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Is Your Patient a Victim of Human
By Amy Wasdin, RN, MBA, Patient Safety
Risk Manager II
The Doctors Company
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
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
- 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
- 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
- Not allowed to speak for himself or herself.
- Reluctance or inability to verify address or contact
- 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
- Do you have to get permission to eat, sleep, or use the
- Has someone taken your personal documents or
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
Call: 888.373.7888 Text: 233733
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 firstname.lastname@example.org.
Association, Protocols and Guidelines to Combat Human Trafficking
Association, How Physicians Can Identify, Assist Human Trafficking Victims
Centers for Disease
Control and Prevention, Sex Trafficking
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
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.
permission. ©2019 The Doctors Company (thedoctors.com).