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Story Publication logo June 15, 2023

“Humiliation, Revolt and Injustice”: From a Hospital Emergency Room to a Courtroom



Journalists investigate the extent of the problem, realizing that there has been frequent situations...

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Multiple Authors

Warning: The following report contains descriptions of sexual violence.

Para ler este relatório em português, clique aqui.

Carlota accused a nurse of sexual abuse in a hospital emergency room. She filed a criminal complaint and was booed, harassed, threatened and mistreated in the city where she had always lived. The nurse was convicted, but only because two other women also reported it. He received a five-year suspended sentence and may soon return to the corridors of a hospital.

Illustration by Rafael Medeiros.

Her sister hadn't heard from her for three hours. It was about two in the morning on that Wednesday when Carlota left the emergency room of the public hospital in a small town in the Alentejo. She got into the car of her sister, Marta, who asked her what had happened. "I woke up in the hospital, but I have no idea what happened," the then 18-year-old answered her, confused.

The way home was short. On a normal day, with no traffic, it would not take them more than 15 minutes to arrive. It was at the traffic circle nearest her home that gave her a flash, she said. She began to remember what had happened to her: a nurse had sexually abused her in the hospital emergency room. "The shortness of breath was tearful, I started screaming, I couldn't even speak properly." Until that day, she had no idea what a panic attack was. "I remember when he started touching my body, I thought, 'I want to die right now.' And I felt a force in me that made me lose consciousness," Carlota says.

It was in 2009 that her sister and brother-in-law left her at the hospital entrance. After being seen in triage — where her symptoms were analyzed — she was given an orange bracelet, because the fact that she couldn't feel her legs "scared" her. In the emergency room, she was taken to a gurney and a doctor gave her an electrocardiogram. The results ruled out any more serious pathology. Then a nurse arrived, went into the emergency room where the patients were lying down, and closed the curtain. He drew her blood and said he was going to inject her with pain medication. Carlota replied "it's okay," but thought it wasn't a matter of feeling pain, because she didn't have any, rather her problem was lack of sensitivity. Carlota was drugged, as was proven in court.

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Carlota filed a criminal complaint a day later. The complaint went to court and resulted in a five-year suspended sentence and 12,000 euros in damages, but she believes she only won the case because the abuser was the subject of another lawsuit by another woman, and for the same reasons. In addition, another witness, who said she had been subjected to similar sexual abuse months earlier, told her story at trial.

These three women did not know or correspond with each other in any way, even though they lived in the same town. But they had three things in common: they were admitted to the hospital emergency room, they were seen by the same nurse, and they have no recollection of what happened to them.

These are three of the 47 women survivors who were sexually abused between 2000 and 2023 that Setenta e Quatro interviewed. Of these 47, only 14 gave us permission to use their testimonies in this research. The remaining 33 stayed with exploratory interviews: the fear and emotional vulnerability they were subjected to in remembering the trauma was enormous. They didn't want to go through it. They did not want to expose themselves, much less denounce their attackers for fear of being discredited. The names of the three women whose story we tell here are fictitious: although they want to tell their stories, so that the consequences of sexual violence against women are known and talked about, they do not want to receive more exposure than they have already had throughout the judicial process.

The nurse gave them benzodiazepines (sedatives). What is the effect? "You get blocked." Carlota explains that there is vision and hearing, but you lose all physical strength. He warned her, "saying that I was going to start feeling light and that everything was fine." The nurse left for a moment and then returned. "He used my hands to masturbate and at the same time he was saying things to me, probably to get himself more excited." He would say in her ear repeated expressions like, "Do you like anal sex? Do you like blowjobs?"

This is the beginning of a long emotional and judicial process. It lasted seven years, but only a few months ago did Carlota stop getting anxious when she passes the now former nurse on the streets of the small town where they live. "I used to wear tops and shorts and I always tended to cover myself up, to cringe all over, but about a few months ago I passed him, got up and didn't do that anymore." She feels that she has been "cured" of her fear.

Carlota, Ana and Joana — the other two protagonists in this story — were subjected to sexual abuse in 2009 by the same nurse. The Istanbul Convention on sexual and domestic violence against women had not yet been signed (it was signed in 2011), there was no Legal Status of the Victim (it was approved in 2015) and there were no figures from the Health Regulatory Authority — complaints were made directly in hospitals and it was only in 2014 that the regulator started compiling data.

Although there is little consistent public data on sexual abuse committed by doctors, nurses, and operational assistants, the case of these three women resulted in a conviction. But they were booed, persecuted and abused in the city where they had always lived. Popular opinion did not believe their stories. "It was unlikely for a nurse to commit acts like this, and it was practically impossible for it to happen in a hospital emergency room," says Carlota.

"An emergency room is, by definition, a very busy place, with people always looking for something or someone, opening doors, pushing aside curtains," explains Mário Macedo, a nurse and coordinator of the Epidemiological and Hospital Public Health Unit at Professor Doutor Fernando Fonseca Hospital, formerly Amadora-Sintra Hospital. But this movement doesn't mean that sexual abuse "can't happen, but it's not such a propitious environment. I would imagine these kinds of situations happening more in inpatient settings, for example."

Although hospitals, in this case emergency rooms, are less propitious places, they are also the ones where there is an easier breach of security, because "we do nights and nights in fact are very particular," says Luís Mós, union representative of the Democratic Nurses Union of Portugal. "There are fewer staff. We manage to work, mostly, on an individual basis."

The beginning of a complaint that led to the conviction

Carlota was advised to drop the complaint by her first, unofficial lawyer. She remembers seeking support that was never reciprocated: "he told me 'this is very complicated, it's not even worth it'". As if that wasn't enough, Carlota recounts, the lawyer also told her, "I'm not going to get involved in that, it's not worth it. You'll have to go to a lawyer to pay for it."

It was the word of a woman, young and sexually abused, against that of an abuser, a male nurse, and no witnesses. These were factors that led the lawyer to walk away from the case, but her new lawyer saw the situation differently: it was an even greater motivation to take the case forward. "I told Carlota that I was going to demonstrate that things were not like that. Even without witnesses, we could prove what had happened to her," says the lawyer, now retired and who accompanied Carlota to the end of the court case. "Very often, the courts acquit abusers for lack of evidence. The only reason he wasn't acquitted there was because the victim put up a fight and presented other cases. It was not something isolated."

Returning to the place where one suffers sexual abuse is "torturous," say the three women survivors of this case. Catarina Barba, a psychologist specialized in Sexual Violence and Post Traumatic Stress, reinforces this: "How am I going to ask a hospital for help if this happens in the hospital?" Carlota did.

Illustration by Rafael Medeiros.

Her sister Marta and brother-in-law immediately returned to the hospital for her to file a complaint. "I got there and told a nurse that I wanted to report it. She was the head nurse of the unit. "She replied to me, with enormous arrogance, tore up some paper, which had things written on the back of it, to write it down," downplaying it, she recounts. "That insensitivity killed me. I was so angry, because even though she [nurse] actually gave it to the rightful person, she treated me like I was making it all up."

The first complaint against the nurse, filed five months before Carlota's, was "dismissed because the clinical council did not find any evidence of abuse by the nurse. His conduct has been, since the beginning of his profession, respectful and flawless."

After making a complaint at the hospital, Carlota returned home. "It was at that moment that everything intensified." By the end of the day, still half stunned by the dose the nurse gave her, Carlota was unable to shower by herself. "I remember Marta with her big belly (she was pregnant) washing me," she recalls. The image she describes is of her sister consecutively wiping away her tears, as Carlota didn't even have the strength to do so.

Her mother gathered the whole family to decide on the next step. The young woman acknowledges that it was a great outpouring of love, but at the same time "a huge shame. It has always been this way: family support has been central at all times of her life, especially after her father died when she was seven.

"That day, I had my arm out [of bed]. Suddenly I wake up, look up and see the nurse .. He grabbed my hand, put it on top of his crotch, and said, 'now close your eyes because you're going to sleep.'"

Her family decided that Carlota would have to go to the police. The first step, to ask the hospital for an explanation, had been taken. Next was the complaint to the police. It was already late in the day when she went to a police station with her uncle. The officer, says Carlota, was in shock, he could not remain indifferent to her pain — so much so that he was her witness in court. The officer took her to the same hospital to have her blood tested. "He [the policeman] stayed by my side the whole time, he never left me alone."

When they arrived, the officer asked for blood analysis expertise to see what kind of drug it was, because it would serve as evidence in court. The doctor who was to do the collection was reluctant, even claiming that the then 18-year-old could have arrived at the hospital drugged. "The cop freaked out. He said it was a disgrace. They tested my urine and blood. I went into the bathroom alone and the officer was always at the door," says Carlota. She felt safe, but even so the agent asked for a second test to ensure that the results would not be falsified.

Carlota spent three years in trial hearings, but the process did not end until four years later. "Those were the worst years of my life." She never walked alone and was always looking everywhere over her shoulder. "It was a mixture of shame, of humiliation, of revolt, of injustice. All at the same time." The nurse sued her for defamation, but the suit was quickly dismissed: "the story he told was that I was his ex-girlfriend and that he was trying to get back at me." The story didn't add up: she had never seen him before that night.

There were times when Carlota was completely sure about continuing with the criminal complaint and others when she plunged into doubt, whether or not she should continue. "That phase took place before the trial. Since this is a small town, she was put under a lot of pressure, both by the local people and by his friends," Carlota's lawyer says.

Carlota began to be sidelined by her friends, and the doubt about whether she was lying gradually took shape. The young woman isolated herself more and more. The same happened to Ana. They insulted them, called them liars as they entered and left the courtroom. They spat at them. They would pass by Carlota's house and offend her, shouting. The abuser's family even threatened her. She was accused of "ruining the life" of the "boy". The courtroom was always full. Hospital staff and friends of the nurse waited inside and outside the courtroom. Between the filing of the complaint and the appeal to the Court of Appeal of Évora, seven years of persecution passed.

"I look at myself at the age of 18 and think: I had a hell of a strength, without knowing where it came from. I've realized that this also has to do with my mother, who is a very strong person," she acknowledges, proudly. "I feel that if it wasn't for my family and my whole emotional structure of faith … honestly, I thought many times about committing suicide."

The reality that these three women experienced became threatening, and the spaces that concentrate all of these experiences can impact the rest of their lives. From the social to the architecture of courts and interrogation rooms, from the environment to the way you talk to a person subjected to these abuses, to the questions the authorities insist on asking. All of this can lead to episodes of victim re-victimization.

Illustration by Rafael Medeiros.

Is the justice system prepared to deal with survivors of sexual abuse? "Being well-informed is not having training in this area solely and exclusively, meaning we have to be aware of our biases. Unfortunately, these people [jurists], like me, have the huge advantage of not deciding anything. It's not me who's going to say if it was true or a lie, if it happened or not, but an inspector from the Judiciary Police, for example, doesn't have that role either," warns psychologist Catarina Barba.

The psychologist believes that this is an important path in a judge's decision. "He is not the one who is going to say whether it happened or not, but he is there to ascertain as much accurate information as possible. The same goes for a prosecutor, supposedly with the role of defending the victim. We have to be there, available to listen, to welcome and ask the questions as carefully as possible," continues the psychologist.

This step-by-step has been in place since the approval of the Victim Statute, added to the Code of Criminal Procedure in September 2015. This statute is very clear and specific about questioning and accompanying victims: questioning must be done by a person of the same sex, unless it is by a prosecutor or judge.

Measures must also be taken so that eye contact between victims and defendants is avoided in the courtroom. A particularly vulnerable victim may even have his or her statements recorded and used for "future memory. But this measure was only implemented starting in 2015. Carlota and Ana have not had the opportunity to appeal to the Victim Statute. The most they could do was to ask for the trial to be held behind closed doors.

"Judges systematically understood that it was indispensable to the discovery of the truth that victims repeat their testimony at trial. That, fortunately, is reversing," says Helena Leitão, a prosecutor who finished her second term as a member of the Council of Europe's Group of Experts on Combating Violence against Women and Domestic Violence (GRÉVIO) at the end of May. "Things will tend to evolve in the positive direction," but it takes time. "Neither laws nor mentalities evolve quickly. It's that security of law, and the security of people," he adds.

"I remember when he started touching my body, I thought, 'I want to die right now.' And I felt a force in me that made me lose consciousness," says Carlota.

Setenta e Quatro asked the General Directorate of Justice Policy for the number of complaints of sexual crime cases and which ones resulted in conviction. In response, the public entity said that, about the medical-hospital context, they did not gather any data. We also contacted the Judicial Police to understand what steps are taken during the taking of victim testimonies, but did not get any answers by the time this article was published.

Sexual violence crimes have increased since 2015. The 2022 Annual Homeland Security Report shows a 30.7% increase (519 cases) in rape crimes compared to 2021. But if we add the data from APAV's 2021 Annual Statistical Report, it becomes clear that reporting to victim support offices for sex crimes has increased by 113% (75445 people reported) compared to the year 2016, in which attendance recorded 35411 victims. The organization recorded 1727 crimes of sexual violence in 2021 alone, including 43 of sexual coercion and 249 sexual crimes against adults. Sexual harassment was also included in this set of sexual crimes, with 89 complaints registered.

But this is a reality that is not only observed in Portugal. The European Crime Statistics published by Eurostat reveal that crimes of sexual violence registered by the authorities increased 173% between 2008 and 2018.

For Helena Leitão, this is representative data of a reality influenced by an idea of "superiority of European culture." "Violence against women is a structural and global phenomenon that knows no economic, social or cultural limits or borders of any kind," she explains. The prosecutor also warns of the "imperative" need for EU member states to adopt different policies to combat gender violence: "It is necessary to evolve in this fight and demonstrate that there is 'zero tolerance' against any form of violence."

The night-shift nurse

For Carlota, the process of complaining and acknowledging the sexual abuse was immediate, because "I had a strong family and a strong mother who always supported me." For Ana the whole path to denouncement was very different.

Ana was admitted to the emergency room of the same hospital with a kidney colic. Alone, she was forced to drive to get there. She arrived at the hospital, was immediately admitted, had an X-ray and was not released without an ultrasound, which would only happen the next day, in the morning, because it was already late. "That's when they put us down on stretchers," she recalls. He continued to IV, in the same room where other patients were also receiving it.

The nurse came and ran the curtain around the gurney. "That day, I had my arm out [of bed]. Suddenly I wake up, look up and see the nurse, in white scrubs. He grabbed my hand, placed it on top of his crotch and said, 'now close your eyes because you are going to sleep.' I confess that I closed them immediately, as if to say 'but what's going on here?' And I blacked out."

Illustration by Rafael Medeiros.

Back at work Ana jokingly commented to her friends that if they went to the hospital emergency room there was a nurse there who didn't mind having her hand placed on his genitals. They told her that this was not at all normal. Another friend, the wife of the hospital's head nurse, insisted that she understand what had happened. "Another thing my friends noticed was that I spent my life washing my hands," Ana recalls. "That's when I started to come to my senses." It was also at that time that one of her friends told her that he had come to visit her in the hospital, but she couldn't remember anything. She even refused her friend's presence.

Ana is divorced, has three children, and has always tried to hide what happened to her from her family. Unlike Carlota, only her children and her ex-husband knew what had happened. If for Ana and Carlota everything became clear a few hours later, for Joana the call for help was almost immediate.

Joana had several heart problems. As she was finishing her day of housework at the home of one of her clients, the owner of the house advised her to go to the hospital. She was extremely pale, had palpitations, and had very bad headaches. It was summer and the hot days in that small town are very intense, she thought that was why. "I had never been in that hospital before. It was the first time and the last time."

She was admitted to the emergency room around 7:30 p.m. and left there the next morning. "I went to a room with several gurneys, separated by a curtain, after having an electroencephalogram and a CT scan, to check for any hint of neurological problems," she explains. Until the nurse came along. "I distinctly remember the big, blue letters he was wearing caked on his scrubs." He said he was going to give her a medication to relax, "which was to help me calm down." Joana didn't quite understand what he was saying, but she believed it would be good for her. "I started to feel extremely numb, I thought that was too strange, and I remember dialing my husband's number on my cell phone: I asked him to tell someone to go there, because something strange was happening."

A friend found Joana 30 minutes later. "She said I had my pants undone and half down, completely unresponsive. He had just left there," she tells Setenta e Quatro. Even today she doesn't know what specifically happened.

Joana's friend helped her file a complaint with the hospital, but it was of little use. "I was called, I spoke with the management and with the hospital lawyer, I explained what had happened and that none of it was fabricated," but the only thing they did was to try to "hush up the case." "I'm not Portuguese, I wasn't exactly able to make myself heard and the language was a big barrier for me, but I know very well that I didn't imagine it," she says assertively.

Carlota spent three years in trial hearings, but the process did not end until four years later. "Those were the worst years of my life." She never walked alone and was always looking everywhere over her shoulder. "It was a mixture of shame, of humiliation, of revolt, of injustice. All at the same time."

It was Carlota's lawyer who found Joana. She graduated in Criminology and Forensic Psychiatry in her home country and worked with the authorities there for several years until she immigrated to Portugal. Today, she no longer lives in the country or works as a domestic worker. "Even though the laws are different, I know very well how justice reacts to victims of sexual violence." She also warns about the serious mental health problems of this nurse: "he has several high psychopathy indexes and a standard element: at that time, we were all blondes." "His posture in court was relaxed, almost total belief that he wasn't going to be held responsible for anything, it was surreal," she adds.

The three women have the "most chilling and painful" memories of the courtroom. They saw their attacker from the front: he laughed while they testified, "It was as if he was on a terrace." Carlota says that people would look at you and feel that you were always naked, "because the shame was effectively a lot." The testimony in court was always very exhaustive. "I was practically crying the whole time, and they took lots of breaks for me to drink water.

They asked him a lot of questions. "Questions that don't fit in anyone's head. Like, for example, how many meters away was my stretcher from the one next to me. I had no idea if I had people next door." She believes they had to be thorough, but she cannot understand to what extent some of the questions she was asked were necessary.

It is in this sense that psychologist Catarina Barba does not fail to shed light on the big problem that exists in the whole path from complaint to conviction: "we observe that things go wrong, it's not at the end, it's not at the decision, it's long before. And that's scary. It's not just that we say that we have bad decisions, that the whole path doesn't sound right, and that people are more traumatized by the justice system than by what happened to them. You have to realize that the preparation, the collection, and the whole path to the final decision is flawed in several ways," argues the Sexual Assault and Post-Traumatic Stress Specialist.

This case resulted in a conviction with a four-year suspended sentence and the payment of damages. The defendant appealed the decision, but the Court of Appeal of Évora increased the suspended sentence to five years and the amount of compensation doubled to 12 thousand euros.

And what's the penalty?

Of the 47 women survivors of sexual abuse heard by Setenta e Quatro, only three filed criminal complaints and eventually made it to court. Of these three cases, all of the convicted abusers were given suspended sentences.

"It is very rare for the first conviction to be for actual imprisonment," explains Helena Leitão. "There is a law in the Penal Code that says that preference should be given to the latter whenever it is 'adequate and sufficient for the purposes of the punishment'. That is, whenever it is considered sufficient in terms of the social rehabilitation of the accused and the rehabilitation of the victim," explains the public prosecutor. Helena Leitão adds that "in systematic terms, the legal institute of criminal law is constructed in this way. Hence also the difficulty in applying effective sentences on first convictions. It is very rare to apply effective prison sentences."

Neutrality in laws is no longer acceptable. In the Shadow Report made to the GREVIO committee in 2019 by the NGOs Associação de Mulheres Contra a Violência, Plataforma Portuguesa para os Direitos das Mulheres and European Women's Lobby, we read that "a revision should be made that brings the national legal framework in line with this benchmark recently adopted by the United Nations. Furthermore, the laws should integrate the commitments ratified by Portugal, namely in the field of equality and non-discrimination".

This same neutrality is questioned by sociologist Isabel Ventura in her book Medusa in the Palace of Justice or a History of Sexual Violation, published in 2018, corroborating the presence of patriarchal culture in the law itself. In an interview with Setenta e Quatro, the sociologist explains that "the difficulty (or even inability) to think of women as authors, decision-makers, and holders of an active sexuality that is not dependent on (and at the service of) male actions is continuously present in the discourses of Portuguese penal experts, before and after the penal reform of 2007," when the law underwent changes about sexual abuse crimes.

Furthermore, "the precept is that the intensity of the crime is proportional to the victim's reaction. The victim is only exempted from this imposition in the case of being unable to do so, that is, in the case of unconsciousness or semi-consciousness," reads her book. The sociologist adds that the inability to resist due to lack of consciousness, caused by the aggressor, is framed in the norm of rape. Otherwise, the crime will be that of sexual abuse of a person incapable of resisting, defined by article 165 of the Penal Code.

"I feel like if it wasn't for my family and my whole emotional framework of faith … honestly, I've often thought about killing myself."

GREVIO, a committee of 15 European specialists to which Helena Leitão belonged until the end of May, was very clear in its recommendations to the Portuguese State. "It was recommended to the State, at the level of maximum importance, to change its legislation in order to convert the crime of rape, among others, into a public crime," she concludes.

All the specialists interviewed by Setenta e Quatro argue that it should be a public crime and not a semi-public one. Some people take years to deal with the trauma. That is why, from jurists, psychologists to non-governmental organizations linked to victim support, the argument is not without commonality: the maximum time of six months to file a complaint after abuse is too short.

"The investigation and trial for the crime of rape, among others, does not depend entirely on the criminal complaint, especially when it says that the process can continue even if the victim withdraws her statement or complaint. This leaves no doubt about the public nature that the crime of rape should have," says Helena Leitão.

In addition, the prosecutor clarifies that if "the crime is public, it is not even necessary to discuss the deadline for filing a complaint. This means that as long as the crime is not time-barred — and a crime of this nature can take up to 15 years — the investigation can go ahead regardless of the wishes of the victim and her family."

What resulted from this conviction?

For Carlota, the Justice acted with "benevolence". "I thought it was very little. For me it was never money. It was really justice for me, for them, and for those who passed through his hands and the hands of others. There I was not just talking about him, but about a whole. I also filed a complaint against the hospital and everything it covered up."

The 32-year-old still suffers from vaginismus today. "I have pain, I've been to the doctor," Carlota says. "Before I didn't have it. So I know I've gotten a lot of emotional pain and the body somatizes."

Psychotherapist Rui Ferreira Nunes explains that "there are causes of sexual problems in adult survivors related to the mind-body dissociation that occurred during sexual abuse, a defense that arises as a way to prevent pain during the sexual act, but which ends up also preventing pleasure." Another mechanism she identifies is "no longer having sensibility in different parts of the body, as if they were anesthetized, namely in sexual positions or practices associated with the abuse."

After the abuse, Ana stopped leaving the house. "I had a boyfriend when I started psychotherapy, about my age. He's no longer in my life at all. I had a really hard time telling him, but I needed to." At a certain point "I thought there was no point in staying here, in this world," she acknowledges, crestfallen.

As we were leaving the small town in the Alentejo region we came across a central beer hall, which Ana's son has been refusing to enter for years. It is owned by the former nurse. This is where he has been doing his business since he was expelled from the Order of Nurses. But, with his suspended sentence completed and the sanction of his expulsion from the Order of Nurses prescribed, the convicted sex offender can return to the halls of a hospital. Professional rehabilitation is included in the Order's Statutes, although until then the Order has not received any request for it.

Freelance journalist Cláudia Marques Santos contributed to this report.


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