A near-drowning had left the woman in a persistent vegetative state for nearly a decade.
Her universe consisted mostly of a room at a Phoenix Hacienda HealthCare facility where she received round-the-clock care. So when she went into labor a few days after Christmas, her caretakers were flummoxed.
"From what I've been told, she was moaning," an unidentified source told Phoenix CBS affiliate KPHO.
"And they didn't know what was wrong with her. … None of the staff were aware that she was pregnant until she was pretty much giving birth."
On December 29, with help from one of the facility's nurses, the patient gave birth to a healthy baby boy, KPHO reported.
The birth - and the sexual assault of a vulnerable individual that must have preceded it - has cast a harsh glare on conditions at a nonprofit organization that bills itself as a leading provider of health care for Phoenix's medically fragile.
A Phoenix police spokesman told The Washington Post that the department is investigating but did not release details about the case. A police report and 911 calls were also not available Saturday.
Hacienda HealthCare, which has 40 programs that serve more than 2,500 people a year in Arizona, according to its website, did not immediately respond to calls and messages seeking comment.
But amid the firestorm that has engulfed it in the first week of the new year, the organization has released two statements, vowing to determine what happened.
"As an organization, Hacienda HealthCare stands fully committed to getting to the truth of what, for us, represents an unprecedented matter," David Leibowitz, spokesman for Hacienda HealthCare, said in a statement.
The statement added that Hacienda is "already conducting a comprehensive internal review of our processes, protocols, and people to ensure that every single Hacienda resident is as safe and well cared for as possible. Anything less than that is unacceptable to our team, our company's leaders and the communities we serve."
No one has been arrested in connection with the incident, and it's unclear whether police have identified any suspects. In Arizona, sexually assaulting a vulnerable adult is a felony.
Karina Cesena told Phoenix independent news station KTVK that she is sleeping in her 22-year-old daughter's room at the facility until the assailant is found.
Cesena's daughter has a traumatic brain injury that causes hundreds of seizures a day.
"I do not [know if my daughter was victimized], but I do ask her, and she can answer yes or no," Cesena told the news station. "She is not able to walk or talk yet, but she does understand."
About Hacienda HealthCare, Cesena said: "Trust has been broken. Trust has definitely been broken."
Other family members of patients told the news station that they'd noticed more security guards and a new protocol requiring male staffers to be accompanied by female staffers if they go into a female patient's room.
Arizona Gov. Doug Ducey's office released a statement saying the reports are "deeply troubling."
In addition to working with police, the state is "reevaluating the state's contract and regulatory authority as it relates to this facility and have been working closely with state agencies to ensure all necessary safety measures are in place," Patrick Ptak, a spokesman for the governor, said in a statement.
The state's Department of Economic Security dispatched a team to conduct health and safety checks at the facility, and the Department of Health Services has beefed up safety measures: more staff, increased monitoring and stronger security.
Hacienda HealthCare was founded five decades ago. Then, it was called Hacienda de los Angeles, or "the dwelling of the angels." Hacienda HealthCare over time became the umbrella for several programs in the Phoenix area that treat chronically ill infants, children and adults.
There have been reports of patient mistreatment. For example, an investigation in 2013 found that a staff member had made "inappropriate, sexual statements" about four clients. The staff member remarked that one client with intellectual disabilities had been placed in a sexual position.
The worker had also been observed watching clients touch themselves. The alleged incidents weren't reported to the facility's administrators until a month after they occurred.
That staff member was ultimately terminated, but the state found that the facility "failed to ensure clients . . . were treated with dignity."
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