As a community health nurse working with dangerously mentally ill clients, Cari Dickson had plenty of scary experiences even before one man she was sent to check on pinned her to the floor of a tiny West Seattle apartment and tried to rape her in February 2021.
Two Seattle police officers kicked down the door, tackled the man and carried Dickson to safety. Afterward, the officers were stunned to learn she had been sent to the man’s apartment by herself.
“They were like, ‘Wait, you’re a health care worker? You were sent here alone? We don’t even go out alone. We always work in pairs. This is not OK,’ ” she said during a recent interview at her attorneys’ downtown Seattle law offices.
One of the officers told her, “I’m pretty sure there’s a law against that,” Dickson said.
It turned out the officer was right.
Attorneys Julie Kays and Cheryl Snow filed a civil lawsuit against King County and Pioneer Human Services last month on behalf of Dickson and another nurse who says she also was sexually assaulted by a client while both women were working separately for one of the county’s Program for Assertive Community Treatment teams, known as PACT Teams.
While Dickson wanted to be identified in hopes that sharing her story will encourage other women to come forward, her former co-worker, a psychiatric nurse practitioner now working in California, asked not to be named. The Seattle Times does not identify victims of sexual violence without their express consent.
The women’s lawsuit alleges King County and Pioneer Human Services, or PHS, violated the state’s Law Against Discrimination by repeatedly subjecting female employees to gender-based discrimination in the workplace, including sexual harassment, assaults, sexual assaults, threats and stalking by clients who were hand-picked for the program from criminal and involuntary-commitment dockets in King County Superior Court.
Safety concerns and requests to work in pairs were brushed off, and the women’s working conditions “were increasingly hostile, toxic, dangerous and volatile,” the lawsuit says.
Though the county was aware of each client’s criminal history and propensity for violence, that information wasn’t shared with PHS PACT Team members, who were required to meet clients in their residences and drive them to appointments in the employees’ personal vehicles, says the lawsuit.
The lawsuit, which is seeking an unspecified amount in general and special damages, also claims King County and PHS violated Marty’s Law, a 2007 law that requires those who provide crisis care to dangerously mentally ill offenders work in pairs. It also bars retaliation against any worker who refuses to go on home visits alone.
Marty’s Law is named for Marty Smith, a crisis responder for the state mental health system who was killed by a client during a home visit in Poulsbo on Nov. 4, 2005. His killer, Larry Clark, now 49, is serving a 30-year prison sentence.
“Because King County and PHS blatantly ignored this critical safety law, it was commonplace for the County and PHS to send female PHS PACT Team workers out alone to the homes of dangerously mentally ill clients with no information on the dangers presented by these offenders,” the lawsuit says.
PHS, which at the time was one of four community-based mental and behavioral health providers contracted by the county to serve dangerously mentally ill clients, would end up dissolving its PACT Team six months after Dickson was attacked, according to Kays. She has yet to learn why the team was disbanded and expects that information to come to light during discovery as the lawsuit proceeds to trial.
An attorney representing Pioneer Human Services did not return a phone call seeking comment about the lawsuit. A spokesperson for King County Executive Dow Constantine declined to comment because the litigation is ongoing.
However, answers to the lawsuit filed in Pierce County Superior Court show that both King County and Pioneer Human Services have denied all allegations of negligence or wrongdoing. Both also have asserted a number of affirmative defenses, including that third parties — PACT clients — were at fault for any alleged damages suffered by the two nurses.
Holding an employer liable for conduct committed against an employee by a nonemployee was without precedent until Sheila LaRose, a former King County public defender, sued King County in 2015 after she was stalked by a former client she had represented in a felony stalking case. Her case was bolstered when the state Court of Appeals adopted the federal standard that an employer may be held liable for the harassment of an employee by a nonemployee and reversed two dismissals.
A Pierce County jury in October awarded LaRose $7 million in damages, but King County has appealed.
In its answer to the nurses’ lawsuit, King County has adopted a similar argument as in the LaRose case, saying that the women’s damages were caused “by the intentional acts of persons … acting outside the scope of any control by defendant or over whom defendant had no control, and defendant is, thus, not responsible for those intentional acts.”
“Shaky and scared”
In 2007, Washington state adopted the Assertive Community Treatment model, which was developed in Wisconsin in the early 1970s, as an outpatient service system to help people with serious mental health conditions move out of long-term state hospitals into community settings.
Funded by Medicaid and the state, the Washington State Health Care Authority designates the number of PACT Teams operating in each county.
Behavioral health providers are contracted by counties to provide PACT services to clients, and PHS became an independent contractor in 2017, according to King County’s answer to the nurses’ lawsuit.
The psychiatric nurse practitioner who asked not to be identified joined the Pioneer Human Services PACT Team in 2018 and Dickson joined in 2019. Their work tasks included delivering antipsychotic medications to clients.
In the first half of 2019, the psychiatric nurse practitioner went to Bruksos House, a housing project run by PHS on Capitol Hill where a number of PACT clients live.
The client she was sent to see had not consistently been taking his antipsychotic medications. When she arrived, she stepped into his room to explain his medications and, at his request, put his pills in her hand.
The man grabbed her wrist, licked the pills off her hand, threw her on the bed, got on top of her and groped her, she said. She fought him off and ran out the door.
“Afterward, I was feeling really shocked and terrified and shaky and scared,” said the nurse, who is now 42.
She didn’t report the attempted rape to police but told her supervisor what had happened.
“He said to me, ‘I’m not your therapist.’ And that was kind of the end of it,” she recalled in a phone interview.
Without her supervisor’s knowledge, she and another PACT Team member went to the man’s Department of Corrections community corrections officer and learned that the man who attacked her “did in fact have a very significant violent history, including a history of attempted sexual assaults on other women that had never been revealed to us.”
After leaving Seattle in June 2019, she went on to work for similar Assertive Community Treatment teams in Colorado and California, where she said workers routinely go in pairs to see clients with violent histories. But her experience in Seattle was traumatizing and has led her to feel unsafe at times, even when accompanied on home visits by another mental health professional.
“It’s damaged me and it’s damaged my work and left me in a place where I’m more vulnerable to just being scared sometimes, even when I don’t need to be,” she said.
Dickson, 38, grew up in Montana and began her nursing career in Seattle in 2004, providing end-of-life care to children who had suffered traumatic brain injuries. She spent three years in Ethiopia, working at an orphanage for children who had lost their parents to HIV/AIDS. Upon her return to Seattle, she continued working in pediatrics.
Then, a few years ago, Dickson noticed the explosion in the city’s homeless population and decided to make a change.
“My heart would just go out to the people I saw on the streets so I quit my job,” she said.
She was hired by a temp agency and landed a three-month contract delivering medications to Pioneer Human Services PACT clients before accepting a full-time job on the PACT Team in June 2019.
Dickson was assigned to work downtown and in Pioneer Square, where clients suffering from severe mental illness and psychosis required the most intensive level of care.
“I would go oftentimes to homeless encampments and shelters and also transitional housing units,” Dickson said. “Another task I was really good at was drawing blood. … I’ve drawn blood in alleyways and camps and it was a lot. I was always on the go.”
One time, Dickson was sent to the Morrison Hotel to draw a client’s blood and after he refused to accompany her to the lobby, she reluctantly went into his room. She had just inserted the needle into his arm when he learned over her and said, “Do you like violence?”
On Feb. 19, 2021, Dickson visited more than a dozen clients and was wrapping up her day when her team leader asked her to check on a man who wasn’t on Dickson’s regular caseload. He appeared to be in crisis and Dickson was geographically closest to his apartment.
She stopped by a friend’s house to use the bathroom and mentioned to her friend that she didn’t have a good feeling about the visit, which was nearby.
Dickson met Marcus Francis outside his apartment building and suggested they get coffee at a nearby Starbucks. He told her he needed to grab his phone first, and she followed him inside the building. Dickson stood outside the door, but when Francis’ roommate went to leave, she had to step into the apartment to let him pass — and Francis jumped up from where he was sitting on the bed and used his body to block the door.
“At that point, I don’t remember what happens — it happened so fast. The next thing I remember is I’m on the floor, pinned. He’s on top of me … and he is suffocating me, he has his hand over my mouth and nose and he’s pressing really hard. And he says, ‘Who sent you to kill me?’ ” Dickson said.
As the attack went on, Dickson fought him as he struggled to pull down her leggings. She was able to reach her phone and type garbled text messages with one hand, asking her friend to call 911.
Dickson said she remembers hearing sirens and the sounds of Seattle police officers forcing their way into Francis’ building.
“OK, this is my chance, I’m going to fight as hard as I can and scream as loud as I can,” Dickson said she remembers thinking. “And so I did and so they were able to hear me and they banged on the door. They kicked it in and tackled him off of me and then a policeman picked me up and I still had my phone in my hand.”
Francis, 34, was charged with attempted second-degree rape but has not been found competent to stand trial, court records show.
His defense attorney declined to comment about his case.
Dickson suffered extensive bruising, muscles strains, a torn tendon in one shoulder and other injuries. She is also contending with post-traumatic stress disorder and hasn’t worked since the attack.
“I’m really jumpy and I have nightmares and wake up screaming,” Dickson said. “I have two therapists and I’m doing all the right things, but it’s such a strange place for me to be in because I’ve always seen myself as a nurse and loved being a nurse and now … I can’t even imagine myself working as a nurse again.”