Incorrect approch to HPV in a news story? Or an over sensitive LJ user?

[josiethefiend.livejournal.com]

The news story behind caught my attention for several reasons, not least of all the horror inspired by the mere thought of someone sexually abusing a disabled person.

Second, the approach to HPV by state officials and the Seattle Times shocks me. What do they mean the other residents tested negative??? How exactly would they claim to have tested the men? And since when does a facility like this one have the money to do HPV screening on a whole group of people? A normal pap alone won't show that a woman doesn't have it, it just means the HPV hasn't caused dysplasia, right?

Asuming that I'm not completely off base here, the misconceptions here anger me greatly as someone with HPV, who strives to educate a few people about it every so often. Anyone else have any thoughts? I'm thinking I may pen a letter to the editor...


Who is disabled woman's rapist? Answer elusive

By Maureen O'Hagan

Seattle Times staff reporter

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ELLEN M. BANNER / THE TIMES

Linda Gravelle holds a photo of her daughter, Jessica, 28, who has been in various types of care facilities since she was about 6.

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ELLEN M. BANNER / THE SEATTLE TIMES

Linda Gravelle: "I know it's not going to be the last time this happens to somebody."

Linda Gravelle got the news in January: Her severely disabled daughter, a 28-year-old with the mental capacity of a toddler, had tested positive for a sexually transmitted disease while living in a Snohomish County group home.

But nearly seven months later, no one knows how Jessica got the disease, and Gravelle isn't convinced anyone has really tried to find out. She says her daughter's apparent rape was brushed aside by nearly everyone she turned to for help.

Part of the problem is new state rules, which have resulted in a bureaucracy that's not geared toward holding perpetrators accountable in homes like Jessica's. It's also because police often see cases involving severely disabled people as unsolvable when the victims can't speak for themselves.

"It's an issue we've had numerous problems with," said Betty Schwieterman, a director of the Washington Protection and Advocacy System, an organization that works on behalf of disabled people.

Even without these problems, the system works slowly. Jessica, who does not share her mother's last name, remained for months in the Everett home where she may have been assaulted. State officials say the delay was because they were working on finding a place for her to live.

If they thought Jessica was at imminent risk of harm, they would have moved her "in a very timely manner," said Shaw Seaman, a manager for the Division of Developmental Disabilities.

But Gravelle wasn't satisfied with that explanation. "Nobody can guarantee me that the person that did this isn't watching her today. Or that he isn't watching someone else," she said.

She understands her daughter's case isn't easy. But she says the way it has been handled shows serious flaws in the system set up to protect the disabled.

"I know it's not going to be the last time this happens to somebody," she said. "I think there ought to be system changes so that people take this seriously."

And thus began Gravelle's mission.

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Evidence of a crime

From the beginning, one thing has been clear: Jessica was the victim of a crime. Because of her disabilities, she isn't considered able to consent to sex — therefore, any evidence of sexual activity is evidence of a crime.

As a baby, Gravelle said, Jessica began having uncontrollable seizures and suffered brain damage after her DPT vaccinations. Today, the seizures continue. Her vocabulary is barely 20 words and she can neither understand nor convey complex ideas. Her disabilities were so profound that Gravelle felt she had to give up caring for her when the girl was about 6, putting her in several different types of care facilities.

Since 1996, she's lived in homes run by Service Alternatives, a company that contracts with the state to care for people with disabilities. Gravelle visits at least weekly.

"She's my big 3-year-old," Gravelle said lovingly, adding that Jessica likes to take walks and go swimming.

In January, as part of a routine exam, she tested positive for HPV, a sexually transmitted disease that can cause genital warts and lead to cervical cancer.

Studies indicate that women with mental or physical disabilities are three to 12 times more likely to be sexually abused than the general population, according to Richard Sobsey, a professor at the University of Alberta who's written numerous books and articles on the subject. In fact, Adult Protective Services (APS) investigates an average of 200 sex-abuse complaints each year in the state involving victims with developmental disabilities. About one of every six of those complaints is found to be substantiated, according to the Department of Social and Health Services.

But for a variety of reasons, those who target vulnerable people such as Jessica are the toughest to hold accountable, experts say. For example, about 40 percent of APS sex-abuse investigations are closed as "inconclusive," meaning investigators are unable to determine whether abuse occurred, or who was responsible.

In Jessica's case, Gravelle is convinced the perpetrator is a staff member, since Jessica doesn't leave home except with her mother or caregivers. (Other residents at the home tested negative for the virus, according to a state investigator.)

Gravelle began her quest with the Snohomish County Sheriff's Office, but they told her they couldn't investigate.

According to Deputy Rich Niebusch, the public-information officer, "it's one of those cases where solvability is a factor" — the victim couldn't tell her story, and it had been three years prior to the January exam since Jessica had had an exam that could have turned up evidence of HPV.

Time, then, has destroyed any DNA evidence the perpetrator might have left behind. Authorities could try to determine whether any staff members at the home also had HPV, but they would need a search warrant to do tests. And that would be nearly impossible to get, given the circumstances, Niebusch said.

Megan Crouse, a social worker at the Harborview Center for Sexual Assault, agreed these investigations are tough. "But that doesn't mean do nothing," she said. "I've heard this before, in these cases of profound disabilities they ... basically throw their hands up."

But Niebusch says there wasn't much else to do. "There's really no leads here," he said.

The sheriff's office did, however, refer Jessica's case to Adult Protective Services, which investigates complaints involving vulnerable adults.

Gravelle quickly shifted her focus to APS, but said they, too, turned her away.

"They told me, 'We don't do this,' " she said. "They didn't say why or who does it instead."

Gravelle, in desperation, left a message on a hotline that takes complaints on behalf of nursing-home residents. Apparently, the complaint made its way to investigators with a state department called Residential Care Services.

RCS in February took over the responsibility of investigating alleged abuse or neglect of the developmentally disabled in homes like Jessica's, known as "supported living" arrangements. Even the sheriff's office didn't know this.

RCS has two full-time staff members to investigate complaints involving the 4,000 people in supported-living homes, Seaman said.

Sheldon Plumer, the RCS manager, said his agency opened a file on Jessica's case in February. They talked with caregivers and examined a variety of records.

A supervisor for Service Alternatives, Karina Briscoe, said they've cooperated. "We're doing everything we can to identify what happened," she said. "We take steps to protect all of our clients."

Gravelle was relieved that somebody finally looked into her daughter's case. But she soon learned that RCS focuses on licensing violations — such things as failing to keep proper medication logs or conduct background checks. So, she wondered, who's trying to find the perpetrator?

"A no-fault deal"?

The investigation has been only half the battle, Gravelle said. She's also frustrated by how long it took the state to find Jessica a new place to live. (Gravelle couldn't move Jessica on her own, because she has to be placed in a home approved to care for her special needs.)

"If this happened in my house, they would already have taken her," Gravelle said. "But since they're paying for the care, it's a no-fault deal."

Seaman, with the Division of Developmental Disabilities, said that if there had been a suspect who was still working with Jessica, he would have been transferred so there would be no contact between the two.

But since the suspect hadn't been identified, Gravelle wondered, how could she be sure Jessica was safe?

It took five months of effort, but on June 23, Jessica moved out of the Everett facility and into a home in King County. Gravelle said it seems like a good fit.

Meanwhile, Plumer's agency made more progress on the investigation, identifying two former workers at the Service Alternatives home who raised red flags. One, Plumer said, stood out because there was a previous finding of neglect against him — drinking on the job. The other, who was previously investigated for emotional abuse, once came back from a trip to the park with Jessica, and she was scraped and disheveled.

Plumer declined to provide their names, but said neither of them still work at the Everett home and that one of them has left the state.

RCS did, however, turn over the names to the Snohomish County Sheriff's Office.

Once again, Gravelle asked them to investigate.

And once again, they said the case is officially closed.

By this point, Gravelle had had enough. It had been five months since her first rejection from them. She decided to pick up the phone one last time, and spoke with a woman at the sheriff's office.

And this time, they agreed to take another look at the case "to make sure everything they could have done was done," Niebusch said, adding, "The outcome, I believe, will be the same."

Comments

[geminigirl]

Please accept my apologies if this is less than coherent, I'm trying not to fall asleep...

The article doesn't say if she had a cancer causing strain or a wart causing strain. In men, the wart-causing strains can often be detected with a visual inspection, or a vinegar swab of the genitals, which will effectively "highlight" the flat warts.

Money to do this kind of testing could come from several sources-without seeing the organization's budget it's hard to say, but anything from insurance to discretionary spending to budget cuts in other areas could provide the funding. Facilities like this often have contracts with labs where they pay very little for analysis. It probably isn't routine to jump in and screen everyone for HPV, but when there's an incident that causes concern like this, the people at risk would be identified and probably screened.

I think the bigger problem here is the lack of ability to care properly for residents that this article describes...there's a failure to figure out who assaulted the woman, the failure to move her promptly when they found out she'd been assaulted, there's the fact that the mother had to chase down someone to even handle her complaint, and that the people who are responsible for it are too overwhelmed to deal with it and so on.

[xdreamsofdramax.livejournal.com]

Couldn't someone in the hospital HAVE a wart causing strain without showing any signs though? A friend of mine has HPV, and never had any genital warts at all for years after she had had sex, but still had the virus and was able to pass it on. So really, that only shows that none of them show any signs of the virus, not that none of them HAVE it.

[marefo.livejournal.com]

Yep, I have the stain that doesn't have warts, and I've maybe had it for about a year. It is a total possibility that someone in the hospital has it and is passing it on to other patients, if the sexual abuse is still going on...that being said, you can have HPV and not know it, aka have it not show up on a pap. That being said I've only slept with two people and I still have no idea who I got it from because it can go undetected for years.

[geminigirl]

Absolutely, it's possible to carry the virus in either the cancer or wart causing strain and spread it and have no warts or symptoms that are visible. It all depends on the immune system. Part of the reason for the vinegar test when there's genital warts suspected are that some types of the warts are flat and the vinegar swabs can help detect that because they change color when swabbed.

[josiethefiend.livejournal.com]

I had a partner for almost a year, who never showed any outward symptoms. About a month after we broke up, I developed warts, without any contact with anyone else. Other girls had the same experience from him; never saw anything weird at all, yet they would develop warts eventually.

It's entirely possible for someone to be a carrier, or to have had one outbreak and no others, but still carry the virus.

[geminigirl]

Oh no question that it's possible, and even probable. The question that I was trying to answer (and it would seem that I did a less than stellar job, and I should stop trying to do that late at night) was about whether it was possible to screen for warts in men, not how accurate or whether it was likely or possible to be an asymptomatic carrier.

[secretbelief.livejournal.com]

The Seattle Times is terrible.
The reporters for the paper usually make up quotes and edit quotes so it will go with their stroy. They do it all of the time with Harborview Medical Center. It's sad.

[geminigirl]

Knowing the reliability of the source is a really important thing. Thank you for pointing that out (I'm completely unfamiliar with the newspapers in Seattle.)

[die-in-a-fire.livejournal.com]

I'm not sure of the technicalities behind this, so I figured I'd ask.

The article said: "Because of her disabilities, she isn't considered able to consent to sex — therefore, any evidence of sexual activity is evidence of a crime."

I'm not saying that it happened, but IF a profoundly mentally disabled man had had intercourse with the woman in question, would that still be a crime? If neither one of them is "able" to consent, how do we know who is the victim? Are both of them victims? Neither? I mean, it certainly could be a possibility.

[frolicnaked.livejournal.com]

From what I know, legally speaking, this is not considered a crime. (Except, perhaps on the part of any staff that may have been supposed to supervise one or both of them. And even then, I don't know that it's an actual crime as opposed to some kind of job-related or civil infraction.) Though it may a good idea for both of them to speak with a counselor (separately) to work through any confusion or discomfort they may be feeling.

("From what I know" means something along the lines of "as the daughter of 2 social workers who serve those with mental disabilities." I can't pinpoint specific sources, especially not at midnight, because most of this comes from perceptions of work-related conversations and teenage summer employment.)

[die-in-a-fire.livejournal.com]

Maybe I just couldn't imagine an employee sexually abusing a mentally handicapped person, but the first thing I thought was: What if it was one of the other residents? I guess other people might not be able to imagine a woman with the mental abilities of a toddler as a sexual being capable of engaging in something like intercourse.

[frolicnaked.livejournal.com]

I think a situation could certainly happen where an employee and/or caregiver sexually abused someone with mental disabilities. However, the more likely situation may be that the caregiver simply neglected to provide the amount of supervision or care necessary for that individual, wherein another resident may have been sexually active with the woman in the article.

In former jobs, I've seen reports of both happen. I certainly don't know enough about this case to make a judgment call here.

[josiethefiend.livejournal.com]

Given that they found two indeviduals working at this home with criminal histories, I think it's way up in the air. It makes me suspicious, though I do fully believe that a criminal past of any sort doesn't necessary mean a criminal present. It just seems to lay out both possibilities for me. Ugh. So disturbing!

[free-me07.livejournal.com]

I think whether or not the actions are criminal (or perhaps punishable) would have to be determined on a case-by-case basis. (I'll note here that I'm a second year law student, and my opinions are nowhere near definitive, but I did some quick research and this seems to be the proper protocol.) It would depend on the mental functioning of the parties involved. If neither party is capable of having the state of mind necessary to commit a crime, then neither could be punished; however, if one party had an IQ that would allow him/her to have the necessary metal state, there would probably be a prosecutable crime. In addition, certain measures might have to be taken to protect others from a person with an IQ too low to create a criminal state of mind if he/she was sexually aggressive (or physically aggressive in a non-sexual way).

Basically, no, from a quick search of a legal database, if neither was able to legally give consent or have an understanding of their actions to the extent necessary to have a criminal state of mind, there might be a crime, but there would be no punishment because the "perpetrator" would be not guilty for reasons of mental disease or defect.

[die-in-a-fire.livejournal.com]

It just left me thinking which one the "perpetrator" would be. We might never know for sure.

[free-me07.livejournal.com]

Unless there was a clear aggressor, it might be impossible to determine. Really, in this situation, the staff should supervise the residents extensively enough to make this a non-issue. If the woman in question has the mental capacity of a three-year-old, she needs to be cared for in the same way that a three-year-old would be. I don't think that, in this case, she would be (or at least should be) alone with other residents without supervision long enough for something like this to happen, so it is likely that she was harmed by someone trusted to care for her.

[josiethefiend.livejournal.com]

That's part of the problem here in my mind. They've considered all the male residents ruled out as possibilities, because the other residents all tested negative for HPV. It is entirely possible that a male resident has HPV, even a wart causing strain, without showing any symptoms. Same for the staff, though I don't remember if it said they had been tested as well or not.

[violet-tigress1.livejournal.com]

Sickened. Just sickened.

[kittybacklash.livejournal.com]

I don't think it's the idea of her having HPV that's the problem it's the idea of how she got it that is causing the controversy.

[josiethefiend.livejournal.com]

I understand that, and I agree that there might be a really, really horrible problem here. But the assumptions made about HPV in the article really disturb me.

[redhawknflight.livejournal.com]

Write, maybe it willdo some good. It can't hurt.

(frozen comment)

[taracnm.livejournal.com]

Excuse me for interupting, but I have a question.
I jus tofund this journal and was wanting to know more about it. I have decided I could get to the right people faster if I posted here so I again apologise for interupting the thought.
I am a Family Nurse Prectitioner and Certified Nurse Midwife, located in Oklahoma working for Indian Health Service. I care for women in all aspects of their lives including pregnant ones, delivering babies, etc. (We have over 350 deliveries here in one month!)
I would like to know more about this journal and offer periodic help if desired. In the past I have gone to providers who spend little time listening, caring for me, etc, and have tried to become a person most women would like to come to. My patients tell me I have become this (I hope so).
Again, sorry for interupting, but I would like to know more!
Let me know!

(frozen comment)

[viellen]

Hey there! You can find tons of information on what VaginaPagina is about on our website, http://vaginapagina.com/ . Basically, we're a community devoted to helping women get factual information regarding sexual-health issues, and anything vagina-related! New members are always welcome, and we'd love to have you! Take a browse through our FAQ and feel free to jump in.

If you have specific questions about the community, we would love it if you could post to contact_vp, rather than replying to this comment. You can also feel free to contact the VP Team directly by shooting an email to vpteam at vaginapagina dot com.

Thanks!
-Rebecca
for the VP Team
contact_vp