Are We Safe? Disability and Sexual Assault in Nursing Facilities & Other Institutions

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Erin Vallely

***TW: caregiver abuse, sexual assault, rape, facilities, various disability/medical references***

On December 29th, 2018, authorities were called to Hacienda HealthCare long-term care facility in Phoenix, Arizona following a report of a patient giving birth.  In the released 911 phone call, staff at the facility admitted they “had no idea this patient was pregnant.”  After authorities arrived, they immediately began investigating what is now known to be the rape of a disabled 29-year-old San Carlos Apache woman, who has lived at the facility since she was three years old.  In a press conference by the Phoenix police department, it was announced that after weeks of investigating and DNA testing, 36-year-old Nathan Sutherland, a licensed practical nurse (LPN) who worked at the facility, was arrested and charged with the crime.  He currently faces one count of sexual assault and one count of vulnerable adult abuse, although that could change as the investigation continues.  As a disabled individual who relies on other individuals for all of my care, and as someone who will likely end up in a facility at some point, this entire situation is terrifying. 

The Situation

According to the Hacienda HealthCare website, it provides “specialized medical care and social services for Arizona’s infants, children and young adults who are medically fragile or chronically ill, including those with developmental disabilities.”  While it was previously reported that the 29-year-old woman is in a comatose, or persistent vegetative state, a local Native American news outlet disputes that characterization.  The article explains that in the most recent medical report filed with the court, the victim weighs 112 pounds, relies on a ventilator for her breathing and a gastrostomy tube (also called a G-tube) for her nutrition and is listed as having a brain injury, seizures and recurrent pneumonia.  Her family states that while she does not speak, she has some mobility in her limbs, head and neck, responds to sounds, voices and faces she recognizes, can make facial gestures, responds to basic things with her eyes and enjoys being read to and listening to music.  However, her disabilities by law classify her as “incapacitated” and “unable to make any decisions or give consent due to her disability.”  Therefore, she relies on the staff at Hacienda HealthCare for all of her personal and medical needs.  By law, due to her “incapacitated state”, she is not able to consent to any sexual activities. 

Some sources report that DNA samples were taken from all male staff that work at Hacienda, while others say only specific suspects were tested.  At the time of the attack, Sutherland was one of her primary caregivers and his DNA was a genetic match to the infant’s.  The Maricopa County Superior Court commissioner set Sutherland’s cash-only bond at $500,000, that, if paid, would still require him to wear an electronic monitoring device until his sentencing.  Sutherland’s attorney has requested a lower bond because his client does not have a criminal record and claims there is not enough evidence against his client, despite the matching DNA test results.

Since the investigation started, several key figures at Hacienda HealthCare have either departed or been disciplined, including the CEO. The organization also reports that one doctor has resigned, and another has been suspended.  One television news station reported that the state has ordered sexually transmitted disease and pregnancy tests for every resident, to find out whether this was an isolated incident or not.  The organization must also bring in an outside manager to handle the facilities operations, at least temporarily, and allow an external audit and review of all policies and procedures.  Already announced are measures to increase security by adding cameras to hallways and implementing a visitor policy with identification badges.  As for the 29-year-old and her baby, both are fine and the baby will be cared for by the woman’s family.

Disability and Sexual Assault

Unfortunately, this woman’s experience is not unique.  According to a report by the U.S. Department of Justice, as of 2015, disabled individuals were 2.5 times more likely to be victims of violent crimes than non-disabled individuals.  Disabled individuals experience rates of rape and sexual assault 3.5 times higher than those without disabilities.  Additionally, 83% of women with disabilities will be sexually assaulted at least once within their lifetime.  The results show that people with intellectual disabilities – women and men – are the victims of sexual assaults at rates more than seven times those for people without disabilities.  All these statistics exclude individuals living in institutions, such as group homes and nursing facilities, like Hacienda HealthCare.  However, a report by CNN investigated nursing home assaults and its findings support those of non-institutional reports of abuse.  The report explains that although facility abuse information is frequently available in separate reports, there is no comprehensive, national data on how many cases of sexual abuse have been reported in facilities.

Many sexual assaults and rapes committed against disabled individuals are by a caregiver they have learned to rely on and trust to help them in their day to day lives.  A significant number of these cases are not reported, or prosecuted, because individuals feel they cannot risk losing their support person, are manipulated by the attacker into thinking the action(s) were acceptable, or because the victim is unable to give investigators enough information to build a solid case.  This allows the perpetrator ample opportunities to repeatedly abuse the victim.  The hashtag #DisabilityToo on Twitter, started by Rooted in Rights, connects to the #MeToo movement by focusing on disabled individuals stories about sexual abuse in an effort to bring recognition to the issue.

Personal Connection

Medical facilities are supposed to be places where patients are well cared for and safe.  The 29-year-old San Carlos Apache woman had lived in the facility since she was a child and has since relied on the staff at Hacienda HealthCare to take care of her and ensure her health and safety.  If she had been getting the proper care, by all the staff, someone should have noticed that something was not right.  Every medical professional needs to be trained to recognize abuse and assault.  As a quadriplegic young woman, with very similar physical needs, it scares me to know that even in a facility I would not necessarily be safe from this type of abuse.  National data must be collected regarding facility abuse so we can work to identify better policies and procedures to ensure individuals with disabilities safety. 

While a major issue is improper oversight, the fundamental issue is the abuse of an individual’s power over another human being.  In our society, medical professionals and caregivers hold tremendous power and all too often take advantage of their position.  When we hear of caregiver wrongdoing, it creates distrust within the entire institution.  Although caregiver abuse is committed by both women and men, men only make up a little less than 10% of the nursing population.  I’m concerned that the actions of Nathan Sutherland will negatively impact trustworthy male caregivers and nurses at facilities like Hacienda and beyond.  I fear that they will be even more likely to be unfairly judged, treated and distrusted because of the inappropriate actions of a problematic male nurse.

Being in the hospital for a month this past summer, I had several male nurses and respiratory therapists and they were all wonderful. As a disabled individual, I am privileged to live at home in my community.  With this privilege comes the right to decide who helps me.  Before I left the hospital, I asked a few of the nurses if they wanted to work with me at home, including a man who was one of the best nurses I had.  He’s the only male nurse I have ever had at home, but since it was my decision to ask him if he would be willing to work with me outside of the hospital, I felt confident about it.  We already had a good relationship and I trust him completely.  

When someone lives in a facility, they do not have the autonomy to choose who takes care of them.  Whoever is on staff that day is who they get.  Everyone deserves the opportunity that I have – to hire the people they choose to help them.  A current bipartisan and bicameral bill entitled the Disability Integration Act, will ensure that people with disabilities have a right to live and receive services in their own homes, whenever possible.  We must encourage our government representatives to pass this legislation, in order to protect individual’s autonomy and safety.  Although not a guarantee, it is possible if the woman had been able to receive the care she requires in a home setting, this crime might not have occurred, or, at the very least, it would have been noticed before she went into labor.

Erin Vallely lives with a rare form of muscular dystrophy and is a proud wheelchair user. Having graduated with a B.A. in Sociology and Anthropology with a Spanish minor from Wells College in Aurora, NY, she will soon pursue her Masters with a focus on disability rights, advocacy, and policy. In her spare time, Erin enjoys reading about other people’s experiences, supporting other minority groups, and traveling. 

Published on January 29, 2019