Vol 23, 2014 Annals of Health Law 78
HEALTH CONSEQUENCES OF SEX TRAFFICKING
their victims, 41 these points of contact with healthcare represent rare
opportunities for victim identification and intervention. 42 In addition,
because of the hearsay exception in the Federal Rules of Evidence for
statements made for medical treatment (regardless of whether the declarant
testifies), 43 statements by victims to healthcare professionals should usually
be admissible in a trafficking prosecution. 44
These opportunities have largely been missed as even those healthcare
professionals who recognized that victims might have been “on the street”
rarely understood that they had a pimp/trafficker. Just over half ( 51.9%) of
respondents who answered (N= 81) said that at least some of the time the
doctor knew they were “on the street,” while the remaining respondents did
not believe doctors were aware of their situations. Almost half of survivors
( 43.1%) (N= 58) said the doctor asked them something about their lives, 45
but only 19.5% of those who answered (N= 41) reported that the doctor
knew they had a pimp. 46 At least two prior studies have demonstrated that
medical care providers are woefully unprepared to identify trafficking
OXFORD DICTIONARIES, http://oxforddictionaries.com/definition/english/pimp?q=pimp (last
visited Nov. 26, 2013). These actions fall within the TVPA’s definition of sex trafficking.
22 U.S. C. § 7102( 10) (West, WestlawNext through P.L. 106-386) (defining sex trafficking
as “the recruitment, harboring, transportation, provision, or obtaining of a person for the
purpose of a commercial sex act.”). Pimps are, therefore, one subset of traffickers.
41. See POLARIS PROJECT, DOMESTIC SEX TRAFFICKING: THE CRIMINAL OPERATIONS OF
THE AMERICAN PIMP 5, available at http://www.polarisproject.org/resources/resources-by-
topic/sex-trafficking (last visited Nov. 26, 2013).
42. See, e.g., Cole, supra note 21, at 466 (citing Jeffrey Barrows & Reginald Finger,
Human Trafficking and the Healthcare Professional, 101 S. MED. J. 521 (2008));
WILLIAMSON, supra note 21, at 4.
43. FED. R. EVID. 803( 4). The exception permits the admission of statements that are
“made for—and [are] reasonably pertinent to—medical diagnosis or treatment” and describe
“past or present symptoms or sensations; their inception; or their general cause.” Id.
44. While such statements must be “made for . . . medical diagnosis or treatment”
purposes, courts have construed this requirement in a manner favorable to sexual assault and
rape victims, generally permitting the admission of statements that identify an abuser
because the identity of an abuser is pertinent to diagnosis and treatment in sexually abusive
contexts. See, e.g., Morgan v. Foretich, 846 F.2d 941, 948-50 (4th Cir. 1988); U.S. v.
Renville, 779 F.2d 430, 435-39 (8th Cir. 1988); U.S. v. George, 960 F.2d 97, 99-100 (9th
Cir. 1992); U.S. v. Tome, 61 F.3d 1446, 1450 (10th Cir. 1995); U.S. v. Chaco, 801 F. Supp.
2d 1217, 1227 ( D.N.M. 2011). This rationale would logically extend to the sex trafficking
context as well, especially where the victim is a minor.
45. Several survivors noted in the margins of their surveys that they were unable to
answer questions about their lives or situations honestly either because their pimp/trafficker
was present or because they feared reprisal from their pimp.
46. Even these numbers may overstate trafficking awareness on the part of medical
personnel. One respondent indicated that the physician who treated them had an established
relationship with the pimp. If other survivors said their doctors were aware they had a pimp
because of similar situations, the awareness statistic would be skewed.