There’s an insidious threat to hospitals and facilities with the potential to impact an organization’s reputation and financial stability. Cases involving this threat have led to settlements of millions to billions of dollars. Additionally, many malpractice policies severely limit or exclude coverage for these types of claims. It is underreported for a variety of reasons, but when it surfaces, the consequences can be immense. This threat is sexual misconduct.
Recently, the Medical Professional Liability Association published an article, “Navigating Extreme Volatility,” to heighten the awareness of the growing number of multiple-claimant, sexual misconduct claims and incidents resulting in nuclear verdicts. The MPLA article presented evidence to support the need to re-evaluate traditional underwriting models and to re-examine strategies to reduce institutional liability related to sexual misconduct.
This LAMMICO article addresses the topic from a hospital risk management perspective and includes medical practices owned by corporations.
According to the Federation of State Medical Boards, sexual misconduct is “behavior that exploits the physician-patient relationship in a sexual way….This behavior may be verbal or physical, can occur in person or virtually, and may include expressions of thoughts and feelings or gestures that are of a sexual nature or that a patient or surrogate may reasonably construe as sexual.” Sexual misconduct behaviors are intentional, inappropriate, and not part of medical treatment. Therefore, standard medical professional liability policies do not cover claims of sexual misconduct. Although this definition states a “physician-patient relationship,” sexual misconduct includes interactions between providers and patients, staff members, or even third-party contractors.
Power imbalances are inherent in physician-patient and other healthcare provider-patient relationships, with the patient in a trusting, vulnerable position. When it may be difficult for a patient to identify or protect themselves from sexual misconduct, they are in a state of vulnerability. Examples of vulnerable populations include children and adolescents, older adults, those with physical or cognitive disabilities or a mental health diagnosis, sedated or anesthetized patients, and non-English speaking patients.
The power imbalance may contribute to the reasons sexual misconduct is underreported. Victims may be uncertain of what they experienced, worry about not being believed, fear abandonment or retaliation, feel shame or embarrassment, or dread reliving the trauma of the misconduct. They may distrust that healthcare organizations or professional licensing boards will act against the offenders. Colleagues and other staff have also identified barriers to reporting sexual misconduct. Similar to victims, they fear retaliation, not being believed, and the perception that no action will be taken. Additionally, colleagues and staff cite discomfort and moral distress in the decision to report other healthcare providers.
Sexual misconduct includes behaviors that involve sexually explicit comments, inappropriate touching or physical contact, coercive behaviors, or physical force. Initially, the abuser may cross professional and ethical boundaries that may seem harmless to gain the victim’s trust and pave the way for more overt or aggressive behaviors. These “grooming” behaviors may include special treatment, sharing of personal information, gift-giving, or other acts or expressions. When children are the intended target of sexual misconduct, parents or guardians may be “groomed,” thereby creating an opportunity for misconduct.
Physicians or other healthcare providers may face a variety of consequences based on the severity of the sexual misconduct, such as criminal prosecution, civil litigation, licensing board actions, and payor network exclusions. Healthcare organizations may also be subject to consequences due to a provider’s sexual misconduct. In addition to reputational damage, organizations may be held liable in situations that enabled the sexual misconduct, including negligent hiring, supervision, or retention practices, inadequate staff training, insufficient staffing, and failing to implement safety measures.
To minimize the risk of sexual misconduct, a multifaceted risk management approach is needed that encompasses strong policies, comprehensive training, and a culture of safety.
- Strong policies that clearly communicate a zero-tolerance for sexual misconduct, define sexual misconduct and at-risk behaviors, identify vulnerable populations, and outline reporting and investigation processes. Other policies to mitigate risk include pre-hire background checks, reference verifications, credentialing, and clear chaperone policies. Mandatory or opt-out chaperone policies help protect both patients and healthcare providers. Chaperones should be used irrespective of the genders of both the patient and healthcare provider. These are particularly important for exams, treatments, or procedures involving the breasts, vagina, genitalia, and rectum. Include the presence of a chaperone or the reasons for patient’s opting out in the medical record documentation.
- Education and training apply to the entire workforce and patients. Educate patients on what to expect and what they may feel during procedures or treatments. Different methods such as handouts, information on patient portals, posters in the exam room, and explanations to the patient before, during, and after the exam, treatment, or procedure.
- Provide sexual misconduct training to all members of the healthcare workforce upon hire and periodically review it. Chaperones require comprehensive training about at-risk behaviors, boundary issues, and vulnerable populations. Staff members need to be aware of a provider’s at-risk behaviors, the organizational factors that may enable the misconduct, and how to report them. Pay attention to grooming behaviors and professional boundary violations. These may be in the form of sexually suggestive comments, gestures, or jokes, inappropriate physical contact/touching, seeing patients at an unexpected time (before or after hours) or place (outside an exam room or behind a locked door), insisting a chaperone is not needed, or oversharing personal information. Have a heightened awareness of patients who are fearful or uncomfortable around certain healthcare providers, have sudden behavioral changes after an interaction with a provider (especially after a sensitive examination), and unexplained bruising to intimate areas without a clear medical cause. The slogan, “If you see something, say something,” also applies to sexual misconduct.
- A culture of safety begins at the top of the organization. Foster an environment where all healthcare staff feel safe to speak up without fear of retribution. Provide safe, confidential, easily accessible reporting mechanisms for sexual misconduct. Listen to patients and staff when issues are reported and follow the established investigation processes and external reporting (if needed). Adequate staffing, supervision of high-risk clinical situations, and compliance monitoring (policies and processes) are additional tools to help reduce the risk of sexual misconduct.
How is your organization handling this insidious threat to patient safety, your financial wellbeing, and your reputation? NOW is the time to evaluate the policies, procedures, training, and safety culture you have in place to minimize your risk for allegations of sexual misconduct.
LAMMICO Webinars
LAMMICO is planning the 2026 webinar schedule to include educational content related to preventing sexual abuse/misconduct by healthcare providers in various settings. The schedule will be posted at lammico.com/online-education and medicalinteractive.com/webinars so please continue to check there for details.
LAMMICO Insurance Coverage
To understand what coverage and limits related to sexual misconduct are or are not included in your facility's LAMMICO insurance policy, contact your insurance agent or LAMMICO Underwriting Department at 504.831.3756 or 800.452.2120.
Note: The "Navigating Extreme Volatility" article first appeared in the MPL Association’s Inside Medical Liability Online.
References
Allen R, Earle MF. Navigating extreme volatility: an underwriting analysis of high-value medical malpractice awards and major sexual misconduct cases in US healthcare settings. Medical Professional Liability Association. 2025.
Earle MF. 5 crucial steps to take now for sexual abuse and molestation (SAM) safety in healthcare. January 2, 2025.
Federation of State Medical Boards (FSMB). Physician sexual misconduct. May 2020.
O’Neill M, Lupton T, Cooke M, Harmon P. Boundary violations and sexual abuse across the health care continuum: strategies to mitigate risk. Presented at: American Society for Health Care Risk Management Annual Conference; September 2025.
Stanley J. Preventing sexual abuse and misconduct in the medical practice. MICA. November 4, 2024.