• A woman with severe intellectual disabilities gave birth in December after being raped at a Hacienda HeathCare facility.
• Her family has now filed a notice of a $45 million claim against the state of Arizona for poorly monitoring the facility.
• According to the claim, the staff disobeyed the family’s wishes to have a female-only care staff and missed at least 83 opportunities to diagnose the pregnancy.
• The documents also claim that the woman was violated repeatedly and may have even been pregnant one other occasion prior to this incident.

Possible Lawsuit

According to a newly filed claim, the severely intellectually disabled woman who gave birth last year after being raped at a Hacienda HealthCare facility may have been pregnant at another point in the past.

The family of the woman has filed a claim against the state of Arizona for doing an “abysmal job” monitoring Hacienda HealthCare. The private facility houses patients that are paid for by the state’s Medicaid program and its cases are also managed by the state.

Background

On December 29th, the severely intellectually disabled woman gave birth, which shocked her family members and captured nationwide attention.

According to the woman’s medical records, she is nonverbal and has no functional use of her arms or legs. She had received care at the Hacienda HealthCare facility since she was three years old and was seemingly unaware of the fact that she was even pregnant.

After an investigation, one of the woman’s caregivers, licensed practical nurse Nathan Sutherland, was arrested and charged with sexual assault and abuse of a vulnerable adult. He has since pleaded not guilty, but did voluntarily gave up his nursing license.

Multiple people, including the CEO of Hacienda HealthCare, stepped down after the news broke and the facility is now being overseen by the Arizona Department of Health Services.

New Claims

According to the notice of claim, the family had requested for the woman to have female-only care staff because of her vulnerability. However, male staff members were repeatedly allowed in her room unsupervised.

This request was apart of her ISP or Individualized Service Plan, which the facility is required to follow. Despite this, according to the claim, Sutherland provided care for the victim more than 1,000 times, including more than 800 times overnight.

The notice also says that the facility repeatedly failed to notice that she was pregnant and even denied her food in an effort to get the victim to lose weight. Because of this, the claim states that she gave birth, “without any pain medication and in a state of malnutrition.”

According to the claim, records indicate that staff at Hacienda missed at least 83 opportunities to diagnose the victim’s pregnancy. Those opportunities include:

• Missed menstrual periods.
• 10 visits to a physician during the victim’s third trimester.
• Three instances where staff noted a large and hard mass in her abdomen.
• 24 instances where staff noted her abdomen was “sticking-out.”
• Noted weight gain at least eight times between September and December 2018.
• 12 instances where staff noted that her feet and legs were swelling.

The claim also cites a note from the Maricopa County Medical Center, who examined the victim after she gave birth. That note states: “On inspection of patient’s vagina and introitus it is determined that this is a non-nulliparous event.” This means that the victim may have been pregnant prior to this incident.

The notice of claim seeks a $25 million settlement for the victim and $10 million each for her parents. If the family and the facility do not come to an agreement within 60 days, the lawyers will take the case to court.

See what others are saying: (NPR) (AZ Family) (CNN)

• A judge has allowed the parents of a deceased West Point cadet to use their son’s sperm for reproductive purposes.
• The family claims their son long dreamed of having kids and says this will allow for his legacy and family name to be carried on.
• The ruling has raised several ethical concerns over whether or not it is okay to posthumously reproduce without someone’s consent.

Judge Rules That Sperm Can Be Used

A New York Supreme Court justice ruled that the parents of a West Point cadet who died in March can retrieve his sperm and use it for reproductive purposes.

Peter Zhu was injured in a skiing accident in on February 23. Four days later, the 21-year-old was pronounced brain dead.

However, because Zhu was an organ donor his body was kept alive for a few more days. During this time, his parents, Yongmin and Monica Zhu received a court order that allowed for his sperm to be retrieved as doctors were removing his organs for donation. At this time, it was unclear if they would actually be able to use the sperm.  

Mr. and Mrs. Zhu claimed that it was their son’s wish to have children. They said that using his sperm would allow for the family name to be carried on and keep their son’s legacy alive.

In the judge’s ruling, there are several claims that Peter Zhu would often talk to his parents about “his dream of having several children, and the responsibility he felt to carry on his cultural and family legacy.”

On May 17, Justice John Colangelo granted his parents the right to use his sperm.

“At this time, the Court will place no restrictions on the use to which Peter’s parents may ultimately put their son’s sperm, including its potential for procreative purposes,” he wrote in the ruling.

As of now, it is unclear what kind of plans Mr. and Mrs. Zhu have for using the sperm, and it looks like they might wait before using it.

Justice Colangelo added in his ruling that when and if they choose to use it, it would not tarnish their son’s legacy.

“Should his parents choose to do so in the future, it would not do violence to his memory,” he wrote.

Case Raises Questions of Ethics

This ruling raised questions many have been asking for a long time regarding the ethics of posthumous procreation.

The first posthumous retrieval of sperm was reported back in 1980, and the first birth as a result of the process was reported almost two decades later in 1999. Since these cases, many have questioned whether or not consent from the deceased should be required before using their genetics to reproduce.

In Zhu’s case specifically, his parents did not have his direct permission to use his sperm in the event of his death. However, Mr. and Mrs. Zhu cited a paper he wrote at school, where he said his dream in life was to get married, have kids, and pursue a career in the military.

Several reports have been written over the years on this topic with differing opinions as to whether or not this would be enough consent to carry out the process.

A peer-reviewed journal report published in the year 2000 called Human Reproduction noted that there are grey areas.

“Written consent or verbal consent documented by a health care provider is not an absolute requirement, although such documentation would be desirable,” the report concluded.

The report did expand upon its point and acknowledged that while family members might have conflicts of interest when it comes to using the sperm, there are still cases when it could be ethical.

“It is possible that in some cases a reasonable inference can be made if the patient has previously discussed these matters with family members,” the report continued.

However, a 2018 ethics report from the American Society for Reproductive Medicine emphasized a stronger need for consent.

“Posthumous gamete (sperm or oocyte) retrieval or use for reproductive purposes is ethically justifiable if written documentation from the deceased authorizing the procedure is available,” their report says.

But it goes on to make one exception, saying “In the absence of written documentation from the decedent, programs open to considering requests for posthumous use of embryos or gametes should only do so when such requests are initiated by the surviving spouse or partner.”

In most cases where someone asks to use a sperm or embryo posthumously, the request is usually coming from a surviving spouse. However, Zhu’s case is not the first involving a request from parents.

In 2007, a court in Iowa granted a request by parents to retrieve their son’s sperm so that they could donate it to their son’s fiance.

A judge in Texas granted a mother the right to have her son’s sperm retrieved when he died at the age of 21 in 2009. She intended to hire a surrogate to carry his child.

Next Steps for the Zhu Family

Now that a judge has made a ruling, there are several steps for Mr. and Mrs. Zhu to take that could be complicated.

According to the New York Times, finding a surrogate willing to carry the baby may not be easy. The same goes for finding a fertility clinic willing to give the sperm to the surrogate so the baby can be raised by its grandparents.

The Times also reported that some hospitals have restrictions on how long they are willing to hold the sperm of a deceased person.

But Westchester Medical Center, which is in the county the ruling was given in, gave a statement to the Washington Post about the situation.

“From time to time, like most hospitals, Westchester Medical Center is presented with complex legal and ethical situations where guidance from the court is appropriate and appreciated,” they said before adding that they are “grateful the family sought a court order during such a difficult time.”

See what others are saying: (New York Times) (TIME) (Washington Post)

• Senator Josh Hawley has drafted a bill that would ban the sale of loot boxes and pay-to-win microtransactions in games that target or are played by children.
• Two of his Democratic colleagues have signed on in support of the legislation, arguing that the features prey on minors and essentially serve as casinos for kids.
• Meanwhile, industry leaders argue that the features do not constitute gambling and say parents already have the ability to prohibit in-game purchases with parental controls.

The BIll

Senator Josh Hawley (R-MO) formally introduced a bill on Thursday that would ban the sale of loot boxes to children.

Hawley’s bill is called “The Protecting Children from Abusive Games Act,” and if approved it will restrict video game companies from including loot boxes or pay-to-win microtransaction in games that target children or are “played by minors.”

The bill calls for financial penalties should a gaming company violate these rules. “Only the addiction economy could produce a business model that relies on placing a casino in the hands of every child in America with the goal of getting them desperately hooked,” Hawley said of the features.

He has teamed up with two Democratic lawmakers, Senator Ed Markey (D-MA) and Senator Richard Blumenthal (D-CT) on this legislation, saying “I’m proud to introduce this landmark, bipartisan legislation to end these exploitative practices.”

“Today’s digital entertainment ecosystem is an online gauntlet for children,” Senator Markey said. ”Inherently manipulative game features that take advantage of kids and turn play time into pay time should be out of bounds.”

“I’m proud to sponsor this bipartisan legislation to protect kids from predatory gaming apps and hold bad actors accountable for their reprehensible practices,” Senator Blumenthal said.

“Congress must send a clear warning to app developers and tech companies: Children are not cash cows to exploit for profit.”

Loot Boxes and Microtransactions

The bill will specifically focus on loot boxes and pay-to-win mechanics. Loot boxes are often incorporated in both free and paid games. They offer players randomized rewards for spending money. Meanwhile, play-to-win microtransactions typically take two forms.

In some instances, game designers create games with difficult paths to entice players into spending money on upgrades to progress further in the game. Many times, these games are free to download, which initially draws players in and allows them to become invested in the game before it becomes more challenging.

In other cases, game engineers create multiplayer games that offer players the chance to purchase upgrades or competitive advantages over other players.

Are Industry Leaders Concerned?

Calls for regulation of loot boxes and pay-to-win mechanics have increased over the last several years. Especially as loot boxes have become increasingly popular features in mobile games and larger games produced by companies like Blizzard and Electronic Arts.

Last fall, the Federal Trade Commission said it would investigate loot boxes following a letter from Senator Maggie Hassan. That letter was written after a string of games in 2017 featured heavy usage of microtransactions. This was seen in games like Middle-earth: Shadow of War and Star Wars Battlefront II.

While some companies have pulled back on the practice, popular games like Overwatch, FIFA, and Apex Legends continue to make huge profits off of randomized microtransactions. However, some countries have taken a stand against these features. Earlier this week, Nintendo was forced removed two games in Belgium for violating the country’s loot box regulations that treat loot boxes as an illegal form of gambling.

In a recent interview with Kotaku, Hawley admitted he is not a gamer, but said that the idea for the bill came from “being a parent of two little boys,” and from “talking to a lot of parents” who were suddenly seeing several charges on their cards after purchasing games for their kids.

Kotaku’s Jason Schreier asked if Hawley had spoken to industry leaders about the bill. Here’s how that conversation went:

• Schreier: Have you been in conversations with the ESA, the video games lobbyist group, or any other video game companies about how this might impact them?
• Hawley: Yes, yes we have.
• Schreier: Can you describe the nature of those conversations?
• Senior policy advisor Jacob Reses: This is Jacob here. I think it’s fair to say the industry has concerns about this… We’ve been trying to be very transparent with them, but there may be some difference of opinion.
• Hawley: Jacob’s being very diplomatic.
• Schreier: Yes, any elaboration you can make here? I ask because I pay a lot of attention to these financial calls that these companies have, and EA for example is very reliant on the loot box income that comes in from FIFA games. A lot of these companies are very reliant on this stuff.“
• Hawley: And FIFA would indeed be covered by this legislation, to be clear. They’ve certainly expressed their, shall we say, concern over this legislation. But I think that’s probably a good indication that we’re getting somewhere.

The bill will likely face pushback from industry leaders who have stood by their use of microtransactions. Earlier this month after Hawley announced his plans for the bill, The Entertainment Software Association, the video game industry lobbyist group, sent over a statement to Kotaku saying:

“Numerous countries, including Ireland, Germany, Sweden, Denmark, Australia, New Zealand, and the United Kingdom, determined that loot boxes do not constitute gambling. We look forward to sharing with the senator the tools and information the industry already provides that keeps the control of in-game spending in parents’ hands. Parents already have the ability to limit or prohibit in-game purchases with easy to use parental controls.”

See what others are saying: (Kotaku) ( (The Verge) (The Gamer)