The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#192 What Dental Professionals Need to Know About Human Trafficking
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Are you aware that dental professionals may be the first to identify victims of sex trafficking? Victims may come into the dental office as a patient due to oral injuries. A sex trafficker may also bring the individual in for cosmetic care to make them more desirable and marketable to their clientele. The Divas will discuss what dental professionals should look for and what dental professionals required to report if sex trafficking is suspected.
Resources:
- U.S. Dept. of State - National Human Trafficking Prevention Month Fact Sheet https://www.state.gov/national-human-trafficking-prevention-month/
- Decisions in Dentistry - Human Trafficking: Red Flags for Dental Professionals https://decisionsindentistry.com/article/human-trafficking-red-flags-dental-professionals/
- Human Trafficking: Oral Health Can Tell a Story That Victims Cannot https://www.rdhmag.com/patient-care/article/14279251/human-trafficking-oral-health-can-tell-a-story-that-victims-cannot
- National Human Trafficking Hotline https://humantraffickinghotline.org/en
- Mandatory Reporting of Oral Injuries Indicating Possible Child Abuse https://jada.ada.org/article/S0002-8177(14)61169-7/abstract
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. My name is Olivia Juan and I'll be your moderator today. In this episode, we are focusing on January is National Human Trafficking Prevention Month. Are you aware that dental professionals may be the very first to identify victims of sex trafficking? Victims may come into a dental office as a patient due to oral injuries. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, the compliancedevas.com. Any resources we mentioned during the podcast can be found on the show notes. Please submit questions to support at thecompliancedivas.com and don't forget, please give us a review. According to the US Department of State, there are estimated to be more than 27.6 million people to include adults and children subject to sex trafficking around the world. Sex trafficking robs millions of their dignity and freedom. One dental article indicated that 26.5% of survivors of human trafficking were seen by a dentist, but only very few victims were identified. So this is a great opportunity for dental professionals to learn more about these signs. We wanted to kick off the episode by speaking with Mary Gavoni about the signs, the oral signs that we could look for to identify a potential victim of human trafficking. Mary, what should we look for, especially with your background in dental hygiene? What are some things that hygienists can look for?
SPEAKER_03Thanks, Olivia. I think your statistic that you quoted before, about 26.5% of survivors of human trafficking reporting that they had been seen by a dentist, means that we can potentially identify a quarter of these people in our dental chairs. And some of the injuries that may occur to these victims are visible in the head and neck region of the body. And we're just in a prime position to identify these. One may be tooth decay because of poor oral hygiene. Maybe they don't have access to toothbrushes and toothpaste, and that's not emphasized for people who are being trafficked. Or perhaps it's also due to malnutrition. You might see other injuries like burns or bruises or lacerations. You might see displaced teeth or teeth that have been knocked out, any kind of tooth or jaw-related trauma. And that may come if these victims are being force-fed or if they've been gagged. We may notice on the hard and soft palate redness erythema or peticii on the hard and soft palate, the floor of the mouth. And they also may have signs of sexually transmitted diseases like human papillomavirus or herpes virus. So there's a lot of things that could be identified just in the oral cavity if we're really taking a critical look. And that, along with some of the other things that we'll talk about in this podcast, should be the impetus for us to always be on the lookout for someone who might be trafficked.
SPEAKER_02I agree, Mary, to think that we could possibly be in a position to identify a victim and get them the help that they need. But my understanding in reading some of these articles and having had a podcast on this topic before, that there are even more indicators beyond the oral cavity and their physical appearance. Linda, can you talk to us about what we could look for during that appointment time?
SPEAKER_01Absolutely, Olivia. And as Mary noted, Dillo professionals are really in a good position to identify someone in these positions of trafficking and abuse. The difficult part for us as clinicians is that it's uncomfortable. So, you know, we get used to seeing patients and talking about their care, their families, happy things when patients come in for their visit. So when a patient presents with suspicious or something that really looks very obvious, situation of sex trafficking or human trafficking in general, it becomes uncomfortable because I think the dental professional may fear confrontation possibly with the trafficker, or maybe initial pushback from the victim because they're scared to let someone help them. So I would encourage our listeners today, before I talk about some of the situations that might also raise concerns, is to think about it as saving a life. And that's what we're in the mission of with dental health is to save a person's life through their total body health and oral cancer prevention and so forth. So let's let's think about it from that perspective and be prepared. So a few situations might arise that when say there's a family member or a friend or a coworker or a student that you have in the practice that's newly showered with a lot of gifts or money. And it's maybe this they talk about a relationship that they're in that's they're it's fast moving or it's overwhelming, and there's a lot of differences in these kinds of relationships, like maybe someone all of a sudden dating someone who's very wealthy, and and this person happens to be a little jealous of them talking to friends or family, you know, the kind of possessive where it might seem unique at first because you're getting showered with this extra attention their patient is, but essentially that person is getting that person the victim into a traffic position. It might be someone, say, you know, family member or student, not some maybe a family member for our for our listeners, but possibly so, but a student or in a in the patient role who's a frequent runaway, and they may be staying with someone who's not their parent or guardian. So when someone comes into practice who's should be of a student age, but they're not living with their parents, can't give you any information, or the guardian doesn't have a lot of good information to share about the health history, that might be another one. And sometimes a patient may come in and they seem too close to someone that they're just only know on social media, and they're sharing that with their hygienists while they're getting their teeth cleaned, and there's just the unusual situations that come up, or maybe this patient is living with a parent or guardian and they show signs of other physical abuse. You know, it's a summertime, and you see they're all covered up because you see some bruises on their arms that they're trying to cover up. And as Mary mentioned, on the face, and as well as enteral trauma. So there's just so many different situations when a patient comes in that doesn't feel right. You know, they avoid answering questions, they're reluctant to provide information about their job or what they do or where they go to school, they seem unusually shy, not able to connect with the dental professional like we normally do with our patients to really get them to open up and talk about their oral health and their health history. And so sometimes we might see patients that are vulnerable, vulnerable to trafficking because they're living in unstable situations, or they've previously experienced other forms of violence or sexual abuse or domestic violence, or maybe this patient is known to have run away from the juvenile justice system or the welfare system at some point, or or anybody who's addicted to drugs or alcohol, even if they won't admit it on their health history. It seems a little bit obvious from all the telltale signs. So there's all kinds of backgrounds because there's no evidence that traffickers may be of a particular race, nationality, gender, or sexual orientation. It's just there's traffickers come from all different backgrounds. So it's very incumbent upon us as dental health care professionals to really take our time and look out for these signs and symptoms for every patient, just as much as we're taking time to make sure we get the necessary x-rays at each visit and perform oral cancer screening, all the different things that we do throughout the day. This should be at the top of the list as well, Olivia.
SPEAKER_02Those are some good points, Linda. Thank you. And I I remember listening to a podcast about a runaway that was caught up into trafficking and how that individual did not perceive herself as the victim initially because she had done something wrong, which was run away with this older man. And so it took a while for her to recognize the fact that she was pulled into this world and it was something she had not consented to. And another thing that concerns me is that if the patient comes into the dental office, especially if they're a minor, this person coming with them really doesn't know anything about their medical history, really doesn't know anything about their family or their background. They can't answer questions, and they don't want that person talking. So they will do all of the conversing as if that person can't speak for themselves. And related but not related. But when I'm working with a law client and I'm having a consultation and they have someone with them, which is usually a family member or a close friend, I see that. I see where they there could be potential duress where they're not letting the person who's supposed to be the client do any talking. And I will actually ask them to leave the room because they may be trying to influence that person to make a legal decision that's not really a decision of their own. So that could be potentially that situation in a dental office where they're not letting that person speak for themselves because they don't want any information divulged. So really, really scary things to be looking for. And I know we did an episode a while back, and Leslie's going to mention that to us, but Leslie's also going to speak to us about that uncomfortable decision of when to report and when it's up to that individual. Can you explain the difference, Leslie, for us?
SPEAKER_00Well, certainly. Olivia, to address the first issue, we had episode number 50, which was an amazing podcast with Deborah Inglehart-Nash. And the topic was one, when dentistry needs to know about human trafficking. And so that would be well worth a listen to, because some of the things that Linda had mentioned about some of the different signs or indicators, and some of the things that you said, Deborah talked about it from a position of having worked with some individual groups and organizations that help people who have been a victim of trafficking. So, in regards to your second question, it's mandatory to report suspected child abuse. And Olivia, when individuals under 18 years old, as a child, we are obligated as healthcare providers to report. And when it comes to someone who is over 18 years old, it's really up to the individual to make a decision of what they're going to do. And I imagine that would extend also to the dental professionals to determine how they're going to respond when they have suspicions of an adult. But I'd like to focus on the child abuse aspect where the Federal Child Abuse Prevention and Treatment Act, it's called CAPTA, requires each state to have provisions and procedures for licensed health care professionals to report any known or suspected incidents of child abuse and neglect to the state protective child services, like the CPS. They have an abuse hotline. And healthcare professionals include dental health care professionals. Many states actually incorporate the mandatory reporter obligations into their dental practice act. And as dental professionals, we all have an obligation to be familiar with our dental practice act and with our state laws and regulations. I know for our California listeners, licensed dental professionals are mandated reporters, and that's part of their dental practice act training that they have to take for license renewal every two years. And addressing the other issue, it sometimes is uncomfortable to make the report. And some team members feel that they're not really up to the test, so they pass the responsibility to the doctor. And that seems like the easiest route to take. But what if the doctor doesn't want to get involved? It's actually now back to the licensee, the person who's licensed. So in California, we have registered dental assistants, and everywhere in the country there are dental hygienists. And if the employer is not going to take action, it is actually the responsibility of the licensee as a mandated reporter. And in the event that this individual, licensee, meaning hygienist or assistant doesn't make the report, they have to keep in mind that as a mandated reporter, they can be held legally liable if there's oral trauma that's present and sexual abuse of a minor is suspected, but not reported. So keeping that in mind, reporters are not obligated to disclose their identity. They're also not obligated to investigate any kind of cases. But it is important to note that it is an obligation, and there's a law that says that any employer is prohibited from retaliating against an employee who makes a report. So check out the laws and policies of 23 states do require that mandatory reporters have training to inform them of their responsibility. And the states that don't have that obligation, there are many different state agencies that offer the training, such as state child welfare agencies and other state agency websites where you can learn to recognize the signs and symptoms and understand what your obligation to report is.
SPEAKER_02Very, very good summary, Leslie. Thank you. And I think, you know, I was trying to think in my mind, what if a dental office didn't report it? You know, how did they come up with these numbers that 26.5% of the survivors were treated by a dentist, but only very few were identified? So what if this particular patient, minor patient, was accessing care, particularly if there was injuries or costly cosmetic services to be more desirable, and it was missed. And then those services were traced back to that dental office. So that would definitely put that practice in the hot seat, so to speak, of liability. Mary, what's your thought on that?
SPEAKER_03Well, I actually witnessed something take place of a child being identified as being trafficked. I was in a practice to do training and an evaluation, and man came in with a young boy, and the young boy obviously had was a pediatric practice, had some very obvious swelling, and the person who was presenting himself as the father or the guardian did not want to fill out the health history, would not present an ID, which you're required to verify identification under HIPAA, so you establish the record for this patient. And we had just a very quick consult with the doctor about what to do. This child was obviously in distress. So we had the gentleman who brought the child in bring the patient back in the chair. And you just exactly like you described, Linda, they did not let the child answer any questions. You only talk to me. I'm the I don't even remember what he he didn't say it was his father, but I'm responsible, whatever, whatever. So while we were talking to them, we had a suspicion that maybe he'd even been kidnapped, didn't really even think about the fact that he might be trafficked. He was only nine years old. So one of the staff members called 911 and told the 911 operator what was happening, and please send an officer, but you know, don't come in with the lights and sirens. Come to our back door, we will let you in. And then when they showed up, they took over from there. And so after the fact, when reports had to be given, they found out that this young boy was actually being trafficked. Now, when the police came, the man tried to leave, but he didn't get far because the staff members had photographed with their cell phones the license plate of the car that the man was driving. So everything kind of fit together. And I just can't imagine a nine-year-old boy being trafficked.
SPEAKER_02That's disturbing. But I think your example, Mary, rings true that the dental professional might be the first one to recognize it and put a stop to it. What do you think, Linda?
SPEAKER_01I think absolutely, and as I mentioned earlier, Olivia, I think I think many people are afraid to uh recognize it because you don't know how to handle it. It's like being unprepared for a medical emergency. So we always have to be prepared for the unexpected. And I think this can happen to any patient, any practice in any area of the country, anytime. And I'd like to share, in addition to the 911 option, which is a great option to call for immediate help, if you have other questions, you can certainly call the National Human Trafficking Hotline, which we'll put in our uh resource notes during the show resources during the show notes, but it's 888-373-7888. That's 888-373-7888. And I would encourage our listeners, Olivia, if they live in a state where it's not mandatory to take a domestic violence or human trafficking course of some kind, to please take a course. This is something that we all have can have a positive impact for making the lives better for our our community, our nation, and just patients, individuals across the country and globe that get caught up into these situations without meaning to. So there's a lot of hope that we can provide today, and it's just hope of staying, the hope is staying involved, staying trained, and being prepared if someone should present in your practice.
SPEAKER_02So true. And to summarize today's episode and to repeat what Linda just mentioned, I do want to direct our listeners' attention on how to report. If you want to, you can send a text, the National Human Trafficking Hotline, which is 233 733. You can also report the hotline through a chat, which is human trafficking hotline.org forward slash chat. And then the number that Linda mentioned, which is the National Human Trafficking Hotline, 888-373-7888. So these are important numbers and information to have readily available in your practices in case you do need to make a report and hopefully it has a happy ending in the case that Mary mentioned that they were able to get law enforcement involved. We appreciate everyone's participation in today's episode and hope that it brings some light to the discussion of a very sensitive issue that one of your patients may be facing. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliance divas.com, and we will list the resources in the show notes. Thanks again for tuning in, and we'll see you next week.