Sexual assault may be suspected by behavior changes

How do sexual predators gain access to vulnerable patients? They may come in the form of an employee, visitor, staffing agency employee, or patient. The healthcare facility is obligated to know who it hires to provide care. Criminal background checks are required to identify sexual predators.

We have seen cases involving the sexual assault of elderly men and women, critically ill patients, and young females in a psychiatric facility. While some sexual assault victims can report the incident, the elderly confused nursing home resident may not be able to articulate what happened. We have seen sexual assault detected by physical signs:

• semen in female urine specimens
• vaginal or rectal tears and bleeding
• fractures from resistance or assaults to subdue a patient
• bruising or rope burns, particularly on the wrists or ankles
• facial fractures, particularly of the teeth or jaw
• troubled sleep and disturbing dreams
• behavior changes when a certain person is around
• torn, stained, or bloody underwear
• injuries in various stages of healing or that are not readily explained
• difficulty walking or sitting due to genital discomfort
• withdrawal, anxiety, depression

The data is only beginning to emerge for this population, but it is known that some cases of sexual assault go unreported. The real extent of elder sexual abuse remains unknown. The importance of diligence of staff in identifying, reporting, and preventing occurrences cannot be understated. The nursing home population is very vulnerable for several reasons. A resident is dependent upon the staff. Cognitive or functional impairment can result in a resident not being able to voice what happened or appropriately describe what occurred. Sadly, some residents mistake abusive caregivers for visitors including a family member such as their husband or wife, or a suitor; they mistake the abuse for affection.

A Maryland woman was suffering from Alzheimer’s disease. She was allegedly raped by another resident, and additionally suffered a physical assault on multiple occasions at the hands of other residents. After her sexual assault, she was taken to a hospital for a post-rape medical workup. She also suffered psychological injuries from her mental deficits. The plaintiff alleged the nursing home violated its standard of care in failing to provide adequate security to protect the patient from other assaultive residents and from herself. The defendant denied liability but agreed to settle the case for $800,000.

A seventeen-year-old physically disabled female suffered posttraumatic stress disorder after she was raped by a nonparty while she was a patient in the defendant nursing home. The plaintiff contended that the defendant failed to appropriately supervise safety and security, and failed to provide the proper standard of care. The defendant settled for $1.5 million compensatory damages. The defendant denied liability. Plaintiff, pro ami v. Reliant/Care Four Seasons Nursing Home, MO, Petis County.

As many residents are cognitively impaired and unable to communicate what has occurred, nurses are expected to make careful observations, document behavior, and report any suspicions of sexual abuse to authorities and to the family. The nursing home should have protocols regarding the collection and preservation of evidence such as bed linens and the patient’s clothing. We were involved in one case in which the nursing home staff disposed of a bloody diaper and gave the resident a complete bath before sending her to the hospital for a rape examination. They rendered the evidence useless. We know of another case in which the husband of a resident sexually assaulted the roommate.

One prevalent misconception about rape is that it is sexually motivated. In the American culture, older people tend not to be considered attractive, so many people will ignore or disbelieve an older woman who says she has been sexually assaulted. The police are expected to involve a Sexual Assault Nurse Examiner (SANE), if available, to use the rape kit to provide evidence to the police.

Sexual assault cases pose proof issues. Many cognitively impaired residents cannot describe what happened. It may be impossible in some cases to determine the identity of the assailant. Nevertheless, the facility has an obligation to protect residents, screen out predators, and correctly report sexual assaults.

These cases often bring large verdicts because the fact patterns are so abhorrent to juries.

Med League provides nursing experts for Nursing Malpractice cases. Call us for assistance.