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Patient's death sparks probe of Effingham rehabilitation center

Union Leader Correspondent

September 30. 2014 9:11PM
Lakeview Neurorehabilitation Center in Effingham. (JOHN KOZIOL)

Following the release of reports alleging abuse, neglect and the death of a patient, Gov. Maggie Hassan has ordered the state to immediately stop placing patients at the Lakeview Neurorehabilitation Center, and called for a thorough investigation of its operations.

On Tuesday, the Concord-based Disability Rights Center issued two reports that it said described “a long-term pattern of poor treatment resulting in abuse and neglect, injuries and, in one case, death” at Lakeview.

Lakeview issued a statement in which it said it “strongly” disputed the DRC reports, the first of which is an investigation into the death of a patient identified as J.D.

The second report, “Isolated, Segregated and Vulnerable — A Report and Call to Action Concerning Lakeview Neurorehabilitation Center,” contains what the DRC called “a comprehensive review of investigation reports issued by various agencies, as well as police logs, public and news reports and other information concerning Lakeview’s operations” over several years.

The reports were presented to both Hassan and to Nick Toumpas, the commissioner of the New Hampshire Department of Health and Human Services. The governor said she found the allegations in the reports “deeply disturbing”

“As a state, we should be working together with families, caregivers and providers to enhance the health, safety and human dignity of all our patients, including those living with the most complex health and developmental needs who have been placed at Lakeview,” Hassan said in a statement.

The governor said after meeting with DHHS officials, she directed daily monitoring of Lakeview; a review of all of the patients currently placed in Lakeview to determine whether they can safely transition to community-based care; and for the DHHS to engage an outside expert to oversee a licensing and complaint review of Lakeview.

Additionally, Hassan said she will initiate “an outside review” of DHHS’ “handling of Lakeview, and its response to recent incidents at Lakeview,” adding that until the matter is resolved, “the state of New Hampshire will not place, or allow area agencies to place, any new patients at Lakeview, and we will notify other states with patients at Lakeview of our decision.”

According to Marilee Nihan, DHHS’ deputy commissioner, the state currently has between 35 and 40 patients placed at the 88-bed Lakeview facility, most of whom are persons with acquired-brain disorders.

She said the state also has 16 to 20 patients at The Meadows in Belmont, which, like Lakeview, is operated by Lakeview Systems. On average, it costs the state about $800 a day to place a patient at either Lakeview or The Meadows, said Nihan, although it can be higher or lower depending on the level of care provided.

When asked about the state’s relationship with Lakeview, Nihan replied it was of “long standing, mixed evolutions” and included a decade or more of “monitoring concerns.” In recent years, the relationship has improved, she said, with Lakeview becoming more “open minded” in terms of recommendations from the state.

Death of “J.D”

The DRC said J.D. had been at Lakeview for 72 days during which time he lost nearly 50 pounds and was “in a metabolic state of starvation.” J.D. had regularly refused food and medications and Lakeview, the DRC said, “minimized these and many other danger signs.”

Karen Rosenberg, the lead investigator in J.D.’s case, said it was “the most horrific case of neglect I have ever seen.” J.D., she said, “was miserably sick and depressed during his short time at Lakeview. Despite the precipitous decline in his health, Lakeview failed to recognize his dire circumstances and minimized his symptoms which ultimately led to his death,” lying on the floor in his own urine.

The DRC said the “gravity of the findings” in J.D.’s death as well as the “receipt of additional complaints of abuse and neglect which suggested deep-seated and longstanding deficiencies at Lakeview,” led the group to undertake the “Isolated, Segregated and Vulnerable” report.

DRC said its reports cumulatively describe “a lack of professional oversight; inadequate coordination of medical, neurologic and psychiatric care; inadequate staffing levels; lack of training for, and indifference of some direct support staff; and broad failures in communication between and among Lakeview’s staff and between Lakeview and its residents’ families and guardians.”

Richard Cohen, who is the DRC’ executive director, said J.D.’s death could have been prevented “had responsible officials heeded the continuous and pervasive warning signals from numerous prior incidents.”

He said it was “particularly disturbing” that the DHHS and the Lakeview administration allowed “this isolated and substandard facility to operate and continue to admit and then mistreat vulnerable individuals from this and other states.”

Reports disputed

David Armstrong, who is Lakeview’s administrator and a member of the leadership team at The Meadows, said in an e-mail that at Lakeview, which has some 400 employees at Lakeview and nearby community homes, “We strongly dispute the NH Disability Rights Center’s white paper.”

“By the very nature of our mission,” he said, “at our Effingham facility, we serve people with cognitive and behavioral needs who are the most difficult to treat, many of whom have repeatedly not been successful in other settings and would otherwise be institutionalized or sent out of state.”

Armstrong said a testament to the effectiveness of the care and treatment provided at Lakeview is the fact that “nearly 90 percent of our program participants successfully transition to less-restrictive community settings, many to home.”

He added that “None of the incidents included in the Disability Rights Center’s white paper are new. All have been reported to, and investigated by, the appropriate authorities. The license of our Effingham facility has been, and remains in good standing.”

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