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Hiring gaps put healthcare organizations at risk

Stronger hiring scrutiny and care oversight needed to mitigate sexual misconduct 

Incidents of sexual assault and abuse in healthcare settings are on the rise. The financial and reputational consequences for providers are growing with them. A 2023 Joint Commission study found that incidents such as assault, rape, sexual assault and homicide increased by 77% over a recent two-year period, and a 2025 report from Praesidium found that the industry-wide average payout for these cases has increased by 79.2% since 2000.

In 2024 alone, the financial impact was striking: an Illinois hospital system agreed to a $453 million settlement in a sexual abuse case, a behavioral health provider faced nearly $900 million in awarded damages and earlier high-profile cases collectively exceeded $2.7 billion in settlements.

While the criminal acts at the center of these cases are excluded from insurance coverage, the hiring, background checks, screening and supervision of the healthcare organization can become the basis for civil claims. Even when an institution can demonstrate that it followed policies and procedures, large multi-claimant cases almost never go to trial. Reputational damage, emotional jury dynamics and media scrutiny drive organizations to settle. 

Insurers and reinsurers, struggling with Medical Professional Liability (MPL) losses and lack of profitability, are responding by pulling back. Limits are shrinking, pricing is rising, exclusions and coinsurance provisions are more common, and in some cases, coverage for Sexual Misconduct Liability (SML) is no longer offered. The result is a growing share of financial risk falling directly on providers and the healthcare systems they operate within.

The MPL industry and its poor results has reached a point of reckoning. Managing these cases reactively is not sustainable. So, what can healthcare organizations do? While no policy or procedure can eliminate risk entirely, providers can take concrete steps to reduce exposure, strengthen patient protections and maintain insurability of their medical professional services.

Strengthen hiring and screen protocols

Preventing harm starts before a provider joins the team. In some cases, background checks are outsourced and limited to verifying education, employment dates, valid licensure and credentials. Hiring process gaps can allow repeat offenders to move between institutions undetected. Direct outreach to prior employers can be far more revealing. A straightforward question to a prior employer such as, “Would you rehire this provider?” can uncover red flags that a routine background check would not reveal. It is not a consistent practice that a hiring employer contacts a prior employer.

Some organizations hesitate to make such calls, concerned about potential defamation claims or other legal challenges from former employees. But the litigation risk of asking a documented, factual question is far less than the potential cost of a multi-claimant lawsuit, reputational fallout or multimillion-dollar settlement. The prudent approach lies in keeping inquiries factual, consistent and well-documented, ensuring they are part of a standardized hiring process.

Standardize and implement an ‘opt out’ chaperone policy

One serious vulnerability is the inconsistent use of properly trained chaperones. Many organizations make chaperones available upon patient request (to ‘opt-in’)  for sensitive exams and particularly with minors. This approach shifts the burden to the patient who may not understand the protective role of a chaperone and unwittingly lose the deterrent effect one can provide. Granted, misconduct can and does occur with a chaperone present.  However, providers and health systems can elevate their chaperone policies to an ‘opt out’ process that requires chaperones for all sensitive examinations and those involving minors.  After explaining the reasons and patient protections in the chaperone policy, patients may opt out if they choose.  That choice can then be properly documented following detailed informed consent.

Invest in staff training and patient education

Written policies are only effective if they are understood, implemented and reinforced. Training should go beyond compliance to focus on recognizing grooming behaviors, taking patients complaints seriously and conducting effective investigations. Education is equally critical — informing patients of their right to chaperone, explaining what to expect during an exam and providing clear avenues for reporting discomfort or misconduct.

Close the reporting gap between employers

State and federal laws typically require reporting to law enforcement when allegations of abuse are credible. What’s missing is effective communication between prospective and former employers, leaving a window in which a provider under investigation can relocate and continue practicing. Regulatory changes could close this gap, but in the meantime, healthcare organizations can strengthen employment applications to include questions regarding prior patient complaints and investigations of a practitioner (whether or not a license was impacted). 

Partner with insurers and risk consultants

Insurers and reinsurers are increasingly offering resources beyond coverage, including risk management grants and access to specialized consultants. These services can help identify overlooked vulnerabilities and verify that policies are being followed in practice. In an environment where coverage is tightening, demonstrating a proactive approach can also help maintain insurability.

Close the gaps before they become claims

No healthcare organization wants to face the human, reputational and financial consequences of a sexual abuse claim. Yet the rising frequency and severity of these cases, and the shrinking availability of insurance, make it clear that more proactive actions are necessary. Self-assessment is critical, as well as more investment in chaperone availability.

By Leo Carroll |Head of US Healthcare, Berkshire Hathaway Specialty Insurance

Berkshire Hathaway Specialty Insurance (www.bhspecialty.com) provides commercial property, casualty, healthcare professional liability, executive and professional lines, transactional liability, surety, marine, travel, programs, accident and health, employer stop loss, homeowners, and multinational insurance. The actual and final terms of coverage for all product lines may vary.  It underwrites on the paper of Berkshire Hathaway's National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor's. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Columbia, Dallas, Houston, Indianapolis, Irvine, Los Angeles, New York, Plymouth Meeting, San Francisco, San Ramon, Seattle, Stevens Point, Adelaide, Auckland, Barcelona, Brisbane, Brussels, Calgary, Cologne, Dubai, Dublin, Frankfurt, Hamburg, Hong Kong, Kuala Lumpur, London, Lyon, Macau, Madrid, Manchester, Melbourne, Milan, Munich, Paris, Perth, Singapore, Stockholm, Sydney, Toronto, and Zurich. For more information, contact [email protected].

The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein must not be relied upon as coverage and does not include all policy terms, conditions, and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.