Creating safe spaces: Addressing sexual misconduct in healthcare settings

An allegation of sexual abuse, assault or molestation (SAM) made by a patient against a care team member can be frightening, unsettling and disruptive for the person making the allegation, the care team member and the organization. In addition, such an allegation of abuse can create the perfect storm, resulting in regulatory findings, reputational risks, criminal actions and possibly a civil suit.

Allegations in care settings can sometimes arise from miscommunication, lack of informed education and consent or differing perceptions. For individuals who are vulnerable or dependent on care, their understanding of interactions and surroundings shapes their reality. Even with the best intentions, the actions of care providers may be interpreted differently by the patient, potentially leading to confusion or emotional distress.

Assault defined

Sexual assault is broadly understood as any act of sexual contact or behavior that occurs without consent. Consent must be freely given, informed and mutually understood; it cannot be obtained through coercion, manipulation, or force. Additionally, consent is legally invalid when the individual is under the age of consent or lacks the mental or physical capacity to provide informed agreement due to impairment, disability, or unconsciousness.

It is important to recognize that legal definitions of sexual assault vary significantly across jurisdictions — including state and territorial laws, federal statutes, tribal codes and military regulations. These variations may influence how allegations are classified, investigated and prosecuted. Organizations should therefore ensure that their policies align with applicable laws and regulatory requirements while maintaining a survivor-centered approach.

Because definitions and thresholds differ by governing authority, organizations must provide clear internal guidance and training to ensure staff understand both the legal and ethical standards for identifying and responding to sexual assault.

Evolving insurance landscape and ERM integration

As the commercial insurance landscape (risk transfer) continues to evolve and back away from coverage for SAM, organizational leadership will increasingly prioritize the development and implementation of a comprehensive risk management framework, including preventative measures and organizational processes. This framework will be most effective when integrated with an enterprise risk management (ERM) approach — one that not only identifies and assesses risks across all levels of the organization but also aligns risk strategy with overall business objectives.

ERM transcends traditional, siloed approaches by delivering a holistic, organization-wide perspective on risk. Rather than viewing SAM risks as isolated departmental issues, an ERM focus integrates them into a unified framework that identifies and evaluates exposures across strategic, operational, financial, compliance and reputational dimensions. By aligning risk appetite and tolerance with overarching business objectives, ERM ensures that risk decisions actively support long-term goals.

Key components of this approach will include:

• Prevention: Take a proactive approach to risk management by identifying potential hazards early and implementing measures to minimize their likelihood. This includes staff training, developing policies, establishing protocols for disruptive care teams, analyzing trends from incident reports and grievance systems and investing in safety technologies.
• Avoidance: Strategically choosing to eliminate activities or exposures that carry unacceptable levels of risk. This could mean modifying operational practices to reduce vulnerability.
• Mitigation: Preparing for the possibility that some risks will materialize despite best efforts. Mitigation strategies focus on minimizing the impact of adverse events through contingency planning, insurance coverage and rapid organizational response protocols.

Embedding these principles into a unified SAM response plan enables organizations to manage allegations effectively, navigate insurance complexities, strengthen resilience and demonstrate accountability to stakeholders.

Closing summary

Creating safe spaces in healthcare is not just a regulatory requirement, it is a moral and operational imperative. Allegations of sexual misconduct can have profound consequences for patients, providers and organizations, making proactive prevention and systemic accountability essential. By integrating a comprehensive ERM framework for SAM, offering robust education, safe reporting mechanisms and survivor-centered care, healthcare organizations can foster trust, resilience and transparency.

As insurance markets evolve, leadership must embrace innovative risk financing strategies and demonstrate underwriting readiness through a culture of safety and integrity. Ultimately, systemic change — driven by collaboration, continuous improvement and legislative advocacy — ensures that patient dignity and organizational accountability remain at the heart of healthcare delivery.