Human trafficking is an incredibly challenging problem to try to solve because it hides in the shadows. Not only are traffickers motivated to keep their activities under the radar of law enforcement, often victims are, too. Is that young woman with the broken arm who was brought to your emergency department by a male “friend” a victim of trafficking? What about the shy young man with the black eye and sexually transmitted infection? And if they are, what can you do about it?

Cynthia M. Deitle, JD

Cynthia M. Deitle, JD, spent two decades with the FBI’s Civil Rights program, which includes a program to combat human trafficking. Her experience ranged from working on individual trafficking cases to being chief of the Civil Rights unit, giving her a broad understanding of the trafficking problem in the United States and the bureau’s efforts to combat it. She recently sat down with ACEP Now Medical Editor-in-Chief Kevin Klauer, DO, EJD, FACEP, to talk about some of the challenges she faced while trying to help trafficking victims and what emergency department staff can do to try to help suspected victims. Here is Part 1 of that conversation; Part 2 will appear in the April issue.

KK: What’s your educational background?

CD: I went to The Ohio State University and received a Bachelor of Arts degree in political science. I then went on to earn my Juris Doctor degree from the New England School of Law in Boston, and I also earned a Master of Law degree at the George Washington University National Law Center in Washington, D.C., and also from New York University School of Law in New York City. The first master’s degree had a concentration in constitutional law, and the second had a concentration in criminal law.

KK: Tell us about your career working on behalf of trafficking victims.

CD: I joined the FBI in 1995. I specialized for 20 out of 22 years working within our Civil Rights program. Our Civil Rights program has four sub-programs underneath it. The first one is hate crimes, the second one is what we call color of law or police brutality, the third is human trafficking, and the fourth is what we call FACE [Freedom of Access to Clinic Entrances], fighting abortion extremism. First, I was a street agent in a New York City office for 12 years. I was promoted and worked in Washington, D.C., from 2007 to 2011, and I was promoted to chief of the Civil Rights unit and then transferred to the Boston FBI office, where I worked on civil rights and public corruption. I finished my FBI career in the Knoxville FBI office, specializing in intelligence and, more specifically, human trafficking. I’ve seen human trafficking in New York, Boston, Washington, D.C., and Knoxville, Tennessee. I’ve worked those cases as an agent, supervised investigations, and seen it from a 30,000-foot level as the chief of the Civil Rights unit. I have a good idea of what the country looks like in terms of where we had the most human trafficking cases and what those cases looked like.

Unless you have attention focused on it, a lot gets overlooked. It will get overlooked all too often as a crime problem [ie, prostitution]. You may see it in other facets, where a gang investigation, for example, has a human trafficking element. Gang members can make a lot of money engaging in trafficking. They can prostitute women against their will and earn a lot of very quick money. They need money, and they need people. One way to get money very quickly is to traffic young girls in the commercial sex trade and earn a lot of money really fast.

Human trafficking can cross over into immigration issues if we see victims coming in from outside the United States and they are held in some type of labor situation [ie, agriculture, landscaping, hair or nail salons, massage parlors, or working as a domestic servant for a family]. We see them all over our communities, but if we don’t know the size of trafficking we’re not going to know what we’re looking at. Another thing that law enforcement and the FBI try to do is bring attention to the problem. We want to bring attention to the issue so people know what they’re looking at and then know what to do about it so that victim can be recovered and rescued and hopefully can be put back on a path to survival.

Although the exact numbers are hard to track, with underreporting by some and overreporting by others, any student of history in the United States or anyone with a social justice conscience would say it’s one victim too many. How dare the United States outlaw slavery and still be perpetuating the slave industry, which is what we’re doing. If you have employers, whether it’s a pimp or a landscaping company who are forcing an individual to work, that’s slavery.

KK: How challenging can it be to identify and help a trafficking victim?

CD: There have been dozens trafficking victims that I would be the first one to say, “The situation in which I have found you, I swear you are a victim of trafficking.” Even though I say that and write that down in a report somewhere, that victim might tell me to go pound sand. She might tell me to go away. She’s going to tell me she doesn’t want to talk to me and she’s going to leave. I have no legal authority to hold her or to force her to self-identify. If she’s done nothing wrong, and I can’t hold her as a perpetrator of a crime or because she has an outstanding warrant, there’s no legal way to hold her.

There’s one girl I encountered three times. On the third try, she wanted to cooperate. She wanted to talk to me, and the only reason was that she had been told by the county, the sheriff’s department, that if she was arrested one more time for prostitution that she would be registered as a sex offender in the state. That was something that would hang over her like a scarlet letter for the rest of her life, and she was not going to have that. She said, “I can’t get arrested again, so what do you want to know?” It wasn’t about, “I need services, I need health care, I’m afraid of my pimp, come rescue me.” I’ve had many other situations in which I encountered a girl, a victim of trafficking, and she told me to go pound sand and I never saw her again. Some of those women popped up in another jurisdiction. Including the concern about possible trafficking in a database has been very helpful.

KK: What I’m hearing from you is a lot of these cases weren’t reported as human trafficking, so you’re overturning stones and finding these victims. It’s not a deliberate process to, let’s say, investigate four claims of human trafficking that were reported by the sheriff’s department.

CD: You’re exactly right. We had a case in east Tennessee where a girl was discovered by Knox County on the side of the road. She was in a physical altercation with her pimp and she was getting the better of him, and he called 911. The sheriff’s department shows up on the side of the road. She’s hitting him, and she says, “I did, I hit him with a tire iron.” She knew full well she would go jail, and she told her public defender, “Yes, I hit him because he had been keeping me in a state of involuntary servitude, in a state of slavery, in a state of trafficking, for about a week or 10 days.” She was completely done, and she thought the one way to get away from him was to get arrested. Kevin, I would love to know the answer to why some victims are able to escape and others are in a trafficking situation for years. Why was she one of the few that said, “I am not doing this?”

KK: When you are in a position of such oppression, you must have a very strong personality to be able to overcome that and do what she did.

CD: Most of the women in these situations are paralyzed by fear, and they do not want to do anything to bring attention to them or their situation because they’re convinced they’ll get deported if they are undocumented or convinced that the trafficker is going to tell the victim’s parents what she has been doing with these johns in hotel rooms. She’s going to be ashamed of videos or pictures taken of what she’s been doing. Many are afraid that the pimp will carry out his threat to kill her because he’s already beaten her to a pulp on numerous occasions. A lot of times, and this is very sad, her life was pretty crappy before she got involved in this situation. She thinks, “I can have that kind of crappy life, or I can be with this guy and make some money. Well, all right, I’ll stay with this guy for a little while.”

Some of those women are then convinced by the pimp to recruit other women. That first victim becomes what we term “the bottom.” The bottom then will recruit other girls because the bottom knows that if they recruit other girls, they don’t have to do it anymore. They can become the one that takes the pictures and puts them online but doesn’t have to be the one who is engaging in sex with the john. So you’re right. The vast majority of the victims that I’ve encountered are going to stay for a while. “A while” could be a year or six months, but they are going to stay because it’s just too paralyzing to think of how they get out of this.

Next month, in Part 2 of this interview, Ms. Deitle will outline some techniques that emergency department staff can use to help suspected victims of human trafficking.