Domestic Violence, with a special focus on Human Trafficking

According to a recent article posted in JAMA online [43] :“…trafficked persons are often isolated from the public, sothey have little opportunity to see their situation in adifferent light, according to the Campaign to Rescue andRestore Victims of Human Trafficking of the U.S.Department of Health and Human Services.”Trafficking survivors who need health care may have anopportunity to escape their captivity, but only if physicians andothers who treat them are able to recognize and reach out tothem. The agency suggests that clinicians ask the following setof questions of persons who do not seem to be able to move to adifferent location or change jobs, who appear fearful ordepressed, lack identification documents, or who seem reluctantor unable to speak for themselves:• What type of work do you do?• Are you being paid?• Can you leave your job if you want to?• Can you come and go as you please?• Have you or your family been threatened?• What are your working and living conditions like?• Where do you sleep and eat?• Do you have to ask permission to eat/sleep/go to thebathroom?• Are there locks on your doors/windows so you cannotget out?• Has your identification card or documentation beentaken from you?”DocumentationIt is important for the physician to document in the patient’schart evidence of the violence and to be accurate in theirdocumentation. It is important to use direct quotes from thepatient. Appropriate photographs or detailed drawings or asketch of a body are important. (See the Injury Location Chartat Appendix A).This documentation is needed when the justice system becomesinvolved. If the victim seeks an injunction for protectionagainst domestic violence or if the state is going to prosecute aperson accused of domestic violence and the victim cannottestify, accurate medical records describing the abuse are criticalevidence. Medical records are so valuable that many abuserswill accept a plea bargaining arrangement rather than go totrial when they are presented <strong>with</strong> this evidence. Thisinformation also is valuable when legal custody of the childrenis being determined by the court or if the violence escalates tothe point where the abuser is killed by the spouse or one of thechildren. Medical records that substantiate violence may keepthe victim from going to jail should she defend herself and killthe abuser because they validate her claim of self defense. It isimportant to think of the children in these situations who maylose one parent to death only to be separated from the otherparent who may be forced to spend years in jail if convicted of acrime.The same rules regarding documentation apply in cases ofhuman trafficking. The justice system could intervene in thesame ways: prosecuting the offender, providing relief for thevictim <strong>with</strong> an injunction for protection or through a civilaction against the trafficker or <strong>with</strong> child custody and supportissues. Particularly in these cases, medical records would becrucial to corroborating the victim’s story to convict thetrafficker, setting restitution for her and for decidingsentencing.Abuse in the Physician’s Personal LifePhysicians experience domestic violence in their personal livesjust as often as anyone else. They may develop a workingrelationship <strong>with</strong> others in their profession (physicians, nurses,office personnel) in which the physician is “never wrong.”Remember, when you are treating a patient, there may bemultiple ways to treat a given diagnosis. Your education andexperience lead you to choose one of those ways to treat thepatient to the exclusion of the others. This means that you havedecided that the other treatments for that problem are not asgood as the one that you have chosen and that the one youhave chosen is the right treatment. The development of thistype of attitude may lead to an abusive relationship if thebehavior pattern is carried into the physician’s own home. Noone is right all of the time!A physician who reviews the Power and Control Wheel(Appendix C) or the Patterns of Behaviors (Appendices Dand E) and finds some of his/her own personal behaviorrepresented there should consider seeking professional helpto deal <strong>with</strong> this problem.Any health care professional may contact the ProfessionalsResource Network (PRN) at (800) 888-8776.18 <strong>Domestic</strong> <strong>Violence</strong> in Florida: <strong>special</strong> <strong>focus</strong> on human trafficking www.fmaonline.org