An Arizona woman in a vegetative state who was sexually assaulted and had a baby received a medical exam nearly nine months before giving birth, according to court documents.
The woman's mother, who is her legal guardian, submitted an annual report as required by state law that included results of a physical done April 16 at a Phoenix long-term care facility where the 29-year-old patient lives.
The doctor who examined her found "no change" in her health, according to the form, and wrote that the exam was external only. Police said it appears that none of the facility's staff members knew about the pregnancy until the December 29 birth, a notion that has drawn scepticism.
But it's possible there were no outward signs that would be noticed, especially by staffers who don't work with pregnant patients, doctors say. The woman is described as having tubes to feed her and help her breathe.
While factors remain unknown, such as how far along she was, someone who is fed the same amount from a tube every day might not show any dramatic changes, like a swollen belly, said Dr. C. Kevin Huls, a clinical assistant professor and maternal-fetal medicine fellowship director at the University of Arizona College of Medicine-Phoenix.
The mother could actually lose weight in other places like her face or arms if a foetus is consuming nutrients, too, Huls added.
"A good way to understand it is that really, the baby's going to continue to grow even at the expense of the mum's nutrition," Huls said. "So, her weight may not change because she's not taking in additional calories. There may be changes to her body that are going to go undetected in a chronic care condition or at a facility like this."
The revelation that an incapacitated woman was raped inside a care facility has horrified advocates for people with disabilities and the community at large. The provider's CEO resigned this week, and the state said the centre has made safety changes.
Phoenix police learned of the situation when they received a call on Dec. 29 about a newborn in distress at Hacienda HealthCare facility. Officers launched a sex crime investigation when it was determined the mother was in a vegetative state, police spokesman Tommy Thompson said.
"She was not in a position to give consent to any of this," Thompson said.
The baby and the woman are recovering at an area hospital, and their conditions were not released.
Her family, who are members of the San Carlos Apache tribe in southeastern Arizona, said in a statement through their attorney that they will care for the baby boy.
It's possible the woman won't have any additional long-term complications from giving birth. Women in a vegetative state after accidents or strokes have successfully delivered babies, Huls said.
Phoenix police, meanwhile, have not ruled out any suspects in the assault. They are gathering DNA samples from the facility's male staffers and have appealed to the public for any information.
It remains unclear to investigators if the woman was sexually assaulted more than once.
"I know at least once she was sexually assaulted, which is way too many times," Thompson said.
The Hacienda intermediate care facility specialises in providing around-the-clock care for infants, children and young adults with developmental disabilities or who are "medically fragile."
Since the woman's delivery came to light, Hacienda HealthCare has implemented increased safety measures. They include more than one staff member being present during patient interactions and more scrutiny of visitors.