By Laura Krausa
The victims of human trafficking are often right before our eyes, and yet we fail to see them. This ugly, clandestine form of modern-day slavery veils its many victims, even from professionals trained to recognize the signs of human trafficking. From law enforcement officials to healthcare providers, a lack of understanding about human trafficking often leads to a failure to identify victims and intervene appropriately.
Studies show that between 50% to 88% of victims say they have been seen by a health provider at some point during their victimization. As we in the healthcare community begin to understand the significance and scope of this crime, our role in addressing the problem becomes obvious. As a result, clinicians are increasingly undergoing training in identification and response. However, until recently, there has been one critical tool missing from this vital work – diagnostic ICD-10 codes (International Classification of Diseases, 10th edition). These codes are used by health professionals to accurately record and classify diseases, symptoms, illnesses, and injuries, accounting for the immediate and long-term impacts on the health of individuals.
The codes also provide data that results in meaningful research, public policy, and resource development. Additionally, the codes are useful in tracking trends, risk factors, and associated, co-existing illnesses to help inform best practices. The significant, long-term health conditions associated with human trafficking make an indisputable case for the need for diagnostic codes.
Three years ago, Catholic Health Initiatives – now CommonSpirit Health, a national Catholic health system formed Jan. 31 from Catholic Health Initiatives and Dignity Health – began its collaboration with the American Hospital Association’s Hospitals Against Violence initiative and Massachusetts General Hospital’s Human Trafficking Initiative and Freedom Clinic to develop ICD-10 codes to allow providers to document sex and labor exploitation. In June 2018, the codes were accepted by a joint committee of the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. The 29 proposed codes were fully implemented in October 2018.
“Like victims of child abuse or elder abuse, victims of human trafficking are coming into emergency rooms and healthcare facilities on a daily basis – and we have to be ready,’’ said Colleen Scanlon, executive vice president and chief advocacy officer for CommonSpirit Health. “This is a significant step forward. Having these codes will help clinicians adequately classify a diagnosis and plan appropriate treatment. And it will demonstrate that this is a serious problem that must be stopped.”
Over the past several years, human trafficking has become a growing, nationwide public health concern. In fact, between 2007 and 2017, the National Human Trafficking Resource Center received more than 40,000 reports of cases in the United States – a number that experts in this field believe is far below the actual figure. The new codes will be used to identify and document both confirmed and suspected cases of forced sexual and labor exploitation of children and adults who go to a hospital or medical facility. A majority of these victims seek treatment in emergency departments for injuries, sexually transmitted diseases, pregnancy and HIV tests, as well as a host of other acute and chronic illnesses.
After the release of the codes, The Joint Commission issued a safety notice identifying the signs of human trafficking and detailing the measures that medical professionals should take when they suspect that a patient might be a victim. CommonSpirit, along with the AHA, Massachusetts General, and many other health organizations and professionals, has created resources to aid coders, clinicians, and other healthcare colleagues in identification, response, and proper diagnostic coding.
This work on the diagnostic codes coincides with other efforts by CommonSpirit to prevent human trafficking. In South Dakota, for example, work was done to raise awareness of the signs of sex trafficking, especially at hotels and truck stops. In Kentucky, recent legislation imposes stiffer penalties on human trafficking, and identification training was completed to ensure safe harbor for victims. In Houston, work is being done to unite hospitals and health providers across the metropolitan area on best practices in identifying and helping victims. In Oregon, a multifaceted community response program serves as a model for essential services and prevention. At the system level, resources and consultation are provided for all forms of violence prevention, and specific education on human trafficking identification and response in the healthcare setting is offered.
“There is great acceptance that human trafficking is a serious public health concern,’’ said Scanlon. “As a large, faith-based health system, we have a moral obligation to do whatever we can to stop this suffering. The new diagnostic codes will help doctors and other healthcare providers know what to ask — and how to respond.’’
Laura Krausa is system director for advocacy at CommonSpirit in Englewood, CO.