Medical chaperone programs grow amid sexual abuse cases
Weill Cornell Medicine announced it had expanded the use of medical chaperones as Dr. Darius Paduch's federal trial on sexual abuse charges was about to begin. Credit: Olivia Falcigno
Medical chaperones who observe intimate physical examinations are becoming more common in hospitals and doctor's offices nationwide amid high-profile sexual abuse cases in which many victims said they were assaulted when left alone with their physician.
As the federal trial of urologist Dr. Darius Paduch on sexual abuse charges was about to begin, Weill Cornell Medicine on April 22 announced that “to rebuild the trust of our patients, their families and our own team members,” it had expanded the use of chaperones and now requires outpatients to complete a “Notice of Right to a Medical Chaperone” before receiving care.
Paduch worked for Weill Cornell in Manhattan from 2003 to 2019 and then with Northwell Health in Great Neck and Lake Success from 2019 until his 2023 arrest, according to court documents. He was convicted last month on federal charges connected with sexual abuse of minor and adult patients and is awaiting sentencing. Hundreds of former patients have filed civil suits against him, alleging sexual abuse and assault, and accusing Weill Cornell and Northwell of failing to protect patients.
Separately, Columbia University Irving Medical Center and NewYork-Presbyterian agreed to new guidelines for its chaperone programs in 2022 as part of a $165 million settlement with 147 ex-patients of former Manhattan gynecologist Robert Hadden, who in July was sentenced to 20 years in prison after he was convicted of sexually abusing four patients.
Most hospitals on Long Island offer chaperones, though health systems were reluctant to discuss the programs for this article.
A medical chaperone witnesses an exam to ensure it is conducted in a medically appropriate way, among other reasons. When chaperones are nurses or other health professionals, they may assist the doctor. Doctors also say they can protect physicians and health systems against false accusations.
Some hospitals with chaperones provide them only for certain types of intimate exams, such as vaginal and pelvic exams, and others provide them for other sensitive exams, such as of external genitalia and the breast, anus and rectum. Some hospitals make them available for any type of physical exam. Sometimes chaperones are mandatory, but in other health systems, they are optional, because of concerns they may increase some patients' discomfort.
On Long Island, one major hospital system, Catholic Health, doesn't have designated chaperones. Others declined to provide full details about their programs, so it's unclear whether patients typically even know they exist.
Only the Northport VA Medical Center, a federally run veterans hospital, agreed to verbally discuss its chaperone program. All others with chaperones replied with written statements.
For hospitals and doctor's offices with chaperones, not publicizing chaperone policies and not informing patients and the public how their policies work makes such programs almost meaningless, said Stefan Turkheimer, vice president for public policy for the Rape, Abuse and Incest National Network, which operates the National Sexual Assault Hotline.
“If nobody knows they’re available to them, they’re not actually giving them a choice,” he said. “There has to be knowledge among patients that this is available to them, what it is and what protections it offers. If you theoretically have the program and nobody knows about it, it’s effectively as if you don’t have a program.”
A chaperone typically is not a full-time position. At Stony Brook University Hospital, the chaperones are “a health care professional or trained unlicensed staff member who has knowledge of the role...," it said in a statement. At Nassau University Medical Center in East Meadow, chaperones are typically health care professionals "who are trained in hospital ethics and procedures which would all apply to this role," said a statement from Nassau Health Care Corporation, which runs NUMC. No other Long Island hospital answered questions as to who can serve as a chaperone and what training, if any, they receive.
Arthur Caplan, who heads the medical ethics division at the NYU Grossman School of Medicine in Manhattan, said training is critical, and there is a worrisome lack of standards for chaperones.
“You can’t just throw somebody in the room and tell them to be a chaperone,” he said. “They need to know what to do, what to report, who to report to, what they’re looking for.”
Turkheimer said physicians sometimes need to touch intimate parts of the body, “and it’s very difficult for the patient to determine where that line is about what is allowable for the doctor to do in this situation and what’s not.” That’s why chaperones must know how to distinguish between legitimate medical exams and sexually abusive conduct, he said.
“They have to have a medical knowledge of what all these procedures are,” he said.
Turkheimer said chaperones are “certainly getting more common. But it’s certainly not standard operating procedure in most places.”
Yale New Haven Health has one of the nation's most expansive chaperone policies. Dr. Christian Pettker, chief of obstetrics at Yale-New Haven Hospital and chief patient safety officer for Yale New Haven Health, said he has had chaperones present during intimate exams since he began practicing medicine two decades ago.
“As a male OB/GYN, I was pretty sensitive to what my patients go through during sensitive exams,” he said. “And I wanted to treat that with the utmost respect.”
At Yale New Haven, there was no formal chaperone policy adopted until 2021, he said. Before that, some physicians always had chaperones during sensitive exams, some never had them and others fell somewhere in between, he said.
Yale’s policy is broad, requiring chaperones for any nonemergency exams of intimate body parts. Patients cannot refuse a chaperone in those situations, Pettker said. Chaperones are available upon request “during any visit and for any reason,” Yale’s policy states.
Yale does not allow patients to decline chaperones because they may not be able to discern if their physician is a potential sexual predator, Pettker said.
“If we review some of the cases of national notoriety, it’s easy to see that some of these physicians were trusted, probably built up a level of trust, and betrayed that trust very easily in quite a sinister way,” he said. “We don’t think that patients should be caught in a position of vulnerability.”
Pettker said chaperones are trained to not be intrusive.
“We don’t believe that our chaperones are voyeurs in the process, but rather they’re monitors of the process,” he said. “They’re not necessarily looking at the sensitive area, but they’re monitoring the examination being done. So we do feel like we can respect privacy.”
In addition to protecting patients, chaperone rules protect physicians “against erroneous accusations of misconduct when it’s a misunderstanding or misinterpretation,” he said.
Other hospitals require chaperones for some intimate exams but not others. Weill Cornell mandates them for vaginal, pelvic and intravaginal exams and procedures, but they're optional for other intimate exams.
Weill Cornell said in a statement that its new chaperone policy went into effect in September but declined to say what the previous chaperone guidelines were because of “the ongoing nature of the litigation.”
Some oppose requiring patients to accept chaperones.
“The patient’s safety and comfort should be prioritized,” said Bridget Mantello, spokeswoman for The Safe Center LI, based in Bethpage, which provides services to survivors of sexual assault and domestic violence. “So not making a decision for them … but making them aware of their right to accompaniment, making them aware, it is an option.”
Mantello said although having a chaperone present may assuage anxiety for some patients undergoing intimate procedures and exams, it could significantly raise anxiety for others.
“There are some people who might want to be alone with a trusted practitioner and would be uncomfortable if … someone they've never met is in the room witnessing that,” she said.
The Northport VA hospital requires chaperones for female breast and pelvic exams and Pap smears, following a national Veterans Health Administration directive, said RosaMaria Williamson, women veterans program manager at Northport. The Northport hospital, and five Long Island VA clinics, go further than the national policy in also requiring them for other procedures that expose the female groin or pubic area, and for electrocardiograms and echocardiograms, she said. Patients can opt out of chaperones, but Williamson is unaware of a patient doing so for breast or pelvic exams, and only in rare instances have they done so for other exams, she said.
“We try to make that visit as comfortable as possible,” including by having the nurse who is the chaperone first talk with the patient and ask questions about interpersonal violence, military sexual trauma, PTSD and any concerns she may have about the exam, Williamson said.
“That rapport is built prior to the exam so that the patient feels comfortable that that nurse will be the person supporting them” as a chaperone, she said.
The Veterans Health Administration has required chaperones for some sensitive exams of women since at least 2010, Department of Veterans Affairs spokesman Terrence Hayes said in a statement. The administration does not have a written policy for male patients, but “the expectation is men are also afforded the opportunity to have a chaperone,” and the department is “working to establish this as policy for all Veterans, regardless of gender,” he said.
The 2022 settlement with NewYork-Presbyterian and Columbia University Irving requires chaperones for all OB/GYN exams unless the patient waives the requirement in writing, said Manhattan attorney Anthony DiPietro, who represented the 147 plaintiffs who signed the settlement.
Columbia requires chaperones for its OB/GYN patients for all “intimate examinations and in certain other situations.”
NewYork-Presbyterian requires them for vaginal and pelvic exams; they are optional for others.
“Arguably they are violating the chaperone rule if they’re not providing chaperones for all [OB/GYN] exams,” DiPietro said.
NewYork-Presbyterian and Columbia declined to comment on DiPietro's allegation, citing the confidentiality of the settlement.
Columbia said it has had a written chaperone policy in place since 2007, and it has been continually revised, but it declined to say whether any changes were made because of the settlement.
DiPietro said chaperones can make a difference in some cases, but, he said, the real problem with the Hadden and Paduch cases was “a failure of the administration to follow up on the reports they were getting” of sexual abuse.
Civil suits allege that Columbia and NewYork-Presbyterian were warned about Hadden, and that Northwell and Weill Cornell were warned about Paduch, but did not stop the doctors from seeing and abusing patients. If chaperones report abuse, it won’t mean much unless management takes action, DiPietro said.
NewYork-Presbyterian referred questions to Columbia, which it said employed Hadden. Columbia, Northwell and Weill-Cornell declined to comment, citing the ongoing civil litigation.
DiPietro said Columbia initially had fought a key plank of the settlement: that chaperones be able to report physician misconduct anonymously.
That is critical because, DiPietro and lawsuits state, chaperones were sometimes in the exam room with Hadden when abuse occurred but did not intervene.
Columbia declined to respond to DiPietro, but said in a statement that its OB/GYN department began training chaperones and “all patient-facing employees” in 2020 on how to anonymously report sexual misconduct.
DiPietro said chaperones may be afraid to report doctor misconduct, because they are considered lower in rank than physicians, and they may worry about losing their jobs.
On Long Island, only the Northport VA hospital, NUMC and Stony Brook confirmed that they allow anonymous complaints from chaperones.
Medical chaperones who observe intimate physical examinations are becoming more common in hospitals and doctor's offices nationwide amid high-profile sexual abuse cases in which many victims said they were assaulted when left alone with their physician.
As the federal trial of urologist Dr. Darius Paduch on sexual abuse charges was about to begin, Weill Cornell Medicine on April 22 announced that “to rebuild the trust of our patients, their families and our own team members,” it had expanded the use of chaperones and now requires outpatients to complete a “Notice of Right to a Medical Chaperone” before receiving care.
Paduch worked for Weill Cornell in Manhattan from 2003 to 2019 and then with Northwell Health in Great Neck and Lake Success from 2019 until his 2023 arrest, according to court documents. He was convicted last month on federal charges connected with sexual abuse of minor and adult patients and is awaiting sentencing. Hundreds of former patients have filed civil suits against him, alleging sexual abuse and assault, and accusing Weill Cornell and Northwell of failing to protect patients.
Separately, Columbia University Irving Medical Center and NewYork-Presbyterian agreed to new guidelines for its chaperone programs in 2022 as part of a $165 million settlement with 147 ex-patients of former Manhattan gynecologist Robert Hadden, who in July was sentenced to 20 years in prison after he was convicted of sexually abusing four patients.
WHAT TO KNOW
Medical chaperones who observe intimate exams and procedures are becoming more common amid high-profile sexual abuse cases involving physicians who usually were alone with patients.
Weill Cornell Medicine in April announced that it had expanded its chaperone program following the arrest of urologist Dr. Darius Paduch on sexual abuse charges. Paduch had practiced for two decades for Northwell Health on Long Island and at Weill Cornell in Manhattan.
Some Long Island hospitals don’t offer chaperones while those that do released only limited details on their programs. Experts say chaperone programs are only effective if hospitals make patients aware of them.
Most hospitals on Long Island offer chaperones, though health systems were reluctant to discuss the programs for this article.
A medical chaperone witnesses an exam to ensure it is conducted in a medically appropriate way, among other reasons. When chaperones are nurses or other health professionals, they may assist the doctor. Doctors also say they can protect physicians and health systems against false accusations.
Some hospitals with chaperones provide them only for certain types of intimate exams, such as vaginal and pelvic exams, and others provide them for other sensitive exams, such as of external genitalia and the breast, anus and rectum. Some hospitals make them available for any type of physical exam. Sometimes chaperones are mandatory, but in other health systems, they are optional, because of concerns they may increase some patients' discomfort.
LI hospitals not detailing programs
On Long Island, one major hospital system, Catholic Health, doesn't have designated chaperones. Others declined to provide full details about their programs, so it's unclear whether patients typically even know they exist.
Only the Northport VA Medical Center, a federally run veterans hospital, agreed to verbally discuss its chaperone program. All others with chaperones replied with written statements.
For hospitals and doctor's offices with chaperones, not publicizing chaperone policies and not informing patients and the public how their policies work makes such programs almost meaningless, said Stefan Turkheimer, vice president for public policy for the Rape, Abuse and Incest National Network, which operates the National Sexual Assault Hotline.
“If nobody knows they’re available to them, they’re not actually giving them a choice,” he said. “There has to be knowledge among patients that this is available to them, what it is and what protections it offers. If you theoretically have the program and nobody knows about it, it’s effectively as if you don’t have a program.”
Stefan Turkheimer, vice president for public policy for the Rape, Abuse and Incest National Network, said hospitals should be upfront about their medical chaperone policies. Credit: RAINN
A chaperone typically is not a full-time position. At Stony Brook University Hospital, the chaperones are “a health care professional or trained unlicensed staff member who has knowledge of the role...," it said in a statement. At Nassau University Medical Center in East Meadow, chaperones are typically health care professionals "who are trained in hospital ethics and procedures which would all apply to this role," said a statement from Nassau Health Care Corporation, which runs NUMC. No other Long Island hospital answered questions as to who can serve as a chaperone and what training, if any, they receive.
Arthur Caplan, who heads the medical ethics division at the NYU Grossman School of Medicine in Manhattan, said training is critical, and there is a worrisome lack of standards for chaperones.
“You can’t just throw somebody in the room and tell them to be a chaperone,” he said. “They need to know what to do, what to report, who to report to, what they’re looking for.”
Turkheimer said physicians sometimes need to touch intimate parts of the body, “and it’s very difficult for the patient to determine where that line is about what is allowable for the doctor to do in this situation and what’s not.” That’s why chaperones must know how to distinguish between legitimate medical exams and sexually abusive conduct, he said.
“They have to have a medical knowledge of what all these procedures are,” he said.
Turkheimer said chaperones are “certainly getting more common. But it’s certainly not standard operating procedure in most places.”
Stringent policy at Yale
Yale New Haven Health has one of the nation's most expansive chaperone policies. Dr. Christian Pettker, chief of obstetrics at Yale-New Haven Hospital and chief patient safety officer for Yale New Haven Health, said he has had chaperones present during intimate exams since he began practicing medicine two decades ago.
“As a male OB/GYN, I was pretty sensitive to what my patients go through during sensitive exams,” he said. “And I wanted to treat that with the utmost respect.”
At Yale New Haven, there was no formal chaperone policy adopted until 2021, he said. Before that, some physicians always had chaperones during sensitive exams, some never had them and others fell somewhere in between, he said.
Dr. Christian Pettker, an OB/GYN with Yale-New Haven Hospital, has had chaperones present during intimate exams since he began practicing two decades ago. Credit: Yale New Haven Health
Yale’s policy is broad, requiring chaperones for any nonemergency exams of intimate body parts. Patients cannot refuse a chaperone in those situations, Pettker said. Chaperones are available upon request “during any visit and for any reason,” Yale’s policy states.
Yale does not allow patients to decline chaperones because they may not be able to discern if their physician is a potential sexual predator, Pettker said.
“If we review some of the cases of national notoriety, it’s easy to see that some of these physicians were trusted, probably built up a level of trust, and betrayed that trust very easily in quite a sinister way,” he said. “We don’t think that patients should be caught in a position of vulnerability.”
Pettker said chaperones are trained to not be intrusive.
“We don’t believe that our chaperones are voyeurs in the process, but rather they’re monitors of the process,” he said. “They’re not necessarily looking at the sensitive area, but they’re monitoring the examination being done. So we do feel like we can respect privacy.”
In addition to protecting patients, chaperone rules protect physicians “against erroneous accusations of misconduct when it’s a misunderstanding or misinterpretation,” he said.
Other hospitals require chaperones for some intimate exams but not others. Weill Cornell mandates them for vaginal, pelvic and intravaginal exams and procedures, but they're optional for other intimate exams.
Weill Cornell said in a statement that its new chaperone policy went into effect in September but declined to say what the previous chaperone guidelines were because of “the ongoing nature of the litigation.”
Opposition to mandated chaperones
Some oppose requiring patients to accept chaperones.
“The patient’s safety and comfort should be prioritized,” said Bridget Mantello, spokeswoman for The Safe Center LI, based in Bethpage, which provides services to survivors of sexual assault and domestic violence. “So not making a decision for them … but making them aware of their right to accompaniment, making them aware, it is an option.”
Bridget Mantello, spokeswoman for Bethpage-based The Safe Center LI, said some patients would want to be alone with a trusted practitioner. Credit: The Safe Center LI
Mantello said although having a chaperone present may assuage anxiety for some patients undergoing intimate procedures and exams, it could significantly raise anxiety for others.
“There are some people who might want to be alone with a trusted practitioner and would be uncomfortable if … someone they've never met is in the room witnessing that,” she said.
The Northport VA hospital requires chaperones for female breast and pelvic exams and Pap smears, following a national Veterans Health Administration directive, said RosaMaria Williamson, women veterans program manager at Northport. The Northport hospital, and five Long Island VA clinics, go further than the national policy in also requiring them for other procedures that expose the female groin or pubic area, and for electrocardiograms and echocardiograms, she said. Patients can opt out of chaperones, but Williamson is unaware of a patient doing so for breast or pelvic exams, and only in rare instances have they done so for other exams, she said.
RosaMaria Williamson, women veterans program manager at the Northport VA hospital, said chaperones are required for some exams. Credit: Fernando X. Burgos Ortiz
“We try to make that visit as comfortable as possible,” including by having the nurse who is the chaperone first talk with the patient and ask questions about interpersonal violence, military sexual trauma, PTSD and any concerns she may have about the exam, Williamson said.
“That rapport is built prior to the exam so that the patient feels comfortable that that nurse will be the person supporting them” as a chaperone, she said.
The Veterans Health Administration has required chaperones for some sensitive exams of women since at least 2010, Department of Veterans Affairs spokesman Terrence Hayes said in a statement. The administration does not have a written policy for male patients, but “the expectation is men are also afforded the opportunity to have a chaperone,” and the department is “working to establish this as policy for all Veterans, regardless of gender,” he said.
Policy changes following settlement
The 2022 settlement with NewYork-Presbyterian and Columbia University Irving requires chaperones for all OB/GYN exams unless the patient waives the requirement in writing, said Manhattan attorney Anthony DiPietro, who represented the 147 plaintiffs who signed the settlement.
Columbia requires chaperones for its OB/GYN patients for all “intimate examinations and in certain other situations.”
NewYork-Presbyterian requires them for vaginal and pelvic exams; they are optional for others.
“Arguably they are violating the chaperone rule if they’re not providing chaperones for all [OB/GYN] exams,” DiPietro said.
NewYork-Presbyterian and Columbia declined to comment on DiPietro's allegation, citing the confidentiality of the settlement.
Columbia said it has had a written chaperone policy in place since 2007, and it has been continually revised, but it declined to say whether any changes were made because of the settlement.
DiPietro said chaperones can make a difference in some cases, but, he said, the real problem with the Hadden and Paduch cases was “a failure of the administration to follow up on the reports they were getting” of sexual abuse.
Civil suits allege that Columbia and NewYork-Presbyterian were warned about Hadden, and that Northwell and Weill Cornell were warned about Paduch, but did not stop the doctors from seeing and abusing patients. If chaperones report abuse, it won’t mean much unless management takes action, DiPietro said.
NewYork-Presbyterian referred questions to Columbia, which it said employed Hadden. Columbia, Northwell and Weill-Cornell declined to comment, citing the ongoing civil litigation.
DiPietro said Columbia initially had fought a key plank of the settlement: that chaperones be able to report physician misconduct anonymously.
That is critical because, DiPietro and lawsuits state, chaperones were sometimes in the exam room with Hadden when abuse occurred but did not intervene.
Columbia declined to respond to DiPietro, but said in a statement that its OB/GYN department began training chaperones and “all patient-facing employees” in 2020 on how to anonymously report sexual misconduct.
DiPietro said chaperones may be afraid to report doctor misconduct, because they are considered lower in rank than physicians, and they may worry about losing their jobs.
On Long Island, only the Northport VA hospital, NUMC and Stony Brook confirmed that they allow anonymous complaints from chaperones.
Chaperone policies on Long Island
Most Long Island hospitals that offer chaperones declined to answer key questions about their programs.
- “NYU Langone Health offers chaperones for anyone undergoing intimate or sensitive exams” was all the health system agreed to say of its two Island hospitals, NYU Langone Hospital–Long Island in Mineola and Long Island Community Hospital in Patchogue.
- The region and state’s largest health care system, New Hyde Park-based Northwell Health, said, “We make chaperones available when a sensitive examination or procedure is performed or when a patient or health care professional requests that a chaperone be present.”
- Mount Sinai South Nassau in Oceanside said it “has a long-standing chaperone policy for sensitive examinations. Mount Sinai South Nassau employees or volunteers can serve as chaperones and advocate for patients’ rights including dignity, privacy, and consent.” Mount Sinai, like NYU Langone and Northwell, declined to provide more details about its chaperone program, including whether patients are told about the availability of chaperones, whether chaperones are trained, which employees are eligible to be chaperones, and how long chaperones have been offered.
- At Stony Brook, chaperones are required for all exams of patients ages 12 to 17, even if a parent is there, and for younger patients if a parent or guardian is unavailable, the hospital said. For adults, “a chaperone may be provided for any type of examination or procedure, regardless of age, if requested by a provider, patient or surrogate decision maker.”
- Northport VA Medical Center, a federally run veterans hospital, requires chaperones for sensitive exams of female patients and exams that expose intimate parts of women's bodies. Patients can decline chaperones, but opt-outs are rare, the hospital said.
- Rockville Centre-based Catholic Health stated it does not have “designated medical chaperones on staff, but we try to accommodate requests when they are both feasible and appropriate.” The health system declined to clarify how those requests are fulfilled.
- Nassau University Medical Center requires chaperones "for all intimate and sensitive examinations," a statement said.
David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.
Updated now Newsday travel writer Scott Vogel took the ferry over to Block Island for a weekend of fun.
Updated now Newsday travel writer Scott Vogel took the ferry over to Block Island for a weekend of fun.
