Human Trafficking in New York: Is Your Patient a Victim?
By Amy Wasdin, RN, CPHRM, Patient Safety Risk Manager II
Across the board, human trafficking is considered the fastest-growing organized crime activity in the country and, as of 2018, over 45,000 trafficking cases have been reported since 2007. According to the National Human Trafficking Hotline, New York has experienced 2,147 cases during that time span. In 2017—the latest year with complete data—New York was fifth in the nation for human trafficking, with sex trafficking making up the majority of that activity.
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 infections.
- 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 trafficking victims:
- 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 finances.
- Not allowed to speak for himself or herself.
- Reluctance or inability to verify address or contact information.
- 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 from leaving?
- Do you have to get permission to eat, sleep, or use the restroom?
- Has someone taken your personal documents or identification?
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 Trafficking Hotline:
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.
Distracting Devices in Healthcare: Malpractice Implications
Shelley Rizzo, MSN, CPHRM, Patient Safety Risk Manager II, The Doctors Company
Digital distraction in healthcare is emerging as a great threat to patient safety and physician well-being.1 This phenomenon involves the habitual use of personal electronic devices by healthcare providers for nonclinical purposes during appointments and procedures.2 Some call it “distracted doctoring.”
But the threat might more aptly be called “distracted practice,” as it impacts all healthcare workers and staff. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients. And the consequences can be devastating.
Distraction can be both a symptom of and a contributor to healthcare provider stress and burnout. As a symptom of burnout, digital distraction is a way to escape a stressful environment. As a contributor to burnout, digital distraction impedes human interaction because of the sheer volume of data demanding our attention.
For most healthcare providers, distractions and interruptions are considered part of the job; it is the nature of their work. If we consider healthcare distraction on a continuum, on one end are distractions related to clinical care (e.g., answering team member questions or responding to surgical equipment alarms). On the other end of the continuum are distractions unrelated to clinical care (e.g., making personal phone calls, sending personal text messages, checking social media sites, playing games, or searching airline flights).
From a litigation perspective, the distinction between distractions related to clinical care and those unrelated to clinical care is important. In a medical malpractice claim where there is an allegation that an adverse event was caused by distracted practice, a distraction caused by a clinical-care-related activity may be found to be within the standard of care and is, therefore, often defensible. But where it can be shown that the distraction was caused by non-patient matters, the plaintiff’s attorney will certainly use that against the defendant. In these situations, the defendant’s medical care may not even enter the equation, because during eDiscovery the metadata (i.e., cell phone records, scouring findings from hard drives) serves as the “expert witness.” Even if the defendant’s clinical care was within the standard, the fact that there are cell phone records indicating that the healthcare provider was surfing the Internet or checking personal e-mail may imply distraction and could potentially supersede all other evidence.
Two new CME courses from The Doctors Company, How Healthcare Leaders Can Reduce Risks of Distracted Practice in Their Organization and The Risks of Distracted Practice in the Perioperative Area, address addiction to personal electronic devices and provide strategies that individuals and organizations can use to minimize the patient safety risks associated with distractions from these devices.
Find these courses and explore our extensive catalog of complimentary CME and CE activities at http://www.thedoctors.com/patient-safety/education-and-cme/ondemand/.
- Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age
- Treat, Don’t Tweet: The Dangerous Rise of Social Media in the Operating Room
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
The guidelines 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 in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.