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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.

State To Shut Down Lakeview Special Ed School, Hassan Says More Actions To Come

Courtesy the Conway Daily Sun/Jamie Gemmiti

New reports commissioned by Governor Maggie Hassan have found state regulators failed to protect residents from abuse and neglect at Lakeview Neurorehabilitation Center in Effingham.

The reports come as the Department of Education - after repeated attempts to push Lakeview into compliance with state regulations - announces it will shut down the Lakeview School. 

The state will now reevaluate how it regulates the facility’s residential program.

“[The state] needs to determine for how long [it] will allow inadequate care of [its] citizens to go on without measurable improvement,” the report concludes.

Lakeview cares for people with disabilities and brain injuries – particularly people with highly complex behaviors and needs. It’s now well documented that Lakeview has chronic problems – understaffing, poor training, and inadequate reporting of instances of abuse and neglect, among others.

But beyond Lakeview itself, these reports point a finger at multiple offices within the Department of Health and Human Services, including the Health Facilities Licensing Unit. The Licensing Unit does yearly, unannounced inspections of Lakeview and about 400 other health facilities.

Credit Conway Daily Sun/Jamie Gemmiti

The report states the Licensing Unit's inspectors are too few and poorly trained. It also states the unit's administration has even suppressed the negative findings of its own inspectors.

“[Former licensing staff] reported that there have been previous times when inspections found egregious concerns about Lakeview that may have warranted closure and no action was taken. They report that the licensing unit is not held in high regard in the community because it is not perceived to be diligent or rigorous,” the report states.

The reports also called out Governor Hassan for not providing enough funding for inspectors in her budget – which the governor says she's now corrected by working with the Department of Health and Human Services. It also points out redundancy of work, gaps in regulations, and poor coordination among a handful of other state agencies.

Of particular concern was the state's inability - and at time unwillingness - to intervene at Lakeview when the problems concerns out-of-state residents.

'[The state] needs to determine for how long [it] will allow inadequate care of [its] citizens to go on without measurable improvement.'

Governor Hassan has ordered DHHS to implement all the recommendations in these reports. Other than simply making sure the state holds Lakeview to tough guidelines, the reports also say New Hampshire has to rewrite some of the rules to be sure they actually apply to Lakeview.  

"I'm continuing the freezing of admissions from New Hampshire to Lakeview," Governor Hassan told NHPR earlier today, "and continuing that monitoring - because what we always need to be doing is making sure that we are attending to the safety and health needs of our most vulnerable. And I think there are serious concerns about Lakeview's past capacity to do that."

As for Lakeview's ability to continue to function, the report undermines what few positive steps the organization has made recently. Even in the last few months - with constant monitoring from the state - the care there is getting worse, not better, the report states. Residents are sitting around in their rooms getting no treatment – not even cleaning up after themselves.

The governor said the state needs a backup plan for if Lakeview closes - no small task. Lakeview has about 60 residents, mostly from outside the state, some from Oregon and Hawaii.

Those people couldn’t find care at home, so they wound up at Lakeview – other alternatives for this demographic often include prison and hospital psych units.

So while the school is shutting down, there are still some big questions looming for Lakeview.

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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