A Different Kind of Patient: CME from TMA Helps Docs ID Human Trafficking Victims
By Joey Berlin Texas Medicine January 2021


The fight against one of the most hideous crimes imaginable continues. Texas physicians are now required by law to be part of that fight – and, if they know what to look for, they can be some of its most effective warriors.

A newly revised Texas Medical Association CME teaches physicians how to recognize human trafficking victims who come into their office, and how to help these patients escape what’s sometimes referred to as “modern-day slavery.”

During its 2019 session, the Texas Legislature passed a bill that requires the Texas Health and Human Services Commission (HHSC) to approve training courses on preventing human trafficking and requires Texas physicians to take one hour of CME on the topic in order to renew their licenses.

TMA then reviewed and updated its CME, Identifying Human Trafficking in Texas: What Physicians Need to Know, with the help of Texas physicians who have expertise on identifying the signs of brainwashing, fear, captivity, and despair that victims often display.

The law mandating a trafficking course “speaks to how large a problem it is, but also what an important role that health care providers play in addressing the topic,” said Austin obstetrician-gynecologist Melinda Lopez, MD, one of the CME’s primary authors. “Because we are some of the few professionals who might interface with victims of trafficking during their time in captivity, it really is important for us to be aware of risk factors for trafficking and some of the red flags for trafficking. When we are encountering patients in a controlled, safe environment in the clinic or in the hospital, we should know the right questions to ask and how to respond when they might share the information with us.”

The newly revised course, which meets the state’s CME requirement, details the steps physicians can take once they suspect a patient needs resources or assistance to escape a trafficking situation – even if the potential victim won’t be forthcoming enough to make that escape happen immediately, says Lubbock orthopedic surgeon Melinda Garcia Schalow, MD, who helped revise the course.

“It’s worth doing, because it provides practical information,” she said. “Texas physicians are given the skills and the tools to recognize a problem that may not be apparent at first glance. But you have to many times realize that you have to be patient, because you can’t have an immediate effect.

“Many times, these victims are not ready to make a change or ready to reveal that they’re in whatever situation that they’re in. But the time that you take to share some information with that patient can make a huge difference in their life. Not necessarily that day, but in the future.”

Signs and next steps

The CME describes how to recognize parts of a patient’s medical history and physical that suggest human trafficking, but also how to identify red flags in a patient’s behavior.

Arlington thoracic surgeon H. Michael Lewis, MD, who helped revise the CME, has worked for years with Dallas Metroplex-area nonprofit Traffick 911. He says trafficking victims usually don’t come to a physician’s office alone; one of the traffickers will accompany them.

“When someone comes in, they’re coming in with a handler,” Dr. Lewis said. “In other words, that pimp is basically going to be there, and they’re going to be answering all the questions.”

Lack of eye contact from the patient can be another telltale sign. So can the presence of certain tattoos that, for example, say “Daddy,” or resemble a bar code.

“They are going to be, very probably, marginally nourished,” Dr. Lewis added. “They may be inappropriately dressed to the weather and location, because many of these [victims] have actually been transported [from elsewhere]. … What happens when you have a major event such as the Final Four, Super Bowl, World Series – all these sports events, these victims are actually trucked in.”

Dr. Lopez listed other potential signs including:

A general lack of preventive care;
Repeat visits for urgent health needs, such as an unplanned pregnancy or sexually transmitted infection; or
Repeat visits for traumatic injuries, such as broken bones and bruises, that can be signs of violence.

The course also details the next step after identifying a potential victim: how to take action.

Dr. Lewis says that involves coming up with a reason to separate the potential victims from their handlers, for example, by saying an X-ray is required, and telling the handler he or she can’t be in the room for the X-ray. Once potential victims are alone, they have a chance to tell their story, and if they do, the physician’s office can get law enforcement involved.

At Dr. Lopez’s clinic, “just for this concern, we adopted a policy about a year ago: We have big signs all over the waiting room saying that it’s just our policy to meet with each patient privately for a few minutes when they’re first getting checked in,” she said.


An atypical problem

Because human trafficking often doesn’t make itself obvious, it’s a markedly different problem than the ones physicians are used to treating, Dr. Schalow cautions.

One thing physicians should keep in mind: They won’t necessarily elicit the information they need from a victim to take action right away, Dr. Schalow says. And if the victim doesn’t reveal what’s going on, the physician’s hands are tied for that day.

Each visit is an opportunity to establish rapport and trust with the patient, she says, so a trafficking victim can view the health care setting as a safe place to ask for help when they’re ready.

Additionally, if an adult victim does reveal his or her captivity, the physician must have their permission to intervene, Dr. Lopez adds.

“If they’re sharing where they are and they’re just not at a point to escape the trafficking situation, then the most that we can do as doctors is to try to support the patient, and let them know that you’re always a safe person for them to reach out to, and that their information will stay confidential, and there’s no shame in their situation,” she said. “You’re not going to be disappointed in them when they come and see you again. You’re not going to give them a guilt trip if they haven’t left the situation. Because they know what they’re dealing with more than anyone else could.”

Tex Med. 2020;117(1):39-41
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Last Updated On

January 04, 2021

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CME | Human Trafficking

Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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