Abuse and Neglect at Lakeview Neurorehabilitation Center, Part 1

Hello and welcome to another episode of
the Disability Rights Center Presents Ii’m your host Cindy Robertson and I’m a
senior staff attorney with the disability rights center. Today’s show is going to
be about lakeview neuro rehabilitation center in Effingham New Hampshire we’re
going to do this as a two-part series and our guests today are Dick Cohen
who’s the executive director of the disability rights center and karen
rosenberg who is a senior staff attorney with the disability right center
so I welcome both to the show thank you you know one thing we wanted to do a
two-part series about Lakeview because of all the controversy and the
publications that have come out recently about the issues and atrocities that are
happening at Lakeview and we know that both of you have worked on an
investigation into some of these atrocities and we wanted to bring it out
to our viewers what’s going on so let’s start our viewers may not actually be
familiar with what Lakeview is so can we start with what Lakeview is. Karen
want to start? Well Lakeview is a advertises itself as a residential
rehabilitation facility in New Hampshire it has a license to serve 88 individuals
children and adults who have neurobehavioral challenges and typically
a brain injuries or other developmental disabilities and behavioral challenges
and that’s what they hold themselves out to providing they have a school that’s
been approved by the Department of Education to provide a special education
program for the students there and that’s what they’re supposed to do the
problem that we’ve seen is that they have not been really providing the
services that they hold themselves out to provide and instead they are really
creating an environment in which people with very significant disabilities who
are vulnerable are placed in situations where they may experience abuse or
neglect or just really substandard treatment now we’re going to we’re going
to save really the meat of the investigation for the second part
but I do want to talk a little bit about how long has Lakeview been around and
how long have you people going there it’s just generally well more than 20
years I don’t know the exact date that they started they have been under prior
ownership until at least the past ten years and when did the Disability Rights
Center start to get some complaints or start to bring to their attention that
there’s things going on there that weren’t appropriate generally I think
well just I think over the years even before it was Lakeview when it was
called Highwatch and under a different ownership we had occasionally
gotten some information about and some complaints about Highwatch and then
Lakeview and you know again most of the residents there were sort of unable to
call us didn’t even have the ability or but we and we would address those and
then beginning especially about three or four years ago we started getting more
and more complaints and began about two to three years ago our first sort of
major investigation that Karen oversaw so it there’s been some history of it in
that it seems to have escalated over the past three to four years maybe because
we have even more presence there and people realize that there is a place to
call that in where they could get some some where there may be some hope right
now for our viewers let’s listen to go back a little bit on history. Lakeview
was initially created to serve what population? I believe people with brain
injuries. Okay but currently there’s people there over and beyond just people
with brain injuries. Sure there’s people who have developmental disabilities,
people with a combination of maybe a brain injury
developmental disability and also psychological issues or and particularly
behavioral challenges. And Lakeview is definitely an institution as we define
it in new hampshire dick I know you did a lot of work with the Laconia state
school which is was an institution as well and you were instrumental in having
it closed down can you give the audience some I’m some history there about sort
of you go from Laconia working really hard to get it shut down we end up in
2015 we still have an institution called Lakeview you could give us sort of how
that came about well that’s a really good point there’s a connection there
the reason why we sort of targeted Laconia state school
this is years ago back in the late 70s was because it was a very isolated
segregated institution although was in Laconia it was sort of outside Laconia
and there were at one point a thousand residents there but when we filed a
lawsuit against the state school and the state for maintaining such a facility
there were about 600 individuals there again that they’re almost their entire
life was at the state school and the reason why the state school became
necessary when it was first built and the reason why it continued was because
of a lack of community-based services and through the 60s and 70s a number of
practices were developed which demonstrated that people even with the
most significant disabilities and even behavioral challenges the type of people
that are Lakeview can be served in the community in other words there’s nothing
magical about bricks and mortar it’s really having quality direct support
staff quality kind of clinical staff where that’s necessary programmatic
staff so with the fact that there was now evidence that all people even with
the people with the most severe disabilities could be served in good
community settings and emphasized good we filed suit against the state saying
not only is Laconia hard but you don’t even need it because with a good
community based system you don’t need a place like Laconia and frankly you don’t
even need a place like Lakeview Lake use a lot smaller it’s theirs as Karen said
about 80 plus individuals but it’s still very segregated a kind of a total
institution and this and we can talk about this more but basically the reason
why a place like Lakeview became necessary at least at least in my view
is because although as a result of the Laconia state school suit a good
community based system was developed even for people with significant
behavioral issues that system started eroding you know once the sort of the
lawsuit kind of withdrew and due to budget cuts in and other factors that
system started started eroding and as a result different private vendors came in
taking advantage of the situation and created a place like Lake
you because the community system you know wasn’t yet wasn’t strong enough
anymore to to serve folks with significant challenges care indeed mine
is going to say I think it’s really important to think about what it means
for a person to live in an institution and what an institution is I mean it’s a
place where you’re not an individual you’re a group with people who have
similar disabilities or only people with disabilities your only opportunities for
interactions and forming relationships for the most part are with people with
disabilities and you don’t have very many opportunities to do things in the
community that people have to can do so forming different relationships
obtaining gainful employment going shopping eating at restaurants going to
movies doing things that people just take for granted in their day-to-day
lives and what we’re doing when we put someone in an institution is we’re
segregating them order isolating them and not giving them the opportunity to
live the way people want to live right and when someone is at Lakeview what
opportunities do they have I mean if the students I the kids I assume are getting
some type of education well barely an hour Department of Education has
recently found that there’s no curriculum there and the kids are only
getting minimal opportunities for education but they are you know if
they’re living on there and most of the students there do live there their lives
are mostly on the top of this small mountain on this campus that’s contained
where they don’t have a lot of opportunities to enjoy what the general
community enjoys and you know at a certain point we’re supposed to be
educating children and helping them to grow up to transition into adulthood to
live in communities where adults live and work and have families and are
active in their participants in their community and being really segregated
like that you’re not getting opportunities to develop those skills or
enjoy those kinds of activities and you raise a good point the location itself
is isolating I mean for those are the audience who know where F
New Hampshire is it’s his rural it’s very very rural and I know that we can
look on Google Earth for those of us who can do that and you can just see the
surrounding trees and forests and mountains and it’s it’s um it’s not like
you’re downtown Manchester and go to the movies right I mean even if you were
really free to come and go there’s really nowhere to go right it was not
within walking distance yeah unfortunately the most tragic example of
this dichotomy between living in really living in the community and going to a
place like Lakeview can be seen through a new one of the one of the
investigations that Karen did was a young man who ended up at Lakeview but
was living in a community was having a really great life participating in all
sorts of community activities both independently and with supports and and
had a kind of a life event in his in his life where he lost the provider and got
depressed ended up at New Hampshire hospital and then he was true for a
brief period of time then it was transferred to Lakeview he lasted a lake
view for two to three months because he started starving himself he would refuse
to eat because he was depressed because he was no longer you know in in the
community living his normal life he was in this place and and we’ll talk about
it more in the next show but as a result of starving and some other factors that
ultimately contributed to his to his death and you know the contrast between
the life he had and the life at lakes you and then the causes of death really
show why we both need and can have a community placement and you know
community services so you know let’s so let’s get into a little bit about the
investigation can you give us just sort of generally the types of complaints
that the DRC was starting to hear or get wind of it get calls about well shortly
after I started at DRC maybe even not that shortly we received a complaint
from a lake view resident who alleged that she was injured due to excessive
force and or strange she alleged that a staff member had actually hauled off and
punched her in the eye during that of restraint and we conducted a really
thorough investigation into her allegations and through that
investigation we learned of other incidences of abuse
at Lakeview including a young woman who had been left unsupervised and was
sexually assaulted by another resident someone who had been jumped by a staff
member and suffered abrasions and bruises on his body we determined that
Lake view’s staffing patterns didn’t really meet what the needs were of the
clients there and that Lake View was relying on staff who were assigned to
provide really direct one-on-one supervision to a particular resident to
also supervise other individuals which meant that no one was getting levels of
supervision that they needed and we published our first report about
Lakeview summarizing those incidences in 2011 we also brought those concerns to
the attention of the state’s Department of Health and Human Services licensing
division and you know nothing much happened they found that Lakeview was
licensed and didn’t feel that the concerns we raised really rose to the
level of violating New Hampshire’s rules for such facilities but that’s the
beginning and then let me just jump in for a minute and hang so give the
audience a little bit of background on the disability rights center I mean how
do you go in and do an investigation of a place like Lakeview when you get a
phone call and said you know whatever my daughter my wife has been raped or has
been assaulted you know maybe you get the name maybe you don’t get the name of
the person give it all these little bit background about the disabilities rights
Center its authority on that well the first thing you need to know is that the
Disability Rights Center is the protection and advocacy agency for the
state of New Hampshire we’re federally designated such and as the these states
protection and advocacy system we are authorized and actually we must
investigate incidents of abuse and neglect of people with disabilities and
provide other kinds of advocacy services to ensure that people with disability is
our Ford at their civil rights that right yeah and when we feel that we have
probable cause to believe that there is abuse and neglect of someone
a disability that gives us not only the responsibility but but the authority to
go to go to the facility to interview folks to access records with after we
follow certain procedures and basically do an investigation that very similar to
what the police can do or what the Attorney General can do look at all the
workforce right you people exactly in jurors right so do you do people have to
give you their names of people there can they just say hey I heard about or
generally how do these come because sometimes you don’t really want to give
a name you don’t want to give your own name it doesn’t matter we can do either
as long as we believe that there’s there’s some credible evidence whether
we get specific names or get a description of conditions and if we go
there and we find that there is not a problem then you know sort of no harm no
foul but the purpose of the federal law which gives us as this Authority is you
know we’re all responsible licensed attorneys and basically you know the
sort of rule on abuse and neglect reporting and and in investigations and
screening is to err on the side of caution if you feel that there’s a
there’s a likelihood or a possibility that this abuse and neglect you should
go and check it out in some fashion and then of course if you find out that that
there is no problem than that then as I say there’s there’s no harm I mean these
are all licensed we go into licensed facilities they’re getting federal
they’re getting state funding and they should be held accountable and this is
one additional protection that Congress decided was necessary to invest in one
agency in every state of protection and advocacy state which is completely
independent from the state the ability to go in when they feel that there’s
abuse and neglect I mean obviously the more information that we receive the
better our investigation can be but we understand that sometimes people may not
want to be taught like the the person who gives us the complaint may not want
their name to be public we can keep that confidential right but it certainly
helps if someone is concerned about a person in an instance
ution to know who the name of the name of the person who is allegedly being
abused or neglected obviously that’s going to help us because if we just get
a sort of a general complaint it’s going to be a lot more difficult to
necessarily see what the person complaining is talking about so Karen
when you when you back in 2011 when you first started to get these complaints
and do the investigation I’m just curious what is the lake views or any
other institutions response when you knock on their door or you show up in
their doorstep and said we’ve got probable cause and we want to come in
and we’ve got these complaints so what did what is their reaction what was
their reaction when I first started working on this started they assign they
had a quality assurance um staff member and she was actually very helpful she
helped us to schedule interviews with all of their employees who were not just
all the employees who were relevant to our investigation they allowed us to
tour the facility we met they gave us a meeting place to have confidential
meetings with not just the person who was the alleged victim but also people
who may have been witnesses so they were very cooperative initially and during
that investigation in the second investigation that we did that I was
involved with the death investigation ultimately they were cooperative
initially the road was a little bit bumpy I think that had to do with the
fact that there was a new quality assurance person in place and that
person was a you know laughed experience they were a little bit more medicine but
ultimately we were able to interview the necessary staff members we were able to
meet with the clients who had who had some experience and perhaps would be
able to contribute to our investigation and so when you get these complaints and
when you first did your first investigation in 2011 was of any other
public authorities involved is the Health and Human Services involved or is
it just strictly a call to the DRC in the DRC is doing this or was there
police involved well in that first investigation I believe that they person
who was the victim called the police on her own and not a lot came out of it we
after week plated our investigation we issued it to
members of the legislature we issued it to the department of health human
services we followed up with both Lakeview and with the licensing Bureau
we sent it to the Joint Commission formerly known as jayco which certifies
facility proves or credits facilities we sent it to carve which is sort of the
Joint Commission equivalent or resident for rehabilitation facilities and this
was back in 2011 2011 when we issued the report and what was the response well
the doors were pretty much closed Donna well people didn’t seem that concerned
let’s get a little bit of details about the 2011 report you talked about the
incidents but so how long is the report and when you give the public to all
these agencies do they read it do they call you up do you talk to the press
what happens when you get they suddenly get this information on their desk were
they had been they’ve been aware of it what happens well like I said the back
in 2011 it was frustrating from my perspective because they really weren’t
media calls there really wasn’t a huge outcry now what we found in that
investigation was that we really we could not substantiate the allegation
that a staff member to actually hauled off and punched this resident in the eye
what we found was that the use of restraint in this case was not warranted
that the staff had acted inappropriately and escalated a situation that could
have been managed that would in a way that wouldn’t have necessitated a
restraint of any kind so we so we thought it was serious and I think it is
serious that staff weren’t complying with this woman’s treatment plan that
they in this case she was it all basically boiled down to she had a
medication that was something that was a PRN something that she could take as
needed she asked for her PRN and the staff member the staffers just refuse
to do anything to get her her PR ends and she was very uncomfortable and she
was upset and decided to get her medication on her own and left her cabin
to go to nursing to get her medication if staff had just followed the protocol
at the facility and made the call and got in her medicine couldn’t nip the
problem in the bud right yes we found and this sort of goes back to you know
if she was living in the community or if that happened to you or I at our house
you know we we could have just gone and gotten our own medications as an aid or
ask somebody to help us it certainly would not have led to allegedly somebody
punch him in the eye because I wasn’t getting my medication it’s you know you
raise a good point about the what happens in an institution and the
institution mindset versus sort of the community mindset it’s more open it’s
more flexible it’s more so did you make where the recommendations made at the
end of year 2011 reports we made a number of recommendations including a
lot of recommendations about communication and complying with
behavior plans that the clients have they’re not relying on staff to provide
both one-on-one coverage as well as coverage for other people we made
recommendations about their protocols yeah you know there were a number of
recommendations all centered around making sure that there’s you know clear
development of behavior plans and that staff were appropriately trained that
there were step in place and that people complied with people’s treatment plans
essentially and so before we get to does a place like Lakeview does it actually
have internal policies and procedures regarding the use of restraints or
seclusion yes yeah and so when you went when you did your investigation 2011 did
it look like they were following the internal protocols or maybe the
protocols themselves were not appropriate well well I think it was a
combination actually but in in large part they weren’t even following their
own protocols and they did not have very good communication between the and among
the administrators the clinical providers and what the direct care staff
who are not very educated people there are the people sort of on the
front lines who are managing and people in their cabins on the grounds on a
day-to-day basis and the and because of that lack of supervision there was a
lack of consensus about how this particular residence should be treated
people just kind of did whatever they felt they wanted to do and in the moment
in the moment and you can’t you know you’re not providing effective treatment
when you have you know someone with multiple needs where everyone isn’t on
the same page about what this person’s treatment plan is and how to effectuate
that plan right and so in her instance some people found her kind of difficult
and decided well they’re going to do X instead of Y and so although when
someone asks for their PRN medications they ought to get them there ought to be
a call to health services a staff member just basically made up a policy that
didn’t exist and this particular he told her no you can’t have your medication
unless you’re in bed which she was smart enough to know wasn’t the case wait and
that just got her obvious that she wasn’t being treated with any kind of
respect at all right and as dick has pointed out earlier it’s really
difficult for people there leave you to even call our office just to call
anybody just say this is not right what’s going on right right right yeah I
mean you know imagine just any one of us or someone else without any training and
you’re trying to provide support for someone with very challenging and
complex behaviors and you know a lot of it is just treating someone with dignity
and with some humanity I mean no not at all and but you know the the folks at
Lakeview who are hired the direct support staff you know or don’t have any
training I mean they’re high school grads or GED grads you know some may
have college but they have no training they’re getting mixed messages and
there’s as Karen pointed out as we found in several investigations you know
little communication across disciplines and then from the clinical and
administrative staff down to direct support staff so they’re kind of left on
their own to figure out what to do and you know the frankly the labor pool that
they’re drawing it’s an isolated area is not vast so
they you know oftentimes are forced to take whoever’s whoever’s available don’t
train him properly he’s not probably that great no I to say the very least
and so as a result you have the sort of perfect storm of people undertrained
understaffing with folks with threat with very challenging behaviors right in
and you don’t have the normal community monitoring I mean this place is very
isolated so you know that kind of natural monitoring that may go may go on
in the community can’t go on at a place like this right right so we’re getting
close to the end of this show because we wanted to give their our audience the
background on it and our next show we’re going to dig further into the second
investigation that was more recent that is beginning the public the publicity I
do want to ask you next show what their response was to your recommendations in
2011 see how that ties into what actually happened later but we do want
to let the audience know that if you have concerns or someone who know is
having issues at lakeview absolutely call our office disability rights center
in Concord New Hampshire we’re going to put up our address and phone number you
can check our website we’ve got a lot of information about the Lakeview
investigation on our website and you can certainly call us at any time so I want
to thank you both and we will be back and we will do the rest of the story as
they say right thank you thank you you

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