Policy 1-200	Effective 4/24/2018
Pages 1-4
Patients Rights and Responsibilities	Revised 7/3/2023
Examinations/Procedures and Use of Chaperones

Policy

The UT Student Health Center (SHC) is committed to providing a comfortable environment where patients and staff feel safe and respected. Therefore, whenever requested by either a patient or clinical staff member, a SHC appointed chaperone shall be made available for any or all parts of a medical appointment (referred to below as Medical Appointments).

To serve as a safeguard for patients against any unacceptable acts or behavior and to minimize the risk of a clinical staff member’s actions being misinterpreted, the SHC requires the presence of a chaperone under the following circumstances:

During any general examination/procedure wherein the patient is completely or partially disrobed, irrespective of the body region being examined/treated (referred to below as Exams Involving Disrobing). Disrobing is the removal of clothing that may expose the genitalia, breasts, and the perianal region, rectum, and/or buttocks.
During all sensitive examinations/procedures (referred to below as Sensitive Exams). Sensitive Exams include examinations/procedures involving the genitalia, breasts, and the perianal region, rectum, and/or buttocks.

Procedures

Notification

Patients shall be made aware of the SHC policy regarding the use of chaperones for Medical Appointments, Exams Involving Disrobing, and Sensitive Exams. SHC literature shall highlight the availability of chaperones for Medical Appointments, and the requirement of chaperones for Exams Involving Disrobing and Sensitive Exams.

Intake staff (e.g. Appointment Clerks, Triage Nurses, and Clinic Nurses) shall review this information with patients as needed. Use of Chaperone patient information sheets shall be made available online at the SHC website to all patients (see Appendix 1).

Signage regarding the availability and use of chaperones shall be posted in all patient evaluation and treatment areas (e.g., Appointment Clerk cubicles, Triage Nurse station, and Exam Rooms), particularly areas where a patient may disrobe or undergo a Sensitive Exam. (See Appendix 2).

Patient information sheets regarding Exams Involving Disrobing and Sensitive Exams shall be made available online to all patients (see Appendix 3 and Appendix 4).

Patients scheduled for or clinically determined to require an Exam Involving Disrobing or a Sensitive Exam shall be provided with patient information appropriate to the planned examination/procedure prior to the planned examination/procedure for their review (see Appendix 3 and Appendix 4).

Prior to a planned Exam Involving Disrobing or a Sensitive Exam, patients shall also be provided with informed consent forms, and complete an authorization form consenting to or refusing the exam (see Appendix 5).

Chaperones

Only SHC healthcare professionals shall serve as chaperones, as healthcare professionals are held to a confidentiality standard and can affirm the formal, professional nature of an examination, treatment, or procedure. The use of a family member or friend as a chaperone is not permitted. However, a parent will be permitted to be present during an examination of a patient who is a minor. In addition, a parent, other family member, or friend will be permitted to be present during an exam of a patient who is not a minor with the consent of the patient and the permission of the healthcare provider, which shall be based on the healthcare professional’s opinion of what is in the best interest of the patient.

If a patient requests the presence of a family member or friend during an exam or procedure where a chaperone is necessitated, either by request or requirement, SHC shall still ensure that an authorized SHC healthcare professional attends the examination/procedure to serve as a chaperone.

A patient’s consent to a the presence of a chaperone during an Medical Appointment, Exam Involving Disrobing, or a Sensitive Exam and the name of the chaperone attending the examination/procedure shall be documented in the patient’s medical record (see Appendix 5).

A patient may refuse the presence of a chaperone during an appointment. However, no SHC healthcare professional shall participate in an appointment without a chaperone when they feel one is necessary or when a chaperone is otherwise required by this policy. The only exception is if the healthcare professional believes that there is a serious risk to the health or safety of the patient if the exam or procedure is delayed, in which case the healthcare professional should perform the procedure without a chaperone.

If a healthcare professional determines that due to the risk to the patient, the healthcare professional needs to perform the exam/procedure without a chaperone, the healthcare provider shall have another staff member witness the patient’s refusal of a chaperone, and the refusal of the patient and the reasons for conducting the examination without a chaperone shall be documented in the patient’s medical records and signed by both the healthcare professional and the witness.

If a patient initially refuses the presence of a chaperone, SHC staff should explain to the patient the role of a chaperone. If the patient still refuses, the patient shall then be provided a referral to an external clinical resource for their further evaluation and care, unless the patient’s health or safety will be at risk if the procedure is delayed. When a patient refuses the presence of a chaperone, the health care provider shall document the refusal, discuss alternatives, and appropriately document the interaction in the medical record (see Appendix 5).

If for ethnic, gender, religious, cultural, or other personal reasons, a patient requests a chaperone different from the one selected by SHC, attempts should be made to accommodate the request, as long as it does not pose an undue hardship or place the patient at risk. If due to a lack of available staff, the request cannot be accommodated, the situation should be politely explained to the patient, and if necessary and medically appropriate, the appointment rescheduled to a date/time when the patient’s preference can be accommodated. If a patient does not consent to the presence of the original selected chaperone or any alternative, SHC should not conduct the exam unless the health or safety of the patient requires the procedure not be delayed, in which case the healthcare professional shall conduct the exam/procedure without a chaperone.

Exams Involving Disrobing or Sensitive Examinations/Procedures

Prior to commencing with an Exam Involving Disrobing and/or a Sensitive Exam, SHC clinical staff members should explain to the patient the nature of the examination/procedure so that the patient will understand what to expect and why it is necessary, thus allowing the patient to raise concerns or objections and to provide consent.

To maintain patient dignity and privacy, when required to disrobe for an exam, a patient should be permitted to undress in private. Prior to disrobing, the patient shall be provided with appropriate covering with clear instructions regarding use.

Once the patient has removed his or her clothing, there shall be no unnecessary delay prior to examination. Any delays should be adequately communicated to the patient and additional covering offered, if needed. Permission from the patient to enter the examination area where a patient may be disrobed should always be requested.

For any necessary clothing or covering adjustments, the patient should be asked to make the adjustment themselves or asked for permission for the clinical staff member to do so.

During a Medical Appointment, Exam Involving Disrobing, or a Sensitive Exam, the role of a chaperone is to:

Help provide a comfortable and considerate atmosphere for the patient and provider,
Assure the patient is appropriately covered and comfortable prior to the examination/procedure,
Support the patient during the examination/procedure,
Position themselves to witness the entire examination/procedure, including the point of physical contact,
Visualize the actions of the patient and provider during the examination/procedure for appropriateness,
Listen for the provider’s explanations and instructions during the examination/procedure,
Provide clinical assistance as needed to the patient and provider during the examination/procedure,
Monitor for signs of patient discomfort and communicate that information to the provider,
Help prevent misunderstandings between the patient and provider, and
Voice any concerns he/she has with the behavior or actions of the patient or provider during the examination/procedure with verbal prompts. For example, the chaperone should speak up when:
1. The chaperone notes that the provider needs to communicate further with the patient during the examination/procedure,
2. The chaperone is unable to visualize the point of physical contact despite re-adjustments in their positioning within the exam room,
3. The chaperone recognizes the need to “pause” the exam/procedure due to patient discomfort, and
4. The chaperone recognizes the need to stop the examination/procedure either due to significant patient discomfort or chaperone discomfort with a patient’s or provider’s actions.

During Exams Involving Disrobing and Sensitive Exams, the attending healthcare professional should:

Offer reassurance.
Remain compassionate, courteous, and mindful of the patient’s feelings.
Keep discussion relevant.
Avoid unnecessary personal comment.
Limit the patient’s exposed anatomy to only the area currently being assessed/treated.
Encourage relevant questions and discussion regarding the process.
Explain actions as they are carried out.
Allow the patient time to respond to instructions.
Remain alert to patient verbal/non-verbal indications of discomfort/distress.
Discontinue if the patient requests to do so or for evidence of severe patient pain/distress.

Reporting concerns/inappropriate behavior

If a patient experiences or witnesses a questionably inappropriate action or behavior during an exam (whether or not a chaperone was present), the patient should notify the university Office of Title IX.

If a patient gives notification to a SHC staff member that they have experienced or witnessed a questionably inappropriate action or behavior during an examination (whether or not a chaperone was present), then an incident report (see Policy 5-120 App1., SHC Adverse Incident Report Form) shall be completed by the staff member to whom it was reported. The incident report shall be submitted to the SHC administration for Risk Management Committee review.

If a chaperone or other SHC staff experiences or witnesses a questionably inappropriate action or behavior during an exam, an incident report (see Policy 5-120 App1., SHC Adverse Incident Report Form) shall be completed by the chaperone or staff member and submitted to the SHC administration for Risk Management Committee review.

The Title IX office will be immediately notified in the event of alleged sexual misconduct. A patient bringing forth any complaint of sexual misconduct will be advised to contact the Title IX Office and/or the Office of Equity and Diversity.

Retaliation against anyone reporting improper activities in good faith is prohibited.