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Ryan Libbey, a former patient at Lakeview. His mother Jennifer Cote gave NHPR permission to publish photos of her son's injuries.This series was the basis for a collaborative investigation by NHPR and Reveal, a new investigative public radio program and podcast produced by The Center for Investigative Reporting, a nonprofit newsroom based in California, and PRX. Click here to read the investigation and listen to the documentary, "A Mountain of Misconduct."0000017a-15d9-d736-a57f-17ff8db50000In September 2014, Lakeview NeuroRehabilitation Center in Effingham, N.H. came under scrutiny for abusing and neglecting some of the people it cares for – children and adults with brain injuries and developmental disabilities.NHPR has been looking into these accusations, and it turns out the state had warning signs about series problems at this facility going back to the early 1990s. In this special series and continuing coverage, reporter Jack Rodolico examines the scope of the problems and the state's role in Lakeview's story.

N.H. Regulators Missed Warning Signs Of Abuse And Neglect At Lakeview

Yesterday, NHPR reported on abuse and neglect of people with disabilities at Lakeview Neurorehabilitation Center in Effingham. This story is the second in a two-part series on Lakeview.

This past fall, when the Disability Rights Center released two reports laying out detailed accounts of abuse and neglect at Lakeview, Governor Maggie Hassan called the allegations “deeply disturbing.” She shut down new admissions and ordered a review of how the Department of Health and Human Services regulates the facility. Here’s Governor Hassan, last week:

"Well obviously the concerns and issues raised by the DRC report were very, very important," Governor Hassan told NHPR last week. "We take them very seriously, as we do all reports of potential violations of licensure standards or other kinds of potential abuse or lack of care. "

But going back to at least 2011, state regulators knew about serious problems at Lakeview. Yet the state renewed Lakeview’s license each year, giving the facility a clean bill of health.

For several years, there has been a stream of incidents at Lakeview – violence, missing residents, frequent 911 calls and a client who died, allegedly of neglect. Yet none of those incidents prompted sanctions from state regulators.

Timeline of neglect and abuse at Lakeview as compared with N.H. oversight giving the facility a clean bill of health

"This was no surprise to them and, yes, they were aware of the gentleman who died up there," says Karen Rosenberg, the attorney with the Disability Rights Center who wrote the reports on Lakeview.

Rosenberg points to the state law regulating residential care facilities.

"That statue authorizes our state Department of Health and Human Services to deny, revoke or suspend licenses when they have reason to believe that people’s lives are being jeopardized, when facilities aren’t providing for their health, emotional, physical wellbeing. And there was plenty of information out there to give the department reason to exercise that authority," says Rosenberg.

NHPR asked why the Department of Health and Human Services didn’t act until the Disability Rights Centers’ reports were published. Health and Human Services Commissioner Nick Toumpas declined an interview for this story.

In an email, though, Toumpas wrote: “I do not think it would be accurate for you to report that the Department did not act prior to the Disability Rights Center report.”

Credit Conway Daily Sun/Jamie Gemmiti
A N.H. DHHS car enters Lakeview's gate on October 1, 2014. The Disability Rights Center issued two reports on abuse and neglect at Lakeview on September 30th.

Within Toumpas’ department, the Bureau of Developmental Services is responsible for caring for people with disabilities and brain injuries. And for years, placing people at Lakeview has been a last resort for the bureau.

"Whenever you place somebody in a place of your last resort, then you better watch what you’re doing," says Joni Beasley with UNH’s Institute on Disability. Beasley travels the country consulting states on services for people with disabilities.

The Bureau of Developmental Services recruited Beasley to go to Lakeview twice – once in 2012, and then again in 2013, after the young man died there.

Beasley says state officials told her: "We have people there who are very vulnerable and we don’t think that they’re getting the kind of services that they need. And we would like to help them do a better job.

Lakeview declined interviews for this story. But Beasley says when she went there, high-level managers were not open to her suggestions. And one year after Beasley’s visit, the State of New York had a similar experience with Lakeview.

The New York Justice Center for the Protection of People with Special Needs took issue with the care some New York residents were getting at Lakeview. In early 2014, the Justice Center sent a series of letters to Lakeview complaining it didn’t report abusive staff, and suggesting Lakeview charged for care it wasn’t providing. The Center threatened New York might pull funding.

That's when the mother of a Lakeview resident secretly recorded a conversation she had with New Hampshire regulators.

Linda Blumkin lives in New York City. Her daughter, Jessica Klurfeld, was at Lakeview from 2010 to 2013. Jessica was neglected and abused. After filing numerous complaints that went nowhere, Blumkin became frustrated with New Hampshire regulators and sought the help of the New York Justice Center.

Credit Allegra Boverman for NHPR
Linda Blumkin filed numerous complaints with N.H. officials about Lakeview that went nowhere. Blumkin eventually sought the help of the New York Justice Center on behalf of her daughter, who was a resident at Lakeview.

In early 2014, the New York Justice Center alerted New Hampshire's Department of Health and Human Services that Lakeview may be operating outside the law. The Justice Center specifically told the New Hampshire office with the power to revoke Lakeview’s license.

That office is headed by John Martin, who Blumkin called and recorded without his knowledge. Here's a partial transcript:

Blumkin: According to your bureau, Lakeview has a clean record. They’re a splendid facility that’s in vi---that’s not in violation of anything. Martin: That’s, that’s exactly right. As, as far as their, as far as their clinical inspections go they have been deficiency free for at least the last four years.

The state does conduct yearly, unannounced visits to Lakeview. At the same time New Hampshire inspectors concluded Lakeview residents received proper treatment, the New York Justice Center found major problems.

The Justice Center also concluded New Hampshire’s regulators weren’t doing their jobs. In emails to Blumkin, a New York investigator called New Hampshire’s conclusions, quote, “sadly illuminating regarding [the Department of Health and Human Services], which we had not intended to rely upon in any case.”

Martin went on to tell Blumkin the state found problems at Lakeview – but not violations of the law.

Martin: We know that they have challenges, but that’s different from being out of compliance with our specific rules.

That was a year ago. Since the Disability Rights Center reports were published, the Licensing Unit has cited Lakeview for violations several times.

Credit Conway Daily Sun/Jamie Gemmiti
The Lakeview campus in Effingham

On December 30, a female resident climbed under a fence – naked – and disappeared in the woods for 45 minutes. Two days later, the state found five staff handling 30 clients, most of whom were supposed to have intensive supervision. And the Department of Education found Lakeview’s special education school failed to meet an array of basic standards.

"I don’t know why it failed so badly in New Hampshire," says Joni Beasley at UNH. "I think it’s a tragedy, though, and a travesty. And I know the State of New Hampshire is really working hard to make positive changes in the right direction as a result of it. But isn’t it terrible that somebody had to die in order for that to happen? Of course it is."

"I have also had conversations with the NH Special Education director [Santina Thibodeau] and DHHS licensing bureau director [John Martin], which were less than satisfying." - NY Justice Center Investigator email to Lakeview parent, January 3, 2014

On February 9, New Hampshire approved Lakeview’s 55-page Plan of Correction. That plan says Lakeview will boost pay for low-level staff by 50 cents an hour - which means staff will still be paid less that the statewide average, according to one survey - and reduce the number of residents with highly complex needs.

While New Hampshire lets Lakeview stay in business, other states are making their own judgments. Maine is pulling all its residents from Lakeview.

And late last year the New York Justice Center wrote to Lakeview. The letter was blunt: “New Hampshire oversight of Lakeview is not sufficient to ensure the safety of service recipients placed from outside of the state.”

Documents and other media used in the reporting of this story are posted in our Reporter's Notebook.

Before joining NHPR in August 2014, Jack was a freelance writer and radio reporter. His work aired on NPR, BBC, Marketplace and 99% Invisible, and he wrote for the Christian Science Monitor and Northern Woodlands.
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