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By AMY WASDIN, RN

Most healthcare providers are aware they have a responsibility to identify and report victims of child abuse, elder neglect, and domestic violence. Another type of abuse -human trafficking - is, however, on the rise in every state throughout the nation. The National Human Trafficking Hotline statistics for 2017 include 8,524 cases reported and 26,557 calls received.

This crime occurs when a trafficker uses force, fraud, or coercion to make an individual perform labor or sexual acts against his or her will. Victims can be any age (adults or minors), any gender, and from any cultural or ethnic group. The trafficker, or abuser, might be a stranger, a family member, or a friend. This criminal industry is very profitable, generating billions of dollars worldwide. Lack of awareness and misconceptions can allow opportunities to identify victims to go unnoticed and unreported.

Although trafficking victims rarely find opportunities to interact with others without approval from the abuser, research shows that an overwhelming majority of victims see a medical or dental professional during captivity. A visit to a physician or dental practice provides a rare opportunity for an individual to receive help.

Human trafficking victims are commonly seen in medical and dental practices with the following conditions:

• Trauma such as broken bones, bruises, scars, burn marks, or missing teeth.
• Poor dental hygiene.
• Gynecological trauma or multiple sexually transmitted infections.
• Anxiety, depression, or insomnia.

Victims are usually afraid to seek help for reasons that stem from fear, shame, or language barriers. Medical and dental providers and their staff should be trained to recognize the signs of human trafficking and know what steps to take.

Below are examples of red flags exhibited by human trafficking victims:

• Fearful.
• Depression or flat affect.
• Submissive to his or her partner or relative.
• Poor physical health.
• Suspicious tattoos or branding.
• Lack of control over personal identification or finances.
• Not allowed to speak for himself or herself.
• Reluctance or inability to verify address or contact information.
• Inconsistency with any information provided (medical, social, family, etc.).

Victims may be fearful and distrustful of their environment, so it is best not to ask individuals direct questions about being a victim of human trafficking. The following questions can help in identifying victims:

• Has anyone threatened you or your family?
• Can you leave your job or home if you want to?
• Are there locks on your doors and windows to keep you from leaving?
• Do you have to get permission to eat, sleep, or use the restroom?
• Has someone taken your personal documents or identification?

Human trafficking is a federal crime with severe penalties. The Trafficking Victims Protection Act, enacted in 2000, provides tools to address human trafficking on a national and worldwide level. Many states also have laws and penalties for human trafficking.

If you suspect that someone is in immediate danger, call 911. If you suspect that a patient is a victim of human trafficking, contact the National Human Trafficking Hotline:

Call: 888.373.7888

Text: 233733

E-mail: help@humantraffickinghotline.org

Online Report: https://humantraffickinghotline.org/report-trafficking

Follow state laws regarding mandatory reporting to provide notification of patient abuse or neglect situations. All states require reporting of child trafficking but may not require reporting for adults. While the HIPAA Privacy Rule allows the disclosure of protected health information without authorization in some circumstances, such as imminent danger, contact your risk manager or legal counsel if you are in doubt. Unless calling the authorities is mandatory or impending danger is suspected, it is best not to do so without the patient's permission.

Healthcare practices and facilities should have protocols in place that outline a process for recognizing the signs of human trafficking and taking action. Staff training opportunities should include role-playing scenarios for various human trafficking situations.

For more information, contact: patientsafety@thedoctors.com.

Additional Resources

American Hospital Association, Protocols and Guidelines to Combat Human Trafficking

American Medical Association, How Physicians Can Identify, Assist Human Trafficking Victims

Centers for Disease Control and Prevention, Sex Trafficking

National Human Trafficking Hotline, Service Providers

The Joint Commission, Quick Safety 42: Identifying Human Trafficking Victims

U.S. Department of Health and Human Services, Adult Human Trafficking Screening Toolkit and Guide

Amy Wasdin, RN, MBA, is a Patient Safety Risk Manager II for The Doctors Company.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2019 The Doctors Company (thedoctors.com).