Anti-trafficking activists enlisting health providers
By Dan Goldberg, Politico
Legislators and medical groups are stepping up efforts to help health care providers better identify victims of human trafficking, as the opioid epidemic sparks fears that an enduring problem is escalating.
The vast majority of trafficking victims are believed to come through the health care system at some point, making providers well-positioned to intervene. But advocates say they’re trying to combat limited awareness among providers and dispel persistent misconceptions about trafficking victims.
In June, the international organization for classifying diagnoses added 29 human trafficking-related codes for the first time to help track victims of sexual exploitation and forced labor.
“It will really help us direct the way we provide health services and prevention efforts,” said Jordan Greenbaum, an Atlanta pediatrician who led the human trafficking code development process for ICD-10.
The Joint Commission, the national hospital accreditation organization, highlighted trafficking in its June newsletter, aiming to bring awareness to a topic rarely discussed in health care settings. The goal was to make providers aware that trafficking occurs in every community and its victims may not look how people expect, said Joint Commission Executive Vice President Ana McKee.
“Because of the Joint Commission’s clout in the United States health care landscape, a simple statement like this … will most certainly make hospitals sit up and realize they need to have a plan in place to address human trafficking,” said Hanni Stoklosa, an emergency medicine physician at Brigham and Women’s Hospital in Boston and the executive director of HEAL Trafficking, an advocacy group.
There is no official estimate of trafficking in the U.S., though anecdotal evidence suggests it is recently on the rise. Polaris, an anti-trafficking organization, reported a 13 percent increase in the number of trafficking cases it identified in 2017.
Nearly 88 percent of self-identified sex trafficking survivors had been seen by a health care provider while being exploited, according to a 2014 study published in the Annals of Health Law. More than 40 percent were seen by a primary care practitioner and about a quarter by a dentist. Advocates are highlighting those statistics in talks with legislators and health care providers, hoping the medical community will understand its potential to help fight trafficking.
Lawmakers are also increasingly recognizing the role health care providers could play. Earlier this year, the House passed bipartisan legislation, H.R. 767 (115), directing HHS to create a program to train providers to recognize human trafficking victims and refer them to social services. The legislation is still awaiting action in the Senate.
Missouri in March enacted a law, MO HB1246 (18R), requiring its Department of Public Safety to create posters providing information on the national human trafficking resource center hotline. The posters must soon be displayed in health care settings, including women’s health centers, as well as hotels, strip clubs and other places where trafficking may occur.
In May, Ohio Attorney General Mike DeWine called on hospitals to develop protocols for helping staff better identify human trafficking victims. That came two months after New York required hospitals and diagnostic and treatment centers to establish similar policies.
Stoklosa, the Boston-based advocate, said it’s particularly important to raise awareness now because the opioid epidemic has provided a powerful tool for traffickers, who will wait outside methadone clinics to trap addicts. It’s not a problem that’s unique to Boston or large cities. U.S. attorneys in West Virginia created a new human trafficking task force earlier this year because they fear the crime is being underreported in a state hit so hard by the opioid epidemic.
“Traffickers are always looking to exploit vulnerability,” Stoklosa said. “Traffickers have seen those addicted to opioids are the perfect prey and opioids are a perfect tether.”
Advocates say health care providers could miss signs of trafficking because its victims typically don’t match expectations.
“People don’t have handcuffs and duct tape over their mouth, they aren’t all little blonde, white girls,” said Rachel Lloyd, CEO of Girls Educational & Mentoring Services, an organization that helps survivors of trafficking. “That’s not what trafficking is going to look like when it walks through your door.”
To identify victims, there are subtle signs providers can look for, such as recurring chest pains, injuries without easy explanations or uncertain answers to basic questions.
Kanani Titchen, a New York-based adolescent medicine specialist who lectures on trafficking across the country, often tells the story of a young patient she saw on an operating table during her OB-GYN rotation several years ago. She describes an awkward silence when the patient, who was in the hospital to have uterine fibroids removed, was undraped — on her groin and pelvis were tattoos of arrows with the words “pay here” and dollar signs. No one in the operating room said anything about the tattoos.
With the benefit of hindsight, Titchen said she is almost certain that patient was a victim of sex trafficking.
“Most of us have seen a patient who was trafficked that we did not recognize,” Titchen said.