Legal considerations
the autonomy patients deserve and need for making informed decisions for their own safety and future. As in cases of intimate partner violence, therefore, health care providers must follow the lead of the patient and respect the decisions of those who decide not to contact law enforcement or accept referrals to other services. Domestic as well as international victims of human trafficking have specific legal rights under federal and state law, but may not know of these rights or be in a position to exercise them. If the patient is willing, a referral to law enforcement, attorneys, or legal service providers is appropriate. shared with other patients, and you must protect their privacy. Mark quickly replies that it is impossible for Jessica to be pregnant, as she is compliant with her oral contraceptives, her periods are normal and questions the necessity of the test. You indicate she will not be treated until the test is complete, and Mark reluctantly agrees. You lead Jessica to a private conference room and emphasize that everything the two of you discuss will remain confidential. You preface your questions by stating, “I am worried about you, and would like to ask some questions about your current living conditions and situation so that I might help you.” 1. Take a moment to consider how you might respond if Jessica refuses to answer any further questions. 2. Take a moment to consider ways you could help Jessica if she did indeed admit to being a victim of human trafficking.
“Health care providers are not required to—and in fact may not—report suspected instances of human trafficking that involve a competent adult victim, without the patient’s express consent.” 8
Clinicians should not involve law enforcement and/or social service providers (e.g., housing/shelter services, legal services, and case management) without first obtaining the explicit informed consent of the patient, or unless otherwise required under relevant law. These laws may include mandatory reporting laws for children, disabled adults, elders, and others. Privacy breaches can erode the provider-patient relationship and remove Case study: Clinical consideration part 2 Continuing Jessica’s visit, you are now beginning her physical examination. Mark indicates he would like to remain in the room during the examination, Jessica agrees and consents to his presence. He stands next to the head of the bed during the pelvic examination. Upon completion, you have identified an outbreak of Genital Herpes, and microscopic examination of the discharge reveals Trichomoniasis, two sexually transmitted diseases. Mark seems unusually undisturbed by the diagnoses. You are concerned about Jessica’s current living situation and would like to question her privately. In discussing the diagnoses with Jessica and Mark, you indicate that she must undergo urine pregnancy testing before beginning treatment and request that she accompany you to the restroom to provide a urine sample. Mark offers to go with her and wait outside of the restroom. You explain that it is not possible as the route to the restroom may pass other patients’ rooms, that the restroom is in a location Conclusion Clinicians, as “first contacts,” have an imperative to make a difference for their patients. Human trafficking poses many health risks, including physical injury, death, and/or long-lasting psychological damage. In the absence of validated tools to screen for victims of human trafficking, health care providers may need to consider implementing universal methods and Resources Texas resources ● Texas Office of the Attorney General humantrafficking@oag.texas.gov 512-463-1646 ● Texas Child Protective Services 800-252-5400 ● Texas Department of Public Safety, Victim Services 512-424-2211 dps.texas.gov/administration/staff_support/victimservices/ pages/index.htm National Resources ● Coalition Against Trafficking in Women www.catwinternational.org References 1. Department of Justice. Federal Strategic Action Plan on Services for Victims of Human Trafficking in the United States, 2013-2017 . 2014. 2. National Human Trafficking Resource Center. Identifying Victims of Human Trafficking: What to look for in a healthcare setting. http://www.acf.hhs.gov/endtrafficking/resource/ fact-sheet-identifying-victims-of-human-trafficking. Published 2016. Accessed November 30, 2016. 3. International Organization for Migration. Caring for Trafficked Persons; Guidance for Health Providers . Geneva, Switzerland 2009. 4. United Nations Office on Drugs and Crime. Trafficking in persons: universally defined in the UN Trafficking in Persons Protocol . https://www.unodc.org/documents/data-and-analysis/ glotip/Annex_II_-_Definition_and_mandate.pdf. Accessed September 22, 2020. 5. U.S. Immigration and Customs Enforcement. Human Trafficking vs. Human Smuggling . https://www.ice.gov/sites/default/files/documents/Report/2017/CSReport-13-1.pdf. Accessed September 22, 2020. 6. Stop the Traffik. Sex trafficking vs sex work: understanding the difference . https://www. stopthetraffik.org/sex-trafficking-vs-sex-work-understanding-difference/. Accessed June 25, 2020. 7. United States Department of State. 2019 Trafficking in Persons Report . https://www.state. gov/reports/2019-trafficking-in-persons-report/. Accessed September 22, 2020. 8. Alpert EJ, Ahn R, Albright E, et al. Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting . Boston MA: MGH Human Trafficking Initiative, Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital;2014.
policies to create a safe environment for all patients. Clinicians who encounter a trafficked person or other exploited individual have a unique opportunity to provide essential medical care and supportive referral options that may be an individual’s first step towards safety and recovery.
● Human Rights Watch www.hrw.org ● SOAR to Health and Wellness acf.hhs.gov/endtrafficking/initiatives/soar ● HEAL Trafficking https://healtrafficking.org
● Caring for Trafficked Persons: A Guide for Health Providers http://publications.iom.int/books/caring-trafficked-persons- guidance-health-providers ● National Human Trafficking Resource Center (NHTRC) Hotline (24/7): 1-888-373-7888 http://traffickingresourcecenter.org/ ● Polaris Project www.polarisproject.org 9. Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in health care settings. Health Hum Rights. 2011;13(1):E36-49. 10. United States Congress. Justice for Victims of Trafficking Act of 2015 . https://www.gpo. gov/fdsys/pkg/BILLS-114s178enr/pdf/BILLS-114s178enr.pdf. Published 2015. Accessed January 9 2017. 11. Texas Human Trafficking Prevention Task Force. Report to the Texas Legislature December 2020 . https://texashistory.unt.edu/ark:/67531/metapth1402173/. Accessed May 17, 2022. 12. Busch-Armendariz NB, Nale NL, Kammer-Kerwick M, et al. H uman Trafficking by the Numbers: The Initial Benchmark of Prevalence and Economic Impact for Texas . Institute on Domestic Violence & Sexual Assault, University of Texas at Austin; 2016. 13. National Human Trafficking Hotline. Texas Statistics . https://humantraffickinghotline.org/ state/texas. Accessed May 17,2022. 14. Emergency Nurses Association. Joint Position Statement: Human Trafficking Awareness in the Emergency Care Setting . https://www.ena.org/docs/default-source/resource-library/ practice-resources/position-statements/humantraffickingpatientawareness. Accessed September 22, 2020. 15. American Medical Association. Policy Statement: Physicians Response to Victims of Human Trafficking H-65-966 . https://policysearch.ama-assn.org/policyfinder/ detail/H-65.966?uri=%2FAMADoc%2FHOD.xml-0-5095.xml. Published 2015. Accessed September 22, 2020. 16. American College of Obstetricians and Gynecologists. Human Trafficking. Committee Opinion No. 507. Obstet Gynecol . 2011;118:767-770.
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