AUA Urology Advocacy Summit 2023: State Advocacy: Chaperone Rules and Criminalization of Physician Care

( The final day of the 2023 AUA Summit included a panel on the efforts surrounding state advocacy and state level bills that impact the practice of urology. Dr. Duty, incoming chair of the AUA’s State Advocacy Committee (SAC) introduced the role of the SAC, which includes tracking relevant state level legislation that may have ramifications on the way urologists practice.

He outlined that in 2022, the SAC sent 17 letters supporting various state legislative initiatives, including biomarker coverage, step therapy, and prior authorization. Additionally, SAC members met with state representatives to support no cost-sharing prostate cancer screening, with legislation being passed in IL, NJ, CA, TX and VA. Lastly, he highlighted work to oppose mandated medical board chaperone rules, naturopaths performing vasectomies, and legislation that would limit pelvic exams.

Next, Dr. Kiechle provided an overview of Wisconsin’s Medical Examining Board’s (MEB) proposed rules regarding medical chaperones. In 2021, the WI MEB sent a notice to all licensed physicians regarding a new proposed rule requiring chaperones for all physical examinations. He reviewed the original language of the rule (see below), and noted that physicians were concerned regarding the economic impact that a required chaperone would have on physician practices. After the AUA SAC, WI Urological Society, and WI Medical Society provided written and oral written testimony, the rule was reworded so that physicians were required to display their chaperone rules in their offices for patients to easily access, but did not make sweeping mandates requiring chaperones for every exam.

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Then, Dr. Drzewiecki addressed the issue of threats to physicians and workplace violence. She acknowledged that in recent years, physicians have faced legislative efforts to limit their ability to treat patients. She outlined the role of patient advocacy groups in raising legitimate concerns about past practices, and the historical “us vs. them” mentality that exacerbated barriers to communication that would have allowed for team-based solutions. Therefore, laws that were introduced made sweeping bans and limitations on pediatric urologic procedures. Subsequently, physicians became the targets of online harassment and written threats that required law enforcement protection.

Dr. Drzewiecki presented recent data quoting that threats to physicians grew by 67% between 2011 to 2018. Further, she stated that healthcare professionals are 5 times more likely to experience workplace violence. She underscored the detrimental impact that this has on physician well-being and professional careers, given that they have fears for their safety. In turn, many physicians fear for their safety in speaking out either for or against specific healthcare policy when, in reality, physician input would be critical. Dr. Drzewiecki suggested that urologists work with patient advocacy groups to better communicate and collaborate on solutions to ensure appropriate and safe care is delivered by urologists.

Next, Dr. Riley discussed the criminalization of physicians in providing care for transgender patients. Urologists are an integral member of the care team for transgender patients, and will certainly be affected by recent legislative efforts in this place. She displayed a map project 28 states that had discussed legislation addressing care for transgender patients. Alabama has passed legislation that would make providing transgender care a felony, while 4 other states have passed legislation that provides other criminal charges or loss of license. Specifically, 23 bills across the nation that have been introduced include revocation of licensure of providers, 16 bills include civil damages against the facility and/or provider, 9 bills include criminalization of the provider (7 of which consider transgender care as felonies), 2 include provisions related to child abuse. Additionally, 7 bills include bans on transgender care for adults up to age 26, and the statute of limitations range from 2 to 45 years. There are also 9 bills related to protections of transgender care.

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In summary, state legislative issues including chaperone rules and criminalization of care have the potential to significant impact the practice of urology. Physicians on the panel and in the audience ended the panel reinforcing the importance of partnering with patients and patient advocacy groups to collaborate and formulate team-based solutions to health policy issues.

Presented by:
  • Brian Duty, MD, MBA, Oregon Health Sciences University
  • Julie Riley, MD, FACS, University of Arkansas for Medical Sciences
  • Jonathan Kiechle, MD, Advocate Aurora Health
  • Beth Drzewiecki, MD, Mass General for Children

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, @RuchikaTalwarMD during the 2023 AUA Annual Urology Advocacy Summit, Washington, DC, February 27 – March 1, 2023