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- The sexual assault investigation into a woman who gave birth in a vegetative state in Arizona is highlighting a bigger issue of institutional abuse.
- Experts say such sexual abuse of the disabled is shockingly common, and that more needs to be done to ensure America's most vulnerable do not continue to become victims.
- Meanwhile, medical studies show that the woman may have been more aware than her vegetative state suggests — meaning it's possible she could have felt the assault but was physically unable to stop it.
The story of a 29-year-old woman who gave birth at a care facility in Arizona last month, despite having been in a vegetative state for more than a decade, has shocked the nation and prompted a sexual assault investigation.
And experts say such abuse is not rare and is an oft-ignored example of the disturbingly high rates of abuse among America's most vulnerable.
Medical studies add another layer of terror to the case, suggesting that the victim may have been more aware than her vegetative state suggests — meaning she may have felt the assault and could even know the identity of her attacker.
The woman is recovering in a local hospital, and the baby boy is healthy.
Phoenix Police are now investigating the incident as a possible rape, and have obtained search warrants to collect DNA from all of the male staffers to see if any of them are the father.
Read more: Police to take DNA from every male caregiver who had access to the woman who gave birth after 14 years in a vegetative state
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This isn't the first case like this
Experts say the vegetative patient's pregnancy is not a surprise for people who study these institutions.
Several similar cases have been documented in the past 25 years. Take the Rochester, New York woman who gave birth to a baby boy in 1996, despite having been in a coma-like state since a 1985 car crash. Two years later, a woman in Massachusetts, who had been in a coma for five years, gave birth to a baby girl. One of the most recent cases happened in 2015, in Argentina, where a woman who had been in a coma for a year became pregnant.
Statistics back up the fact that institutional abuse is a systemic problem at care facilities.
Several studies have shown that women with disabilities in particular are at an increased risk of being the victims of sexual assault. One 2006 study found that women with disabilities are four times more likely to be sexual assaulted as abled women are.
"There are statistics that even suggest that if a woman has a disability ... she will be abused in some form or fashion,"Sara Plummer, an assistant professor at the Rutgers University School of Social Work, told INSIDER. "So that's 100% — whether that be sexual abuse or physical abuse or emotional abuse or financial abuse."
She says what's disturbing about the case is that the abuse likely wouldn't have been discovered if the woman didn't get pregnant.
It should also be mentioned that the victim in this case was Native American, another population that reports extremely high rates of sexual assault. According to a 2016 report from the National Institute of Justice, more than four in five American Indian and Alaska Native women have experienced violence in their lifetime — including 56% who have specifically reported being sexual assaulted.
Despite abuse of people with disabilities being such a widespread problem, Plummer said there isn't much research into the issue.
"No one really wants to talk about it, because it's really awful. And I've been talking about it for 20 years," she said.
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Who could have done it?
Investigators in Arizona appear to be zeroing in on the possibility that someone who works at the facility got the patient pregnant.
When it comes to sexual abuse, Plummer says that it is often the people who work with the disabled who commit these types of crimes. Family members, on the other hand, are much more likely to abuse a disabled relative financially, physically, or emotionally, she said.
But Pamela Teaster, director of Virginia Tech University's Center of Gerontology, who has also studied institutional abuse, said investigators shouldn't rule out the possibility that it wasn't a staff member.
Teaster says she once conducted a study that looked into the abuse of elderly people in nursing homes and it found that the staff "were actually less likely to do the abusing."
"It was the [other] residents — it was the van driver, it was when ... somebody went home on a weekend with a family member. It happened then," she said.
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The birth raises questions about care levels in these facilities
Both Teaster and Plummer were suspicious of reports that say the staff had no idea the patient was pregnant until she went into labor. Teaster said "it doesn't pass the sniff test."
"I'm confident that people didn't know, but somebody knew. Something is amiss there," she said.
If no one truly did know that the woman was pregnant, Plummer said it's indicative of the kind of care she was receiving.
"It seems off that all of a sudden they are surprised that she is giving birth, which says that the level of care that this patient was receiving was really the bare minimum," Plummer said.
INSIDER uncovered at least two other disturbing incidents from the facility's past. In 2017, Hacienda was cited when a female nurse walked in on a male patient bathing, and in 2013, a staffer was fired for making inappropriate sexual comments about several patients.
Teaster and Plummer say these kind of incidents are common at such facilities because the jobs are hard to fill. Teaster said several states have also tried to make it legal to hire ex-felons for these jobs.
And like other kinds of abuse, some people out there specifically work at these facilities to target vulnerable people.
Plummer said these predators look for places where they know "individuals are going to be vulnerable."
The issue with these care facilities, Plummer said, is that administrators rarely report such abusers to the police because they're worried about the negative attention the business will get.
"The problem is that they don't want to highlight it because then nobody else would put their family there and they won't make money. So they quietly dismiss the person and then that person goes on to abuse other individuals at a new setting," Plummer said. "The patient is not the priority, unfortunately."
But predators aren't the only issue. Overworked and under-trained staff can also hurt patients, Plummer said.
"If you let somebody sit in their diaper for five hours, is that abuse? I would say it is because it’s neglect," Plummer said. "But these individuals aren't taught well enough to understand what these kinds of things are that they should avoid. They're not trained."
Another issue that Teaster pointed out is that some of these workers don't see the patients as equals.
"There is a population of people who don't respect the dignity of people for whom they see as less than human," she said.
Teaster said these kind of abuses can happen "at any kind of facility," no matter how well-funded they are.
Plummer agrees.
"Having affluence will not protect a person with disabilities, especially if they are particularly vulnerable," she said.
This means that people who have a disabled loved one should be careful if they are looking to place them in an institution, Plummer warned.
"I would be very hesitant to put somebody into an institution unless I was very close to that institution and I visited on a regular basis, because there are so many people coming in and out of the room and taking care of my loved one," she said. "I want to know that they're safe and I cannot assume and I cannot rely on the fact that the people that work there have my loved one's best interest at heart."
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Preventing future abuse
A first step for making these facilities safer for patients is to focus on the staff, adding training and increasing pay so "that there's incentive to do your job and to do it well," Plummer said.
She also recommended a database be started to track employees who have been fired for mistreating patients, so they can't simply move to a new facility to start abusing all over again.
She said that if the person who assaulted the Arizona patient isn't caught, it's likely that they're a worker who's already moved on to another facility.
Teaster mentions increasing the ratio of staff to residents and starting at a young age to teach kids that people with disabilities should be respected.
Both Teaster and Plummer say there needs to be more oversight at these centers.
"People need advocacy if they are going to be in a facility," Teaster said. "They need advocates, they need people who come and go, who watch for them, because the majority, many of them, are understaffed and overburdened. And when you're understaffed and overburdened, care and monitoring are not optimal."
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What is a vegetative state?
Since the story broke, many have confused a vegetative state with being in a coma. They are not the same thing, University of Washington neurologist Dr. Claire Creutzfeldt told INSIDER.
A coma is a period of unconsciousness and unresponsiveness that a person enters into immediately after sustaining a serious brain injury. Eventually, this person will either die, gain consciousness again, or transition into a persistent vegetative state (PVS). Some people may eventually regain consciousness, but that chance deteriorates over time, according to the Brain Foundation.
PVS is different from being in a coma in that a person may open their eyes or respond to some triggers. But there is still no thought going on in their head and they should not feel pain, Creutzfeldt says.
Read more:A woman in a nursing home gave birth while in a vegetative state. Here's what to know about the condition.
Creutzfeldt said someone in a vegetative state can improve and enter into a "minimally conscious state." The issue here is that it's sometimes hard to figure out whether someone is in a PVS or has regained some consciousness, especially if they still have no control over their movement.
In August, the American Academy of Neurology released a new set of guidelines for how to treat people in a PVS, after multiple studies found that about 40% of patients are misdiagnosed as vegetative when they actually have some cognitive function.
One of recent study from 2014 had 13 patients diagnosed as vegetative take a special MRI that created an image of their brain function when responding to questions. These scans were compared with the brain images of healthy individuals. When the vegetative patients were asked to visualize playing tennis, four of the patients' brains lit up in a way that was similar to the healthy individuals.
That adds another layer to the case. If true for this patient, it means that she may have felt the assault and even know who her attacker is.
But there's almost no chance that she will one day regain consciousness and be able to identify her attacker. Creutzfeldt says the chances of regaining consciousness after being in a vegetative or minimally-conscious state for more than a decade are very slim.
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