Jury awards woman $25M after HCA Citrus hospital delayed reporting of sexual abuse
INVERNESS — The nightshift had just begun when a male nurse was assigned to care for Lenna Ray in the emergency department.
Doctors at HCA Florida Citrus Hospital ordered Ray a morphine injection after she fell at work. Her nurse, Hiram Bonilla, instead fed a dose of the painkiller into her IV drip, rendering her docile and woozy more quicklycourt records show.
Then, he taped a bed pad over the hospital room's only window.
Over the next four hours, Bonilla repeatedly sexually assaulted Ray, who felt too groggy to defend herself due to the drugs he'd given her. She said in a deposition that Bonilla ordered her to stay quiet.
"I was really scared that he could kill me if I didn't comply or if I yelled out," Ray testified.
After a criminal trial, Ray's abuser went to prison. A jury in September found the hospital negligent and awarded her $25 million in damages. The case is the latest in the hospital's history of sexual abuse allegations, including one situation that prompted a state law to protect patients.
The abuse of Ray has reignited concerns over patient safety and the hospital's protocols for dealing with allegations of abuse by staffers. HCA Florida Citrus Hospital is part of HCA Healthcare, a for-profit company that operates more than 40 health centers across the state, including 15 in Tampa Bay.
The level of abuse uncovered at both the criminal and civil trials at the Citrus facility was shocking.
Security camera video showed that Bonilla, 60, entered Ray's room 28 times between 10 p.m. and 2 a.m. — an average of every 8.5 minutes — just yards from the nurse's station. Ray said she was too scared to call the police as Bonilla kept coming back. She feared 911 call-takers would ask too many questions and he'd catch her talking to dispatchers.
"She sat in that room knowing he was coming back," said Eric Rosen, one of two attorneys who represented Ray during the civil trial. "That is horror in and of itself."
As the drugs wore off, Ray, then 67, called her therapist who notified a nearby rape crisis hotline. Hospital staff was alerted to what happened.
But her ordeal was far from over.
Hospital officials delayed calling law enforcement for six hours, during which a colleague of Bonilla accused Ray of concocting the abuse allegations, according to court records. Ray was unaware that Bonilla had been sent home and fretted he would return to harm her.
After she was moved to a different room, Ray testified that she heard staffers outside her door laughing at her story. She also learned that the bed where the abuse took place had been stripped, leaving her fearful there would be no proof of what happened.
A history of abuse
The day Ray entered the hospital in January 2021, HCA Florida Citrus Hospital was still reeling from the arrest of another male nurse.
Mark Miskar, 68, was accused of sexually abusing a 54-year-old female patient in September 2020, which led to his conviction. The abuse took place after the nurse administered a suppository, records show.
An investigation by the Citrus County Sheriff's Office found text messages the nurse sent his patient calling her kinky and asking for "under the covers photos," which she took to mean explicit photographs. Investigators also identified a second female patient who said she had twice been abused by Miskar on two separate stays in the hospital.
Miskar was charged with sexual battery involving the 54-year-old. He initially pled not guilty but later agreed not to contest the charge. He was sentenced to five years and five months in prison.
His victim sued the HCA hospital in 2022. The hospital agreed to a confidential settlement.
In Ray's case, her attorneys recently agreed to a confidential settlement in place of the jury award to avoid going to appellate court where cases can drag out for 18 months or more.
Two other reports of abuse by male nurses on female patients were investigated by the sheriff's office in 2012 and 2014 when the hospital was known as Citrus Memorial and was owned and run as a nonprofit. Both cases were closed with no charges filed after the patients stopped responding to requests for information from detectives, records show.
The sordid history dates back even further.
In 1994, Citrus Memorial was at the center of one of Florida's most infamous sexual abuse cases.
Nurse Bruce Alan Young was arrested after a colleague found him semi-naked atop an unconscious 15-year-old girl recovering from surgery.
Hospital officials waited three hours before calling law enforcement, according to Tampa Bay Times archives.
An investigation by the sheriff's office led to the identify of more victims, some of whom said he had given them sexually transmitted diseases.
Young, then 45, pled guilty to sexually assaulting seven women. As part of a plea deal, he received a 17-year prison sentence followed by 13 years of state supervision. He was released in 2005 but confined indefinitely in a civil commitment center in Arcadia under the Jimmy Ryce Act, a 1999 law that allows for the continued confinement and treatment of sexually violent offenders after their prison sentence expires.
Young escaped from there in 2008 and was recaptured two days later. He was resentenced to seven consecutive 30-year terms. He died in prison in 2018.
After Young's arrest, dozens more women came forward to report post-operative rapes and abuse. Prosecutors didn't bring charges for each, but Citrus Memorial paid $5 million to 40 women who they concluded Young had raped or abused.
The case led lawmakers to pass legislation requiring at least two staffers be present when attending a patient in the recovery room unless the room is monitored by security cameras. It also provided legal protection for hospitals to provide accurate records and information about former employees when prospective employers ask.
It later emerged that Laura Dixon, the hospital's director of nursing, failed to report an earlier allegation of abuse by Young on another patient. She was fined $300 by the state's board of nursing for failing to notify either a law enforcement or state regulatory agency.
Dixon, who supervised about 600 employees, kept her job and retired in 2000. It's unclear if any other Citrus hospital staffers over the years lost their jobs related to the handling of sexual abuse cases.
Missing red flags
The Miskar case should have heightened awareness of red flags like covering the windows of patients' rooms, said Eric Rosen, one of two attorneys who represented Ray during the civil trial.
But the jury watched security video footage that showed numerous nurses, security staffers and others had walked past Ray's hospital room at the time she was being abused.
No one apparently questioned why her window was covered or the door was closed. Nor did anyone ask why Bonilla needed to attend to his patient 28 times, Rosen said.
"They just weren't following the rules from the chief nursing officer down," Rosen said. "That's how people get abused. That's how bad things happen behind closed doors."
The Citrus County Sheriff's Office was finally called — six hours after hospital staff had been alerted of the abuse. When forensic investigators arrived, the bed in Ray's room had been stripped. It appeared wet, as if it had been wiped, according to the sheriff's office. Investigators did, however, find traces of Bonilla's DNA on Ray's breasts.
Bonilla was tried one year later on charges of sexual battery and lewd and lascivious molestation of an elderly or disabled person. It took a jury 45 minutes to find him guilty. He received a 20-year sentence.
Attorney Mandi Karvis, who represented the hospital during the civil trial, painted Bonilla as a rogue outlier. He had been a nurse for 30 years and had a clean criminal record. The hospital could not have known he would commit such a crime, she said during closing arguments, and its actions when alerted to the abuse met the "applicable standard of care."
The abuse took place during the pandemic, she said, "an incredibly difficult and stressful time" when hospitals were overrun and faced staffing shortages.
"We worked with law enforcement to ensure that the individual responsible for that crime was convicted and is now in prison," the hospital said in a statement after the verdict. "In light of our disagreement with the allegations, court rulings and award, we were prepared to appeal but ultimately reached a resolution to end the litigation. Patient safety remains our priority and it is a commitment our colleagues are focused on."
The hospital did not respond to a question on whether it has revised any rules, procedures and staff training in response to Ray's case.
Repeated trauma
The four hours she was left alone with Bonilla left deep, traumatic scars, Ray said.
Growing up in Southern California, Ray's father physically abused her and her mother was an alcoholic. A neighbor who babysat her took sexually explicit pictures of her.
She ran away from home at 14.
At 17, she was put into foster care and finished high school. She married when she was 27. Just two weeks later, she came home to find her husband dead from a suspected heart issue. She had an emotional breakdown and was ordered by the state into a mental health clinic.
She said she had post-traumatic stress disorder stemming from her childhood that was exacerbated by her first husband's death. It made her tend to be passive around men.
Ray sought therapy as she got older and had become more social. In 2019, she trained and was qualified to work as a medical technician.
The day she fell at work was her first day at a temporary job at a McDonald's in Inverness. She had taken the job to earn extra money while visiting her daughter for Christmas.
She drove herself to HCA Florida Citrus expecting she might need a blood transfusion.
About a week after the abuse, Ray went back to her home in Idaho. She kept her blinds closed even during the day and became a recluse, said her attorney, Gregory Roe. She had to quit her job because the sight of men in scrubs triggered her anxiety.
"She had been making good progress in addressing those issues and this was a catastrophic event that sent her into a tailspin," Roe told the Times during the trial.
Failure to report
The two-year legal battle between Ray and the hospital highlighted several concerns over its handling of Ray's allegation of sexual abuse, her attorneys said.
The six-hour delay in reporting the crime runs counter to U.S. Department of Justice's protocol for sexual assault examinations, which states law enforcement should be called if the patient requests it. Ray told officials she wanted the police called at around 2:30 a.m., more than five hours before the crime was reported.
Hospital officials, however, followed a checklist for sexual abuse allegations that required its own internal investigation. Calling law enforcement is No. 19 on the list, coming after notification of the hospital's marketing team "in case of any social media or media attention." The reporting of the abuse of a child or vulnerable adult to the Florida Department of Children and Families is No. 20. The checklist is used at other HCA hospitals.
During her deposition, Lisa Lee, a registered sexual assault examination nurse who took part in the criminal investigation of Ray, criticized the hospital. She described HCA's abuse protocol as "inappropriate and not in a patient's best interests at all."
The U.S. Department of Justice recommends that victims be provided an advocate. Ryan Brown, a detective in the Special Victims Unit, testified that Ray was not offered one until she was examined by Lee roughly nine hours after the abuse came to light.
Sandra Doehl, a nurse at the hospital who took over Ray's care after Bonilla was sent home, testified that it was not her job to assess whether the patient needed someone to counsel her.
Ray's lawsuit was filed with her name listed as Jane Doe to protect her identity. But as the legal battle played out, her anger convinced her to speak out.
When the verdict was read, she sobbed and leaned her head on Roe's shoulder.
"I knew I wasn't just fighting for myself anymore," she said after leaving the courtroom. "This was important for everyone walking into a HCA emergency room."
