Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes. Existing law sets forth provisions for the prevention of domestic violence, including procedures for the issuance of protective orders.

This bill would require all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence, as defined, to hospital personnel. The bill would require the policies and procedures to meet certain minimum requirements, including, among others, providing for patient confidentiality and facilitating a reasonably prompt, private, and voluntary interview of the patient by medical personnel, as defined, for the purpose of providing certain information to the patient relating to local services and resources for victims of human trafficking or domestic violence, if any. The bill would authorize general acute care hospitals subject to these provisions to track specified information related to the use of the self-identification procedure.

The bill would limit the liability of a general acute care hospital, including its directors, officers, employees, medical staff, contracted health care providers, agents, and specified licensed persons, acting in compliance with provisions described above for any injuries or damages arising from, or related to, a patient who is offered or receives the information described above or who self-identifies, as specified, so long as the hospital has acted in good faith.

By creating new requirements for certain health facilities, thereby expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes. Existing law sets forth provisions for the prevention of domestic violence, including procedures for the issuance of protective orders.

This bill would require all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence, as defined, to hospital personnel. The bill would require the policies and procedures to meet certain minimum requirements, including, among others, providing for patient confidentiality and facilitating a reasonably prompt, private, and voluntary interview of the patient by medical personnel, as defined, for the purpose of providing certain information to the patient relating to local services and resources for victims of human trafficking or domestic violence, if any. The bill would authorize general acute care hospitals subject to these provisions to track specified information related to the use of the self-identification procedure.

The bill would limit the liability of a general acute care hospital, including its directors, officers, employees, medical staff, contracted health care providers, agents, and specified licensed persons, acting in compliance with provisions described above for any injuries or damages arising from, or related to, a patient who is offered or receives the information described above or who self-identifies, as specified, so long as the hospital has acted in good faith.

By creating new requirements for certain health facilities, thereby expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes. Existing law sets forth provisions for the prevention of domestic violence, including procedures for the issuance of protective orders.

This bill would require all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking, as defined, or domestic violence trafficking or domestic violence, as defined, to hospital personnel. The bill would require the policies and procedures to meet certain minimum requirements, including, among others, provide providing for patient confidentiality and facilitating a reasonably prompt, private, and voluntary interview of the patient by medical personnel, as defined, for the purpose of providing the patient with information on certain information to the patient relating to local services and resources for victims of human trafficking or domestic violence, if any. The bill would authorize general acute care hospitals subject to these provisions to track specified information related to the use of the self-identification procedures described above. The procedure.

The bill would limit the liability of a general acute care hospital, including its directors, officers, employees, medical staff, contracted health care providers, agents, and specified licensed persons, acting in compliance with provisions described above for any injuries or damages arising from, or related to, a patient who is offered or receives the information described above or who self-identifies, including any injuries inflicted by a trafficker or abuser based on acts or omissions taken pursuant to the policies and procedures established pursuant to these provisions, as specified, so long as the hospital has acted in good faith. By

By creating new requirements for certain health facilities, thereby expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes.

This bill would require all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking, as defined, or domestic violence to hospital personnel. The bill would require the policies and procedures to meet certain minimum requirements, including, among others, provide for patient confidentiality and a reasonably prompt and private prompt, private, and voluntary interview of the patient by medical personnel. personnel, as defined, for the purpose of providing the patient with information on local services and resources for victims of human trafficking or domestic violence, if any. The bill would authorize general acute care hospitals subject to these provisions to track specified information related to the use of the self-identification procedures described above. The bill would limit the liability of a general acute care hospital acting in compliance with these provisions against damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence for good faith conduct taken under the policies and procedures established pursuant to these provisions, except as specified. a general acute care hospital, including its directors, officers, employees, medical staff, contracted health care providers, agents, and specified licensed persons, acting in compliance with provisions described above for any injuries or damages arising from, or related to, a patient who is offered or receives the information described above or who self-identifies, including any injuries inflicted by a trafficker or abuser based on acts or omissions taken pursuant to the policies and procedures established pursuant to these provisions, so long as the hospital has acted in good faith. By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes.

This bill would require all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking, as defined, or domestic violence to hospital personnel. The bill would require the policies and procedures to meet certain minimum requirements, including, among others, provide for patient confidentiality and a reasonably prompt and private interview of the patient by medical personnel. The bill would authorize general acute care hospitals subject to these provisions to track specified information related to the use of the self-identification procedures described above. The bill would limit the liability of a general acute care hospital acting in compliance with these provisions against damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence for good faith conduct taken under the policies and procedures established pursuant to these provisions, except as specified. By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes.

This bill would require all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking, as defined, or domestic violence to hospital personnel. The bill would require the policies and procedures to meet certain minimum requirements, including, among others, provide for patient confidentiality and a reasonably prompt and private interview of the patient by medical personnel. The bill would require a general acute care hospital authorize general acute care hospitals subject to these provisions to, at minimum, collect specified information. to track specified information related to the use of the self-identification procedures described above. By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes.

This bill would require all general acute care hospitals with an emergency department to make a self-identifying human trafficking system available to patients at the emergency department. adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking, as defined, or domestic violence to hospital personnel. The bill would require the system policies and procedures to meet certain minimum requirements, including, among others, providing provide for patient confidentiality and facilitating immediate interviews with a reasonably prompt and private interview of the patient by medical personnel. The bill would also require the system to, require a general acute care hospital subject to these provisions to, at minimum, collect specified information. By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. Existing law imposes certain requirements on licensed general acute care hospitals, including, among others, maintaining a medical records system and complying with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault, as specified. Existing law generally makes a violation of these provisions a misdemeanor.

Existing law makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or with the intent to effect or maintain any violation of specified crimes.

This bill would require all general acute care hospitals with an emergency department to make a self-identifying human trafficking system available to patients at the emergency department. The bill would require the system to meet certain minimum requirements, including, among others, providing patient confidentiality and facilitating immediate interviews with medical personnel. The bill would also require the system to, at minimum, collect specified information. By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 UNFINISHED BUSINESS  

Bill No: SB 963

Author: Ashby (D), et al.

Amended: 8/20/24

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 4/10/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE JUDICIARY COMMITTEE: 11-0, 4/23/24

AYES: Umberg, Wilk, Allen, Ashby, Caballero, Durazo, Gonzalez, Laird, Min, Niello, Wahab

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SENATE FLOOR: 38-0, 5/16/24 (Consent)

AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Wahab, Wiener, Wilk

NO VOTE RECORDED: Eggman, Umberg

ASSEMBLY FLOOR: 77-0, 8/26/24 - See last page for vote

SUBJECT: Hospitals: self-identification procedure: human trafficking or domestic violence

SOURCE: California Medical Association

Coalition to Abolish Slavery and Trafficking

San Francisco SafeHouse

DIGEST:

This bill requires general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.

Assembly Amendments define “medical personnel” for purposes of the requirement that there be an interview of the patient by medical personnel, to include any licensed health care professional, and specifies that the interview is voluntary for the patient and is for purposes of providing patients with information on services and resources; revises the immunity from liability provision for hospitals, including by extending the immunity to the hospital’s employees and medical staff, among other individuals; clarify that the requirement to maintain patient confidentiality is in accordance with the Confidentiality of Medical Information Act.

ANALYSIS:

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. Requires a health practitioner, as defined, employed by a health facility, clinic, physician’s office, local or state public health department, or a local government agency, who provides medical services to a patient whom the health practitioner knows or reasonably suspects is a person described as follows, to immediately make a report to a local law enforcement agency:
3. A person suffering from a wound or other physical injury inflicted by the

person’s own act or inflicted by another where the injury is by means of a firearm; or,

1. A person suffering from a wound or other physical injury as a result of

assaultive or abusive conduct. [PEN §11160 et seq.]

1. Requires, under the Child Abuse and Neglect Reporting Act, a “mandated reporter” (which includes teachers, peace officers, firefighters, and health care practitioners, among others) to make reports of suspected child abuse or neglect to law enforcement agencies, as specified. [PEN §11164 et seq.]
2. Requires, under the Elder Abuse and Dependent Adult Civil Protection Act, health practitioners, among others, to report known or suspected cases of abuse of elders and dependent adults. [WIC §15600 et seq.]
3. Defines the following terms:
4. “Human trafficking” defines, in part, as a person who deprives or violates the personal liberty of another with the intent to obtain forced labor or services, or who causes, induces, or persuades a minor to engage in a commercial sex act. [PEN §236.1]
5. “Domestic violence” is defined, in part, as abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship. [PEN §13700(b)]
6. Requires a list of specified businesses and establishments, including emergency rooms within general acute care hospitals, urgent care centers, and facilities that provide pediatric care, to post a notice in a conspicuous place near the public entrance that states the following (in part): “If you or someone you know is being forced to engage in any activity and cannot leave – whether it is commercial sex, housework, farm work, construction, factory, retail, or restaurant work, or any other activity – text 233-733 (Be Free) or call the National Human Trafficking Hotline at 1-888-373-7888 or the California Coalition to Abolish Slavery and Trafficking (CAST) at 1-888-KEY-2-FRE(EDOM) or 1-888-539-2373 to access help and services.” [CIV §52.6]

This bill:

1. Requires general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.
2. Requires the policies and procedures to meet all of the following minimum requirements:
3. Provides for patient confidentiality in accordance with the Confidentiality of Medical Information Act;
4. Provides an emergency department patient with a safe and discreet means of informing hospital personnel that they are a victim of human trafficking or domestic violence;
5. Facilitates a reasonably prompt and private interview of the patient by medical personnel for purposes of providing information to patients as specified in d) below. Specifies that “medical personnel” includes any licensed health care professional. Specifies that the patient is not required to participate in a private interview if the patient declines;
6. Provides patients with information to local services and resources for victims of human trafficking or domestic violence, if any; and,

e) Incorporates principles of trauma-informed care.

1. Permits general acute care hospitals with an emergency department to track the use of the self-identification procedures, including the total number, ages, and racial demographics of patients who self-identify as a victim of human trafficking or domestic violence, to the extent that this information is provided by the patient.
2. Specifies that a general acute care hospital is not required to report the identities of any patients who self-identify as a victim of human trafficking or domestic violence to CDPH or to any law enforcement agency, except as required under Existing law 2), 3) and 4) above.
3. Exempts a general acute care hospital, including its directors, officers, employees, medical staff, contracted health care providers, agents, and all licensed health care professions, as defined, acting in compliance with this bill from liability for any injuries or damages arising from, or related to, a patient who is offered or receives the information provided pursuant to 2) d) above, or who self-identifies, including any injuries inflicted by a trafficker or abuser based on acts or omissions taken pursuant to the policies and procedures in this bill, so long as the hospital has acted in good faith. Prohibits this exemption from liability from being construed to limit a person’s liability for any act or omission that constitutes gross negligence or willful or wanton misconduct.
4. Defines “human trafficking” and “domestic violence” as having the same meaning as the definitions in Existing Law 5) above.

Comments

Author’s statement. According to the author, “this bill requires emergency room departments to implement self-identifying human trafficking and domestic violence prevention programs. Existing initiatives within emergency room departments have demonstrated their effectiveness in identifying victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. This bill seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.”

Background

1. Background on human trafficking. According to the U.S. Department of Justice, human trafficking is a crime that involves exploiting a person for labor, services, or commercial sex. The Trafficking Victims Protection Act of 2000 and its subsequent reauthorizations define human trafficking as: a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or, b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. According to the National Human Trafficking Hotline, human trafficking can happen to anyone but some people are more vulnerable than others. Significant risk factors include recent migration or relocation, substance use, mental health concerns, involvement with the child welfare system, and being a runaway or homeless youth. The National Human Trafficking Hotline maintains statistics based on aggregated information learned through signals, including phone calls, texts, online chats, emails, and online tip reports, that are received by the hotline. The use of the word “case” in these statistics is used to represent distinct situations of trafficking reported to the hotline, and is not an indication of law enforcement involvement. In 2021, there were 10,360 human trafficking cases reported nationally. In California alone, there were 1,334 cases identified, involving 2,122 victims.
2. Human trafficking in the healthcare context. According to the National Human Trafficking Hotline, in one study from 2014, 87.8% of trafficking survivors reported accessing health care services during their trafficking situation, and of these, 68.3% were seen at an emergency department. Victims can seek medical services in an emergency, after an assault, for gynecological services, for prenatal care, for routine checkups, for mental health services, for addiction treatment, or for pre-existing conditions. Barriers to victim self-identification include shame or guilt, fear of retaliation by the trafficker, fear of arrest or deportation, lack of transportation or controlled movement, fear of a report to social services, and a lack of understanding of the U.S. healthcare system. There are health indicators for both labor trafficking victims, and sex trafficking victims, and the National Hotline recommends that health care settings plan ahead by building protocols when patients present with one or more trafficking indicators. Recommendations include conducting initial assessments individually in a safe location, assess the patient’s immediate safety, use language understandable to the patient, and do not ask for unnecessary information. The National Hotline recommends a victim-centered approach that includes meeting basic needs, reassuring the potential victim, building trust and rapport, remaining sensitive to power dynamics, and avoiding re-traumatization.
3. Sutter Health protocol impetus for this legislation. According to the author, Sutter Health has implemented a self-identification protocol for trafficking victims that was at least partly the impetus for this legislation. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes a discrete method that allows patients to self-identify without alerting their abuser. This is a very delicate scenario as abusers often attempt to control every moment and activity of their victim. Patients suspected of being victims of human trafficking are provided a bag containing a urine cup, a blue dot sticker and asked to give a urine sample. Inside both men’s and women’s restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then placed in the lab who notifies the RN of the presence of a blue dot. The RN will notify a Case Manager, Social Worker, or House Supervisor of possible human trafficking. A bogus order for an X-ray is submitted and the patient is isolated in Diagnostic Imaging to have a private conversation to determine if the patient needs help. If they need our services, we follow the steps to connecting with appropriate support and care and notify police department. All contacts with suspected abusers occur with Law Enforcement off site and away from any other Sutter Health patients or staff.

Related/Prior Legislation

SB 376 (Rubio, Chapter 109, Statutes of 2023) provided that a victim of human trafficking or abuse has the right to have a human trafficking advocate and a support person, of the victim’s choosing at an interview by a law enforcement authority.

AB 1740 (Sanchez, Chapter 104, Statutes of 2023) added pediatric care facilities to the list of establishments that must post a notice regarding human trafficking.

AB 2130 (Cunningham, Chapter 256, Statutes of 2022) required every emergency medical technician, upon initial licensure, to complete at least 20 minutes of training on issues relating to human trafficking.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Assembly Appropriations Committee, CDPH estimates minor and absorbable costs for periodic surveys and conducting a small number of related complaint investigations.

SUPPORT: (Verified 8/27/24)

California Medical Association (co-source)

Coalition to Abolish Slavery and Trafficking (co-source)

San Francisco SafeHouse (co-source)

California Association of Nurse Anesthetists

California Chapter of the American College of Emergency Physicians

California Hospital Association

California Kidney Care Alliance

California Nurses Association

FindHelp

San Francisco Marin Medical Society

Sutter Health

OPPOSITION: (Verified 8/27/24)

None received

ARGUMENTS IN SUPPORT:

This bill is co-sponsored by the California Medical Association, the Coalition to Abolish Slavery and Trafficking (Cast) and San Francisco SafeHouse. According to these sponsors, emergency departments and front-line healthcare workers have the opportunity to play a critical role in identifying victims of domestic violence and human trafficking. Sponsors cite a 2010 study that found emergency room personnel have the highest likelihood of coming into contact with human trafficking victims, and trafficking victims are more likely to talk to medical staff than police. A 2016 survey from Cast found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers. Sponsors state that California has a chance to become a leader in ensuring that survivors are identified and connected to services in a trauma-informed manner. Sutter Health writes in support that it understands the importance of their role in this system and have implemented programs, like those outlined in this bill, in their emergency departments to help victims of human trafficking, and believes that their programs have been able to break the cycle of abuse these victims incur.

ASSEMBLY FLOOR: 77-0, 8/26/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Ortega

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

8/27/24 12:15:21

**** END ****

SENATE THIRD READING

STR Bill Id:SB 963

Author:(Ashby)

As Amended Ver:August 20, 2024

Majority vote

SUMMARY

Requires all general acute care hospitals with an emergency department (ED) to adopt and implement policies and procedures to facilitate the self-identification of an ED patient as a victim of human trafficking or domestic violence to hospital personnel.

Major Provisions

COMMENTS

Human trafficking is a violation of human rights, involving force, coercion, or fraud to exploit a person into slave labor or sexual exploitation. Human trafficking happens to people of all ages and genders and any race or religious background.

1. Human Trafficking and the ED. According to a 2020 report in Emergency Medicine Resident, "Concealed but Not Forgotten: Human Trafficking in the ED," Emergency physicians are in a unique position to recognize human trafficking, as the ED may be the first or only contact a victim has with the medical community.

The report notes that in 2018, the National Human Trafficking Hotline received the most calls from California, followed by Texas and Florida. It is also estimated that 50,000 people are trafficked into the United States each year, most often from Mexico and the Philippines. In 2018, 1,649 human trafficking victims were cited in criminal cases with approximately half being adult and half being children. Child-only sex trafficking encompasses 52% of cases and females make up 94% of all human trafficking victims identified. The internet was used to facilitate trafficking in 88% of the cases. It is estimated that only 0.04% of victims and survivors of human trafficking cases are identified. Although there is no true profile of a human trafficking victim, individuals who were at one time homeless and runaway youth have been shown to make up greater than 50% of prostitutes. Foreign nationals and individuals who have experienced trauma and violence in the past are also noted to be at increased risk of exploitation through human trafficking.

Studies have shown that 50% to 90% of human-trafficking victims have sought medical care while being trafficked. This population suffers from increased morbidity and mortality, both while being trafficked and after surviving trafficking. Victims that are forced into prostitution have an increased rate of being murdered and increased overall mortality when compared to the general population. Mortality rates for victims of child- and labor-trafficking are more difficult to ascertain as these victims are often concealed by their perpetrators.

1. Sutter Health protocol. According to the author, Sutter Health has implemented a self-identification protocol for trafficking victims that was at least partly the impetus for this bill. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes a discrete method that allows patients to self-identify without alerting their abuser. This is a very delicate scenario as abusers often attempt to control every moment and activity of their victim. Patients suspected of being victims of human trafficking are provided a bag containing a urine cup, a blue dot sticker and asked to give a urine sample. Inside both men's and women's restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then placed in the lab who notifies the registered nurse of the presence of a blue dot. The RN will notify a Case Manager, Social Worker, or House Supervisor of possible human trafficking. A bogus order for an X-ray is submitted and the patient is isolated in Diagnostic Imaging to have a private conversation to determine if the patient needs help. If they need services, staff follows the steps to connecting with appropriate support and care and notify the police department. All contacts with suspected abusers occur with Law Enforcement off site and away from any other Sutter Health patients or staff.

According to the Author

Existing initiatives within hospital EDs have demonstrated their effectiveness in identifying human trafficking victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. The author concludes that this bill seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.

Arguments in Support

This bill is cosponsored by the California Medical Association, CAST and San Francisco SafeHouse. According to the sponsors, EDs and front-line healthcare workers have the opportunity to play a role in identifying victims of domestic violence and human trafficking. Sponsors cite a 2010 study that found ED personnel have the highest likelihood of coming into contact with human trafficking victims, and trafficking victims are more likely to talk to medical staff than police. A 2016 survey from CAST found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers. Sponsors state that California has a chance to become a leader in ensuring that survivors are identified and connected to services in a trauma-informed manner. Sutter Health writes in support that it understands the importance of their role in this system and have implemented programs, like those outlined in this bill, in their EDs to help victims of human trafficking, and believes that their programs have been able to break the cycle of abuse these victims incur.

Arguments in Opposition

There is no known opposition to this bill.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, the Department of Public Health estimates minor and absorbable costs for periodic surveys and conducting a small number of related complaint investigations.

VOTES

SENATE FLOOR: 38-0-2

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Wahab, Wiener, Wilk

ABS, ABST OR NV: Eggman, Umberg

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Jackson, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM JUDICIARY: 11-0-1

YES: Kalra, Dixon, Bauer-Kahan, Bryan, Connolly, Haney, Maienschein, McKinnor, Pacheco, Reyes, Sanchez

ABS, ABST OR NV: Joe Patterson

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta

ABS, ABST OR NV: Villapudua

UPDATED

VERSION: August 20, 2024

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003800

SENATE THIRD READING

STR Bill Id:SB 963

Author:(Ashby)

As Amended Ver:June 11, 2024

Majority vote

SUMMARY

Requires all general acute care hospitals with an emergency department (ED) to adopt and implement policies and procedures to facilitate the self-identification of an ED patient as a victim of human trafficking or domestic violence to hospital personnel.

Major Provisions

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COMMENTS

Human trafficking is a violation of human rights, involving force, coercion, or fraud to exploit a person into slave labor or sexual exploitation. Human trafficking happens to people of all ages and genders and any race or religious background.

1. Human Trafficking and the ED. According to a 2020 report in Emergency Medicine Resident, "Concealed but Not Forgotten: Human Trafficking in the ED," Emergency physicians are in a unique position to recognize human trafficking, as the ED may be the first or only contact a victim has with the medical community.

The report notes that in 2018, the National Human Trafficking Hotline received the most calls from California, followed by Texas and Florida. It is also estimated that 50,000 people are trafficked into the United States each year, most often from Mexico and the Philippines. In 2018, 1,649 human trafficking victims were cited in criminal cases with approximately half being adult and half being children. Child-only sex trafficking encompasses 52% of cases and females make up 94% of all human trafficking victims identified. The internet was used to facilitate trafficking in 88% of the cases. It is estimated that only 0.04% of victims and survivors of human trafficking cases are identified. Although there is no true profile of a human trafficking victim, individuals who were at one time homeless and runaway youth have been shown to make up greater than 50% of prostitutes. Foreign nationals and individuals who have experienced trauma and violence in the past are also noted to be at increased risk of exploitation through human trafficking.

Studies have shown that 50% to 90% of human-trafficking victims have sought medical care while being trafficked. This population suffers from increased morbidity and mortality, both while being trafficked and after surviving trafficking. Victims that are forced into prostitution have an increased rate of being murdered and increased overall mortality when compared to the general population. Mortality rates for victims of child- and labor-trafficking are more difficult to ascertain as these victims are often concealed by their perpetrators.

1. Sutter Health protocol. According to the author, Sutter Health has implemented a self-identification protocol for trafficking victims that was at least partly the impetus for this bill. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes a discrete method that allows patients to self-identify without alerting their abuser. This is a very delicate scenario as abusers often attempt to control every moment and activity of their victim. Patients suspected of being victims of human trafficking are provided a bag containing a urine cup, a blue dot sticker and asked to give a urine sample. Inside both men's and women's restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then placed in the lab who notifies the registered nurse of the presence of a blue dot. The RN will notify a Case Manager, Social Worker, or House Supervisor of possible human trafficking. A bogus order for an X-ray is submitted and the patient is isolated in Diagnostic Imaging to have a private conversation to determine if the patient needs help. If they need services, staff follows the steps to connecting with appropriate support and care and notify the police department. All contacts with suspected abusers occur with Law Enforcement off site and away from any other Sutter Health patients or staff.

According to the Author

Existing initiatives within hospital EDs have demonstrated their effectiveness in identifying human trafficking victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. The author concludes that this bill seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.

Arguments in Support

This bill is cosponsored by the California Medical Association, CAST and San Francisco SafeHouse. According to the sponsors, EDs and front-line healthcare workers have the opportunity to play a role in identifying victims of domestic violence and human trafficking. Sponsors cite a 2010 study that found ED personnel have the highest likelihood of coming into contact with human trafficking victims, and trafficking victims are more likely to talk to medical staff than police. A 2016 survey from CAST found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers. Sponsors state that California has a chance to become a leader in ensuring that survivors are identified and connected to services in a trauma-informed manner. Sutter Health writes in support that it understands the importance of their role in this system and have implemented programs, like those outlined in this bill, in their EDs to help victims of human trafficking, and believes that their programs have been able to break the cycle of abuse these victims incur.

Arguments in Opposition

There is no known opposition to this bill.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, the Department of Public Health estimates minor and absorbable costs for periodic surveys and conducting a small number of related complaint investigations.

VOTES

SENATE FLOOR: 38-0-2

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Wahab, Wiener, Wilk

ABS, ABST OR NV: Eggman, Umberg

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Jackson, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM JUDICIARY: 11-0-1

YES: Kalra, Dixon, Bauer-Kahan, Bryan, Connolly, Haney, Maienschein, McKinnor, Pacheco, Reyes, Sanchez

ABS, ABST OR NV: Joe Patterson

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta

ABS, ABST OR NV: Villapudua

UPDATED

VERSION: June 11, 2024

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003794

Date of Hearing: August 7, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 963

Author:(Ashby) – As Amended Ver:June 11, 2024

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires every general acute care hospital (hospital) with an emergency department (ED) to implement policies and procedures to facilitate the self-identification of an ED patient as a victim of human trafficking (trafficking) or domestic violence (DV) to hospital personnel, and to facilitate a voluntary private interview of the patient for the purpose of providing information on local services and resources for victims of trafficking or DV.

Specifically, this bill:

1. Requires every hospital with an ED to adopt and implement policies and procedures to facilitate the self-identification of an ED patient as a victim of trafficking or DV to hospital personnel. Requires the policies and procedures to meet the following requirements:
   1. Provide for patient confidentiality in accordance with the Confidentiality of Medical Information Act.

• 1. Provide an ED patient with a safe and discreet means of informing hospital personnel that they are a victim of trafficking or DV.
     
  2. Facilitate a reasonably prompt and private interview of the patient by health care personnel, as defined, for the purpose of providing information to the patient described in item d, below, unless the patient declines the interview.
     
  3. Refer patients to local services and resources for victims of trafficking or DV, if any exist.
     
  4. Incorporate principles of trauma-informed care.

1. Authorizes a hospital to track the use of the self-identification procedure, including total number, ages, and racial demographics, of self-identified victims.
2. Prohibits a hospital from being required to report the identity of any patient who self-identifies as a victim of trafficking or DV to the California Department of Public Health (CDPH) or to any law enforcement agency, except as may be required by law.
3. Exempts a hospital, including its directors, officers, employees, medical staff, contracted health care providers, and agents, and all persons licensed under the Healing Arts chapter of the Business and Professions Code, acting in compliance with this bill and in good faith, from being liable for any injuries or damages arising from or related to a patient who is offered or receives a referral to local services and resources for victims of trafficking or DV, pursuant to this bill, or who self-identifies, including any injuries inflicted by a trafficker or abuser based on acts or omissions taken pursuant to the policies and procedures established pursuant to this section.
4. Clarifies that the liability limitations described in the preceding paragraph are not to be construed to limit a person’s liability for any act or omission that constitutes gross negligence or willful or wanton misconduct.

FISCAL EFFECT:

CDPH estimates minor and absorbable costs for periodic surveys and conducting a small number of related complaint investigations. 

COMMENTS:

1. Purpose. This bill is cosponsored by the California Medical Association, Coalition to Abolish Slavery and Trafficking (CAST), and San Francisco SafeHouse. According to the author:

SB 963 requires emergency departments to implement self-identifying human trafficking and domestic violence prevention programs. Existing initiatives within emergency departments have demonstrated their effectiveness in identifying victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. SB 963 seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.

1. Background. Researchers estimate 50% to 90% of trafficking victims have sought medical care while being trafficked. This population suffers from increased morbidity and mortality, both while being trafficked and after surviving trafficking. Victims forced into prostitution have an increased rate of murder and overall mortality when compared to the general population. Mortality rates for victims of child- and labor-trafficking are more difficult to ascertain as these victims are often concealed by their perpetrators.
   
   Sutter Health Self-Identification Protocol. Sutter Health implemented a discrete self-identification protocol that allows patients to self-identify without alerting their abuser: a patient suspected of being a victim of trafficking is provided a bag containing a urine cup and a blue dot sticker and is asked to give a urine sample. Inside both men’s and women’s restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then given to the lab, which notifies a registered nurse (RN) of the presence of a blue dot. The RN notifies a case manager, social worker, or house supervisor of possible human trafficking. A bogus X-ray order is submitted and the patient is isolated in the diagnostic imaging lab for a private conversation to determine if the patient needs help. If the patient needs help, staff follows the steps to connect with appropriate support and care and notify the police department. All contacts with suspected abusers occur with law enforcement off site and away from other Sutter Health patients or staff.
   
2. Related Legislation. AB 1740 (Sanchez), Chapter 104, Statutes of 2023, adds pediatric care facilities to the list of establishments that must post a notice regarding trafficking.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: June 25, 2024

ASSEMBLY COMMITTEE ON JUDICIARY

Ash Kalra, Chair

SBPCA Bill Id:SB 963

Author:(Ashby) – As Amended Ver:June 11, 2024

Proposed Consent

SENATE VOTE: 38-0

SUBJECT: Health facilities: self-identifying human trafficking system

KEY ISSUE: should the state require hospital emergency departments to adopt and implement policies that facilitate self-identification by a victim of human trafficking or domestic violence to hospital personnel?

SYNOPSIS

This bill seeks to offer support to victims of human trafficking and domestic violence at a place where victims often find themselves: the emergency rooms of general acute care hospitals. Because victims often live under the control and surveillance of their traffickers and abusers, they have limited opportunities to seek the assistance of law enforcement or support services. According to the National Human Trafficking Hotline, one study found that nearly 70% of human trafficking survivors received treatment in an emergency room during the period in which they were trafficked. Although we do not have similar data for victims of domestic violence, their situation often necessitates emergency room care. Existing law already recognizes these facts, for example, by making health care providers mandatory reporters of various kinds of physical abuse and requiring hospital emergency rooms to post notices directing victims of human trafficking to the National Human Trafficking Hotline or the Coalition to Abolish Slavery and Trafficking (CAST). As noted in the analysis, some hospital emergency rooms have already developed the policies and procedures required by this bill.

Specifically, this bill would require general acute care hospitals with an emergency department to adopt and implement policies that will allow emergency room health professionals to identify victims of human trafficking and domestic violence and empower them to self-identify so that emergency personnel can direct them to legal and other resources. The bill requires the policies and procedures adopted, at a minimum, to protect patient confidentiality, provide for a reasonably prompt and private interview with medical personnel, and refer patients to local services and resources for victims of human trafficking and domestic violence.

The bill is co-sponsored by CAST, the California Medical Association, and San Francisco Safehouse. Several other professional health care associations support the bill and there is no opposition. The bill recently passed out of the Assembly Health Committee on consent.

SUMMARY: Requires all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel. Specifically, this bill:

1. Requires all general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.
2. Requires the policies and procedures referenced above to meet certain minimum requirements, including, among others, to provide for patient confidentiality; to provide a reasonably prompt, private, and voluntary interview of the patient by medical personnel; to provide the patient with information on local services and resources for victims of human trafficking or domestic violence. 
3. Permits a general acute care hospital with an emergency department to track specified information related to the use of self-identification policies and procedures.
4. Specifies that a general acute care hospital with an emergency department are not required to report the identities of patients who self-identify as a victim of human trafficking or domestic abuse, except as required by other laws.
5. Limits the liability of a general acute care hospital with an emergency department for any injuries or damages to a patient who receives the information or who self-identifies, so long as the hospital complies with the provisions of this bill and has acted in good faith. Specifies that limitation on liability does not extend to acts or omissions that constitute gross negligence or willful or wanton misconduct.

EXISTING LAW:

1. Establishes, in federal law, the Trafficking Victims Protection Act of 2000, with the purpose to combat trafficking in persons, a contemporary manifestation of slavery whose victims are predominantly women and children, to ensure just and effective punishment of traffickers, and to protect their victims. The Act criminalizes trafficking and authorizes various federal actions against “severe forms of trafficking in persons.” (22 U.S.C. Section 7101 et seq.)
2. Identifies two “severe forms of trafficking in persons,” for purposes of the above, and defines them as follows:
   1. “Sex trafficking” means the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act.
   2. “Labor trafficking” means the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. (22 U.S.C. Section 1702.)
3. Provides for the licensing, regulation, and inspection of various types of health facilities by the State Department of Public Health, including general acute care hospitals. This includes requirements that licensed general acute care hospitals maintain a medical records system and comply with the standards for the examination and treatment of victims of sexual assault and attempted sexual assault. (Health & Safety Code Section 1250 et seq.)
4. Requires a health care practitioner, as defined, who provides medical service to a patient whom the practitioner knows or reasonably suspects is suffering from a gunshot wound or an injury resulting from assaultive or abusive conduct to make a report to a local law enforcement agency. (Penal Code Section 11160 et seq.)
5. Requires “mandated reporters” (which includes health care practitioners, among others) to make reports of suspected child abuse and neglect to law enforcement agencies, as specified. (Penal Code Section 11164 et seq.)
6. Requires health care practitioners, among others, to report known or suspected cases of elder or dependent adult abuse, as specified. (Welfare & Institutions Code Section 15600 et seq.)
7. Makes it a crime of human trafficking for a person to deprive or violate the personal liberty of another with the intent to obtain forced labor or services, or who causes, induces, or persuades a minor to engage in a commercial sex act. (Penal Code Section 236.1.)
8. Requires specified businesses and establishments, including emergency rooms within acute care hospitals, urgent care centers, and facilities that provide pediatric care to post a notice that directs persons who may be victims of human trafficking to contact the National Human Trafficking Hotline or the California Coalition to Abolish Slavery and Trafficking in order to access help and services. (Civil Code Section 52.6.)

FISCAL EFFECT: As currently in print this bill is keyed fiscal.

COMMENTS: According to the author, requiring emergency rooms to implement self-identifying human trafficking and domestic violence prevention programs will provide for “the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed.” The author contends that SB 963 will “build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from an abuser or trafficker.”

According to a study cited by the National Human Trafficking Hotline, nearly 70% of human trafficking survivors received treatment in an emergency room during the period in which they were trafficked. As noted in the Assembly Health Committee analysis, “Emergency physicians are in a unique position to recognize human trafficking, as the [emergency room] may be the first or only contact a victim has with the medical community.” Although we do not have similar data for victims of domestic violence, their situation is similar; one might assume they too end up in an emergency room in the company of their abuser. The presence of the human trafficker or the abuser makes it difficult for a patient to reveal their situation, but with training and the proper protocols, emergency room personnel might be the best situated to identify victims and find ways to separate the victim and victimizer, at least temporarily.

This bill, therefore, seeks to identify and offer support to victims of human trafficking and domestic violence at a place where one often finds them: the emergency rooms of general acute care hospitals. Specifically, this bill would require general acute care hospitals with an emergency department to adopt and implement policies that will allow emergency room health professionals to identify victims of human trafficking and domestic violence, empower them to self-identify, and direct them to legal and other resources. The bill requires the policies and procedures adopted, at a minimum, to protect patient confidentiality, provide for a reasonably prompt and private interview with medical personnel, and refer patients to local services and resources for victims of human trafficking and domestic violence.

Sutter Health Model. According to the author, some hospitals are already developing the policies and procedures envisioned by this bill. For example, Sutter Health has implemented a self-identification protocol for trafficking victims that, at least partly, inspired this bill. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes discrete methods that allow emergency room personnel to interview a patient privately, outside the presence of the abuser. If the patient needs services, the staff may direct them to appropriate support services or notify law enforcement.

Existing law already designates many health care professionals as “mandated reporters” if they suspect various kinds of physical abuse and requires many establishments, including emergency rooms, to post notices directing victims of human trafficking to the National Human Trafficking Hotline or the Coalition to Abolish Slavery and Trafficking (CAST). This bill is a logical complement to these existing laws. As the Sutter Health experience indicates, some acute care hospitals have demonstrated the value of adopting such policies and procedures. Sutter Health is not alone. Dignity Health developed 50-page manual for its “Human Trafficking Response Program” as early as May of 2017. (See https://healtrafficking.org/wp-content/uploads/2017/08/Dignity-Health_HTRP_SharedLearningsManual_170512.pdf.) This bill would effectively require all general acute care hospitals with emergency rooms to develop such policies.

What does it mean to “facilitate” self-identification? As noted below, the California Academy of Preventive Medicine (Academy) supports this bill but seeks amendments that would provide more guidance on just how to “facilitate” self-identification. The Academy points out that “spontaneous” self-identification is uncommon. Clearly, the policies and procedures already in place at Sutter Health and Dignity Health recognize that before emergency room professionals can encourage patients to “self-identify” as victims, they must first recognize the signs of human trafficking and domestic violence and, if the perpetrator is present, create an opportunity to converse privately with the victim. The Academy is correct that the bill does not provide protocols with the level of specificity that one would find, for example, in the Sutter Health and Dignity Health guidelines. However, the language in the bill nonetheless makes it clear that the policy would need to facilitate a “private interview” to separate the victim from the perpetrator, while at the same time recognizing that the hospital cannot compel a private interview if the patient declines. The bill, appropriately, does not overly prescribe the contents and protocols of the required policies and procedures; presumably, acute care hospitals that have not already adopted them will look to existing practices and protocols and adapt them to their particular circumstances and communities.

Limitations on Liability. Finally, the bill limits the liability of acute care hospitals, including their directors, officers, employees, and licensed staff. The bill provides that they will not be liable for injuries or damages arising from, or related to, a patient receiving information pursuant to the provisions of this bill. This would include, for example, injuries inflicted by a trafficker or abuser based on acts or omissions of the hospital or staff, so long as the acts or omissions do not constitute gross negligence or willful or wanton conduct. This limitation is fully consistent with other statutory grants of qualified immunity in the health care setting.

ARGUMENTS IN SUPPORT: The California Chapter of the American College of Emergency Physicians (ACEP) supports SB 963 because it will “require emergency departments in California to adopt programs to allow patients to self-identify as victims of human trafficking or domestic violence.” ACEP notes that health care providers “have a unique opportunity to connect human trafficking and domestic violence victims with much-needed support and services. The physical and psychological trauma caused by human trafficking is undeniably enormous; its impact on the health of patients, communities, and society at-large is only just the beginning to be determined. Our members report self-identification programs at their hospitals have been successful in identifying victims and connecting them to resources” and with only “a low impact on the workflow of the [emergency department].”

Arguments in support if amended: The California Academy of Preventive Medicine (Academy) supports this bill if amended. The Academy notes that while the bill requires hospitals to “facilitate” self-identification by victims of human trafficking and domestic violence it “does not provide guidelines on how to do this.” The Academy notes that “spontaneous” self-identification is uncommon, and more often it requires hospital personal know how to identify the signs and then to interview the patient in a private area. In addition, the bill does not specify how emergency departments will learn of this requirement if the bill becomes law. Thus, the Academy recommends that a state agency – most likely the Department of Public Health – provide notice to emergency departments and provide informational materials on how to effectively identify victims and then facilitate their self-identification.

REGISTERED SUPPORT / OPPOSITION:

Support

California Medical Association (CMA) (co-sponsor)

Coalition to Abolish Slavery and Trafficking (CAST) (co-sponsor)

San Francisco Safehouse (co-sponsor)

California Association of Nurse Anesthetists (CANA)

California Chapter of the American College of Emergency Physicians

California Emergency Nurses Association

California Hospital Association

California Kidney Care Alliance

California Nurses Association

Findhelp, a Public Benefit Corporation

San Francisco Marin Medical Society

Sutter Health

Support if Amended

California Academy of Preventive Medicine

Opposition

None on file

Analysis Prepared by: Tom Clark / JUD. / (916) 319-2334

Date of Hearing: June 18, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 963

Author:(Ashby) – As Amended Ver:June 11, 2024

SENATE VOTE: 38-0

SUBJECT: Health facilities: self-identifying human trafficking system.

SUMMARY: Requires all general acute care hospitals (GACHs) with an emergency department (ED) to adopt and implement policies and procedures to facilitate the self-identification of an ED patient as a victim of human trafficking or domestic violence to hospital personnel. Specifically, this bill:

1. Requires all GACHs with an ED to adopt and implement policies and procedures to facilitate the self-identification of an ED patient as a victim of human trafficking or domestic violence to hospital personnel.
2. Requires the policies and procedures adopted and implemented pursuant to 1) above to meet all of the following minimum requirements:
   1. Provides for patient confidentiality in accordance with the Confidentiality of Medical Information Act;
   2. Provides an ED patient with a safe and discreet means of informing hospital personnel that they are a victim of human trafficking or domestic violence;
   3. Facilitates a reasonably prompt and private interview of the patient by hospital personnel for the purpose of providing information to the patient pursuant e) below, and clarifies that a patient is not required to participate in a private interview if the patient declines;
   4. Defines “hospital personnel” to includes any health care professional licensed under the Business and Professions Code;
   5. Refers patients to local services and resources for victims of human trafficking or domestic violence, if any, and,
   6. Incorporates principles of trauma-informed care.
3. Authorizes every GACH subject to the provisions of this bill to track the use of the self-identification procedure, including the total number, ages, and racial demographics of patients who self-identify as a victim of human trafficking or domestic violence, to the extent that this information is provided by the patient.
4. Prohibits a GACH subject to the provisions of this bill from being required to report the identities of any patients who self-identify as a victim of human trafficking or domestic violence to the Department of Public Health (DPH) or to any law enforcement agency, except as may be required pursuant to 4) of Existing Law, below.
5. Exempts a GACH, including its directors, officers, employees, medical staff, contracted health care providers, and agents, and all persons licensed under the Business and Professions Code acting in compliance with this bill, from being liable for any injuries or damages arising from or related to a patient who is offered or receives the information in 2) above, or who self-identifies, including any injuries inflicted by a trafficker or abuser based on acts or omissions taken pursuant to the policies and procedures established pursuant to this section; so long as they have acted in good faith.
6. Specifies that the liability limitations described in 5) above, are not to be construed to limit a person’s liability for any act or omission that constitutes gross negligence or willful or wanton misconduct.

EXISTING LAW:

1. Licenses and regulates health facilities, including GACHs, by DPH. [Health and Safety Code §1250, et seq.]
   
2. Requires a health practitioner, as defined, employed by a health facility, clinic, physician’s office, local or state public health department, or a local government agency, who provides medical services to a patient whom the health practitioner knows or reasonably suspects is a person described as follows, to immediately make a report to a local law enforcement agency:
   1. A person suffering from a wound or other physical injury inflicted by the person’s own act or inflicted by another where the injury is by means of a firearm; or,
   2. A person suffering from a wound or other physical injury as a result of assaultive or abusive conduct. [Penal Code (PEN) §11160 et seq.]
      
3. Requires, under the Child Abuse and Neglect Reporting Act, a “mandated reporter” (which includes teachers, peace officers, firefighters, and health care practitioners, among others) to make reports of suspected child abuse or neglect to law enforcement agencies, as specified. [PEN §11164 et seq.]
   
4. Requires, under the Elder Abuse and Dependent Adult Civil Protection Act, health practitioners, among others, to report known or suspected cases of abuse of elders and dependent adults. [Welfare and Institutions Code §15600 et seq.]
   
5. Defines the following terms:
   1. “Human trafficking” as, in part, a person who deprives or violates the personal liberty of another with the intent to obtain forced labor or services, or who causes, induces, or persuades a minor to engage in a commercial sex act. [PEN §236.1]
   2. “Domestic violence” as, in part, abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship. [PEN §13700(b)]
      
6. Requires a list of specified businesses and establishments, including EDs within GACHs, urgent care centers, and facilities that provide pediatric care, to post a notice in a conspicuous place near the public entrance that states the following (in part): “If you or someone you know is being forced to engage in any activity and cannot leave – whether it is commercial sex, housework, farm work, construction, factory, retail, or restaurant work, or any other activity – text 233-733 (Be Free) or call the National Human Trafficking Hotline at 1-888-373-7888 or the California Coalition to Abolish Slavery and Trafficking (CAST) at 1-888-KEY-2-FRE(EDOM) or 1-888-539-2373 to access help and services.” [Civil Code (CIV) §52.6]
7. Prohibits, under the state Confidentiality of Medical Information Act, a health care provider, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States that a violation of these provisions that results in economic loss or personal injury to a patient is a crime. [CIV §56, et. seq.]

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, existing initiatives within hospital EDs have demonstrated their effectiveness in identifying human trafficking victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. The author concludes that this bill seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor
2. BACKGROUND. Human trafficking is a violation of human rights, involving force, coercion, or fraud to exploit a person into slave labor or sexual exploitation. Human trafficking happens to people of all ages and genders and any race or religious background.
   
   1. Human Trafficking and the ED. According to a 2020 report in Emergency Medicine Resident, “Concealed but Not Forgotten: Human Trafficking in the ED,” Emergency physicians are in a unique position to recognize human trafficking, as the ED may be the first or only contact a victim has with the medical community.
      
      The report notes that in 2018, the National Human Trafficking Hotline received the most calls from California, followed by Texas and Florida. It is also estimated that 50,000 people are trafficked into the United States each year, most often from Mexico and the Philippines. In 2018, 1,649 human trafficking victims were cited in criminal cases with approximately half being adult and half being children. Child-only sex trafficking encompasses 52% of cases and females make up 94% of all human trafficking victims identified. The internet was used to facilitate trafficking in 88% of the cases. It is estimated that only 0.04% of victims and survivors of human trafficking cases are identified.
      
      Although there is no true profile of a human trafficking victim, individuals who were at one time homeless and runaway youth have been shown to make up greater than 50% of prostitutes. Foreign nationals and individuals who have experienced trauma and violence in the past are also noted to be at increased risk of exploitation through human trafficking.
      

Studies have shown that 50% to 90% of human-trafficking victims have sought medical care while being trafficked. This population suffers from increased morbidity and mortality, both while being trafficked and after surviving trafficking. Victims that are forced into prostitution have an increased rate of being murdered and increased overall mortality when compared to the general population. Mortality rates for victims of child- and labor-trafficking are more difficult to ascertain as these victims are often concealed by their perpetrators.

• 1. Sutter Health protocol. According to the author, Sutter Health has implemented a self-identification protocol for trafficking victims that was at least partly the impetus for this bill. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes a discrete method that allows patients to self-identify without alerting their abuser. This is a very delicate scenario as abusers often attempt to control every moment and activity of their victim. Patients suspected of being victims of human trafficking are provided a bag containing a urine cup, a blue dot sticker and asked to give a urine sample. Inside both men’s and women’s restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then placed in the lab who notifies the registered nurse (RN) of the presence of a blue dot. The RN will notify a Case Manager, Social Worker, or House Supervisor of possible human trafficking. A bogus order for an X-ray is submitted and the patient is isolated in Diagnostic Imaging to have a private conversation to determine if the patient needs help. If they need services, staff follows the steps to connecting with appropriate support and care and notify the police department. All contacts with suspected abusers occur with Law Enforcement off site and away from any other Sutter Health patients or staff.

1. SUPPORT. This bill is cosponsored by the California Medical Association, CAST and San Francisco SafeHouse. According to the sponsors, EDs and front-line healthcare workers have the opportunity to play a role in identifying victims of domestic violence and human trafficking. Sponsors cite a 2010 study that found ED personnel have the highest likelihood of coming into contact with human trafficking victims, and trafficking victims are more likely to talk to medical staff than police. A 2016 survey from CAST found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers. Sponsors state that California has a chance to become a leader in ensuring that survivors are identified and connected to services in a trauma-informed manner. Sutter Health writes in support that it understands the importance of their role in this system and have implemented programs, like those outlined in this bill, in their EDs to help victims of human trafficking, and believes that their programs have been able to break the cycle of abuse these victims incur.
   
2. PREVIOUS LEGISLATION.
   1. SB 376 (Rubio), Chapter 109, Statutes of 2023, provides that a victim of human trafficking or abuse has the right to have a human trafficking advocate and a support person, of the victim’s choosing at an interview by a law enforcement authority.
   2. AB 1740 (Sanchez), Chapter 104, Statutes of 2023, added pediatric care facilities to the list of establishments that must post a notice regarding human trafficking.
   3. AB 2130 (Cunningham), Chapter 256, Statutes of 2022, requires every emergency medical technician, upon initial licensure, to complete at least 20 minutes of training on issues relating to human trafficking
3. DOUBLE REFERRAL. This bill is double referred, upon passage of this committee, it will be referred to the Assembly Judiciary Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

California Medical Association (cosponsor)
Coalition to Abolish Slavery and Trafficking (cosponsor)
San Francisco SafeHouse (cosponsor)
California Association of Nurse Anesthetists
California Chapter of The American College of Emergency Physicians
California Emergency Nurses Association
California Hospital Association
California Kidney Care Alliance
California Nurses Association
FIndHelp, a Public Benefit Corporation
San Francisco Marin Medical Society
Sutter Health

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097

 CONSENT  

Bill No: SB 963

Author: Ashby (D)

Amended: 4/25/24

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 4/10/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE JUDICIARY COMMITTEE: 11-0, 4/23/24

AYES: Umberg, Wilk, Allen, Ashby, Caballero, Durazo, Gonzalez, Laird, Min, Niello, Wahab

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT: Health facilities: self-identifying human trafficking system

SOURCE: California Medical Association

Coalition to Abolish Slavery and Trafficking

San Francisco SafeHouse

DIGEST:

This bill requires general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.

ANALYSIS:

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. Requires a health practitioner, as defined, employed by a health facility, clinic, physician’s office, local or state public health department, or a local government agency, who provides medical services to a patient whom the health practitioner knows or reasonably suspects is a person described as follows, to immediately make a report to a local law enforcement agency:
3. A person suffering from a wound or other physical injury inflicted by the

person’s own act or inflicted by another where the injury is by means of a firearm; or,

1. A person suffering from a wound or other physical injury as a result of

assaultive or abusive conduct. [PEN §11160 et seq.]

1. Requires, under the Child Abuse and Neglect Reporting Act, a “mandated reporter” (which includes teachers, peace officers, firefighters, and health care practitioners, among others) to make reports of suspected child abuse or neglect to law enforcement agencies, as specified. [PEN §11164 et seq.]
2. Requires, under the Elder Abuse and Dependent Adult Civil Protection Act, health practitioners, among others, to report known or suspected cases of abuse of elders and dependent adults. [WIC §15600 et seq.]
3. Defines the following terms:
4. “Human trafficking” defines, in part, as a person who deprives or violates the personal liberty of another with the intent to obtain forced labor or services, or who causes, induces, or persuades a minor to engage in a commercial sex act. [PEN §236.1]
5. “Domestic violence” is defined, in part, as abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship. [PEN §13700(b)]
6. Requires a list of specified businesses and establishments, including emergency rooms within general acute care hospitals, urgent care centers, and facilities that provide pediatric care, to post a notice in a conspicuous place near the public entrance that states the following (in part): “If you or someone you know is being forced to engage in any activity and cannot leave – whether it is commercial sex, housework, farm work, construction, factory, retail, or restaurant work, or any other activity – text 233-733 (Be Free) or call the National Human Trafficking Hotline at 1-888-373-7888 or the California Coalition to Abolish Slavery and Trafficking (CAST) at 1-888-KEY-2-FRE(EDOM) or 1-888-539-2373 to access help and services.” [CIV §52.6]

This bill:

1. Requires general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.
2. Requires the policies and procedures to meet all of the following minimum requirements:
3. Provides for patient confidentiality;
4. Provides for an emergency department patient with a safe and discreet means

of informing hospital personnel that they are a victim of human trafficking or domestic violence;

1. Facilitates a reasonably prompt and private interview of the patient by medical personnel;
2. Refers patients to local services and resources for victims of human

trafficking or domestic violence, if any; and,

e) Incorporates principles of trauma-informed care.

1. Permits general acute care hospitals with an emergency department to track the use of the self-identification procedures, including the total number, ages, and racial demographics of patients who self-identify as a victim of human trafficking or domestic violence, to the extent that this information is provided by the patient.
2. Specifies that a general acute care hospital is not required to report the identities of any patients who self-identify as a victim of human trafficking or domestic violence to CDPH or to any law enforcement agency, except as required under Existing law 2), 3) and 4) above.
3. Exempts a general acute care hospital acting in compliance with this bill from liability for damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence for good faith conduct taken under the policies and procedures established pursuant to this bill. Prohibits this exemption from liability from being construed to limit a person’s liability for any act or omission that constitutes gross negligence or willful or wanton misconduct.
4. Defines “human trafficking” and “domestic violence” as having the same meaning as the definitions in Existing Law 5) above.

Comments

Author’s statement. According to the author, “this bill requires emergency room departments to implement self-identifying human trafficking and domestic violence prevention programs. Existing initiatives within emergency room departments have demonstrated their effectiveness in identifying victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. This bill seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.”

Background

1. Background on human trafficking. According to the U.S. Department of Justice, human trafficking is a crime that involves exploiting a person for labor, services, or commercial sex. The Trafficking Victims Protection Act of 2000 and its subsequent reauthorizations define human trafficking as: a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or, b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. According to the National Human Trafficking Hotline, human trafficking can happen to anyone but some people are more vulnerable than others. Significant risk factors include recent migration or relocation, substance use, mental health concerns, involvement with the child welfare system, and being a runaway or homeless youth. The National Human Trafficking Hotline maintains statistics based on aggregated information learned through signals, including phone calls, texts, online chats, emails, and online tip reports, that are received by the hotline. The use of the word “case” in these statistics is used to represent distinct situations of trafficking reported to the hotline, and is not an indication of law enforcement involvement. In 2021, there were 10,360 human trafficking cases reported nationally. In California alone, there were 1,334 cases identified, involving 2,122 victims.
2. Human trafficking in the healthcare context. According to the National Human Trafficking Hotline, in one study from 2014, 87.8% of trafficking survivors reported accessing health care services during their trafficking situation, and of these, 68.3% were seen at an emergency department. Victims can seek medical services in an emergency, after an assault, for gynecological services, for prenatal care, for routine checkups, for mental health services, for addiction treatment, or for pre-existing conditions. Barriers to victim self-identification include shame or guilt, fear of retaliation by the trafficker, fear of arrest or deportation, lack of transportation or controlled movement, fear of a report to social services, and a lack of understanding of the U.S. healthcare system. There are health indicators for both labor trafficking victims, and sex trafficking victims, and the National Hotline recommends that health care settings plan ahead by building protocols when patients present with one or more trafficking indicators. Recommendations include conducting initial assessments individually in a safe location, assess the patient’s immediate safety, use language understandable to the patient, and do not ask for unnecessary information. The National Hotline recommends a victim-centered approach that includes meeting basic needs, reassuring the potential victim, building trust and rapport, remaining sensitive to power dynamics, and avoiding re-traumatization.
3. Sutter Health protocol impetus for this legislation. According to the author, Sutter Health has implemented a self-identification protocol for trafficking victims that was at least partly the impetus for this legislation. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes a discrete method that allows patients to self-identify without alerting their abuser. This is a very delicate scenario as abusers often attempt to control every moment and activity of their victim. Patients suspected of being victims of human trafficking are provided a bag containing a urine cup, a blue dot sticker and asked to give a urine sample. Inside both men’s and women’s restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then placed in the lab who notifies the RN of the presence of a blue dot. The RN will notify a Case Manager, Social Worker, or House Supervisor of possible human trafficking. A bogus order for an X-ray is submitted and the patient is isolated in Diagnostic Imaging to have a private conversation to determine if the patient needs help. If they need our services, we follow the steps to connecting with appropriate support and care and notify police department. All contacts with suspected abusers occur with Law Enforcement off site and away from any other Sutter Health patients or staff.

Related/Prior Legislation

SB 376 (Rubio, Chapter 109, Statutes of 2023) provided that a victim of human trafficking or abuse has the right to have a human trafficking advocate and a support person, of the victim’s choosing at an interview by a law enforcement authority.

AB 1740 (Sanchez, Chapter 104, Statutes of 2023) added pediatric care facilities to the list of establishments that must post a notice regarding human trafficking.

AB 2130 (Cunningham, Chapter 256, Statutes of 2022) required every emergency medical technician, upon initial licensure, to complete at least 20 minutes of training on issues relating to human trafficking.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

SUPPORT: (Verified 5/1/24)

California Medical Association (co-source)

Coalition to Abolish Slavery and Trafficking (co-source)

San Francisco SafeHouse (co-source)

California Association of Nurse Anesthetists

California Chapter of the American College of Emergency Physicians

California Kidney Care Alliance

FindHelp

San Francisco Marin Medical Society

Sutter Health

OPPOSITION: (Verified 5/1/24)

None received

ARGUMENTS IN SUPPORT: This bill is co-sponsored by the California Medical Association, the Coalition to Abolish Slavery and Trafficking (Cast) and San Francisco SafeHouse. According to these sponsors, emergency departments and front-line healthcare workers have the opportunity to play a critical role in identifying victims of domestic violence and human trafficking. Sponsors cite a 2010 study that found emergency room personnel have the highest likelihood of coming into contact with human trafficking victims, and trafficking victims are more likely to talk to medical staff than police. A 2016 survey from Cast found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers. Sponsors state that California has a chance to become a leader in ensuring that survivors are identified and connected to services in a trauma-informed manner. Sutter Health writes in support that it understands the importance of their role in this system and have implemented programs, like those outlined in this bill, in their emergency departments to help victims of human trafficking, and believes that their programs have been able to break the cycle of abuse these victims incur.

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

5/13/24 16:09:13

**** END ****

SENATE JUDICIARY COMMITTEE

Senator Thomas Umberg, Chair

2023-2024 Regular Session

Bill No: SB 963 (Author:Ashby)

Version: April 15, 2024

Hearing Date: April 23, 2024

Fiscal: Yes

Urgency: No

Consultant: CK

SUBJECT

Health facilities: self-identifying human trafficking system

DIGEST

This bill requires general acute care hospitals with an emergency department to adopt policies and procedures to facilitate identification of victims of human trafficking or domestic violence, as provided, and to collect demographic data. The bill provides total immunity to these hospitals for any injuries inflicted by traffickers or abusers upon patients, as specified.

EXECUTIVE SUMMARY

Human trafficking and domestic violence are widespread scourges that are particularly difficult to address in large part because of the isolation of victims and the control imposed by their traffickers and abusers. A host of current laws attempt to make available services and resources for these victims in locations they are most likely to access. Given the nature of the violence inherent in many of these situations, medical facilities and particular emergency rooms are an access point for these victims that may serve as an effective point to provide victims options for escape or other resources.

This bill requires general acute care hospitals to implement policies and procedures to help facilitate the self-identification of victims of domestic violence and human trafficking. The bill requires this to be a discreet and trauma-informed process. The bill requires demographic data to be collected from those identifying as victims. The bill also provides total immunity from any liability for the hospitals for damages for subsequent injuries inflicted on those that self-identify as victims.

This bill is sponsored by the Coalition to Abolish Slavery and Trafficking (Cast), San Francisco Safe House, and the California Medical Association. This bill is supported by a variety of advocacy groups, including Sutter Health. No timely opposition was received by the Committee. It previously passed out of the Senate Health Committee on an 11 to 0 vote.

PROPOSED CHANGES TO THE LAW

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). (Health & Saf. Code § 1250 et seq.)
2. Defines the following terms:
   1. “Human trafficking” is defined, in part, as a person who deprives or violates the personal liberty of another with the intent to obtain forced labor or services, or who causes, induces, or persuades a minor to engage in a commercial sex act. (Pen. Code § 236.1.)
   2. “Domestic violence” is defined, in part, as abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship. (Pen. Code § 13700(b).)
3. Requires specified businesses and establishments, including emergency rooms within general acute care hospitals to post notices in a conspicuous place near the public entrance of the establishment or in another conspicuous location in clear view of the public and employees where similar notices are customarily posted. Requires the notices to include specific language regarding a textline and various hotlines to contact if one is aware of or is a victim of human trafficking. (Civ. Code § 52.6.)
4. Provides that every person is responsible, not only for the result of their willful acts, but also for an injury occasioned to another by the person’s want of ordinary care or skill in the management of their property or person, except so far as the latter has, willfully or by want of ordinary care, brought the injury upon themselves. (Civ. Code § 1714(a).)

This bill:

1. Requires general acute care hospitals with emergency departments to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel that meet these minimum requirements:
   1. Provide for patient confidentiality.
   2. Provide an emergency department patient with a safe and discreet means of informing hospital personnel that they are a victim of human trafficking or domestic violence.
   3. Facilitate a reasonably prompt and private interview of the patient by medical personnel.
   4. Refer patients to local services and resources for victims of human trafficking or domestic violence, if any.
   5. Incorporate principles of trauma-informed care.
2. Authorizes general acute care hospitals subject thereto to track the use of the self-identification procedure, including the total number, ages, and racial demographics of patients who self-identify as a victim of human trafficking or domestic violence, to the extent that this information is provided by the patient.
3. Provides that such hospitals are not required to report the identities of any patients who self-identify as a victim of human trafficking or domestic violence to the California Department of Public Health (CDPH) or to any law enforcement agency, except as may be required by law, such as in the case of child abuse or neglect.
4. Provides complete immunity for general acute care hospitals subject to this section for damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence.

COMMENTS

The troubling prevalence of human trafficking and domestic violence

Human trafficking is the world’s fastest growing criminal enterprise, bringing in annual profits in the tens of billions of dollars. Human trafficking is generally defined as the use of force, coercion, or fraud to obtain coerced labor or personal services. Existing law provides that any person who deprives or violates the personal liberty of another with the intent to obtain forced labor or services is guilty of the crime of human trafficking.

The International Labour Organization estimates that approximately 40 million people were victims of some form of human slavery worldwide in 2016.^[1] This includes 24.9 million in forced labor, meaning they were being “forced to work under threat or coercion as domestic workers, on construction sites, in clandestine factories, on farms and fishing boats, in other sectors, and in the sex industry.” Over 70 percent of these victims were women and girls and 1 in four victims were children. In their 2019 Data Report, the U.S. National Human Trafficking Hotline identified over 22,000 victims and survivors and over 4,300 traffickers.^[2]

Traffickers look for people who are susceptible for a variety of reasons, including psychological or emotional vulnerability, economic hardship, lack of a social safety net, membership in a marginalized group, natural disasters, or political instability. Human trafficking is often described as a hidden crime as victims rarely come forward to seek help because of language barriers, the severe trauma resulting from these crimes, fear of the traffickers, and/or fear of law enforcement.

According to the National Domestic Violence Hotline, an average of 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States, more than 12 million annually; about 15 percent of women have been injured as a result.^[3]

Providing resources to victims where they are at

This bill attempts to meet these victims with resources where they are. As pointed out by Sutter Health:

Emergency departments and front-line healthcare workers have the opportunity to play a critical role in identifying victims of domestic violence and human trafficking. According to a 2010 study published in West Journal of Emergency Medicine, emergency room personnel have the highest likelihood of coming into contact with human trafficking victims^[4], and trafficking victims are more likely to talk to medical staff than to police.^[5] A 2016 survey from the Coalition to Abolish Slavery and Trafficking found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers.^[6]

This bill requires general acute care hospitals with emergency departments to have procedures in place to allow for victims to self-identify and for hospital personnel to refer for local services and resources. The relevant policies and procedures must meet these minimum requirements:

• Provide for patient confidentiality.
• Provide an emergency department patient with a safe and discreet means of informing hospital personnel that they are a victim of human trafficking or domestic violence.
• Facilitate a reasonably prompt and private interview of the patient by medical personnel.
• Refer patients to local services and resources for victims of human trafficking or domestic violence, if any.
• Incorporate principles of trauma-informed care.

According to the author:

SB 963 requires emergency room departments to implement self-identifying human trafficking and domestic violence prevention programs. Existing initiatives within emergency room departments have demonstrated their effectiveness in identifying victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. SB 963 seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.

Writing in support, the co-sponsors of this bill, the California Medical Association, San Francisco SafeHouse, and Cast, assert that “[s]urvivors of domestic violence, human trafficking, and other crimes deserve consistent, reliable access to help” and argue that this bill “would require the system to meet certain minimum requirements, including, providing patient confidentiality, facilitating immediate interviews with medical personnel, and providing referrals to human trafficking and domestic violence services.”

Broad immunity for hospitals

As a general rule, California law provides that persons are responsible, not only for the result of their willful acts, but also for an injury occasioned to another by their want of ordinary care or skill in the management of their property or person, except so far as the latter has, willfully or by want of ordinary care, brought the injury upon themselves. (Civ. Code § 1714(a).) Liability has the primary effect of ensuring that some measure of recourse exists for those persons injured by the negligent or willful acts of others; the risk of that liability has the primary effect of ensuring parties act reasonably to avoid harm to those to whom they owe a duty.

Conversely, immunity from liability disincentivizes careful planning and acting on the part of individuals and entities. When one enjoys immunity from civil liability, it is relieved of the responsibility to act with due regard and an appropriate level of care in the conduct of its activities. Immunity provisions are also disfavored because they, by their nature, preclude parties from recovering when they are injured, and force injured parties to absorb losses for which they are not responsible. Liability acts not only to allow a victim to be made whole, but to encourage appropriate compliance with legal requirements.

Although immunity provisions are rarely preferable, the Legislature has in limited scenarios approved measured immunity from liability (as opposed to blanket immunities) to promote other policy goals that could benefit the public. Immunities are generally afforded when needed to ensure the willingness of individuals to continue taking on certain roles that may involve some risk and to incentivize certain conduct, such as the provision of life-saving or other critical services. However, as indicated, rarely is immunity absolute, and these immunities generally do not cover grossly negligent conduct or intentional misconduct.

This bill provides that a general acute care hospital subject to this section shall not be liable for damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence. This is a total immunity for those injuries; this could be interpreted to cover situations where the hospital shares the self-identified victim’s report with the abuser.

Clearly the goal of the provision is to ensure hospitals are not held liable for carrying out their duties under this law. To more appropriately tailor this provision, the author has agreed to amend this provision to read:

(2) (A) A general acute care hospital acting in compliance with this section shall not be liable for damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence for good faith conduct taken under the policies and procedures established pursuant to this section.

(B) The liability limitations described in subparagraph (A) shall not be construed to limit a person’s liability for any act or omission that constitutes gross negligence or willful or wanton misconduct

SUPPORT

California Medical Association (sponsor)

Coalition to Abolish Slavery and Trafficking (sponsor)

San Francisco Safehouse (sponsor)

California Association of Nurse Anesthetists

Findhelp, a Public Benefit Corporation

Sutter Health

OPPOSITION

None received

RELATED LEGISLATION

Pending Legislation: AB 1966 (Davies, 2024) requires primary ticket sellers to add notices relating to commercial sex and labor trafficking to electronic confirmations when a mobile or electronic ticket to an event at an entertainment facility is purchased. AB 1966 is currently pending referral in the Senate Rules Committee.

Prior Legislation:

SB 376 (Rubio, Ch. 109, Stats. 2023) provided that a victim of human trafficking or abuse has the right to have a human trafficking advocate and a support person, of the victim’s choosing at an interview by a law enforcement authority.

AB 1740 (Sanchez, Ch. 104, Stats. 2023) added pediatric care facilities to the list of establishments that must post a notice regarding human trafficking.

AB 2130 (Cunningham, Ch. 256, Stats. 2022) required every emergency medical technician, upon initial licensure, to complete at least 20 minutes of training on issues relating to human trafficking.

PRIOR VOTES:

Senate Health Committee (Ayes 11, Noes 0)

**************

1. Global Estimates of Modern Slavery (2017) International Labour Organization, http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_575479.pdf. All internet citations are current as of April 17, 2024. ↑

2. 2019 Data Report, U.S. National Human Trafficking Hotline, https://humantraffickinghotline.org/sites/default/files/Polaris-2019-US-National-Human-Trafficking-Hotline-Data-Report.pdf. ↑

3. Domestic Violence Statistics, National Domestic Violence Hotline, https://www.thehotline.org/stakeholders/domestic-violence-statistics/. ↑

4. Patel R.B., Ahn R., Burke T.F. “Human trafficking in the emergency department,” Western Journal of

   Emergency Medicine. 2010;11(5):402–404. ↑

5. Bespalova N., Morgan J., Coverdale J.“A pathway to freedom: An evaluation of screening tools for the

   identification of trafficking victims,” Academic Psychiatry. 2014:1–5. ↑

6. Carolyn Liu Lumpkin, LCSW, and Adriana Taboada, MPA, Identification and Referral for Human Trafficking Survivors in Health Care Settings: Survey Report (castla.org), January 2017. ↑

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: SB 963

SUBJECT: Health facilities: self-identifying human trafficking system

SUMMARY:

1. Requires general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. Requires a health practitioner, as defined, employed by a health facility, clinic, physician’s office, local or state public health department, or a local government agency, who provides medical services to a patient whom the health practitioner knows or reasonably suspects is a person described as follows, to immediately make a report to a local law enforcement agency:
   1. A person suffering from a wound or other physical injury inflicted by the person’s own act or inflicted by another where the injury is by means of a firearm; or,
   2. A person suffering from a wound or other physical injury as a result of assaultive or abusive conduct. [PEN §11160 et seq.]
3. Requires, under the Child Abuse and Neglect Reporting Act, a “mandated reporter” (which includes teachers, peace officers, firefighters, and health care practitioners, among others) to make reports of suspected child abuse or neglect to law enforcement agencies, as specified. [PEN §11164 et seq.]
4. Requires, under the Elder Abuse and Dependent Adult Civil Protection Act, health practitioners, among others, to report known or suspected cases of abuse of elders and dependent adults. [WIC §15600 et seq.]
5. Defines the following terms:
   1. “Human trafficking” is defined, in part, as a person who deprives or violates the personal liberty of another with the intent to obtain forced labor or services, or who causes, induces, or persuades a minor to engage in a commercial sex act. [PEN §236.1]
      
   2. “Domestic violence” is defined, in part, as abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship. [PEN §13700(b)]
6. Requires a list of specified businesses and establishments, including emergency rooms within general acute care hospitals, urgent care centers, and facilities that provide pediatric care, to post a notice in a conspicuous place near the public entrance that states the following (in part): “If you or someone you know is being forced to engage in any activity and cannot leave – whether it is commercial sex, housework, farm work, construction, factory, retail, or restaurant work, or any other activity – text 233-733 (Be Free) or call the National Human Trafficking Hotline at 1-888-373-7888 or the California Coalition to Abolish Slavery and Trafficking (CAST) at 1-888-KEY-2-FRE(EDOM) or 1-888-539-2373 to access help and services.” [CIV §52.6]

This bill:

1. Requires general acute care hospitals with an emergency department to adopt and implement policies and procedures to facilitate the self-identification of an emergency department patient as a victim of human trafficking or domestic violence to hospital personnel.
2. Requires the policies and procedures to meet all of the following minimum requirements:
   1. Provide for patient confidentiality;
   2. Provide for an emergency department patient with a safe and discreet means of informing hospital personnel that they are a victim of human trafficking or domestic violence;
   3. Facilitate a reasonably prompt and private interview of the patient by medical personnel;
   4. Refer patients to local services and resources for victims of human trafficking or domestic violence, if any; and,
   5. Incorporate principles of trauma-informed care.
3. Requires general acute care hospitals with an emergency department to collect, at a minimum, the total number, ages, and racial demographics of patients who self-identify as a victim of human trafficking or domestic violence, to the extent that this information is provided by the patient.
4. Specifies that a general acute care hospital is not required to report the identities of any patients who self-identify as a victim of human trafficking or domestic violence to CDPH or to any law enforcement agency, except as required under Existing Law 2), 3) and 4) above.
5. Exempts a general acute care hospital subject to this bill from liability for damages for any subsequent injuries inflicted by a trafficker or abuser upon a patient who self-identified as a victim of human trafficking or domestic violence.
6. Defines “human trafficking” and “domestic violence” as having the same meaning as the definitions in Existing Law 5) above.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, this bill requires emergency room departments to implement self-identifying human trafficking and domestic violence prevention programs. Existing initiatives within emergency room departments have demonstrated their effectiveness in identifying victims, particularly impacting the lives of women and children in dangerous situations. These programs serve as a vital foundation for the proactive identification of trafficking victims, addressing a concerning trend where many victims, despite seeking emergency medical attention, often go unnoticed. This bill seeks to build on the successes of existing programs by further strengthening the capacity of all emergency rooms to detect and support victims of human trafficking and violence, further emphasizing the importance of equipping emergency rooms with the necessary resources to empower victims to self-identify safely, without fear of consequences from a suppressor.
2. Background on human trafficking. According to the U.S. Department of Justice, human trafficking is a crime that involves exploiting a person for labor, services, or commercial sex. The Trafficking Victims Protection Act of 2000 and its subsequent reauthorizations define human trafficking as: a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or, b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. According to the National Human Trafficking Hotline, human trafficking can happen to anyone but some people are more vulnerable than others. Significant risk factors include recent migration or relocation, substance use, mental health concerns, involvement with the child welfare system, and being a runaway or homeless youth. The National Human Trafficking Hotline maintains statistics based on aggregated information learned through signals, including phone calls, texts, online chats, emails, and online tip reports, that are received by the hotline. The use of the word “case” in these statistics is used to represent distinct situations of trafficking reported to the hotline, and is not an indication of law enforcement involvement. In 2021, there were 10,360 human trafficking cases reported nationally. In California alone, there were 1,334 cases identified, involving 2,122 victims.
3. Human trafficking in the healthcare context. According to the National Human Trafficking Hotline, in one study from 2014, 87.8% of trafficking survivors reported accessing health care services during their trafficking situation, and of these, 68.3% were seen at an emergency department. Victims can seek medical services in an emergency, after an assault, for gynecological services, for prenatal care, for routine checkups, for mental health services, for addiction treatment, or for pre-existing conditions. Barriers to victim self-identification include shame or guilt, fear of retaliation by the trafficker, fear of arrest or deportation, lack of transportation or controlled movement, fear of a report to social services, and a lack of understanding of the U.S. healthcare system. There are health indicators for both labor trafficking victims, and sex trafficking victims, and the National Hotline recommends that health care settings plan ahead by building protocols when patients present with one or more trafficking indicators. Recommendations include conducting initial assessments individually in a safe location, assess the patient’s immediate safety, use language understandable to the patient, and do not ask for unnecessary information. The National Hotline recommends a victim-centered approach that includes meeting basic needs, reassuring the potential victim, building trust and rapport, remaining sensitive to power dynamics, and avoiding re-traumatization.
4. Sutter Health protocol impetus for this legislation. According to the author, Sutter Health has implemented a self-identification protocol for trafficking victims that was at least partly the impetus for this legislation. According to Sutter Health, its practice for assisting patients who are potentially victims of human trafficking includes a discrete method that allows patients to self-identify without alerting their abuser. This is a very delicate scenario as abusers often attempt to control every moment and activity of their victim. Patients suspected of being victims of human trafficking are provided a bag containing a urine cup, a blue dot sticker and asked to give a urine sample. Inside both men’s and women’s restrooms are posted instructions in multiple languages directing individuals in an abusive situation to place the dot on the urine sample cup. The cup is then placed in the lab who notifies the RN of the presence of a blue dot.  The RN will notify a Case Manager, Social Worker, or House Supervisor of possible human trafficking.  A bogus order for an X-ray is submitted and the patient is isolated in Diagnostic Imaging to have a private conversation to determine if the patient needs help.  If they need our services, we follow the steps to connecting with appropriate support and care and notify police department. All contacts with suspected abusers occur with Law Enforcement off site and away from any other Sutter Health patients or staff.
5. Prior legislation. SB 376 (Rubio, Chapter 109, Statutes of 2023) provides that a victim of human trafficking or abuse has the right to have a human trafficking advocate and a support person, of the victim’s choosing at an interview by a law enforcement authority.
   
   AB 1740 (Sanchez, Chapter 104, Statutes of 2023) added pediatric care facilities to the list of establishments that must post a notice regarding human trafficking.
   
   AB 2130 (Cunningham, Chapter 256, Statutes of 2022) requires every emergency medical technician, upon initial licensure, to complete at least 20 minutes of training on issues relating to human trafficking.
6. Support. This bill is co-sponsored by the California Medical Association, the Coalition to Abolish Slavery and Trafficking (Cast) and San Francisco SafeHouse. According to these sponsors, emergency departments and front-line healthcare workers have the opportunity to play a critical role in identifying victims of domestic violence and human trafficking. Sponsors cite a 2010 study that found emergency room personnel have the highest likelihood of coming into contact with human trafficking victims, and trafficking victims are more likely to talk to medical staff than police. A 2016 survey from Cast found that although 64% of survivors had accessed healthcare at least once during their trafficking situation, almost all (97%) were never provided information or resources about trafficking from healthcare providers. Sponsors state that California has a chance to become a leader in ensuring that survivors are identified and connected to services in a trauma-informed manner. Sutter Health writes in support that it understands the importance of their role in this system and have implemented programs, like those outlined in this bill, in their emergency departments to help victims of human trafficking, and believes that their programs have been able to break the cycle of abuse these victims incur.
7. Re-referral to Rules Committee. Recent amendments to this bill include a provision related to liability. Should this bill pass out of this committee, it will be referred to Rules Committee for consideration of a referral to Senate Judiciary Committee.

SUPPORT AND OPPOSITION:

Support: California Medical Association (co-sponsor)

Coalition to Abolish Slavery and Trafficking (co-sponsor)

San Francisco SafeHouse (co-sponsor)

California Association of Nurse Anesthetists

FindHelp
Sutter Health

Oppose: None received

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