I Think My Patient Is Being Trafficked

Roxanne Nelson, RN, BSN


September 24, 2019

Anti-trafficking experts have identified specific "red flag" indicators that can signal a possible trafficking situation. The presence of any one of these should heighten suspicions about the patient's safety. These include:

  • A delay in seeking medical care;

  • Discrepancy between the stated history and the clinical presentation or observed pattern of injury;

  • History seems scripted or memorized;

  • Brings a third party along who does all of the talking;

  • Cannot produce any identification;

  • Evidence of lack of care for previously identified or obviously existing medical conditions;

  • Presence of tattoos, branding, or other marks or insignias that may indicate a claim of "ownership" by another;

  • Evidence of any kind of physical violence including torture (bruises, burns, scars, cuts);

  • Has a history of repeated sexually transmitted diseases (STDs) and/or pregnancies;

  • Appears malnourished;

  • Pays cash and has no health insurance;

  • Shows signs of substance addiction or withdrawal; and

  • Gives an age that is older than visual appearance.

"Other indicators may be if, clinically, the pieces don't seem to fit together," explained Jeffrey Barrows, DO, MA, a retired ob/gyn and founding board member of HEAL Trafficking and founder of Gracehaven, a rehabilitative facility for victims of domestic minor sex trafficking in Ohio. "And if the patient has an unusual infection for the United States, such as tuberculosis, or if they can't give an address."

"It's important to observe nonverbal communication from the patient and interaction with the accompanying person, and the clinician should be looking for signs of fear, anxiety, or submission," he said.

Overall, healthcare professionals should pay close attention to vulnerable populations, such as children, adolescents, and those who have identifiable risk factors.

Many trafficked patients are accompanied by a companion who does all of the talking and refuses to leave the room. This is a red flag suggesting abuse, neglect, or violence, and the key is to try to separate the patient from the companion in a nonthreatening manner. "One way of doing this is to ask for a urine sample and then walk the patient down the hallway," said Stoklosa. "This may not work in some settings, but asking for a urine sample usually doesn't raise alarms."

Other tactics are to take the patient to radiology, cite the requirement for patient privacy during an exam, or ask for the companion's help in completing registration forms out by the front desk—and away from the patient.

What if the companion refuses to be separated from the patient? "It may not be safe to insist on it," explained Holly Austin Gibbs, a survivor of child sex trafficking and nationally known expert who is now program director of Dignity Health's Human Trafficking Response, "and the conversation may have to come to an end. At that point, the clinician will need to find out what the protocol is for reporting safety concerns internally and what the policy is on mandated reporting."

If able to proceed with the conversation, the patient is more likely to be open to discussion if the clinician is perceived to be knowledgeable about abuse and violence, nonjudgmental, respectful, and supportive.

A growing number of large health systems have acknowledged the need for training staff to recognize trafficked victims and have established programs and protocols. Barrows helped Kansas-based Ascension Via Christi Health develop one of the first response protocols in the country in 2013.

There is a need for any hospital/clinic/office to have a response protocol in place that addresses what to do when a potential victim of trafficking is encountered.

"More hospitals are beginning to get on board with one, but I estimate that still less than 10% of hospitals around the country have what I would call a comprehensive specialized response protocol for victims of trafficking encountered within their healthcare setting," he said. "There is a need for any hospital/clinic/office to have a response protocol in place that addresses what to do when a potential victim of trafficking is encountered. It will obviously need to be fairly comprehensive for larger hospitals, but it's helpful even at the office level."

That said, he also recommends that clinician training on human trafficking should take place after the protocol is completed, so that the training can incorporate the important sections of the protocol.


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