Hospital Pelvic Exams Will Now Require Written Patient Consent, Under DHHS Orders

Patient consent for sensitive examinations cannot be sacrificed in order to provide practice for doctors in training, new DHHS guidelines state.

Federal health officials are calling on medical schools and teaching hospitals to require written consent for sensitive pelvic examinations, due to a common practice employed at many facilities, which allow students to participate during doctor training, without the patient’s knowledge.

The Department of Health and Human Services (DHHS), through the Centers for Medicare & Medicaid Services (CMS), sent a letter to the nation’s teaching hospitals and medical schools on April 1, warning that the practice skirts patient privacy laws, and that hospitals need to start seeking patient permission before performing sensitive exams–including pelvic, breast, prostate, and rectal examinations–while patients are under anesthesia.

The unauthorized hospital pelvic exams were highlighted in a New York Times investigation published in 2020, which found that medical students are often allowed to conduct pelvic exams and other sensitive exams on patients under anesthesia, as part of doctor training, even though they are not medically necessary. The exams are done without prior patient authorization and, in most cases, are only done for the benefit of training doctors, not because the patient needs the exam as part of their treatment.

The DHHS denounced the medical practice in the letter, emphasizing that hospital and legal requirements call for patients to receive informed consent when doctors perform sensitive exams.

The new guidance now clarifies the need for informed consent, requiring that patients provide written authorization to participate in the training. If facilities fail to comply with the new requirements, they will not be eligible to participate in CMS programs.

Informed consent includes the right for a patient to refuse sensitive examinations, including those conducted for teaching purposes. It also includes the right to withhold consent for any other any examinations that are not agreed to prior to undergoing anesthesia.

Under the Office for Civil Rights and Health Insurance Portability and Accountability Act of 1996 (HIPPA) privacy rules protecting a patient’s health information, a patient can restrict who has access to their information, including when the patient is unconscious, such as during anesthesia or other medical procedures.

The law also protects and enforces a patient’s civil rights, prohibiting discrimination during sensitive examinations and when a patient is under anesthesia.

“While we recognize that medical training on patients is an important aspect of medical education, this guidance aligns with the standard of care of many major medical organizations, as well as state laws that have enacted explicit protections as well,” Xavier Becerra, Secretary of DHHS, said in the letter. “Informed consent is the law and essential to maintaining trust in the patient-provider relationship and respecting patients’ autonomy.”

The DHHS acknowledged hands-on medical training is an important aspect of medical education, but the new training guidance is in line with the standard of care for many major medical organizations and state laws, indicating that patient consent and privacy cannot be sacrificed to put doctor training first.