Dr. Melina Lopez: On the front lines with human trafficking in health care settings

June 5, 2019 Roxanna Maiberger

Dr. Lopez is an ob-gyn based in Austin, Texas, who actively works to increase awareness of human trafficking in health care settings. Through her work, she has gained valuable insight into dealing with this sensitive and difficult topic.

When asked what advice she has for health care professionals on treating and interacting with trafficked patients, she advises adopting a trauma-informed care approach for patients. She also points out that this is not a problem with a short-term solution. “Human trafficking has been around since the beginning of human civilization; therefore, we are in it for the long haul.”

Because of the long-term outlook for this topic, Dr. Lopez advises that physicians seek ways to avoid burnout on this topic; become self aware when treating suspected victims; and re-adjust one’s outlook on working with these patients.

Dr. Lopez took time from her work — practicing at People’s Community Clinic as the Director of Reproductive Health and at Austin Regional Clinic where she treats patients on an on-call basis — to answer some of our questions on human trafficking in health care settings.

Q: What are some practical recommendations for health care professionals with regard to human trafficking?

Dr. Lopez: “Do not assume a patient is or is not being trafficked based on their appearances. But don’t ignore what your gut is telling you; pay attention to the red flags. It’s also beneficial to know the resources, partners, and services in your community that are aimed at helping trafficked persons. The National Human Trafficking Hotline can refer you to local services.” (The National Human Trafficking Hotline can be reached at 1-888-373-7888.)

Q: What are the greatest knowledge gaps in the health care system regarding human trafficking?

Dr. Lopez: “When presenting on this topic, I generally see two types of reactions from health care providers: 1) feeling helpless, as if nothing can be done, and 2) becoming overwhelmed because saving a trafficked person immediately after identification is often not feasible. There needs to be a middle ground that emphasizes where and how health care providers fit into the task of combatting human trafficking.”

Q: Which red flags/indicators are the most subtle and easy to miss?

Dr. Lopez: “The nuances that you would not think about unless you are aware of and actively looking for signs of human trafficking, such as the patient’s living situation and employment status. Asking questions about the patient’s ability to spend money autonomously is important. Essentially, it is the everyday life activities that may be taken for granted and therefore not thought of or asked about.”

Q: What similarities (if any) does human trafficking have with domestic violence? Are there key differences in trafficked patients versus patients involved  in situations of domestic violence? What should a physician do in either situation?

Dr. Lopez: “Both of these patient populations are traumatized and share many similar ‘red flags’ or indicators. However, individuals who have been trafficked will often present with more exaggerated indicators, such as malnourishment. Both situations can (and should) elicit screening questions from health care providers.”

Q: Regarding issues of consent for adult trafficked persons, should a report always be made anonymously through the National Human Trafficking Resource Center hotline? Even when mandatory reporting is required? Why?

Dr. Lopez: “It is encouraged to contact the National Human Trafficking Hotline for all instances of human trafficking. Anonymous reports can be made to avoid consent issues for non-minor patients.

It is worth noting that, in some instances, reporting  patients can further endanger them due to potential retaliation by their trafficker(s). This is why obtaining consent and/or making an anonymous report is important. The exception to this rule is for minors, which will require a mandatory report regardless of the patient’s consent. For minors, it is still encouraged to make an additional report to the National Human Trafficking Hotline.”

Q: If a physician suspects a patient is being trafficked, what can that physician do?

Dr. Lopez: “Trafficked patients often require long-term care due to the trauma endured. Therefore, scheduling regular appointments is important because this allows the patient to be consistently seen and treated.

Have a protocol in place for working with trafficked patients. Often, the care needed by trafficked patients is outside the physician’s scope of practice and having an interdisciplinary team can bridge some of these care gaps.

When feasible, having social workers on staff is beneficial. If that’s not feasible, consider identifying an interested medical assistant or nurse in your office as the designated person for working with trafficked patients outside of treatment and diagnosis.”

Q: What would you say is the primary role physicians/ health care professionals play in combatting human trafficking?

Dr. Lopez: “The health care provider’s primary role is addressing patients’ primary medical concerns. Additionally, the practice can take on the roles of  identifying trafficking indicators, providing information and resources, and creating a safe place for patients where they feel respected. Educating these patients in small but consistent ways is powerful. It is the role of the physician to educate the patient so that he/she can make informed decisions about their health care and their safety.”

As a reminder, by contacting the National Human Trafficking Hotline, you can be directed to resources, partners, and services in your community aimed at combatting human trafficking. Below is contact information for the National Human Trafficking Hotline:

Below are links to resources on red flags and indicators of human trafficking:

Additional reading:

This article is published in the Reporter Q1 2019.

About the Author

Roxanna Maiberger is an Associate Risk Management Representative at TMLT. She completed her undergraduate and graduate degrees at The University of Texas at Austin. Her master’s degree is in Public Affairs from the LBJ School of Public Affairs with a concentration in health care policy. Roxanna Maiberger can be reached at roxanna-maiberger@tmlt.org.

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