_____________________________ Recognizing and Responding to Human Trafficking in Texas, 2nd Edition
CASE STUDY 1 (CONTINUED) Continuing Rebecca’s visit, you are now ready to begin her physical examination. Derek insists he would like to stay in the room during the examination, and Rebecca consents to his presence. He remains standing at the head of the bed during the pelvic examination. The exam helps you determine Rebecca’s presentation is consistent with an outbreak of genital herpes, and microscopic examination of the discharge reveals trichomoniasis. These are two sexually transmitted infections. Derek seems unusually undisturbed by the diagnoses. You are concerned about Rebecca’s current living situation and would like to question her privately. While discussing the diagnoses with Rebecca and Derek, you inform them that you would like Rebecca to have a urine pregnancy test done before beginning treatment and request that she accompany you to the restroom to provide a urine sample. Derek states he will go with her and wait outside of the restroom. You explain that this is not possible because the route to the restroom passes other patients’ rooms and that this may result in an unintentional disclosure of protected patient information. Derek quickly replies that it is impossible for Rebecca to be pregnant and insists she has been compliant with her oral contraceptives and her periods are normal. Then he begins to question the necessity of the test. You inform them that she will not be treated until the test is complete, and Derek reluctantly agrees. You lead Rebecca to a private conference room and emphasize that everything the two of you discuss will remain confidential. Before continuing, you say to Rebecca, “I have a few concerns and would like to ask you some questions about your current living conditions and situation. Would that be alright?” • What questions would you ask Rebecca to help determine if she is a victim of human trafficking? • If Rebecca discloses that she is a human trafficking victim, what are ways that you could help her? • What resources would you provide Rebecca? Who else would you contact/involve in the situation? • How might you respond if Rebecca declines to make an explicit disclosure or refuses to answer any questions?
or age of interpreter), and should told that they can refuse a particular interpreter if they are not comfortable speaking in front of them (National Human Trafficking Training and Technical Assistance Center, 2022). Once an interpreter has been selected, a pre-interview meeting should be held in which the interpreter is informed about the risk of hearing traumatic details about the potential victims’ life, is asked to apply a trauma- informed approach, use person-centered language, maintain neutral body language and facial expressions, and translate verbatim all questions and answers (National Human Trafficking Training and Technical Assistance Center, 2022). Be aware of mandatory state reporting laws. In Texas, healthcare providers who are concerned that their patient has been trafficked should provide medical care to the patient while also following mandatory state reporting laws and institutional policies regarding abuse to a child, elderly person, or person with a disability, or reporting that a child is unaccompanied by an adult (Texas Health and Human Services, 2024). A professional who becomes aware of child abuse must report it within 48 hours. This reporting duty cannot be delegated and must be made non-anonymously. Health care providers should follow institutional policies for reporting to law enforcement if the patient is in immediate, life-threatening danger but should work with the patient in deciding to contact law enforcement to avoid putting the patient in further danger (Texas Health and Human Services, 2024). In Texas, it is mandatory that health care practitioners report the abuse of those 65 or older and adults with disabilities to law enforcement and/or the Department of Family and Protective Services immediately. Victims of human trafficking may not want law enforcement contacted due to concerns for safety of themselves and their loved ones, fear of reprimand for crimes they have been forced to commit, mistrust of law enforcement, stigma and shame with reporting, and the emotional burden of the judicial system (Canadian Centre to End Human Trafficking, 2024; Palombi et al., 2019). Providers should also offer the patient the National Human Trafficking Hotline number, 888-373-7888, and text number, 233733 and should encourage the patient to call if they want help or to talk to someone (Texas Health and Human Services, 2024). A practitioner can report to the National Human Trafficking Hotline that they suspect an adult (not 65 or older and not disabled) is being trafficked, but they cannot provide identifying information without the adult’s consent.
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