Change of Law: Hospital Action Required
To: Chief Medical Officers, Legal Counsel and Government Affairs Staff
From: Sarah Chicoine | Legal Intern | SarahC@wsha.org
Staff Contact: Zosia Stanley, JD, MHA, Associate General Counsel | ZosiaS@wsha.org | (206) 216-2511
Subject: New Law Prohibiting Pelvic Exams on Patients Under Anesthesia or Who Are
This bulletin contains information for providers about a new state law that prohibits health care providers from performing or from authorizing students to perform pelvic exams on patients who are under anesthesia or unconscious without the patient’s informed consent.
Requirements in ESB 5282 apply to all health care providers licensed under RCW 18.130 and to students practicing under the health care provider’s authority.
The prohibitions in ESB 5282 are effective as of June 11, 2020.
- Review this bulletin to understand the new requirements.
- Evaluate current hospital standards and training for providing pelvic exams and obtaining informed consent.
- Educate providers of pelvic exam informed consent requirements.
Health care providers are prohibited from performing or authorizing students to perform a pelvic examination on a patient when the treatment or diagnosis does not require a pelvic exam. To perform a medically unnecessary pelvic exam on an anesthetized or unconscious patient, health care providers must first obtain informed consent from the patient or surrogate decision maker.
Informed consent specific to a pelvic exam is not required in two instances:
- The exam is necessary for diagnostics or treatment
- Informed consent is not specifically required when a pelvic exam would be necessary for diagnostics or treatment under the assumption that the requisite informed consent would be provided when the patient consents to the treatment.
- Sexual assault is suspected and
- The patient is not capable of providing informed consent due to the patient’s medical condition; or
- Evidence will be lost.
Violators are subject to discipline under the Uniform Disciplinary Act (UDA). A violation is considered unprofessional conduct under the UDA.
The requirements in ESB 5282 are effective as of June 11, 2020. While the new regulations generally align with current practices in Washington, facilities should review relevant policies and procedures to ensure policies follow the informed consent requirements. Training policies for students and residents should also be reviewed to ensure compliance.
Informed consent generally requires providers to inform patients of all material facts that a patient would want to know before consenting to health care. Informed consent protects patients’ individual autonomy when making health care decisions.
In some cases nationally, medical students have been allowed to perform pelvic exams, for educational purposes, on patients who were under anesthesia, including in cases where the patients’ care did not require pelvic exams and patients were unaware that a pelvic exam was being performed. Washington state legislature passed ESB 5282 to prohibit that conduct.
WSHA’s 2020 New Law Implementation Guide
Please visit WSHA’s 2020 implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
Engrossed Senate Bill 5282—An Act Concerning Informed Consent Requirements for Pelvic Exams
RCW 18.130—Uniform Disciplinary Act
RCW 18.130.180—Unprofessional Conduct
RCW 7.70.065—Informed Consent