suitable chaperone. However, by “reasonable request”, providers may comply to have a relative or friend present, as well as a chaperone.

Definitions

Clinical Care services are clinically indicated in either of the following circumstances:

• a health care provider, exercising prudent clinical judgment, would provide them to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, disease, condition, or its symptoms;
• as performed, they meet the applicable Standard of Care (as defined below);
• as performed, they are appropriate, in terms of type, frequency, extent, site, and duration; and
• as performed, they are considered effective for the patient’s illness, injury, disease, condition, or symptoms.

Standard of Care: The reasonable degree of skill, knowledge and care, based on credible scientific evidence published in current peer-reviewed medical literature, and ordinarily possessed and exercised by members of a person’s profession and specialty under similar circumstances. The Standard of Care encompasses whether and under what circumstances a procedure is performed; the way it is performed; and whether and if so in what manner informed consent should be obtained prior to performance.

Sensitive Exam: an office visit, test, or procedure in any setting requires a patient to expose the patient’s breasts, buttocks, or pelvic area or that requires the patient’s health care provider to touch any of these areas, whether or not the patient is disrobed.

Health Care Provider: an appropriately credentialed physician, nurse practitioner, or physician’s assistant performing a Sensitive Exam.

Trained and Independent Chaperone – A trained chaperone is a health care worker (e.g., medical assistant or nurse) who receives training on professional boundaries and the University’s Sexual Violence and Sexual Harassment Policy, and who is assigned to witness a sensitive exam and, if sexual misconduct occurs or if they believe it may have occurred, to immediately intervene if practicable, and in any event to report it immediately.

Chaperones must report to supervisors other than the physicians or other health care providers who they are assigned to chaperone and should, if feasible, be rotated so that they do not consistently chaperone the same clinician.

Note on Informed Consent: “Informed consent” of a patient or the patient’s legally authorized representative to an examination or procedure the health care provider knows or should know is not Clinically Indicated, or to the making or distribution of media involving an examination or procedure for purposes unrelated to Clinically Indicated patient care, or legitimate research or education activities, is not a defense to an allegation of Prohibited Conduct under the SVSH Policy.

Reporting Discrimination, Sexual Violence or Sexual Harassment

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