It was Saturday evening and Joe Johnson, VP of Patient Services, was relaxing with his family after dinner and watching a situation comedy. As the administrator on call (AOC), he was grateful things had been quiet—so far. The last time he was AOC, a psychiatric patient attacked a nurse in the middle of the night and tried to choke her to death. He really didn’t want another one of those nights. His phone vibrated and he was chagrined to see the Emergency Department (ED) number. Please, not another attack on a nurse. “Hey Joe, this is Liz. We’ve had a bit of a situation here.” It was the head of the ED, Elizabeth Watkins, a woman he liked and respected. Joe breathed a sigh of relief. Liz was a competent emergency physician and could handle just about anything. She’s probably just calling to give me a heads up. No biggie. Joe kept his eyes on the TV and smiled at the last joke.

 “What’s up?”

“I’ve called the police. I think we have things handled for the moment. I just have one question—”

He jumped up from the sofa and went into the kitchen. “Things?

What things?”

“An older man brought in a young woman, a girl really. We think she’s about twelve or thirteen, she doesn’t speak English, so it’s hard to tell. She’s been beat up pretty badly. He said she fell. But, her injuries were inconsistent with his description of what occurred. She was dressed in a short skirt, spike heels, and wore a ton of make-up. When I told him he had to leave the room so I could examine her in private, he refused to leave.” She blew out a long breath. “I told him to hold on, I needed to get some paperwork. I lied.”

“You what?” Joe’s head was about to explode.

“I got the off duty police officer who serves as our security guard in the ED to come back with me and escort the man to another room. The guy wasn’t happy, started yelling at me in Spanish. I knew enough to understand he wasn’t calling me nice names.” Joe ran his hand over his head. “What made you do that? Do you really think it’s necessary to get a cop when a patient’s family member won’t leave the room? She’s a minor, her father has a right to be present.

He could sue us.”

“He’s not her father. He’s her pimp.”

Words escaped him. After several long breaths, at last he was able to get something out. They were in an affluent county, not in an urban area. Things like that didn’t happen in his community, not in his back yard.

“This sounds like a stretch, Liz. We’re not in the city. What made you decide that?”

“You know that human trafficking course I insisted everyone take?

The one you missed? She had all the hallmarks of an enslaved minor child.”

“Okay, okay. So the police are on the way to arrest the guy. What about the girl?”

“That’s what I was calling you about, Joe. Did you make a plan for these types of victims? That was your job. Who am I supposed to call? How do we handle a girl like Maria?”
DISCUSSION QUESTIONS 

1. What are the facts of this case?
2. What were the clues to Liz that the girl was being trafficked?
3. What were Joe’s attribution errors in this scenario?
4. What are the management implications of this case? What should Joe have done to prepare for this situation?
5. What should the ED staff do with Maria?