Ph Physicia ian-Victim Appr pproac oach h to o Hum uman an Tr Traf afficking ng A A Heal ealthc hcar are and and Heat eath Law h Law Per erspec pective: The The nec neces essar ary com ombi binat nation on of of Heal ealth, h, Law Law, Dat ata a pr prot otec ection, n, and and Publ ublic Order der Prof of. Alfons onso o Lopez Lopez de de la a Osa a Escriba bano no Uni niver ersity of of Hous ouston Law on Law Cent enter er
Human Trafficking, Healthcare approach and Health Law: What is the U.S. Law saying about HT? What is the framework existing at State and Federal level? What are the legal issues arising?
When speaking about heal health and human human t traf afficki cking, we normally talk about: Range of abu abuse ses and traumas victims endure The cons nsequen equences es of them, in acute and long-term physical and psychological problems (Atkinson et al, JHT, 2016) Adverse physi physica cal outcomes: Injuries from violence (bruises, concussions, fractures, lacerations, perforations of vagina an rectal walls), infections (sexually transmitted diseases –STDs), pelvic inflammatory disease – PID, and HIV/AIDS; gynecologic issues (repeated unintended pregnancies/abortions, lacerations, hemorrhaging), untreated chronic conditions (diabetes), malnourishment and poor dental care (Kiss et al, 2015) Adverse psychol chologi ogical al outcomes: Complex trauma related posttraumatic stress disorder (PTSD), anxiety disorder, major depressive disorder, suicidal ideation, psychosomatic illness, trauma-bonding and Stockholm syndrome, drug/alcohol addictions, and eating disorders (Zimerman et. al 2008)
We can also understand, Pu Public lic H Health lth and Human uman T Traf affick cking ng: What is the Pub ublic H Heal ealth appr approach? Actions taken to protect people from a commu ommunity per y persp spective ve; o The individual is seen as membe member of of the he commu ommunity: and is protected through pr promot omotion of good health habits and conditions, educ ucat ation on, etc. in our topic: about identifying HT, educating to know more about it, to detect it, setting • commu ommunity ear y early w y war arni ning al aler erts. Then, the Heal ealthca care approach oach, What is the Heal ealthca hcare approach? The individual dual p perspect pective of the victim of human trafficking when he/she interacts with a physician, or healthcare provider, in a large sense. In Indiv ivid idual h l health lth vs. col ollect ctive ve heal health ( ( of of cou ourse se, t they ar hey are not e not di disco connected ) o By connecting HT with a Heal ealth Law h Law perspective, we narrow the circle to fight it, helped by the Law, and addressing questions such as…
A Bila Bilate teral l dia ialo log, built normally on: reciprocal con onfide dence and t and trust ust, pat patien ent pr privacy cy and confid fidentia tiality lity, on informed c ed cons nsent ent: information and voluntarily approach, true information given by patients for diagnosis and treatment by physicians, are basic. But are HT victims really in a confident atmosphere? No, not initially. Why? hy? shame, fear of retaliation, unwilling to identify themselves or tell the real origin of their suffering, vulnerability, lack of education, lack of knowledge of until what point the system can be of help, abduction, etc. Who are these heal health per h perso sonnel interacting with them? Physicians, medical intern, hospital personnel engaged in the examination, care or treatment of persons, medical examiner, psychologist, emergency medical technician, dentist, nurse, chiropractor, podiatrist, optometrist, osteopath, allied mental health and human services professional, drug and alcoholism counselor, psychiatrist . Physicians are in a uni uniqu que pos position at the intersection between health and the law (Powell et al. JHT, 2017), “ vital important players ”, “ play a critical role ”, they ar hey are e PRICELESS, because of the situation in which they are.
Able to det etect after correspondent trainings, or to some healthcare personnel, even without it, with the characteristics clin linic ical e l eye , medical intuition: “ something is wrong here… ” Able to repo port to law enforcement, or public health authorities. They can contribute with their action in the Prosecut ution. As well as in allowing the he victim’s repa pair: a a comp mpen ensation ( (is the here f finally any ny…?).
Down the road, we can find different legal i gal issues ues arising in the Physi ysici cian-Vi Vict ctim a m appro roach ch t to HT: Data p a prot otec ection ion i issues ues. Professional secrecy, privacy, confidentiality, In general, when an information is Protec ected H ed Healt alth I h Infor ormat atio ion (PHI) I) according to HIPAA (Health Insurance Portability and Accountability Act 1996), no discl closu sure re i is p possi ssible. Lack o ck of c conse sent to discl sclose se Diffic icult lt p proc oced edur ure e to r repor port, complexity of it. Besides, psycho holog logic ical al i issues ues: fear of retaliation from victim and physician, individualism, etc.
HIPP IPPA. HIPA IPAA regulates the people who hold the information: hospitals, health plans, & health care clearinghouses : called “covered entities”, and how they have to safeguard medical information. HIPAA, created in 90’s: electronic health records were pretty new concepts. HIPAA, to facilitate: the exchange of electronic health info and continuity of insurance coverage, but pr privacy and y and s secu ecurity r y rul ules es are key, because HT T Vic Victim tims: have their right ght to o pr privacy cy t too oo. HIPA IPAA Pr Priv ivacy R Rule le specified: how cove vered ent entities may es may us use and and di discl close se PHI, What are pat patien ent r right ghts with respect to PHI. 45 45 CFR sect ection 164. 164.500 et et seq eq.
What is is PHI? I? Rules define protected health information (PHI) as heal alth i h infor ormat ation paired with at leas ast o one ne o of 1 18 i 8 ident dentifiers. Individually identifiable information ; that can be used on a reasonable basis, to iden dentify i indi ndivi vidual al. 1. Name mes 2. All geographical subdivisions smaller than a State, including street eet a addr dres ess , , city ty , , coun ounty , , pre reci cinct ct , , zip c p code ode , and their equivalent geocodes, except for the initial three digits of a zip code, 3. All elements of dates (except year) for dates directly related to an individual, including birth date , admission date , discharge date , date of death 4. Phone n e number bers 5. Fax n number bers 6. Electron onic m c mail addr dres esses es 7. Soci ocial S Secu ecurity number bers 8. Medical al r recor ord n d number bers 9. Health p h plan b n benef eficiar ary n number ber s 10. Accoun unt n number bers 11. Certificat ate/ e/licens ense n e number bers 12. Ve Vehi hicl cle iden dentifiers a s and s nd seri erial num umbers rs , including licen cense se p plat ate numbers 13. Devi vice ce i iden dentifier ers and serial numbers 14. Web U Univer ersal al Resou ource ce L Locat ator ors ( URLs ) 15. Inter ernet net P Protoc ocol ol (IP) address numbers 16. Biomet etric i c identifier ers , including finger and voice prints 17. Full f face p e photogr graphi aphic images ges and any comparable images; and 18. Any other unique ue ident ntifying n ng number ber, c charac acter eristic, c, o or code (note this does not mean the unique code assigned by the investigator to code the data)
Very hard to de de-id identify tify d data ta ( encryption , codification , dissociation , pseudonomyzation processes) and still have have it it be usefu ful l for many purposes. Not to mention in HT (it is not impossible though: giving a code de to the victim?). De-id identific tificatio tion, makes difficult use the information with law enforcement premises (identity, location, habits, etc.) Main premise, the HIPAA Rule: PHI i is con onfide dential and c and can annot be be rel elea ease sed w without hout pat patien ent’s w s written en aut autho horiza zation. Except… for: Treatment Payment Hospital Operations To friends and family involved in the patient’s care For directory purposes (and to the clergy) For research if the IRB waives consent/authorization For preparatory to research purposes Incidental disclosures of PHI publ public heal c health, l law aw enf enfor orce ceme ment, and l and legal egal pr proce ocess ss ex except eptions ons, wher here H HT ent enter ers
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