MESA, AZ (3TV/CBS 5) - A Mesa gynecologist says it would be very difficult to determine whether a Hacienda HealthCare patient had a prior pregnancy after she unexpectedly delivered a baby in December 2018.

“I can’t put a lot of stock in a vaginal exam that was performed immediately following a delivery,” says Dr. Greg Marchand.

[WATCH: Gynecologist talks about Hacienda HealthCare rape victim's possible possible prior pregnancy]

Marchand points to a passage in a notice of claim against the state where the family of a Hacienda patient who was raped and impregnated is seeking $45 million. The document cites Maricopa County Medical Center records saying the condition of the patient’s genitals following delivery “suggest that repeat coitus has occurred and likely this is a repeat parous event.”

[ORIGINAL STORY: Hacienda HealthCare rape victim 'likely' pregnant before, notice of claim says]

“They’re trying to say that she’s had previous vaginal deliveries,” says Marchand. “I think that’s a very difficult thing to do when someone’s just had a 9-month baby come out.”

Hacienda HealthCare staffers missed more than 80 opportunities to diagnose the patient as pregnant, according to the notice of claim. Some of those red flags included missed periods.

[RELATED: Nurse who witnessed incapacitated woman giving birth speaks for first time]

“That would be more forgivable, especially if you weren’t seeing the patient on a regular basis,” says Marchand. “But it’s really tough to discount that enlarging abdomen.”

Rather than diagnosing a pregnancy, the documents say staffers tried to treat the developmentally disabled patient for a mass in her abdomen, giving her laxatives and changing her diet so she can lose weight.

[ORIGINAL STORY: Woman in vegetative state gives birth at Hacienda HealthCare in Phoenix]

The notice says the day before the patient gave birth, her primary care doctor recorded bowel sounds but failed to hear a baby inside.

[SPECIAL SECTION: Hacienda HealthCare pregnancy investigation]

“The heartbeat of a baby is evident after 30 weeks,” says Marchand. “You can hear the heartbeat of a baby with a stethoscope if you know what you’re looking for and have the stethoscope in the right positions.”

The Phoenix Police Department released the following statement about the notice of claim's findings:

"Phoenix Police Detectives have worked diligently in an attempt to determine if the victim in this case was sexually assaulted more than once. However, they have not been able to identify any other instances. In addition, based upon the statements by the doctor at the hospital following the delivery of the baby, detectives were aware of the possibility of a previous pregnancy. The evidence obtained from the victim was examined by forensic doctors. Their secondary review did not support that there was a previous pregnancy."


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