Sexual Misconduct / Boundary Violations FAQs

Sexual contact means knowingly touching directly or through clothing, where the circumstances surrounding the touching would be construed by a reasonable person to be motivated by the health care practitioner's own prurient interest or sexual arousal or gratification.

Sexual contact is not only sexual intercourse but also includes any kind of inappropriate sexual touching or fondling. For a practitioner, sexual contact includes erotic behavior such as kissing, nudity, and sexual proposition or comment. Any erotic sexual contact between a practitioner and a patient constitutes sexual misconduct. It is important to also note that complete physical examinations often include, by necessity, touching of genitals or palpation of breasts, but avoid sexual or erotic manipulation.

If a patient acts in a seductive manner or makes overtures towards their healthcare practitioner, the practitioner must respond in a professional manner. The practitioner must avoid comments or behavior that could be interpreted as flirting or an invitation to a sexual relationship. Practitioners should also avoid sharing personal sexual problems with patients, but may inquire into a patient's private life if this information is needed for medical reasons.

A practitioner should carefully explain the purpose of the examination and exactly what is about to happen during the examination. All examinations should also be conducted in a way that is sensitive to the patient's modesty and prevents possible embarrassment. This may help prevent any misinterpretation of the physical examination and reduce the patient's anxiety about the necessity or appropriateness of any touching that may occur.

Primarily, the chaperone eases the concerns of the patient during more intimate examinations, and secondarily, the chaperone protects the health care practitioner from unfounded sexual misconduct accusations. For more information on chaperone accessibility in a patient-practitioner context, please refer to AMA Code of Ethics - Use of Chaperones.

No. Key third-party individuals participate in the health and welfare of the patient concurrent with the physician-patient relationship and include, but are not limited to:

1. Spouse;
2. Partner;
3. Family member;
4. Guardian;
5. Surrogate; or
6. Proxy designated by a durable power of attorney.

A healthcare practitioner may not engage in sexual behavior with a key third-party individual if the key third party's decisions directly affect the health and welfare of the patient, or if the relationship could otherwise compromise the patient's care based on the following considerations, which include, but are not limited to:

1. The nature of the patient's medical problem and the likely effect on patient care;
2. The length of the professional relationship;
3. The degree of emotional dependence on the health care practitioner;
4. The importance of the clinical encounter to the key third party and the patient; and
5. Whether the health care practitioner-patient relationship can be terminated in keeping with ethics guidance and what implications doing so would have for the patient.

Warning signs are violations that include making seductive overtures, discussing personal sexual life, asking to meet socially outside the office or during non-office hours, physically caressing or touching in a sexual manner, and providing alcohol or drugs during treatment sessions.

At a minimum, the practitioner-patient relationship should be severed prior to any social or romantic relationship. For psychiatrists, a romantic relationship with a current or former patient is prohibited under psychiatric ethical standards and may result in disciplinary action by the Board. Other factors that would be considered include:

1. The duration of the health care practitioner-patient relationship;
2. The nature of the health care services provided;
3. The lapse of time since the health care practitioner-patient relationship ended;
4. The extent to which the former patient confided personal or private information to the health care practitioner;
5. The degree of emotional dependence that the former patient has or had on the health care practitioner;
6. The extent to which the health care practitioner used or exploited the trust, knowledge, emotions, or influence derived from the previous health care practitioner-patient relationship; and
7. Whether the health care practitioner-patient relationship was terminated in order to enter into a romantic or sexual relationship.

The Board's sexual misconduct regulations can be found here.