Thursday, November 13, 2008

Institutional Rape in Washington State

I haven't posted often about current events while on the road, but this I could not ignore, and you shouldn't either. Anne Sommers forwarded this: I am pissed off all the way from New Zealand! This case is complex but that does not mean it is okay that as a society (as a world) we should remain silent and we should avoid solutions. I think this woman's guardian is right on when at the end of the article she said that we must let the public know what is going on. So here it is....

Voiceless and Abused: Woman allegedly raped by caregiver may have been attacked before


To her attacker, Jamie must have seemed like the perfect victim: blind, nonverbal, infantlike in her mental ability and utterly dependent on her caregivers.

But her body revealed what she could not say -- that someone had raped and impregnated Jamie in her own home. When she miscarried in March, a DNA match pointed to a nursing assistant at Integrated Living Services in Kent.

It wasn't the first time that a nursing assistant at that agency was suspected of sexually abusing Jamie, records obtained by the Seattle P-I show. Two years earlier, a different man was named as a "person of interest" in a police investigation that was dropped for lack of evidence. State officials determined that the agency had followed regulations and required no additional safeguards.

That proved disastrous for Jamie. And it highlighted troubling gaps in Washington's system of protecting vulnerable adults, from questions about whether male caregivers should work alone with vulnerable female clients to the adequacy of state oversight of home care agencies and their employees.

"I feel so betrayed," said Bessie, Jamie's legal guardian, who asked that her last name be withheld and that Jamie be identified by her middle name. "I trusted them with my daughter. They made me guilty, too, because I could not protect her."

Bessie suspects her daughter has been raped not once, but three times, while in the care of state-funded providers.

She first met the tiny, frightened Jamie while working as a school bus monitor in 1976. "This little blond girl screamed and cried every day on the bus. My heart went out to her. I'd hold her hand and walk her in to school," said Bessie, whose own daughter is developmentally disabled.

Jamie, who was in foster care at the time, had a history of neglect and malnourishment. Bessie soon became her foster parent and married the girl's father in 1978. When they divorced, she remained Jamie's legal co-guardian. Bessie is the only mother Jamie knows.

As a teen, Jamie spent more than a year at Fircrest Residential Habilitation Center, an institution for the developmentally disabled, when Bessie was too ill to care for her. During a visit home, Bessie noticed bruising on Jamie's thighs and upper arms. While a medical examination was inconclusive, Bessie believes that she was sexually assaulted.

In January 1983, Jamie moved into supported living in the community with Integrated Living Services, the same nonprofit that would provide services for her for more than two decades. By 2002, she was living in an apartment with two other developmentally disabled clients. The agency provided 24-hour care, hiring nursing assistants who did everything from help with showers and dressing to buying groceries and making meals.

Jamie seemed content in her apartment and grew attached to her regular female caregivers, who indulged her love for spicy Chinese food, popcorn and hand-clapping games. She hummed when happy and shrieked when she was not.

On Feb. 6, 2006, one of Jamie's caregivers noticed odd bruising on her right inner thigh in the shape of fingerprints, according to Department of Social and Health Services and police records.
The next morning, the caregiver found another bruise and scratches on her upper inside arm while bathing Jamie, who seemed moody.

One of the weekend staff members had also reported that she had stripped naked and lain "spread-eagle" on her bed. The agency notified Adult Protective Services. A day later, staff members took her to Harborview Medical Center, where she had to be sedated for a rape exam.
Kent police began investigating.

"It was an awful experience to go through," Bessie said. "The state said, we're sorry, this will never happen again."

The agency's program director, Kenneth Abercrombie, told a detective that they suspected sexual assault because the bruises on Jamie's groin looked "like someone had grabbed her" and, along with those on her arm, could not have been self-inflicted. He said a male nursing assistant had filled in on the weekend night shifts. The man, who was still on employment probation, had just been fired for unrelated "poor performance," Abercrombie said, according to police records.

The rape exam, done at least three days after the man worked with Jamie, found no physical evidence, and police closed the case without interviewing the "person of interest."

An investigator from Residential Care Services at DSHS determined that the agency had followed regulations, from doing criminal checks on staff members to training on how to report abuse. "We didn't find that they were doing anything wrong," said Sheldon Plumer, quality assurance administrator of Residential Care Services.

The state investigator did not look into the allegation against the man. Soon after that, the state began requiring investigations of in-home caregivers named in abuse complaints. Agency staff members told Bessie that the man had returned home overseas.

Convinced that Jamie had been sexually assaulted, Bessie said she asked the agency not to let male nursing assistants work alone with her when her female staff members were off. She said officials balked, saying they could not afford it.

"There's no regulation that males can't work with females," Plumer said. "Under the current guidelines, I don't think there's anything else we could have required of the agency."

In late January 2008, staff members took Jamie to the doctor because she wasn't having regular menstrual periods. She was sleeping a lot and seemed out-of-sorts. The doctor referred her to Harborview because she would need to be sedated for a gynecological exam -- an exam that was never done. No one suspected that she was pregnant or tested for it. They thought she might be pre-menopausal.

On March 18, Jamie began moaning and bleeding so heavily that staff members took her to the emergency room at Auburn Regional Medical Center. Doctors determined that she was miscarrying and notified Kent police. Abercrombie, the agency's program manager, called Bessie with the bad news.

"I was shocked," Bessie said. "This was the second time in two years. I couldn't believe it was happening."

Late that night, the hospital sent Jamie back to her apartment. "All I'm thinking is, you don't take someone back to where they've been raped," Bessie said.

The next day, Bessie had Jamie moved to the Fircrest infirmary. Fircrest sent Jamie to Harborview, where she underwent a surgical procedure. Doctors estimated that she had been 12 to 16 weeks pregnant when she miscarried.

DNA evidence was sent to the state crime lab, and police obtained voluntary DNA samples from at least 10 male staff members who had had contact with Jamie in recent months. Among them was a nursing assistant who had quit less than a month before being charged with second-degree assault for allegedly attacking an autistic teenager at another facility.

Two days after Jamie miscarried, Integrated Living Director Greg Miller wrote an irate e-mail to DSHS objecting to Bessie's decision to remove Jamie from their care. "It is an incredibly violent emotional action for both (Jamie) and our staff," Miller wrote. He said the agency "has taken the correct steps and actions" at every point.

A state investigator again found that the agency had followed regulations. But until a suspect was identified, the state told the agency that male staff members were not allowed to work alone with female clients. On April 7, Miller asked the state to lift the double-staffing rule, saying it was too costly. The state refused.

Joseph Thurura, 31, a nursing assistant, pleaded not guilty in July to second-degree rape. He is being held with bail set at $250,000. On June 17, Kent police got the DNA results and arrested Joseph Thurura, 31, a registered nursing assistant who had worked at the agency since immigrating to the U.S. from Kenya two years earlier. During a police interview, Thurura calmly denied raping Jamie, whom he had worked with occasionally as a "float" for regular staff members. He was jailed with bail set at $250,000 and pleaded not guilty to second-degree rape.

Thurura's attorney, Sandro Parrotta, refused a request for an interview with his client, who remains in jail.

Miller, of Integrated Living, also refused to be interviewed. "Throughout our history we have always done everything we can to hire the most qualified, most trustworthy staff possible, and we will continue to do so," he wrote in an e-mail.

The months since the miscarriage have been tough for Jamie. During one visit with Bessie in September, Jamie was inconsolable, wandering restlessly and making tortured sounds.

"What are you trying to tell me?" Bessie whispered, as Jamie laid her head on her mother's shoulder. "You're not feeling good, are you?" Soon after that, doctors diagnosed Jamie with gestational trophoblastic disease, a serious medical condition in which benign tumors develop from placental cells. Jamie is now undergoing treatment.

No one knows how long Jamie endured the abuse before she got pregnant.

"The obvious question is, if they don't get pregnant, how do we know?" said Dick Sobsey, a Canadian expert on violence and disabilities. "Many of these cases are just never uncovered."

One of the biggest barriers to protecting vulnerable adults from sexual abuse is that "nobody wants to believe it's going on," said Ann Burgess, a professor of psychiatric nursing at Boston College and a national expert on trauma and abuse. "There have to be very strict guidelines. I firmly believe you have to stop the offender. You can't expect the victims to protect themselves because they can't."

That means creating tougher standards for supervision, training and screening of nursing assistants.

To become a registered nursing assistant, Thurura had to take brief AIDS training and pass a national criminal check -- a screening that meant little because Thurura had just arrived in the U.S. on an immigrant visa. To get a green card, Thurura would have had to submit a Kenyan police certificate showing he had a clean record, a State Department spokesman said. The reliability of foreign police certificates varies, according to a 2007 government report.

A ballot initiative that passed last week, Initiative 1029, will boost training for caregivers, including registered nursing assistants, to 75 hours. A second category of certified nursing assistant already requires 85 hours training and an exam.

When problems do arise, disciplinary actions against nursing assistants are rare. Less than 10 percent of nursing assistants have had their licenses revoked since 1998, according to a Seattle P-I analysis of state Health Department data.

Disciplinary actions are increasing, resulting in revocations or suspensions 39 percent of the time over the past year, said Health Department spokeswoman Allison Cook. Sexual misconduct made up 3 percent of the almost 19,000 complaints filed against nursing assistants over the past decade.

Thurura's license was revoked in August.

Where the system failed Jamie was in not putting safety measures in place after the 2006 episode, Burgess said. "Lying with her legs spread on the bed was a red flag," Burgess said. "They are covering themselves by saying they couldn't prove anything."

Officials should have assessed whether using male caregivers was a "reasonable" risk, said Sobsey, a University of Alberta professor. "I really don't think you can say, well, we really just hoped for the best," he said.

Surveillance cameras can deter impulsive abusers, he said. "It might be better to sacrifice a little privacy to protect them," Sobsey said.

The state Attorney General's Office is proposing stiffer penalties for those convicted of abusing vulnerable adults and wants to set up a public database of perpetrators, measures that will go before legislators next year.

Bessie often finds herself in a "cold rage" at what Jamie has endured. She launched a lawsuit against Integrated Living on behalf of her daughter and settled out of court last month for a confidential amount.

But money can't erase the pain. "We have to find a better way to protect people," Bessie said. "The public needs to know what's going on."

P-I reporter Ruth Teichroeb can be reached at 206-448-8175 or


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That's hard because a friend of mine who is also nurse got a similar situation, now she has a sever trauma because the damage the sick man caused her.

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