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Despite the emergence of the #MeToo movement, we have still seen women’s voices belittled, dismissed, and outright silenced as they’ve testified against the men who have sexually assaulted them, from Bill Cosby’s and R. Kelly’s accusers to the congressional testimony of Dr. Christine Blasey Ford. Imagine, then, the plight of those who so often don’t have a voice. Right now in America, disabled women of all ages and intellectual and physical capacities are being sexually assaulted by the very people pledged to their care and protection—nurses, aides, and other caregivers—often in nursing homes, long-term care facilities and group homes that advertise compassionate and loving care in a home-style environment. Hacienda HealthCare, in Phoenix, Arizona, is one of those places.

It was a shocking story. A young Native American woman who is severely disabled, non-verbal, and incapable of moving on her own, gave birth to a baby at Hacienda HealthCare, a long-term care facility, on December 29, 2018. The woman had been living at the facility since she was 3 years old. Although initial reports described the woman as in a “persistent vegetative state, her family has since clarified that she is not, but has “significant intellectual disabilities as a result of seizures very early in her childhood.”

Though its website portrays a diverse, compassionate, loving home serving “infants, children and young adults who are ‘medically fragile’ or have developmental disabilities,” the story unfolding at Hacienda HealthCare since the initial discovery of the woman’s giving birth paints a starkly different portrait. The panicked call to 911 operators reveals that nurses, who called because the baby was turning blue, weren’t even aware the patient was pregnant.

On January 16, pending investigations, Arizona state regulators, including the Arizona Department of Health Services, ordered the facility to retain a state-approved third-party manager to oversee the daily operations of the facility. They collected DNA samples from male staff who had contact with the woman, and on January 23, Nathan Sutherland, 36, a licensed practical nurse (that is a nurse who provides basic and more intimate nursing care), was arrested on suspicion of one count of sexual assault and one count of vulnerable adult abuse.

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The case raises myriad questions, not the least of all, how this woman’s caretakers—who change and bathe and dress her and tend to her menstrual needs—failed to notice she was pregnant. Though its website portrays a diverse, compassionate, loving home serving “infants, children and young adults who are ‘medically fragile’ or have developmental disabilities,” the story unfolding at Hacienda HealthCare paints a starkly different portrait. The call to 911 operators reveals that the nurses were in a state of panic, unaware that the woman was even pregnant. Equally troubling was that Phoenix police did not initially call the incident a sexual assault—why? “I can’t think of a legitimate reason not to call it what it is,” said former chief sex crimes investigator Bill Richardson. “The woman who gave birth is incapable of giving consent, that means that it’s a sexual assault. It’s that simple,” he said.

In a January 9 statement, the family’s attorney John Micheaels said they were “outraged at the neglect of their daughter,” adding that “the family would like me to convey that the baby boy has been born into a loving family and will be well cared for.”

A week later, after Hacienda was ordered to obtain a third-party manager, Micheaels released another statement to the press from the family, which said in part, “The facility chose not to express any remorse or apology for the inexcusable failure to protect and safeguard their vulnerable daughter.” Hacienda said five days later that the two doctors caring for the young woman were no longer caring for patients. One resigned and one was suspended. The CEO who had been overseeing them all resigned a week after the news broke.

Is this egregious Phoenix case an anomaly? In just the past few months, there have been similar stories in the news reporting incidents of sexual assault of disabled women, often at the hands of a caregiver. In several cases, the rapes were only discovered because the women became pregnant. In October, caregiver Divine Nde Momuluh, 39, was charged with sexual assault of a vulnerable adult after he impregnated a woman with intellectual disabilities at the Minneapolis group home where she lived. In late December, Rusty Lee Love was released on $50,000 bond, but not officially charged in the suspected sexual assaults of three developmentally disabled women for whom he was a ride-provider in Orange County, California.



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Police are currently investigating whether there are other victims.

A Lubbock, Texas maintenance man was charged January 9 with sexually assaulting a disabled woman in her apartment where she is under nearly 24-hour supervision due to the extent of her disability. In a case reported on January 17, a developmentally disabled, nonverbal woman, 23, who cannot move on her own and is fed through a tube, was raped and impregnated at a Pensacola facility for children and young adults. That same day, in Indiana, a man was charged with raping a nonambulatory, disabled woman while her mother was sleeping. He was arraigned on January 20.

If non-disabled women are afraid to report their sexual assaults for all the reasons we have become familiar with, how are the most vulnerable women in our society expected to report?

As these cases show us, women with disabilities, especially intellectual disabilities, are often perceived as “easy targets” because they may be more vulnerable to manipulation and have difficulty reporting the abuse. And the statistics bear this out. In 2017, 77 percent of incidents of rape and sexual assault were not reported to the police. The enormity of that number suggests that within the context of disability, where so many victims may not even have access to language, or where the person they would report it to is the same person perpetrating the assaults (and on whom they are dependent for their most basic care), the number might be perilously close to 100 percent. If non-disabled women are afraid to report their sexual assaults for all the reasons we have become familiar with, how are the most vulnerable women in our society expected to report?

According to Human Rights Watch (HRW), disabled women are at greater risk of being sexually assaulted than other women and are far less likely to be able to get help because they “tend to have lower educational, financial, professional, and social success than both non-disabled females and their disabled male counterparts. Because women with disabilities are more isolated than most under-represented groups, their plight typically has not been addressed. Women with disabilities, therefore, warrant unique attention when examining abuse and violence.”

This means that every aspect of the disabled woman’s life might be controlled by one or more caregivers and there is literally no way for the victim of sexual assault to tell anyone because she has no access to outside intervention. In the Arizona, Florida, and Minnesota incidents, the pregnancies alerted authorities to the rapes. But how long had those women been being victimized? And how many other women might have been preyed upon by the same, or other, caregivers who have yet to be caught?

HRW says disabled women are subjected to forced sex with workers, caretakers, or other residents of group homes; being beaten, slapped, or hurt; forced sterilization or abortions; being locked in a room alone; ice baths or cold showers as punishment; forced medication (i.e., tranquilizers); having to undress or be naked in front of other people; watching other people be abused or hurt; being tied down or put in restraints. The list is harrowing as it is egregious. If these things were being done to a non-disabled person, it would be considered torture. But these are common experiences for disabled women.

The most recent U.S. Department of Justice report on Crimes Against Persons With Disabilities released in 2017 cites the rate of serious violent crime, including rape or sexual assault, robbery and aggravated assault, of people with disabilities as more than three times the rate of assaults on people without disabilities. One in five violent crime victims with disabilities said they believed they were targeted due to their disability. Women are the most frequent victims with at least 60 percent reporting abuse.

And there are 27 million American women who have a disability, with a full 50 percent of women over 65 who have at least one disability, according to the Centers for Disease Control. The DOJ uses the term disability to include limitations such as sensory (vision, hearing), cognitive, self-care, and ambulatory or mobility limitations.

A year-long investigation in 2017 by NPR News’ Joe Shapiro, in partnership with the DOJ, led to a series of reports that aired last January on “Morning Edition” and “All Things Considered,” revealed that people with intellectual disabilities are sexually assaulted at a rate seven times higher than those without disabilities.

Toni Lewis’s* mother was among the statistics. Lewis placed her mother in a long-term care facility after her mother’s early-onset Alzheimer’s when they could no longer care for her without help. Lewis, whose partner is a social worker, said the couple had visited several facilities and finally chose one that was a manageable distance from their home “so I could check in on her and visit a few times a week,” and had the services required for dementia patients.

“Mom goes in and out,” Lewis says about her 68-year-old mother. “She’ll be perfectly lucid and having a conversation with you and then she just forgets where she was in the conversation and even in physical space. We had to move her out of our house because there was no one to watch her during the day and there had already been an incident with the stove being left on and another where she was found wandering in our neighborhood. We couldn’t risk her being hurt.”

Yet that was exactly what happened within her first six months at the nursing home. “Everyone gets the occasional bruise,” Lewis says. “But it seemed Mom was getting a lot of bruises. On her wrists, her upper arms. When I spoke to the nurse about it, she dismissed it as ‘normal from bathing and dressing’ and said some medications made older women more prone to bruising.”

One evening while visiting, Lewis was helping her mother into bed and she saw bruises on her mother’s thigh. When she reflexively reached out to touch them, her mother began crying, and saying, “no, no, no” and rocking back and forth. “I felt sick,” says Lewis. “I went into the bathroom and threw up in the sink. I was pretty sure I knew what had happened and I both couldn’t believe it and didn’t know what to do about it.”

Advocates for the disabled say that most people do not know what to do about sexual assaults in nursing homes and long-term care facilities, especially for victims who cannot speak for themselves. Many victims like Lewis’s mother don’t have the capacity to explain what has happened to them because they have memory problems or limited to no speech. They also may have difficulty understanding or conveying time sequences and thus cannot describe when something happened to them.

In June 2018, the Arc of New Jersey, an advocacy group for disabled people, held a state summit on sexual abuse of disabled adults in New Brunswick, New Jersey. Jessica Oppenheim, director of the Arc’s Criminal Justice Advocacy Program, told WBUR that “offenders are going to look for an easier target. And someone who doesn’t feel they have the right to say anything, someone who may not understand what their rights are, someone who’s not comfortable—or maybe is even afraid to say anything—makes for an easier target.”

Lewis’s mother was moved to a different nursing home and the family filed a lawsuit against the facility where she’d been sexually assaulted. But police explained that due to her mother’s deteriorated mental state, there was no way to determine if a sexual assault had actually taken place, regardless of what Lewis suspected and her mother implied with her behavior.

Like most disabled people with long-term needs, Lewis’s mother had contact with more than a dozen aides and nurses over the course of any given week, who each had intimate contact with her associated with the daily tasks of toileting, bathing, and dressing. Unlike the cases in Arizona, Florida, and Minnesota where there was an actual pregnancy and DNA evidence that would reveal a perpetrator, as the police told Lewis, there would be no way to determine who had been responsible—there, in fact, may have been more than one person. People with intellectual disabilities are at a constant and heightened risk of sexual assault because they are always in someone else’s care and that care is often close contact, solitary contact, and/or semi-intimate. The NPR data shows that unlike most women sexual assault victims, disabled women are more likely to be assaulted by someone they know, and during daytime hours.

Elizabeth Bartlett*, who was physically disabled from advanced osteoporosis, when she entered a nursing home at 58, wants to talk about her experience, but she signed a non-disclosure agreement when she received an out-of-court settlement from the nursing home where she was sexually assaulted. Her assault was at the hands of an Alzheimer’s patient who came into her room one night, believing her to be his deceased wife. There was a financial settlement, but no arrest due to the circumstances of the perpetrator’s own disability. The settlement allowed Bartlett to move in with one of her adult children and hire a nurse to care for her. But she said the experience was harrowing and left her with long-term fear for her safety and her care throughout the remainder of her life.

Bartlett says that the breadth of her physical disability meant that she was “trapped. I couldn’t move, I couldn’t call for anyone.” Her assault happened at night when there were limited staff and no visitors roaming the halls of the nursing home. The man who assaulted her had come into her room while she was sleeping, closed and locked the door, climbed into her bed and raped her, all the while calling her by his dead wife’s name.

She feels the assault was “much worse because this man thought I was someone he loved. I felt that everyone I talked to about it, from the nurses to the police felt that I should consider this man a victim, not a perpetrator. But I was raped. I kept saying this and people said, ‘Well technically, yes.’ There was no ‘technically.’ It was non-consensual, it was painful, it was terrifying for me and I will never get over it. Yet throughout this entire experience I was told I needed to look at the assault from the perspective of the man who raped me because ‘he didn’t think it was rape.’”

Rebecca Cokely, Senior Fellow for the Center for American Progress working on disability policy, says that “the data tells us that four out of five women with disabilities are survivors of sexual assault, yet we rarely hear about it in the media. Part of this is because of the hard to dispel stereotype that disabled people are incapable of engaging in sexual activity or are so undesirable that no one would want to engage with them. The other part is that when it comes to assault, the moment it is discovered that the victim is a person with a disability, the disability shapes how they are looked at as a victim through an ableist lens. If they have a mental health disability, perhaps they gave consent but are now taking it back because they’re unstable? Would the victim be seen as a bad witness because they speak with a stutter, or they’re deaf and would require an interpreter? These false narratives make it difficult for disabled women to feel like they can come forward and report.”

The cases that make news are like Hacienda HealthCare, where there is no way to cover up the crime. But disability-rights advocates, as well as law enforcement acknowledge that most of the crimes committed against the 83 percent of disabled women who are victims of sexual assault go mostly unseen, unprosecuted, and unpunished. The abuser, like Rusty Lee Love in California, out on bond after assaults on three women, is often able to continue to abuse other—or even the same—victims.

Right now, no one knows whether Nathan Sutherland had been abusing other patients because the pregnancy is what incriminated him. Police and prosecutors are often reluctant to take these cases because they are difficult to win in court due to lack of victim or witness testimony. There are several laws being proposed to help disabled people who have been sexually assaulted, but none has managed to get out of state legislatures. In Pennsylvania, House Bill 2321 was submitted in September to help sexual assault victims with intellectual and developmental disabilities get help with testifying against their abusers. In Massachusetts, Bill S. 64 would create a special registry of abusive caregivers, whereby names would go in the registry even if the case isn’t prosecuted. As it stands now, when an allegation of abuse is made, a state agency investigates to see if the claim can be proven. But names of alleged perpetrators are only made public if a prosecutor takes a case to trial.

In December 2018, the Violence Against Women Act, first authorized in 1994, expired, despite Texas Congresswoman Sheila Jackson Lee submitting H.R.6545, the Violence Against Women Reauthorization Act of 2018. A bill tagged to the renewal of the VAWA, the CARE Act (H.R. 5547), was introduced in May 2018 by California Congressman Ken Calvert and stipulates funding to address sexual assaults of women with intellectual disabilities. Due to the VAWA not being re-authorized and the recent government shutdown, this bill and all it would provide is in legislative limbo.

Even though a handful of perpetrators have been caught, we have to wonder how many other disabled women are suffering in silence, unsure—or unable—to voice their pain and recount the violations. The issue of violence against women with disabilities deserves particular focus, as their voices may be lost not only by their marginalization, but also by the particular attributes of their disabilities and the isolation in which those disabilities often place them.”

It is way past time for disabled women to be included in the #MeToo movement and to have their stories told, even if–or perhaps especially because–they cannot tell those stories themselves.