The Department of Health and Human Services said on Monday that hospitals must obtain written informed consent from patients before they undergo sensitive examinations — like pelvis and prostate exams — especially if the patients will be under anesthesia.

A New York Times investigation in 2020 found that hospitals, doctors and doctors in training sometimes conducted pelvic exams on women who were under anesthesia, even when those exams were not medically necessary and when the patient had not authorized them. Sometimes these exams were done only for the educational benefit of medical trainees.

On Monday, the secretary of Health and Human Services, along with top officials from the department’s Centers for Medicare and Medicaid Services and Office for Civil Rights, sent a letter to the country’s teaching hospitals and medical schools denouncing the practice of doctors and students conducting the exams without explicit consent.

“The Department is aware of media reports as well as medical and scientific literature highlighting instances where, as part of medical students’ courses of study and training, patients have been subjected to sensitive and intimate examinations,” the letter said. “It is critically important that hospitals set clear guidelines to ensure providers and trainees performing these examinations first obtain and document informed consent.”

The department issued a set of guidelines clarifying a longstanding requirement that hospitals must obtain written informed consent as a condition for participating in Medicare and Medicaid programs.

“Patients who are participating in future clinicians’ education should be aware, should have the opportunity to consent, should be given the same opportunity to participate in that education that they would be given if they were awake and fully clothed,” said Ashley Weitz, who underwent an unauthorized pelvic exam while she was under sedation in an emergency room. “We can only expect to have better trust in medicine when both patients and providers can expect a standard of care that prioritizes patient consent.”