An incapacitated female patient in Arizona who gave birth although no one at her long-term care center realized she was pregnant was "violently and repeatedly raped" and may have been impregnated before, the family claims in court documents

In a $45 million notice of claim — the first step in a possible lawsuit against the state — the woman's family said that doctors who examined her the day she gave birth found signs indicating that this may not have been the first time she was pregnant.

The examination found lacerations that were old and already healed that were "not caused as a result of this delivery," the court document says.

The woman had been in care at the Hacienda HealthCare facility in Phoenix since she was 3 years old in 1992, after she was diagnosed with brain damage with psychomotor retardation and partial to total blindness, the notice of claim says.

She was 29 when in December 2018 she gave birth to a baby boy.

A Hacienda staff member who had been her caretaker, Nathan Sutherland, was arrested on suspicion of sexual assault and vulnerable adult abuse in January. He has pleaded not guilty to the charges.

The attorney representing the woman and her parents told NBC affiliate KPNX that it came as a surprise to her family that she may have been impregnated before.

"That was the opinion of the person that examined her," attorney John Micheaels said. "At a minimum, there were repeated violations" of her, evidenced by physical scarring.

"How certain anyone is of a prior pregnancy, I don't know," he added.

The family claims the facility failed to realize she was pregnant despite her showing obvious physical signs.

"Hacienda staff failed to accurately assess or diagnose the hardened mass in (the woman's) distended abdomen, her significant weight gain, and swollen genitalia and lower extremities," the document states, claiming caretakers instead treated her for constipation and reduced her caloric intake because of the weight she had gained.

According to the notice of claim, the family believes the woman was raped multiple times and that the sexual assaults could have been happening for months, if not years.

The woman's mother had previously requested that her daughter only be cared for by female employees. The state and the facility agreed to honor the mother's wishes, but did not follow through, the document claims.

The claim seeks a $25 million settlement for the woman and $10 million each for her parents.

The state Attorney General's Office confirmed to NBC News that it received the notice of claim and declined comment, noting that the state is represented in this matter by outside counsel.

NBC News also reached out to Hacienda HealthCare for comment but did not immediately hear back.