Patient Chaperones: A Practice that is Useless and Abusive

First reported by Courthouse News Service, "Unconscious Patient Says Doctors Mocked Him," plaintiff D.B. sued Safe Sedation LLC and Safe Sedation Management in Fairfax County Court, alleging defamation and infliction of emotional distress. He allegedly captured audio on his cellphone of doctors mocking him as an unconscious colonoscopy patient,  joking that he has syphilis and talking about firing a gun up his rectum. Drs. Tiffany Ingham and Soloman Shah, who are not named as defendants, mocked him from the moment he was unconscious.

"A medical assistant at GMA touched plaintiff's penis during the colonoscopy," the complaint states. "Although plaintiff's penis is not involved in a colonoscopy, the medical assistant noted there was not 'much of a penile rash.' Tiffany Ingham, M.D. responded, 'No, you'll accidentally rub up against it. Some syphilis on your arm or something.' Solomon Shah, M.D. responded, 'That would be bad. That would be real bad.'" (Source:
Courthouse News Service)

Now The Washington Post has reported that a court has has ruled in his lawsuit against two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000.

The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages.

Abuses such as these happen in the presence of other doctors, nurses, medical assistants, techs, etc. Rarely are they ever reported. I have previously mentioned Dr. Twana Sparks, who gave patients genital exams for over 10 years, and in one case slapped the head of an unconscious patient's penis.

It has been alleged that it was commonly known that she did this for over 10 years and was the topic of jokes among hospital staff.

The Certified Registered Nurse Anesthetist, Alison Garner, who was providing anesthesia for the case, found Dr. Sparks’ conduct to be so unprofessional that she reported it to the administration at Gila Regional Medical Center (New Mexico) and eventually to the New Mexico Medical Board. Reporting Dr. Sparks may not have been the best professional move for Garner. Sparks is a money maker for the hospital who will generate an estimated 20 million dollars in revenue over the next 10 years. She is also the only ENT surgeon residing within 100 miles of Gila Regional.

As a show of their appreciation, the Gila Regional Medical Center revoked Alison Garner's privliges there and NO action was taken against Twana Sparks. (Source: Outpatient Surgery Magazine) Garner claims she personally delivered her first complaint on Sparks’ conduct to Gila Regional’s Director of Anesthesia, Mark Donnell, M.D. According to Garner, Donnell laughed and said, “Oh, wait, is Twana doing one of her exams again?”

SILVER CITY -- Dr. Twana Sparks, who was accused of performing non-authorized genital exams on male patients without their consent while they were under anesthesia, will not lose her medical license and has signed an agreement with the New Mexico Medical Board that allows her to continue to practice, but with numerous restrictions.

The Medical Board had issued a notice of contemplated action against Sparks, a board-certified otolaryngologist (ear, nose and throat surgeon) who is on staff at Gila Regional Medical Center, in April that alleged: 

"(A) For many years, up to and including at least July 17, 2007, Respondent performed genital exams on many of her Ear, Nose and Throat patients while they were under anesthesia without obtaining prior written, informed consent from the patients and did not refer to the exams in the patients' hospital records."

"(B) For many years while she was performing Ear, Nose and Throat surgeries at the Gila Regional Medical Center, Respondent wrote messages and created artistic images on the bodies of many of her patients while they were under anesthesia without obtaining the patients' prior written informed consent."

Sparks had the right to request a hearing before the Medical Board, but instead signed an agreed order with the board, dated Nov. 17, denying any wrongdoing but acknowledging that the board could present evidence in support of the allegations if the matter were to proceed to a hearing.
The agreed order outlines numerous terms and conditions that Sparks must comply with in order to continue practicing. Those terms are:

• All interactions with patients, whether in an office setting or in surgery, be done in the presence of a chaperone who is over the age of 18
• Only diagnose and or treat ear, nose and throat conditions of her patients.
• Not perform any genital, rectal or breast exams for any reason.
• Inform patients that they need to be seen by other providers for any other conditions that they have.
• Participate in the Resource Center for Health Professionals under the direction of Connie Merrell-McDonald and comply with all requirements.
• Waive any rights to confidentiality with respect to information gathered by the Resource Center for Health Professionals, with regard to her participation in, compliance with the order and benefit from treatment and rehabilitation activities. The waiver extends six months beyond the end of her participation, and Sparks is responsible for having RCHP submit quarterly reports to the Board assessing her participation.
• Participate in regular individual therapy sessions with an RCHP approved psychotherapist and waive confidentiality rights with respect to information gathered by the psychotherapist regarding her participation and benefit from treatment, and have that therapist submit quarterly reports beginning Feb. 1.
• Go to the Professional Research Center in Kansas for further therapy if recommended and waive confidentiality with regard to the New Mexico Medical Board's access to that information.
• Undergo polygraph exams every four months that would ask specific questions regarding similar conduct outlined in the notice of the contemplated action.
• Obtain a worksite monitor at each facility where she performs surgery and have that person provide quarterly reports to the medical board regarding any behavioral concerns beginning Feb. 1.
• Submit quarterly reports to the New Mexico Medical Board.
• Appear before the medical board quarterly or upon request.

If the board has reasonable cause to believe Sparks has violated any of the terms it may suspend her license immediately. The Agreed Order also states that its terms and conditions will be reported to the National Practitioners Data Bank and the Healthcare Integrity and Protection Data Bank.
Calls for comment to Sparks' office and her attorney, Deborah Solove, were not returned.
In a previous statement, citing the confidentiality of the Medical Practice Act, J.J. Walker, spokesperson for the board, would not confirm if the allegations against Sparks involved more than one patient, the age of the individuals, why the complaint dates back to 2007, or if Sparks has had other complaints lodged against her.
Walker did say that anyone can file a complaint about a physician with the board and that all complaints are reviewed by a committee, which then makes a recommendation to the board. Every complaint is investigated, but not every complaint results in action by the board. If the Board votes to close the case with no action taken, then no documents would be filed.
Following her earlier signing of an agreed interim order, Sparks requested leave from the hospital, beginning Aug. 14, said Gila Regional Medical Center spokesperson Holley Hudgins. She has since returned from that leave.
Hudgins released this statement via e-mail:
"Gila Regional Medical Center conducted a full investigation. We cannot comment on our findings or actions taken as such are protected in accordance with the New Mexico Review Organization Immunity Act. We are aware of the New Mexico Medical Board's investigation and recommendations and that we trust they have acted in the manner they feel is best."
A medical professional from Gila Regional Medical Center, who spoke on condition of anonymity for fear of retaliation, said the hospital's risk management attorney, Carrie Young, informed nurses and other operating room staff in two separate meetings that Sparks could only see patients with a chaperone who was over the age of 18, and the chaperone would have to record that information somewhere in the nurse's notes. The source said medical personnel were not informed if they would be paid extra for chaperoning Sparks and they were not given a time frame of how long the chaperoning would have to continue.
The medical professional also said the hospital had the name of one of the patients who was examined without his knowledge or consent but was not aware if the hospital had contacted that patient with that information.
Hudgins declined to answer questions as to whether the hospital informed or had plans to inform the patients who allegedly had their genitals examined under anesthesia without their consent or knowledge. Hudgins also refused to confirm the date Sparks returned to the hospital following her leave in August.
The medical professional said Sparks returned to work at the hospital sometime in October. (Source: Silver City Sun News)

In Front of Others...

It is obvious that chaperones offer NO protection. According to a paper written by nurse and researcher, Joan Emerson, having more people in the room, is a way to "force" compliance from a patient.

 In fact, one of the main functions of her presence is to provide a team member for the doctor in those occasional instances where the patient threatens to get out of line. Team members can create a more convincing reality than one person alone. Doctor and nurse may collude against an uncooperative pa- tient, as by giving each other significant looks. If things reach the point of staff collusion, however, it may mean that only by excluding the patient can the definition of re- ality be reaffirmed. A more drastic form of solidifying the definition by excluding recalcitrant participants is to cast the patient into the role of an "emotionally disturbed per- son." Whatever an "emotionally disturbed person" may think or do does not count against the reality the rest of us acknowledge.

This advocates bullying in the healthcare setting.


Dr. Joel Sherman has written a very good article on his blog: Chaperones Do They Reassure or Disturb Patients? The consensus is that chaperones are primarily for the protection of the healthcare provider, and do offer some comfort to some patients. Here are some other articles that discuss the issue (as Dr. Sherman notes, much is written about it in US as well as British literature):

• Your exam, plus audience 
• NY Times, Do Patients Need a Chaperon? 
• Rogstad KE. Chaperones: protecting the patient or protecting the doctor? Sex Health. 2007 un;4(2):85-7. PubMed PMID: 17524284. 
• Wai, D., Katsaris, M., & Singhal, R. (2008). Chaperones: are we protecting patients? The British Journal of General Practice, 58(546), 54–57. doi:10.3399/bjgp08X263893 
• Baber JA, Davies SC, Dayan LS. An extra pair of eyes: do patients want a chaperone when having an anogenital examination? Sex Health. 2007 Jun;4(2):89-93. PubMed PMID: 17524285.
• Who should be privy to your privates? CMAJ April 3, 2012 vol. 184 no. 6 First published March 12, 2012, doi: 10.1503/cmaj.109-4129 

It’s clear however that many patients aren’t comfortable with the presence of chaperones for a variety of reasons.  Surprisingly nearly 50% of women don’t want chaperones present even when male physicians do a pelvic exam.  For men, the figure is 80 to over 90% refuse chaperones when given a choice in most studies.

With the Supreme Court's recent ruling that gay , with transgender actress Laverne Cox being the first openly transgender person to be nominated for a Primetime Emmy Award in the acting category, and Caitlyn Jenner's public transition, there are new issues being raised, there are new questions about chaperones. Edwin Leap discusses the potential new complexities of "Medical Chaperones in a  Brave New World."

Chaperones do NOT protect patients!
Use of a chaperones should always be a mutual decision between the doctor and patient.