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Voiceless, Defenseless

Page history last edited by PBworks 15 years, 7 months ago

April 30, 2002


Voiceless, Defenseless And a Source of Cash


The vans pulled up at the Leben Home for Adults in Elmhurst, Queens, collecting the mentally ill residents who had been led outside and told to take a seat. Among them were Robert Dowling, who communicates in half-sentences and twitches; his roommate, Robert Fazio, who cannot bathe or dress himself; Seymour Levine, stooped and unkempt; and Gail Barnabas, so depressed she sometimes does not speak.


None of them resisted, as if they were being chaperoned to a movie or a ballgame. The doors closed and the vans headed for the offices of a doctor who billing records show had never examined some of the residents, but who was about to perform a variety of eye surgery on them.


The scene would be repeated throughout 1999 and 2000, a few residents at a time. In all, the doctor conducted nearly 50 operations on more than 30 residents, the billing records show.


So many people were having the eye surgery, it was like it was a catchable disease, recalled Peter Peterson, one of the more alert Leben residents.


Few of the residents had been complaining about their eyesight, and their general physicians had not noted problems with it, according to Leben workers and medical records. Neither the ophthalmologist, who had built a substantial practice around adult home residents, nor Leben notified their families.


The procedures, which ranged from cataract operations to laser surgery and required local anesthesia, cost the government more than $25,000, the billing records show. To this day, most of the residents cannot explain what was done to them, or why. Then again, having spent much of their lives in institutions, most are used to not asking questions.


The State Department of Health, which regulates adult homes, did not learn of the eye operations until they were uncovered by The New York Times. The department is now investigating them.


Ever since New York began closing its psychiatric wards in the 1960's and essentially replacing them with adult homes, the for-profit residences have become magnets for schemes that exploit the mentally ill, a yearlong investigation by The Times found. The investigation drew upon thousands of pages of billing and medical records and state files, as well as more than 200 interviews with workers, residents and family members.


Those interviews and records show that at several homes, what little money some residents have is simply stolen by the operators. At dozens of homes, residents are brought before a swarm of outside providers for treatment -- from surgery to allergy shots -- that seems more intended to generate revenue from government programs than to improve residents' well-being.


The State Department of Health, in fact, knew well before the eye operations that doctors might be taking advantage of residents at Leben, long one of the state's most notorious adult homes. In early 1998, department officials began investigating a complaint, later substantiated, that two doctors had coerced 24 Leben residents into having unnecessary prostate surgery.


Yet the department's records show it otherwise ignored the home, and did not increase oversight or take precautions to safeguard the people who lived there -- or at any other adult home, for that matter. In the regulators' absence, at least eight Leben residents who had had the prostate surgery then had the eye procedures, according to billing records and interviews.


The Health Department would not comment on its investigation of the eye operations. The ophthalmologist, Dr. Shaul Debbi, would not comment, citing the privacy of his patients. Leben's operator at the time, Jacob Rubin, would also not comment. He was removed by the state in May 2001 after The Times published two articles about malfeasance at the 361-bed home.


As with so much else involving adult homes for the mentally ill, this was not the way it was supposed to be. The homes, conceived as a decent alternative to the dead-end misery of the state psychiatric hospitals, were intended to give the mentally ill a chance at lives in which they might have jobs, receive better care and join society in an authentic way.


Instead, The Times's investigation shows, many of the homes have become another universe in which the mentally ill are taken advantage of and poorly served.


On one side are the homes' operators, a group of businessmen who include a disgraced lawyer and a state senator's husband who went unpunished by state officials despite stealing money from residents, court records show. On the other side are the providers, which include hospitals and doctors with tarnished state records. One nonprofit group, which offers psychiatric therapy to residents, even took the opportunity to use more than $1 million in government payments to engage in risky stock trading, according to its tax records.


In the middle are thousands of vulnerable people. Nearly all the residents can legally sign consent forms, and persuading them to do so is not hard. Workers at several homes said that if residents do refuse to see doctors or other providers who have financial arrangements with the operators, administrators threaten to hospitalize the residents or to withhold their spending money, which is typically entrusted to the homes.


We would usually tell them, 'You don't see the doctor, you don't get your allowance,' said Velma McFarlane, a former Leben worker. I had to do that. I'm not lying. It makes me feel bad, but that was the policy.


Some residents undoubtedly require an array of services. Studies have shown that mentally ill people suffer higher rates of heart disease, diabetes and other ailments. Some may also be resistant to care that they genuinely need.


Yet at virtually all the 26 homes The Times examined, workers and residents spoke of coercive tactics aimed at dubious needs. While residents often go without proper psychiatric or medical care, they are paraded before allergists, vocational therapists, dermatologists and podiatrists, among others.


The government should not be shocked that the system is rife with seeming abuse and waste. The way in which the state set up the homes all but invited it.


The state decided it would pay the homes a small daily sum -- still only $28 per person -- to feed, shelter and supervise the residents. The fee is taken from the residents' monthly Social Security disability checks.


The homes were to bring in outside health care providers. The operators, who have long complained that the state pays them too little, quickly learned they could make significant money by charging rent or fees to the providers. In return, they guaranteed a bountiful supply of patients. Or the operators could start side businesses, like van services that residents are required to use to go to clinics or doctors' offices.


The fees are then billed to Medicaid or Medicare, which pay for services for the poor and mentally ill. Federal and state agencies rarely question the fees, and on average, along with disability payments, spend $40,000 annually on each resident, according to interviews and billing records. For the 15,000 mentally ill people in adult homes in New York State, that comes to $600 million a year.


The evidence of fraud and waste has not entirely escaped state officials. The mental health commissioner, James L. Stone, described in a December report a layering of services in some adult homes that had led to excessive costs. His office oversees the mental health providers who treat residents, though not the homes themselves.


But neither his agency nor any other arm of the state government -- including the Department of Health, the Legislature and the attorney general's office -- has made efforts to investigate or revamp the system, according to state records and interviews. Asked what it was doing to safeguard adult home residents, the State Department of Health could point only to a recent crackdown on part-time medical clinics across the state, some of which are in adult homes.


Robert R. Hinckley, a deputy state health commissioner, said the department had refused to renew the licenses for 50 such clinics in adult homes statewide, and delayed approving licenses for an additional 23. The disapprovals of part-time clinic applications for adult homes were based on quality of care concerns and the potential for Medicaid fraud, Mr. Hinckley said.


Perhaps even more surprising than the state's limited response is the utter lack of one by the federal government, which shoulders an enormous portion of the more than half-billion-dollar-a-year industry.


Through disability payments, Medicaid and Medicare, the federal government essentially supports the adult homes. Yet in 30 years, it has rarely if ever examined their finances or moved to protect the civil rights of the people who live in them.

Danielle Grush, a spokeswoman for the New York office of the federal Centers for Medicare and Medicaid Services, said the office was concerned about abuses in the homes, but she could offer no examples of inquiries into them.


There is an enormous amount of public money that goes toward supporting the people living in these homes, said Clarence J. Sundram, a former chairman of the Commission on Quality of Care for the Mentally Disabled, a state watchdog agency. But they end up living in wretched conditions.



The Surgery

Eye Procedures By the Vanful


Workers at Leben still recall the peculiar sight: Mentally ill residents walking down the labyrinthine corridors of the home during 1999 and 2000 with their eyes bandaged or covered by dark sunglasses.


They didn't warn me or anything, Robert Fazio, now 61, said of his eye surgery. They just took me. And then he put a laser beam in my eye.


Dr. Debbi, who operated on Mr. Fazio, performed an assortment of surgery on the more than 30 Leben residents during an 18-month period in 1999 and 2000. Some had cataract operations, according to billing records, and others had laser surgery for ailments listed as glaucoma and retinal tears. Some residents had more than one procedure.


He said it was cataracts, and if he corrected it, it would be beautiful, said Gail Barnabas, now 53. We were all brought into the van on the same day. We were there from the morning until 4 p.m., and just made it back for supper. Everybody had it. The whole van was filled.


Because adult home residents are often profoundly sick, the state requires the homes to notify their relatives of any medical procedures. Yet in numerous instances, relatives of the Leben residents said they were never told of the surgery.


I didn't know anything about it, said Henry Dowling, the brother of Robert Dowling. I think that it was totally unnecessary. There was nothing wrong with him.


For his part, Dr. Debbi was required by the state to ensure that the residents, like any other patients, fully understood the procedures, including the risks, before they signed consent forms. But a number of relatives said they found it hard to imagine their mentally ill family members making an informed decision on their own.


Ms. Barnabas's sister, Barbara Casali, said Ms. Barnabas never really complained about her eyes. I was very surprised when she said she was having a cataract operation. I said, 'You're kind of young to have it.' And she said, 'Well, the doctor says I need it, so I had it.'

Cataract surgery is rare for someone Ms. Barnabas's age. And she was among at least three Leben residents in their 50's to have such a procedure, according to interviews and billing records.


A cataract is a cloudy or opaque area in the lens of the eye. In the surgery, the lens is replaced with a plastic implant. Many ophthalmologists say that the surgery should generally be considered only when cataracts impair quality of life. Many people with cataracts need only corrective lenses.


It was not just people from Leben who were being shuttled to Dr. Debbi's office during the 18-month period. He also performed roughly 70 procedures on residents from three other adult homes, according to billing records: Ocean House and Wavecrest in Queens, and Parkview in the Bronx, which have a total of 379 beds.


In two brief telephone interviews, Dr. Debbi would not comment. I would prefer not to cooperate -- why should I? he said. I prefer to keep my practice private and my patients' care private.


Jeffrey Edelman, whose family runs the Parkview and Wavecrest homes, praised Dr. Debbi. Mr. Edelman said he would have no reason to believe that the surgeries were unnecessary. Dr. Debbi is as far as I know a very trustworthy individual.


After The Times uncovered the eye procedures, a group that represents adult home residents, the Coalition of Institutionalized Aged and Disabled, filed a complaint last July with the Health Department, seeking an investigation of Dr. Debbi and the surgery.


Most of the residents who had the surgery continue to live at the home, which is under new management and was recently renamed Queens Adult Care.


Kurt Trentmann, who is one of the more lucid residents, said he had told a Health Department investigator that his cataract operation had made his vision worse, and that Dr. Debbi had not responded when he told him about complications.


I told Debbi that I was having problems with my eye, that everything was distorted, Mr. Trentmann, 55, said. He says, 'This is going to take time.' Well, it's been over two years now. And I haven't talked to him since.


Mr. Trentmann has switched to doctors at a Veterans Administration hospital, who told him that Dr. Debbi had implanted the wrong lens, according to his treatment records.


Others, like Mr. Dowling, 59, have no memory of the procedures. Dr. Debbi performed four operations on Mr. Dowling in four months, two cataract operations and two laser procedures, according to billing records. Dr. Debbi received more than $3,000 from Medicaid and Medicare for his services. Other costs for the four procedures totaled $2,500.


Those eye procedures were just a few of a lengthy list of services for Mr. Dowling that numerous providers billed to Medicaid and Medicare. From 1998 through the first half of 2001, the services cost roughly $150,000, even though Mr. Dowling had no serious physical ailments, the billing records show.


Among the fees were $70,000 for therapy sessions and nearly $20,000 for van services to take him to appointments, the records show. During this time, Leben would not fix a broken lock on Mr. Dowling's door, his brother said, and his clothes were stolen.



The Operators

Tainted Records And Family Ties


In 1991, a resident at Brooklyn Manor received $45,626 in retirement benefits, a veritable windfall in the world of adult homes. The money was entrusted to the home, and its operator, Benito Fernandez, took every penny of it, according to multiple reports by state inspectors.


It was not an isolated case. Throughout the early 1990's, state inspectors cited Mr. Fernandez and his associates for mishandling or misappropriating residents' money, as well as for poor conditions and supervision at the 216-bed home, in East New York.


Based on the inspectors' findings, the State Department of Social Services, which regulated adult homes at the time, refused to renew Mr. Fernandez's license. In 1996, an administrative law judge upheld the decision, citing overwhelming evidence.


The department had won, yet its senior officials soon withdrew the case against Mr. Fernandez, who is married to State Senator Nellie Santiago of Brooklyn. In addition, the senior officials rebuked the inspectors, taking away their authority over the home and giving it to inspectors based on Long Island. The records in the case contain no explanation for the state's reversal. State officials, repeatedly questioned in recent months about the case, would also offer none.


After the department withdrew its case, two nonprofit groups that represent adult home residents -- MFY Legal Services and Disability Advocates -- sued the department to force it to revoke Mr. Fernandez's license, but lost the case on technical grounds.


I always had a sense that calls were being made to the higher-ups and political pressure was put on them, said Ann Pegg Biddle, a lawyer for MFY at the time.


Mr. Fernandez still runs the home. He and his wife did not respond to requests for comment. Shortly before she was elected in 1992, Senator Santiago was an administrator at the home, but the state ordered her removal after charging she had falsified records to make it appear as if she had attended classes required for administrators.


Last year, after The Times began investigating adult homes, the Health Department, which now regulates the homes, returned Brooklyn Manor to the city inspection office's jurisdiction. It found the home in disarray and cited it for many serious violations, including inaccurate, incomplete or nonexistent records.


Mr. Fernandez and Brooklyn Manor are hardly distinctive. He is among several operators with checkered records, and his home is symptomatic of a system that is loosely regulated and licensed.


The operators do not need mental health training, and the state often fails to scrutinize their backgrounds. A 1999 audit by State Comptroller H. Carl McCall found the Health Department did not verify references and financial information submitted by applicants and did not seek to determine whether the applicants had criminal histories.


So, in addition to an operator like Mr. Fernandez, the state ends up entrusting the mentally ill to people like Beryl Zyskind.


In the early 1990's, Mr. Zyskind ran what is now called Ocean House, and was charged by federal prosecutors with stealing money from residents, including $120,000 in Veterans Administration benefits from one resident who was a Vietnam War veteran. Mr. Zyskind, who was also charged with bank fraud, was convicted and sentenced to 30 months in federal prison.


The state soon gave its blessing to a new boss for the 125-bed home. He was Mr. Zyskind's brother-in-law, Sherman Taub, a lawyer who had resigned from the bar after being accused of billing his law clients for $232,000 of his personal expenses, according to records from the Appellate Division of the State Supreme Court.


In December, the State Commission on Quality of Care for the Mentally Disabled issued a report on Ocean House that alleged a staggering array of violations. It said Mr. Taub had engaged in an elaborate scheme to siphon millions of dollars from Ocean House through improper mortgage transactions and other maneuvers.


It said a company co-owned by Mr. Taub's son, Jay, had received $420,000 in Medicaid payments by submitting improper claims for home health aide costs for residents.


The Manhattan district attorney is also investigating the allegations.


Ocean House is technically one of the few nonprofit adult homes in the city, but interviews and records suggest that Mr. Taub has run it like a profit-making entity.


Among the items obtained by the home in recent years, according to the records, were three Lexus luxury sedans, which cost at least $40,000 each. At the same time, residents were sleeping on soiled sheets in filthy rooms, inspection reports show.


In a brief interview about the commission report, Mr. Taub said, I can assure you that every allegation in there is not factual and not true.


Ocean House's lawyer, Mel P. Barkan, acknowledged that Ocean House had paid for Mr. Taub's personal expenses. But he explained that such disbursements were subtracted from money that Ocean House, a nonprofit entity controlled by Mr. Taub, owed Mr. Taub.


Asked about Mr. Taub's credentials for running a home for the mentally ill, Mr. Barkan said: I think that he has a very fine understanding today of what is required to treat these people as well as they can be treated. And I think that this home is doing a very fine job.


The State Department of Health was not aware of the allegations against Mr. Taub and Ocean House until they were brought to light by the Quality of Care Commission and Manhattan prosecutors. After the commission report was issued in December, the Health Department said it would try to revoke the home's license.


For now, Mr. Taub continues to run the home. The state has also not taken any action against Jay Taub, who runs a nonprofit adult home in Staten Island called Hylan Manor, even though he was implicated in the allegations against Ocean House.



The Providers

Thousands in Rent For Space Unoccupied


With vast amounts of government dollars available, the business of treating residents has attracted numerous players, from small practitioners to major hospitals.


A rare look at the financial arrangements between the homes and providers was offered by the Quality of Care Commission's report on Ocean House in December. Investigators determined that Ocean House reaped at least $185,000 in rent annually from five providers, including $120,000 from St. John's Episcopal Hospital, and lesser sums from two home health aide agencies, an internist and a podiatrist, the report said.


The investigators concluded that the hospital was paying for space that it never occupied, suggesting that the fees might have been kickbacks. One home health agency, Americare, paid $36,000 annually under a lease that included provisions for a waiting area in the basement and two parking spaces. None of them existed, the report said.


Ocean House responded by saying that St. John's had merely not used space it was entitled to under its contract with the home.

The home said Americare did have the basement area, and that the parking spaces were on a grassy spot next to the home.


St. John's conceded it had rented space it did not use, but said it had not done so for improper or fraudulent reasons.


In looking into some of the services provided to Ocean House residents, commission investigators found that St. John's had billed Medicaid for $300,000 in clinic sessions for Ocean House residents that were social or recreational, not psychiatric, in nature.


For example, at an art group run by the hospital, residents colored on a sheet and had soda and potato chips. There was almost no conversation, and the session ended within 20 minutes, the commission's report said. The cost: $141 per person per session. At other times, residents were taken on trips to the mall and the movies, or sang songs.


St. John's said that it had done nothing wrong, but that it had changed its practices.


Others hospitals have also been accused of inappropriate billing practices. In 1999, in one of the largest Medicaid fraud inquiries in the nation's history, Staten Island University Hospital agreed to reimburse the state $45 million for improper billing practices, largely at clinics for adult home residents.


Groups that are nominally nonprofit have also been involved in scandals. Last year, the State Office of Mental Health closed down one, New Hope Guild Centers, which operated mental health clinics for adult home residents and others. The office charged that New Hope had expanded its services without approval, lied to cover up its violations and billed Medicaid for unauthorized services like biofeedback therapy.


This month, two New Hope officials were charged by the state attorney general with defrauding Medicaid of $9 million.


Other nonprofits continue to prosper from the homes.


New Horizon Counseling Center, which offers therapy and other programs for adult home residents, pays its executive vice president $315,000, according to its recent filings with the Internal Revenue Service. New Horizon has had such robust revenue from Medicaid, reaping $4.5 million annually, that in the late 1990's it made the more than $1 million in high-risk stock trades. New Horizon says it no longer engages in such trades.


New Horizon's biggest competitor is New York Psychotherapy and Counseling Center, which had $8.5 million in annual revenue, also almost entirely from Medicaid, according to its tax filings. It paid its executive director and medical director $260,000 each, and spent $75,000 lobbying in Albany.


That revenue derives from the close relationships the two nonprofit groups have built with the homes' operators, workers said.


In 1999, for example, residents of Surf Manor in Brooklyn were told by the home that instead of attending a New York Psychotherapy program twice a week, they would have to go five days, even though they did not want to and social workers said they did not need to go that often. The change came about after the home's operator, Robert Lichtschein, set up a transportation service to earn Medicaid money by driving residents to a variety of appointments.


Mr. Lichtschein said the residents had not been pressured to go. The caseworkers here tell them that it is to their benefit to go out to different programs, he said.


Muriel Dethomas, a former administrator at New York Psychotherapy, disputed that account. Ms. Dethomas said it was common for Surf Manor and other homes, as well as the clinic, to pressure residents to go to the program by telling them that if they did not, they would be hospitalized or evicted or would lose their allowance.


What they did was force them to come, Ms. Dethomas said.


Eric Bettelheim, director of corporate administration at New York Psychotherapy, said he was not aware that residents had been pressured. He said some residents might be making up complaints in an effort to retaliate against the home.


They might be trying to manipulate the situation, Mr. Bettelheim said.



Feet First

$50 to $75 a Session For Clipping Toenails


There is no evidence of a medical link between mental illness and diseases of the foot, but the amount of podiatric care in the homes might indicate otherwise.


Talk to dozens of residents at the homes, and most say the same thing: they are lined up at least once a month to see a podiatrist. The session lasts a few minutes at most, and the government gets the bill.


They put your name on the list and then a nurse calls you in and tells you that you have to go to the doctor, said Eileen Marcus, 45, who has lived at several adult homes in the city, including Oceanview Manor and Seaport Manor in Brooklyn. It's outlandish. My nails don't grow that fast. That's all they do -- clip my nails.


The cost is not insignificant, especially considering how little money is spent by the state to house, feed and supervise the residents. An examination of several residents' billing records shows that Medicaid and Medicare were paying $750 to $1,000 annually per resident just for podiatric care.


Posted on the door of the medication room at Seaport Manor one Friday last summer, for example, was the morning schedule for a podiatrist named Dr. David B. Fuchs. It was three pages long, with 137 names in all. Those who saw Dr. Fuchs each received a few minutes of his time at a cost to the government of up to $100 per person.


The amount of care for one resident is evident in the case of Ernest Nelson, a 46-year-old who until this month lived at Seaport Manor.


Between 1998 and the first half of 2001, billing records show, Mr. Nelson was treated for various conditions, including 19 times for dermatophytosis (otherwise known as athlete's foot), 7 times for ingrown toenails, 4 times for corns and calluses, 4 times for heel pain, 2 times for hammertoe and once for a sprained foot. In all, Medicaid paid more than $2,500.


Dr. Fuchs defended his practice. We see maybe 15 or 20 patients in a morning, he said. They need the care. They have corns, they have calluses, they have pain.


Mr. Nelson has a different take. They are just trying to make money off of us, he said.


At Leben, numerous residents have been treated monthly by a podiatrist named Dr. Stephen Smirlock, whose license plate reads FOOTBIZ. Some residents saw him more than 40 times from 1998 through 2001, billing records show. Dr. Smirlock did not respond to three messages seeking comment.


Some adult home administrators said paying podiatrists $50 or $75 a visit to clip toenails was appropriate, even though state regulations say the homes should provide such basic care themselves.


Cutting somebody's toenails can be extremely injurious, said Benay Phillips, who helps manage the Elm-York home in Queens.


Medical fraud investigators in New York have long been suspicious of the podiatric profession. In the late 1980's and early 1990's, so many podiatrists were punished for cheating Medicaid that the state attorney general's office had the entire profession severely restricted from the program. But podiatrists working in adult homes have found ways to get around the rules.


And the state has largely stood by, records show, even though its inspectors have come across clues.


At Seaport, they cited the home in January 2000 after discovering prescription podiatric creams in residents' rooms, a violation of rules that bar residents from administering prescription medication themselves. But the inspectors apparently never looked into why so many residents had the cream in their rooms in the first place.


Had the inspectors questioned workers, they would have learned that podiatrists had prescribed so much cream that the home was running into a problem.


It seems that there was not enough space left in the medication room to store the psychotropic drugs.


A Roll Call: Decrepit Rooms To Wrong Pills


As operators and providers profit from adult homes, state inspection reports show that many of their residents go untreated and unbathed. Here are excerpts of findings since 1998.



427 beds, New Brighton, Staten Island


Resident with dementia wore urine-stained clothes for three days. Another had lesions draining onto clothes that went unchanged for two days. Another hid in room for days without eating or bathing, and was not hospitalized. While inspection going on, workers completed long-overdue records. Many residents complained about getting wrong psychotropic medication. When pills were missing, workers borrowed from other residents' prescriptions. Resident hospitalized after receiving wrong pills. Worker flushed pills down toilet instead of distributing them.



216 beds, East New York, Brooklyn


Resident had old and new blood stains on face and body, and was filthy. Staff did not respond to emergency calls from rooms. One resident lost 54 pounds in a year; home did not determine why. Records were inaccurate, incomplete or nonexistent. Worker signed that she gave medication to all 200 or so residents at 9 p.m., when she was not on duty. Kitchen and many rooms infested with flies. Residents made to work as janitors and in kitchen, in place of employees. One resident in charge of home one evening.



202 beds, Bensonhurst, Brooklyn


Operator routinely threatened residents with eviction, verbally harassed them and demanded compliance with unlawful rules, creating abusive environment. Medication handling chaotic, with psychotropic pills given haphazardly and at wrong times. Resident vomited for two days, no one called doctor or family, or monitored her. Meals meager and unappetizing.



361 beds, Elmhurst, Queens


Rooms so decrepit that 60 residents evacuated. Security guards distributed pills. Incontinent resident wandered home with wet pants. No activities in home, numerous fire hazards. Many residents ill-groomed and malodorous. Workers psychologically abusive to residents. One resident burned in fight, another shot.



125 beds, Far Rockaway, Queens


Rooms infested with cockroaches. Residents sleeping on soiled sheets. Kitchen floor rotted. Widespread hazardous conditions due to dilapidated home, ongoing renovations. Operator and son accused of embezzling millions of dollars from home and Medicaid. Serious deficiencies in medication handling and residents' hygiene.



134 beds, Olinville, the Bronx


Anorexic resident allowed to deteriorate so much that she weighed only 76 pounds and then died. Of 15 case management evaluations sampled, none completed. Numerous residents not receiving psychotropic medication. Workers did not know basic first aid. Resident refused to sleep in room because roommate harassed him and had history of violence.


Broken Homes


A yearlong investigation by The New York Times of adult homes for the mentally ill found a universe plagued by neglect, malfeasance and death.


DAY 1: A Final Destination


DAY 2: Where Hope Dies


DAY 3: The Operators




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