HHS: Hospitals must get consent for pelvic, breast, rectal exams by students

The U.S. Department of Health and Human Services (HHS) has issued new guidance requiring hospitals to obtain written consent from patients before conducting pelvic, breast, prostate or rectal exams for "educational and training purposes" performed by medical students, nurse practitioners, or physician assistants.

The guidance, issued on Monday, clarifies federal regulations that already require consent for other "important tasks" related to surgeries. HHS Secretary Xavier Becerra and other health officials criticized the common practice of conducting these exams without explicit consent in a letter sent to teaching hospitals and medical schools.

The letter emphasized the need for hospitals to set "clear guidelines" to ensure providers and trainees obtain and document informed consent beforehand. If hospitals do not obtain explicit consent, they may be ineligible for participation in Medicare and Medicaid programs, and may also face fines and investigations for violating patient privacy laws.

At least 20 states have passed laws requiring consent for these exams, however, it is difficult to say how often these exams take place without explicit consent. Experts noted that patients often sign forms consenting to a range of procedures before surgery, without a clear understanding of the specific examinations that may be conducted.

The issue garnered attention after a physician assistant student in Ohio performed a pelvic exam on a patient without consent while she was unconscious. This led to a state bill mandating consent, which is currently being considered.

The new guidance has been applauded by advocates, such as the Rape, Abuse and Incest National Network, who hope it will ensure patient dignity and respect, and protect trainees from invasive practices.