Glori Enzor, DDS
Human trafficking, a form of slavery, is a widespread global issue of human rights, as well as a moral, ethical, social, financial, and health care problem which has only recently beg unto be addressed by government and health care professionals.
The U.S. Government and the state of Florida defines human trafficking as “sex trafficking, in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age, and the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery”1, and although transportation is often used as a form of control over its victims, the defining characteristic is the exploitation for profit2.Florida follows only California and Texas in the prevalence of trafficked persons3,and human trafficking is estimated to be a $32 billion industry, second only to drug trafficking.4Sextrafficking accounts for 82% of U. S. victims, with labor trafficking victims representing 11%5.
Dental professionals are in a unique position to recognize these victims, to provide appropriate treatment, and to connect these victims with resources and referrals. Nearly 30% of victims will visit a healthcare professional during their captivity, and virtually none will be identified6. Because of the nature and conditions of their servitude, these individuals may suffer malnutrition, abuse, and medical neglect. Inflicted injuries are often to the head and neck region, involving jaw fractures/dislocations, broken teeth, untreated caries and abscesses, as well as indicators of sexually transmitted diseases or addictions. Bruises, burns, ligature marks, and identifying tattoos or brands are frequently in are as visible to the oral health care provider. Individuals may also present for cosmetic procedures to enhance their salability.
The ADA Code of Conduct, Section 3.E, Abuse and Neglect, states that “Dentists shall be obliged to become familiar with the signs of abuse and neglect and to report suspected cases to the proper authorities, consistent with state laws.”7In the state of Florida, all dental professionals are mandated bylaw to report the suspicion of abuse or neglect of a child or a vulnerable adult8. Furthermore, the failure to report carries both civil and criminal liabilities. Florida Statute 39.205 states that any person who is required to report and who fails to do so is guilty of a third degree felony. If further injuries result, a civil suit may be brought against the mandated reporter who should have recognized the possibility of abuse and failed to report as required by law. In addition, malpractice insurance does not cover criminal acts; therefore, injuries resulting from a failure to report may expose a health care professional to uninsured professional liability.
More importantly, however, is our moral and ethical responsibility to act. “The suspicion of abuse or neglect provides us with the opportunity to interrupt the chain of events which threaten the life and the well-being of our patients. By learning the signs and symptoms of abuse, knowing how to document what is seen, and by fulfilling our legal duty to report suspected abuse or neglect, dental teams may help to mend a family in distress or to save the life of a helpless child or adult.”
Some of the red flags of human trafficking that may be observed by the clinician or staff include a patient who:
·Appears to be under the control of someone who never leaves them alone
·Has someone else speaking for them, regardless of their command of English
·Does not appear to be their stated age
·Lacks identification, a wallet, or spending money
·Shows signs of malnutrition, dehydration, poor general health, poor hygiene, physical abuse or neglect, untreated illnesses or injuries, or drug abuse/addiction
·Appears frightened, anxious, or depressed
·Does not appear to be aware of their location
The clinician should try to separate the patient from their companion to ask screening questions. This can be done by invoking a clinic “rule” for privacy, for example. Remember that these individuals are victims of trauma and proceed non-judgmentally and sensitively; your words of kindness and validation may bring them strength and dignity. Confidentiality, of course, is key. Some assessment questions include:
·Are you living and working in a safe place? Where and when do you sleep?
·Have you ever been pressured to do something that you didn’t want to do or were uncomfortable doing?
·Have you ever been threatened or intimidated by someone? If so, what did this person say would happen to you?
·Are you able to come and go freely to home and work?
·What happens if you leave or talk of leaving home or work?
·Do you have access to any money or the money you earn? Has anyone taken some or all of your money, or held your money with promises to keep it safe?
·Do you owe money to someone? Are you in debt to someone, and how are you paying off the debt?
·Has your communication with others been restricted or cut off? Do you have a phone or computer? What happened to those items?
·Do you have days off from work and what do you do on your days off? Are you allowed to take breaks at work? If you are not feeling well, are you able to take time off from work?
·Has someone ever controlled your access to food and drink, health care, and/or medication?
·Has someone ever taken your identification papers, passport, or other personal documents?
Document any injuries thoroughly, and treat any needs as definitively as possible in one appointment, as they may not be permitted to return; your records and the answers noted from the questions above constitute legal evidence.
Just as we prepare for any other emergency, it’s not a matter of “if” you will see these patients, but “when”. Be prepared for abused and trafficked individuals by locating your area’s resources in advance for child protection centers, domestic violence shelters, and legal assistance and be ready to provide these referrals (many centers have free contact cards you can make available in your restrooms, for instance). Your first contact may be local law enforcement; have the contact information for your county sheriff’s office and city police department handy. In the event of a person who is frightened to return to the controlling companion, dialing 911 for immediate intervention for safety is appropriate. Although we are all mandated reporters for the suspected abuse of a child or vulnerable adult, remember to respect an adult’s decision whether to report or to allow a report; however, they may accept your helpful resources. National resources include:
·National Human Trafficking Hotline, 888-373-7888
·Polaris Project, Text HELP or INFO to Be Free (233733)
·National Center for Missing and Exploited Children, 800-THE-LOST (800-843-5678) Dental professionals are often critical first responders in addressing human trafficking, and for setting in motion the path not only to health, but to freedom.
Dr. Enzor earned her dental degree from the University of Maryland School of Dentistry. She is certified by the Florida Bureau of Investigation in the National Crime Information Center Coding. Dr. Enzor is a consultant for seven medical examiner districts in Florida and maintains a private practice in Sarasota, FL.
Dr. Enzor will present the course “Practical Abuse Education for the Dental Professional” with Special Agent Terry Thomas on Saturday, June 21, from 2 to 4 PM at the Florida Dental Convention. Learn more and register at www.floridadentalconvention.com.
Beyond the Bite 