A woman who had been in a coma for more than a decade gave birth at a private nursing facility in Arizona last week, in a case that highlights a vulnerable population that advocates say have received far less attention in the #MeToo era: people with disabilities and in long-term care. The patient, whose age and identity has not been made public, was left in a persistent vegetative state after nearly drowning 14 years ago. She’s since depended on around-the-clock care at Hacienda Healthcare, a private facility based in Arizona that treats chronically ill and developmentally disabled patients. But the staff there were reportedly unaware that she was even pregnant until she went into labor on December 29 and gave birth to a healthy baby boy, according to KTVK, the CBS News affiliate that was the first news outlet to report the case Thursday. “From what I’ve been told she was moaning,” an unidentified whistleblower told KTVK. “And they didn’t know what was wrong with her.” The Phoenix Police Department has launched a sexual assault investigation into the case, and a Hacienda spokesperson said the facility has promised to get to the bottom of what they called “an unprecedented matter.” In the meantime, state regulators have demanded that the facility step up its safety measures, asking that male employees be accompanied by another person while treating female patients. While many crucial details remain unknown, news of the case was met with outrage online, with women’s advocates questioning why staffers reportedly remained unaware of the patient’s pregnancy for so long, and why authorities were treating it as a “possible sexual assault” rather than calling it outright rape. The patient had been in a vegetative state for more than a decade. She could not consent to any sexual contact or defend herself during an attack, nor did she have the power to report inappropriate behavior or assault. Patients like the one at Hacienda are particularly vulnerable Though the scope of the problem is hard to assess — research on abuse of patients living in long-term care facilities lags decades behind research for other populations — experts say those patients are particularly at risk of becoming victims of abuse or sexual violence because of how often they’re at the mercy of others to live their lives. “People who need total care are very, very vulnerable,” says Regan Smith, an ombudsman with Area Agency on Aging, based in Maricopa County, Arizona. “And nobody wants to believe that things are happening to them — they’re our most vulnerable population.” Some may have cognitive disabilities, while others may be tied to ventilators or feeding tubes, and require hands-on care around the clock. Patients unable to communicate obviously can’t give consent, while those who are physically incapacitated are unable to protect themselves from an attack. Add to those circumstances the fact that many patients are isolated from older support networks or their families, and experts say that can make patients easy targets. “Opportunistic assailants are common, and we see them show up in all kinds of environments where there are inherent vulnerabilities,” said Kristen Houser, spokesperson for the National Sexual Violence Resource Center. According to Smith, instances of abuse as extreme as the Arizona case — in which a patient without the ability to consent to sex is impregnated while receiving around-the-clock care — are relatively rare within the industry of long-term care and nursing homes. But the circumstances aren’t unheard of: Over the last few decades, there have been several high-profile cases involving women who were impregnated against their will while they were in a coma. Less extreme cases are more common. There have been other complaints of sexual misconduct, for example, at the same Arizona facility where the latest pregnancy occurred. A 2013 complaint filed against the facility alleged that a male employee directed sexually explicit comments toward patients. In one instance detailed in a report from the Arizona Department of Health Services, the employee made explicit comments while bathing a patient, saying he was going to have a “happy morning” due to his semi-erect penis. The employee was eventually fired, and the facility’s operators promised the state it would implement new training on how to report patient abuse. But stories of abuse like that patient’s and others in long-term care facilities often don’t get as much attention as they deserve. Advocacy groups complain that studies on elder abuse lags “as much as two decades” behind similar research on child abuse and domestic violence. The scale of abuse complaints inside long-term care facilities is also largely obscured from the public eye. Federal agencies frequently catalog these complaints into overly broad categories, where data on “abuse” could be a catch-all for everything from neglect to sexual assault. A 2017 investigation by the Kansas City Star sorted through the data and found that sexual abuse allegations in long-term care facilities were on the rise nationwide. More than 20,000 complaints of sexual abuse were filed over the course of a 20-year period, the report found. But there’s reason to believe that at best, the statistics paint an incomplete picture of the scale of the problem. Assault allegations made by elderly or disabled victims are often met with skepticism or disbelief Rates of reporting sexual abuse or violence are already notoriously low nationwide — but advocates believe only a fraction of individuals who experience violence within a long-term facility come forward. By some estimates, only one in five do so. One of the primary concerns is whether victims who have physical or cognitive disabilities are believed if they do come forward, Smith says: “Do staff always believe what they hear from patients? If they can communicate at all, are they heard, are they listened to — is everything taken seriously?” Working against victims are false assumptions that the elderly or disabled could never be victims of abuse or sexual assault — people simply don’t want to believe that such vulnerable groups would be taken advantage of. As Houser points out, our society tends to think of people with disabilities as asexual, and are therefore “infantilized” and less likely to be taken seriously when reporting abuse. “Our nation is very much in denial about how widespread the problem of sexual abuse is — especially when you have a population that does not fit the mainstream criteria as a sexual being,” Houser said. In one case in Minnesota in 2014, nursing home administrators said they believed an elderly woman was “making up” her rape allegations, and even blamed her for being a “flirt.” Their testimony was captured by the Star Tribune: ... an administrator at Edgewood Vista appeared to defend the rapist even after his admission to police. According to court testimony, Marilyn Moore, clinical services director at the home, asked Flesvig, “Did she tell you that this was consensual? Did she tell you that she flirts with this boy mercilessly?” #MeToo changed our understanding of sexual assault. But the culture shift isn’t over. The story of the Arizona case — and the systemic issues that enable abuse in long-term care facilities — follow a similar narrative arc to the stories unearthed since #MeToo entered our cultural lexicon. Victims are often the most vulnerable. They face many barriers in their ability to come forward with allegations of abuse. And even if they report, often they’re not believed. Thanks to the countless number of victims who have come forward with stories of assault and violence since the start of the #MeToo movement, challenging power structures and the unequal application justice, there’s been a shift in our culture’s understanding of just how widespread sexual assault and abuse truly is. But what happened in Arizona is an important reminder: Not all victims may be able to speak out on their own.<doc-sep>In the 911 call, the nurse at Hacienda HealthCare repeatedly says staff members at the facility 'had no idea' the woman was pregnant 'The Baby's Turning Blue! ': Panicked 911 Call After Woman in Coma Gives Birth in Nursing Facility Phoenix police have released the 911 call from inside an Arizona nursing facility after a woman in a long-term vegetative state gave birth to a baby boy. On the audio, which was obtained by PEOPLE, a nurse at the long-term care facility run by Hacienda HealthCare expresses shock and fear that the child might not survive. Get push notifications with news, features and more. “The baby’s turning blue! The baby’s turning blue!,” the nurse says in the Dec. 29 call released by police investigating the birth to the 29-year-old mother as the result of a sexual assault. “One of the patients just had a baby and we had no idea she was pregnant,” the nurse frantically tells a paramedic on the line in the 5-minute, 15-second call. “And the mom is doing OK?” the paramedic asks. “We’re not sure, we had no idea this patient was pregnant,” the nurse replies. The records obtained by PEOPLE from Maricopa County Superior Court date back to a 2009 order that transferred guardianship of the woman from her biological father to her mother. According to the documents, the woman suffers from quadriplegia, recurrent pneumonia and a seizure disorder. The documents do not reveal what led to her condition. The facility described the assault as “deeply disturbing but unprecedented.” Gary Orman, the facility’s executive vice president, pledged to assist with the police investigation, which includes collecting DNA samples from male staffers who work at the facility. The company’s CEO resigned following reports of the birth. • Want to keep up with the latest crime coverage? Click here to get breaking crime news, ongoing trial coverage and details of intriguing unsolved cases in the True Crime Newsletter. In the 911 call, the nurse assures the paramedic that CPR is being performed on the newborn. The paramedic asks how far along the woman’s pregnancy was. “We have no idea,” the nurse says. “This is a complete surprise. We were not expecting this.” Moments later, after asking someone in the background if the baby has begun breathing, the nurse says with obvious relief, “Oh, the baby’s breathing. Oh my god, thank God.” The paramedic confirms he hears the sounds of a newborn crying in the background. “You guys did great, OK,” he says, before confirming that paramedics are “on the way.” John Micheaels, an attorney for the woman’s family, said in a statement to PEOPLE that they were “outraged and traumatized,” by the incident but added, “The family would like me to convey that the baby boy has been born into a loving family and will be well cared for.”<doc-sep>Update: Nathan Sutherland, a 36-year-old nurse at the Hacienda HealthCare facility has been arrested and charged with one count of sexual assault and one count of vulnerable adult abuse, according to the Associated Press. The CEO of a Phoenix, Arizona, health facility has resigned amid a police investigation into the rape and subsequent pregnancy of a female patient who has been a vegetative state for more than a decade. Bill Timmons “terminated his employment” with the Hacienda HealthCare center earlier this week, the facility said in a statement to Huffington Post. According to KPHO-TV, which broke the story, the unidentified 29-year-old patient had been raped several times, and the staff had no idea she was pregnant until she went into labor and gave birth to a healthy baby boy on December 29th. On Tuesday, January 8th, investigators served Hacienda HealthCare with a search warrant for DNA samples from all of its male employees in hopes of finding out who is responsible for the woman’s rape and pregnancy. In a statement, the facility said this latest step by law enforcement is a “welcome development” in the investigation. “We had consulted attorneys to determine whether it would be legal for our company to compel our employees to undergo DNA testing conducted through Hacienda or for Hacienda to conduct voluntary genetic testing of staffers,” the facility said. “We were told it would be a violation of federal law in either instance. … We will continue to cooperate with Phoenix Police and all other investigative agencies to uncover the facts in this deeply disturbing, but unprecedented situation.” The victim has been in a vegetative state for 14 years following a near drowning incident, and is an enrolled member of the local San Carlos Apache Tribe, the tribe’s spokesman said in a statement on Tuesday. “On behalf of the Tribe, I am deeply shocked and horrified at the treatment of one of our members,” Terry Rambler said. “When you have a loved one committed to palliative care, when they are most vulnerable and dependent upon others, you trust their caretakers. Sadly, one of her caretakers was not to be trusted and took advantage of her.” In an anonymous interview with ABC-15, a former caregiver for the woman expressed disbelief that her pregnancy went unnoticed. “I can’t believe that somebody would bathe her daily for nine months and never know that she wasn’t having a period, that she [was] growing in her midsection, that nurses weren’t keeping track [of her weight],” the former caregiver said. “Those things are shocking to me.” Comatose pregnancies — including those resulting from sexual assault while the person is temporarily or permanently unconscious, or braindead — are extremely rare but not without precedent. In 2015, a Spanish-language publication in Argentina reported on a similar case in which a woman in a coma had been sexually assaulted and impregnated, but the family didn’t press charges and the case was never investigated by police. Regardless of the legality of the precipitating sex act, comatose pregnancies come with both medical risks and complex ethical issues for the victim’s family to navigate. “It’s possible to bring a fetus to term, but it depends on how far you are in the pregnancy,” bioethicist Arthur Caplan said in an interview with Vice in 2015. “If you’re at 28 weeks, you could probably have a C-section. But if you were only two weeks pregnant, I don’t think many hospitals would try that, because it could harm the fetus.” However, that’s exactly what happened in 2001, when doctors in Cincinnati learned a patient named Chastity Cooper was two weeks pregnant when she suffered serious head injuries in a car accident and lapsed into a coma. The pregnancy was carried to term and delivered vaginally, as doctors ruled out a C-section because of the risks of giving anesthesia to comatose patients. In 1995, a woman identified only as “Kathy,” who had been in a coma for a decade, was raped and impregnated by an aide at a New York nursing home. Kathy’s pregnancy was discovered when she was four months along, but her Roman Catholic family was against abortion and chose to have her carry the fetus to term. Kathy died shortly before her son’s first birthday, and the case resulted in the passing of “Kathy’s Law” in 1998, which requires background checks for nursing aides. Family members for the woman in Phoenix have declined to give a public statement for the time being, but their attorney told Huffington Post,”The family obviously is outraged, traumatized and in shock by the abuse and neglect of their daughter at Hacienda Healthcare. … [They] would like me to convey that the baby boy has been born into a loving family and will be well cared for.”<doc-sep>
The 29-year-old Native American has been under the care of the facility since she was between ages 2-3, according to court documents obtained by PEOPLE Woman in Coma Who Gave Birth Had Been in Nursing Facility Since She Was a Toddler: Court Docs The woman in a vegetative state, who gave birth to a baby boy on Dec. 29, has been at the Phoenix-based nursing facility since she was a toddler, PEOPLE confirms. Records obtained from Maricopa County Superior Court state the woman has been a resident of the facility run by Hacienda HealthCare for more than 27 years — nearly double the length of time that appeared in previous reports. The patient, who has been identified as a 29-year-old Native American, has been under the care of the facility since she was between ages 2-3, according to the documents, which also state that the woman suffers from quadriplegia, recurrent pneumonia and a seizure disorder. “She lacks sufficient understanding and mental capacity to make decisions or give consents for her medical, placement or financial estate,” the court documents say. The records date back to a 2009 order that transferred guardianship of the woman from her biological father to her mother. 10051962a Hacienda HealthCare | Credit: Ross D Franklin/AP/REX/Shutterstock In addition, the records reveal that the patient’s last doctor’s examination took place more than eight months prior to the Dec. 29 birth, which according to Phoenix Police Sgt. Tommy Thompson “took everyone [at the facility] by surprise.” Thompson told PEOPLE, “It’s my impression that the staff there had no clue that this lady was having a baby,” adding that she was “quite a ways along” before she had a natural birth. An annual guardian’s report filed with the court and dated April 30, 2018, says that the woman’s last court-ordered annual doctor’s examination took place on April 16, 2018. “No changes,” says a handwritten note in response to a form question asking whether there have been “any major changes in the ward’s physical and/or mental condition in the last year.” PEOPLE was unable to reach the doctor who performed the examination. Thompson confirmed the baby and his mother have been recovering in an area hospital following the birth. hacienda-healthcare Credit: Google Maps “We’re tickled that the baby’s okay,” Thompson said. “I think it’s a miracle. I hate to draw a miracle of such a horrific event, but the baby survived. Words can’t describe the thoughts we have, the questions that go through our mind about this.” On Tuesday, the woman’s family attorney, John Micheaels, said in a statement to PEOPLE, “The family would like me to convey that the baby boy has been born into a loving family and will be well cared for.” Micheaels revealed the woman’s relatives are “outraged, traumatized and in shock by the abuse and neglect of their daughter at Hacienda Healthcare,” adding, “The family is well aware of the intense news and public interest in their daughter’s case, but at this time is not emotionally ready to make a public statement.” It is not yet known exactly where the baby is being raised or who he is being raised by. • Want to keep up with the latest crime coverage? Click here to get breaking crime news, ongoing trial coverage and details of intriguing unsolved cases in the True Crime Newsletter. Following news of the birth, Bill Timmons, the longtime chief executive officer of Hacienda Healthcare, resigned. In 2017, the facility was cited by the state for failure to protect residents’ privacy while they were naked in the shower, according to records from the state Department of Health and Human Services. After being assured by administrators that staffers “have been counseled on privacy during showering residents,” the state issued a follow-up report in January 2018 which concluded those and other deficiencies uncovered by investigators “have been corrected.” Phoenix police have confirmed a sexual assault investigation concerning the woman’s pregnancy. Officials and Hacienda HealthCare both have confirmed the collection of DNA from male staffers in an effort to find a link to the apparent assault of the woman.