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Nov 7, 2015

A mountain of misconduct

Co-produced with PRX Logo

UPDATE, May 14, 2016: Reporters Jack Rodolico and Laura Starecheski followed up on what’s happened since we first told you about 40 years of alleged abuse and neglect of people with disabilities at specialty rehab centers across the U.S. An updated version of the original episode can be heard below.

This month on Reveal, we team up with New Hampshire Public Radio health and science reporter Jack Rodolico to unveil 40 years of alleged abuse and neglect of people with disabilities at specialty rehab centers across the U.S.

We zoom in and take a close look at Lakeview NeuroRehabilitation Center, a facility nestled in the wooded foothills of New Hampshire’s White Mountains, where people with severe disabilities were treated. For families all over the country, Lakeview was the last resort for their loved ones. For the owners, it was a lucrative business.

But patients suffered. Reveal exposes how for-profit rehab centers thrive on public dollars with little oversight.

Segment 1

Nov 7, 2015

Partners

NHPR NHPR

Exposing abuse and neglect on ‘The Mountain’

During Ryan Libbey's roughly one-month stay at Lakeview in 2011, his mother, Jennifer Cote, found unexplained bruises all over his body.
Credit: Courtesy of Jennifer Cote

New Hampshire Public Radio reporter Jack Rodolico spent a year uncovering allegations of patient abuse and fraudulent billing practices at Lakeview NeuroRehabilitation Center – like charging Medicaid for changing channels on a TV. Along the way, he encountered a crusading mother who made secret recordings of state regulators in a desperate attempt to get someone to help her daughter.

DIG DEEPER

Segment 2

Nov 7, 2015

Partners

NHPR NHPR

Inappropriate love triangle blossoms at rehab

Amy Mueller’s mother, Jackie, sued Lakeview NeuroRehabilitation Center for ethical and financial violations during the time her daughter was there.
Credit: Jack Rodolico/New Hampshire Public Radio

We travel back to the late 1990s with the story of another Lakeview patient, Amy Mueller, then a teenager, and her romantic relationship with at least one staff member.

Mueller’s family later sued the facility for billing for services that never were provided and putting her in danger.

DIG DEEPER

  • InteractiveMeet the other major players in this investigation.

Segment 3

Nov 7, 2015

Partners

NHPR NHPR

The family behind the neuro rehab racket

Joseph Brennick’s brain injury rehab center – the Florida Institute for Neurologic Rehabilitation, also known as FINR – sprawls across nearly 1,000 acres of gator-infested swampland in Wauchula.
Credit: Laura Starecheski/Reveal

Lakeview NeuroRehabilitation Center originally was part of a national chain of brain injury rehab centers called New Medico, owned by Charles Brennick of Boston. Nursing-home abuse investigator Sue Bessette teamed up with former New Medico patient Lucy Gwin in the early ’90s to uncover fraud and abuse across a $10 billion industry – leading to an FBI investigation.

We look for answers about why and how the Brennicks are still in business, heading to the swamps of Wauchula, Florida, to visit with Charles’ son, Joseph, at his brain injury rehab center, the Florida Institute for Neurologic Rehabilitation.

DIG DEEPER

  • Interactive: Meet the Brennicks and see the pivotal roles they played in the private neurorehab industry.

Credits

Host: Al Letson
Executive Producer: Kevin Sullivan
Executive Editor: Susanne Reber
Managing Director: Christa Scharfenberg
Lead Sound Designer and Engineer: Jim Briggs
Reporters: Laura Starecheski, Reveal; Jack Rodolico, New Hampshire Public Radio
Lead Show Producer: Laura Starecheski
Producers: Stan Alcorn, Julia B. Chan, Peter Haden, Delaney Hall, Michael Montgomery, Ike Sriskandarajah and Amy Walters
Show Editor: Deborah George
Digital Editor: Julia B. Chan
Editors: Sarah Ashworth and Josh Rogers, New Hampshire Public Radio; Amy Pyle, Reveal
Senior Management for CIR: Joaquin Alvarado and Robert J. Rosenthal
Senior Management for PRX: John Barth, Kerri Hoffman and Jake Shapiro

Track list:

  • Jim Briggs, “There’s Something to This” (Cut-Off Man Records)
  • Jim Briggs, “Pieces to Pick Up (Full reversal)” (Cut-Off Man Records)
  • Jim Briggs, “Pieces to Pick Up (Main theme)” (Cut-Off Man Records)
  • Jim Briggs, “Pieces to Pick Up (Variation 1)” (Cut-Off Man Records)
  • Jim Briggs, “Pieces to Pick Up (Max counterpoint version)” (Cut-Off Man Records)
  • Jim Briggs, “Pieces to Pick Up (Full orchestration)” (Cut-Off Man Records)
  • Jim Briggs, “Pieces to Pick Up (Full orchestration reprise)” (Cut-Off Man Records)
  • Jim Briggs, “mixtup” (Cut-Off Man Records)
  • Jim Briggs, “the setup” (Cut-Off Man Records)
  • Jim Briggs, “the tangled web (pts 1+2)” (Cut-Off Man Records)
  • Jim Briggs, “the setup (return)” (Cut-Off Man Records)
  • Jim Briggs, “the tangled web (pt3)” (Cut-Off Man Records)
  • Jim Briggs, “The Mountain (phase one)” (Cut-Off Man Records)
  • Jim Briggs, “The Mountain (phase two)” (Cut-Off Man Records)
  • Jim Briggs, “The Mountain (phase groove)” (Cut-Off Man Records)
  • Jim Briggs, “The Mountain (phase groove two)” (Cut-Off Man Records)
  • Sylvia Brennick, “Have Yourself a Merry Little Christmas” from “Christmas at Highwatch" (A+R Records)
  • Camerado / Lightning, “True Game (Reveal show theme)” (Cut-Off Man Records)
  • Wild Arrows, “Pleasure” from “Tell Everyone” (Shiny Shoes)
  • Wild Arrows, “F” from “Tell Everyone” (Shiny Shoes)
  • Trans Am, “Insufficiently Breathless” from “Volume X” (Thrill Jockey)
  • The Sharp Things, “Something Big” from “Live on WFMU with Irene Trudel, 2/2/2016”

Support for Reveal is provided by the Reva and David Logan Foundation, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation and Mary and Steven Swig.


TRANSCRIPT:

Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal's radio stories is the audio.

Al :                             From The Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson. Jennifer Cote’s son Ryan is autistic. He doesn't speak and he also has a disease that causes chronic pain. When the pain gets bad-

Jennifer:                He starts rocking violently, he doesn't sleep, he doesn't eat

Al :                             Jennifer couldn't care for Ryan at home because he needs it all, school, medical care and staff attention 24/7.

Jennifer:                I really had to rally to get him there.

Al :                             But on her first visit, she found bruises all over his body and when she asked the staff what happened.

Jennifer:                Nobody knew, nobody noticed. I don't know how you don't notice these marks on his body.

Al :                             There are families like Jennifer across the US who's loved ones are being neglected and abused in for profit rehab centers.

Jack:                         These places are clever. They are alert, it's a big business.

Al :                             That's next on Reveal. From The Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson and our entire show today is a core production with New Hampshire Public Radio and one of their reporters who spent the last year doing story after story about this one place in New Hampshire. In that time there was something he'd never done. He never actually went to this place until a few months ago.

Jack:                         Okay, so we're calling up and it's this huge expensive facility with a big metal gate around it. Looks like there's an orchid?

Maurice:               Yeah, it's an apple orchid. There's a lower orchid and then there's an upper orchid.

Jack:                         It's really pretty.

Al :                             That's Jack Rodolico, a reporter for New Hampshire Public Radio. He's approaching Lakeview NeuroRehabilitation Center, close to the main border in the foothills of the White Mountains. It's a Sunday morning in July about 8am. Why such an odd time? Well, Jack has asked the people who run Lakeview for a tour, but he's always been refused. So he arranged with one of the staff psychologist a guy name Maurice Regan to give him a client destined tour.

Jack:                         It's quite a hill to get up from the road to the building wow.

Maurice:               Yeah, I know it. It's challenging in the winter.

Al :                             It's also peaceful and beautiful. There's a cluster of office buildings in the middle of campus then cabins scattered around in the woods.

Jack:                         All right, so we're on the grounds.

Maurice:               We're looking straight here at the administration building, the high school. Three of the cabins are monary 1, 2 and 3 are now vacant. Monary 3 is the place where we had our most recent sexual assault.

Al :                             Jack has been reporting on conditions at Lakeview sexual assault on patients and other allegations including abuse and neglect. At its peak Lakeview had about 88 patients. When Jack went in July, the place was in deep trouble. There were only about 10 clients left. Staff were getting laid off left and right. Maurice, the psychologist would be gone within a week, but that day he told Jack about the constant problems that staff had with patients running away.

Maurice:               Well, you can see just from the facility here how if a resident were to take off how difficult it would be to find them. There's tall grass, it's easier to get over or under the fences.

Jack:                         There was an instance around new years where somebody got out of the shower and went under the fence naked?

Maurice:               Yeah, that would have been particularly dangerous because this is a dark place at night. Once you're gone, you're gone.

Al :                             We're going to spend a lot of time talking about this one place in the woods in New Hampshire, and there's good reason for that. The more we found out about Lakeview sorted history, the more we realized the abuse that happened here is connected to abuse at other rehab centers around the country owned by a small group of people and has been going on for decades. In fact we're going to tell you the story backwards. We'll start at the end and work our way at the beginning tracing a long line of problematic institutions with owners who face little accountability. So we're going to let Jack tell the story from the beginning or really the end.

Jack:                         My coverage of Lakeview started as a job and turned into a kind of obsession, and part of that obsession was driven by the fact that someone died there. I found out about the facility after an advocacy group started investigating complains. Their reports alleged abuse and neglect of 4 patients. One of whom was a 22 year old man with autism, he died at Lakeview. Lakeview residence came from all over the country, from Hawaii to New York. Social workers, special education departments, state bureau responsible for people with disabilities, they all sent people to Lakeview. It was fully accredited and licensed and it marketed itself as a place that would take people no one else would.

Jennifer:                I went to visit Lakeview and I thought it was great.

Jack:                         Jennifer Cote lives in Lebanon, Maine. Her son Ryan Libbey was a Lakeview client in 2011.

Jennifer:                I really had to rally to get him there. It was a lot of work to get him there.

Jack:                         Jennifer was motivated because her son was in a crisis at age 11 living in a psychiatric hospital in Maine. Ryan is autistic and he can't talk, but he also has Crohn's disease which causes severe pain in his belly. So when Ryan is in pain. 

Jennifer:                He starts rocking violently, he rocked really, really hard.

Jack:                         Jennifer needed a place that had it all, medical care, psychiatrist, a school and 24 hour a day care, but a few weeks after she dropped her son off, Jennifer visited Ryan with a social worker. They took Ryan for a drive off campus.

Jennifer:                So we went to change him in the car and when we took his pants off, we noticed his upper legs completely covered in bruises. That devastated me, I've never seen him in bruises like that.

Jack:                         Did you suspect that he had done it to himself?

Jennifer:                No, at his worst crisis he has never had marks on him like that ever.

Jack:                         When Jennifer brought Ryan back to the Lakeview campus that day, the staff told her they didn't know what had happened to him. A week or so later, Jennifer pulled her son from Lakeview and took him to the hospital. A nurse counted 22 marks all over Ryan's body, purple and yellow bruises everywhere, severe diaper rash and a big bald spot on tip of his head. Ryan had been at Lakeview for a month. Lakeview never explained what happened to Ryan, that wouldn't have surprised Linda Blumkin another Lakeview mum. Linda lives in New York City and her daughter is Jessica Klurfeld. Jessica is autistic and has a rare genetic disorder.

Linda:                      You basically had people like Jessica with severe behavioral challenges who were left in the care of untrained and unsupervised people.

Jack:                         A nurse admitted Jessica to Lakeview but that nurse signed off as a psychiatrist on the paper work. Another time Lakeview's medical director without even examining Jessica, prescribed her a foot fungal ointment for a vaginal yeast infection. Then there were repeated incidence while Jessica was bathing.

Linda:                      Jessica was a young lay in her early 20s being observed undressed by male staff including one who insisted on scrubbing her back while she was in the bath tub.

Jack:                         Linda complained to Lakeview again and again nothing changed. Her daughter wasn't getting the education and psychological therapy Lakeview had promised, so Linda Blumkin broke the mold in a long line of disgruntled Lakeview families. That's because she had the skills set needed to fell out the responsible parties.

Linda:                      So basically get one level, I'm a Harvard educated lawyer and another level I'm a Jewish mother who was born in Brooklyn right? You know the phenomenon.

Jack:                         So what is an IV League educated Jewish mother to do? From an apartment in New York City 320 miles away, she didn't feel like she can protect her daughter. So she went over Lakeview's head, she reached out to New Hampshire regulators.

Linda:                      I just did whatever I could to dig around to get into whatever bureaucracies, looked as if they might be willing to offer some aid and support.

Jack:                         Linda essentially burred dog the bureaucrats, she called them rogue epic emails, and she documented her interactions with them even recording phone called without their knowledge. That's illegal in New Hampshire but not in New York where she was calling from.

John:                        I talked to Lakeview.

Linda:                      Sir, whatever your authority is to order them to do things you are-

Jack:                         John Martin was then head of the New Hampshire unit that licensed Lakeview. This bureau had the power to sanction Lakeview for abuse, neglect or inadequate health care.

Linda:                      According to your bureau Lakeview has a clean record. They are a splendid facility that's not in violation of anything.

John:                        That's exactly right as far their clinical inspections go. They have been deficiency free for at least the last 4 years.

Jack:                         Linda got the sense New Hampshire regulators has a too cozy relationship with Lakeview. For one thing, Lakeview seemed to know whenever she complained to the state. Lakeview began to put up road blocks to keep Linda and her ex husband from seeing their daughter and they told Linda that since she was so unhappy with the program, Jessica should be discharged.

Linda:                      To which we had said there's nothing that we would rather do but as you know.

Jack:                         New York couldn't find another placement for her, she was stuck in New Hampshire.

Linda:                      So when Tina Trudel suggested that we meet with her at an office that they had in New York.

Jack:                         Tina Trudel was Lakeview's COO.

Linda:                      We thought it would be prudent for our own protection to record the conversation which I did.

Jack:                         Tina Trudel had no idea she was being recorded.

Tina:                         So I wanted to meet today to just talk about the whole issue with communication and your clear dissatisfaction with the program.

Jack:                         After just a few minutes Trudel says regulators are complaining to her about Linda.

Tina:                         I even have state officials saying, "Why is this kid still here? We keep getting harassed by these people. What are you doing about it?" And I have to come to terms with that.

Linda:                      State officials have told you that they're being harassed by us?

Jack:                         Trudel blamed Linda's communication style. She said Linda's hostility was alienating her daughters care givers. Trudel who is a psychologist even suggested, "Linda go to therapy."

Tina:                         You may or may not have considered how your distress manifest itself, and if that's something that you would consider counselling for.

Jack:                         Linda declined the offer. For almost 2 hours she just kept making the point that the care at Lakeview was dysfunctional at every level.

Linda:                      If I communicate to you factual information reflecting something that has enormous impact on Jessica's life, and you don't want to hear and you say that I'm complaining.

Tina:                         You're doing this again and what you're not hearing is that-

Jack:                         We asked Tina Trudel to talk to us about what happened at Lakeview but she turned us down. As for Jessica, her care was costing a lot over $1000 a day, and because of the type of disability she had, the state of New York was required to pick up the bill. So when Linda Blumkin got in touch with New York regulators, they started investigating. They found abuse and potential fraud. Lakeview denied this but I spoke with a lot of Lakeview employees people like Danny Adams.

Danny:                    They didn't want people to leave, they didn't want them to get better. The plan was to keep them there, and continue to collect their money and do that as cheaply as possible.

Jack:                         Danny was weekend manager at Lakeview in 2013. A year the facility took in close to $22 million, 5.5 million of that was profit. Danny says the company executive taught employees how to get the most money from Medicaid.

Danny:                    This is how it was done, if there was a TV on in the main room of the house, and there was more than one individual watching that TV, they could bill for social interaction group.

Jack:                         What he's saying is, Lakeview was sending a bill to Medicaid for propping a few clients in front of a TV and after a couple of hours.

Danny:                    They would change the channel and figure out between the individual who were watching the TV if that channel was acceptable for them. So there's 2two hours of billing for community decision making, and so on. So-

Jack:                         Wait a minute, wait a minute. So you're saying the decision of choosing the show was billed as a service?

Danny:                    Yes, it's like it was a matching game all right. What does this activity match? Let's put it in that, boom.

Jack:                         So this all sounds kind of technical right? Medicaid bills, doctored paper work, but on the ground it all had a very real and very dangerous impact.

Danny:                    And to the best of your knowledge ultimately was Lakeview billing for one to ones when they weren't providing them?

Danny:                    Yes.

Jack:                         A one to one means Lakeview had promised to provide a patient with one staff member all the time. One to ones were reserved for patients with serious behavior problems or unstable medical conditions and they're expensive. In an email Lakeview told me that ...

Jack:                         And they're expensive. In an email, Lakeview told me their average charge per client was 292,000 dollars a year. That price jumped when a client needed one to one attention. A lot of patients were supposed to get this service, but they often didn't.

Male:                       Which is why I said it's kind of a scam. They kept just enough staff on hand to be able to build for those services if nothing ever went wrong.

Jack:                         Things went wrong all the time.

Female:                 On June 9th of this year, an 18 year old named [Joel 00:14:32] vanished from the residential treatment home where she was living, setting off an all out search and heavy media coverage. Joel was found 2 days at the top of a mountain in Effingham.

Jack:                         A 911 call log documents almost 1,000 calls from Lakeview in 5 years. Clients pulled fire alarms to get attention and disappeared in the woods. There were medical emergencies from seizures to a broken hip. Just about every week, the state received a complaint about abuse at Lakeview. Clients beat up staff, staff beat up clients. There were a startling number of sexual assaults. Staff on client, client on staff, and client on client. Maurice Regan, the psychologist who showed me around Lakeview, says "No one got better there. There were too few staff, and too many challenging patient who quickly learned they could do whatever they wanted."

Male:                       They didn't have to get out of bed in the morning. They didn't have to go to school. If they went to school, they didn't have to study. If they wanted to break something, they could.

Jack:                         At one point you called Lakeview a high priced homeless shelter.

Male:                       Someone else there referred to Lakeview as the trailer park of neuro rehab facilities.

Jack:                         This is the environment where a young man with Asperger syndrome named Kory [Horion 00:15:55] came for care in 2012. He was only supposed to be at Lakeview for a short stay, but 72 days after he was admitted, he died.

Male:                       Hello.

Male:                       Hello.

Jack:                         Linda Anderson is Kory's grandmother and she's suing Lakeview based on the findings of the disabilities rights center. They're the advocacy group that investigated Lakeview. They say Kory's health declined dramatically while he was there. He stopped taking medication for his seizure disorder, and he lost about 6 pounds a week. Lakeview never told this to his family, but his grandmother knew something was wrong when she talked to him on the phone just a few days before he died.

Linda:                      He was just making this awful sound in the phone. He couldn't even talk. It sounded like he was without his medication. I know this because I've heard the sound before.

Jack:                         Here's what the Disabilities Rights Center says happened on the day Kory died. "He had a grand mal seizure in the middle of the night. At 5 AM, a staff member found him naked on the floor of his room, in a puddle of his own urine. The staff member left Kory there without telling anyone. Over 4 hours, staff entered his room at least 4 times. Each time, they saw Kory on the floor, and they didn't call for help. At 9 AM, when a nurse checked on him, he was blue in the face. When he got to the emergency room, Kory was pronounced dead."

                                    How did you found out that he had died?

Linda:                      I got a phone call. I don't know who it was. He says "Your grandson is dead." It's a cruel, cruel thing.

Jack:                         Linda says Kory's mother, her daughter, died of cancer when he was only 4 years old.

Linda:                      All his life, he's asked for his mother. Want to be with his mother. At least he got his wish, didn't he? He's with his mother. It's too bad he got it in the way he did. I'm sorry, but-

Jack:                         When the Disabilities Rights Center published their report, New Hampshire governor, Maggie Hassan shut down new admissions. She ordered an investigation of both Lakeview and the regulators who failed to stop abuse there. That's when Lakeview fell apart at the seams. States started pulling their clients. Regulators were at Lakeview all the time, but really bad things just kept happening. State records show patients routinely went missing, a hand gun was found in the staff break room, and a client allegedly raped another client. As all this was happening, Lakeview claimed their clients were in good hands. For a year I've been asking Lakeview officials to talk to me. They always declined, but I caught up with Chris Slover, Lakeview's owner, just once. The day he announced he was closing the facility.

Chris:                       I think the vast majority of the parents and clients and staff members at Lakeview are doing their very best to make sure that those folks are safe and served in the least restrictive environment. I think that we do an excellent job and have helped thousands of people and it's too bad that that won't continue.

Al:                              But it might continue. When we put this show together, Lakeview was empty. The buildings and the grounds deserted. The state of New Hampshire had pulled all of Lakeview's licenses, forcing it to close. It did, but the at the same time, Lakeview's CEO Chris Slover created a new company that would work with the same type of clients on the same grounds as Lakeview. Later in the show, we'll see how this is a cycle that's happened before.

                                    Coming up next, Jack takes us back to Lakeview's early days, with the story of someone who's still haunted by what happened to her there.

Amy:                         It's 17 years later and I still have nightmares about it, it still affects me in everything that I do.

Al:                              That's story when we come back on Reveal from The Center for Investigative Reporting and PRX.

                                    From The Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson, and this episode we're working with New Hampshire public radio on the entire hour. We've been taking a hard look at a controversial Neurorehabilitation center called Lakeview, treating people with brain injuries, autism, and a whole range of neurological disorders. It's remote, so remote that the people who work there just call it "the mountain." It's employed thousands of locals over the years, but because of abuse and fraud allegations it's been shut down. Jack Rodolico started reporting on Lakeview at the end of 2014. At the time, Lakeview's problems seemed to go back a few years, but then people came out of the woodwork with stories, lawyers, psychologists, special education teachers.

                                    There was one story that went way back, almost 20 years, it seemed to highlight everything that was wrong with Lakeview in places like taking on clients who shouldn't have been there just for the insurance money and sometimes actually leaving those clients in worse shape, physically or psychologically damaged. This one story though was a bizarre mix of a Danielle Steel novel with One Flew Over the Cuckoo's Nest and a little bit of Jerry Springer thrown in. The person at the center of the story, a former Lakeview patient, was eager to talk to Jack.

Jack:                         You ready?

Amy:                         I think so.

Jack:                         Okay.

Amy:                         All right.

Jack:                         Okay good.

                                    That's Amy Mueller. She drove all the way from New Jersey to New Hampshire to tell me her story.

Amy:                         I still carry it to this day. It's 17 years later and I still have nightmares about it, it still affects me in everything that I do. It's made me a crazy person.

Jack:                         Amy's 34. She was born in South Korea, adopted by Jackie and George Mueller, and grew up in New Jersey. When Amy was 11 years old, one day they were all in the car together. Her father was driving.

Amy:                         They had a cleaning business so we were on the way to one of the jobs and a drunk driver jumped over the divider and landed on top of us. It essentially crushed him to death but I didn't see his face, thank god, because that probably would've been even more traumatic. I did see he was slumped over and I saw the back of him.

Jack:                         Amy's father was dead, her mother was unconscious, but Amy was awake and alert through the whole thing, even as rescue workers tried to save her parents. Soon after, Amy was diagnosed with post-traumatic stress disorder. The traumatic loss of her father and the near loss of her mother, it all had a strange impact on Amy. She started to form very intense attachments to people, obsessions. Kids at school, celebrities like Rosie O'Donnell.

Amy:                         I guess the biggest issue was I became extremely attached to one of my therapists. That's when I started self mutilating and I would carve initials into my arm and like-

Jack:                         Do you still have the initials in your arm?

Amy:                         Nah, you can't tell them anymore. There's a big A on my arm that's faded. There's angels written right here, starting to fade.

Jack:                         Amy was a teenager. She was cutting herself a lot. She'd lash out at her mother and break things around the house. Amy's mother was desperate, and that's when she found Lakeview. A marketing rep came to her house and sold her on the program. When Amy arrived at Lakeview in September 1997, her first day was odd. She was assigned to a cabin filled mostly with little boys with severe disabilities. A staff member let Amy read her own clinical file.

Amy:                         My mom wrote a comprehensive biography. There's a lot of information about my family, about my dad, about her that I never knew about.

Jack:                         Amy was not supposed to see this file. The staff member who gave it to her had no clinical training, but the experience forged a connection between Amy and this woman. On day one, Amy was obsessed with her.

Amy:                         I was an attention seeker. I wanted her attention.

Jack:                         This was just the kind of attachment Amy was prone to since the car accident. In fact, Lakeview's treatment plan was supposed to help stop her obsessions. Amy's mother declined to talk, but I spoke with her attorney, David Wolowitz. He represented them in a lawsuit against Lakeview. David says "Instead of separating Amy from the women she was obsessed with, Lakeview's clinical staff actually pushed them together."

David:                     Let me give you an example that I found, frankly, horrifying. Amy was a victim of sexual misconduct.

Jack:                         Amy said she was molested in the back of a van by another Lakeview resident. She was distraught, but when the clinical team found out, they didn't send a psychologist or social worker. Instead, they sent the woman Amy was obsessed with to console her.

David:                     From that day forward, Amy only wanted to talk to her, wanted to put her pictures on the wall, wanted her and no one but her to deal with her.

Jack:                         This is Charity?

David:                     This is Charity.

Jack:                         It's fine.

Charity:                  I'm Charity.

Jack:                         Nice to meet you.

Charity:                  Nice to meet you.

Jack:                         Thanks for having us.

Charity:                  I'm going to get a chair.

Jack:                         Yeah, sure.

                                    Charity Randel is still in New Hampshire. We sat on her porch to talk. Charity was 26 when Amy came to Lakeview, Amy was 16. Charity was a former graphic designer. Like most Lakeview employees, she was low paid and had only a week of training. She says the clinical staff pushed her and Amy into something that got out of hand really fast.

Charity:                  I think they were using her crush on me and they dealt with her through me because they knew that she would talk to me and open up to me. I told them a few times that it got to a point where I don't think it was therapeutic anymore.

Jack:                         Amy started carving Charity's initials into her arm. Charity would call Amy on her day off.

                                    Did you express your feelings to her?

Charity:                  Yeah, I probably did. At the tail end, I started caring about her.

Jack:                         Did you love her?

Charity:                  Yeah.

Jack:                         Amy began talking about being gay while she was at Lakeview. The clinical staff nicknamed her "Baby Dyke." Then, as if Amy and Charity's relationship wasn't inappropriate enough, Lakeview's clinicians added a new dynamic, a second staff person.

Kathy:                     Hello?

Jack:                         Hey it's Jack.

Kathy:                     It's Kathy.

Jack:                         Hey Kathy.

Kathy:                     Hi.

Jack:                         Kathy [Comone 00:27:08] now lives in Florida. When she came to Lakeview, Kathy had no clinical training. She was shocked by how the clinical staff pushed Charity and Amy together.

Kathy:                     It seemed like it was a joke to them like baby dyke [inaudible 00:27:22] meet big dyke and have her first experience.

Jack:                         Kathy took her concerns to the clinical director, Tina Trudel who was in charge of Lakeview when it was shut down this year.

Kathy:                     She ended up giving me a lesbian newsletter that had an article about younger and older lesbians being together. She told me "See if Amy's interested in reading this."

Jack:                         That newsletter was later evidence in court. Tina Trudel said she didn't recall giving the article to Kathy, even though Trudel's name was on the mailing label. Kathy says she was concerned about Amy's attachment to Charity, but then Kathy herself-

Al:                              About Amy's attachment to Charity. But then, Cathy herself took an unusual step. Here's Attorney David Wolowitz again.

David:                     Cathy was trying to become Amy's foster mother and take Amy away from her own mother.

Al:                              The clinical team knew about this. In court, one of them said Cathy had a savior complex. When Amy's mother found out, she went to Lakeview and brought her daughter home.

David:                     The discharge record said that Amy had a successful treatment and if I remember correctly, it said something like just be careful in the future for unhealthy attachments. It didn't say why and didn't acknowledge of course that Amy didn't want to go home to her mother, was in love with somebody at Lakeview and was trying to be essentially adopted by another person.

Speaker 3:            This trial sounds like it was a soap opera.

Speaker 4:            This trial was a tragic opera.

Al:                              Amy's mother, Jackie Mueller, sued Lakeview for ethical and financial violations. When the case went to court, David Wolowitz says Amy's story was only a small part of what came to light. He said staffers testified Lakeview regularly lied to their clients, their clients' parents, and state officials.

David:                     They told us, for example, that when the state came to do its reviews, one person testified that she was told to create false employment records so that the staffing ratio would be sufficient. She said that under oath. Another person said that it was her job to destroy records. Another person said that it was her job to make up records.

Al:                              The jury sided with the Muellers and awarded the monetary damages. David Wolowitz wrote a long letter to state regulators in New Hampshire, spelling out everything that came out in court. He urged the state to do something to protect other Lakeview clients. We asked the state if they took action but they couldn't find any records. We do know Tina Trudel got a promotion at Lakeview. What happened to Amy? She was still a teenager, she was traumatized by the courtroom drama, and she was still obsessed with two women. A therapist told Amy to quit these relationships; instead, Amy quit therapy, and after court, Cathy, the woman who tried to adopt Amy, visited her in New Jersey and stayed.

Amy:                         We decided to try being together and we were together for four, five years?

Al:                              Living together as a couple?

Amy:                         Mm-hmm (affirmative).

Al:                              Like a romantic couple? She was like a mother figure, I mean she was talking about adopting-

Amy:                         Yeah, I know.

Al:                              Was that a bad decision for you at the time?

Amy:                         Yeah, I was 19. I wanted to go to school, I wanted to do tons of things. She never exploited me in any way, she was never ... she was always good to me.

Al:                              Did she exploit your vulnerability?

Amy:                         I don't think so ... I don't think it was conscious if she did.

Al:                              Amy and Cathy broke up but they're on good terms. They still talk all the time. That leaves Charity, the other Lakeview employee Amy was obsessed with. Over the years, Charity kept her distance from Amy, and then last fall happened. The news about abuse and death at Lakeview came crashing into the daylight. Amy and Charity got in touch to talk about it. Back on her porch in New Hampshire, Charity tells me as she and Amy started talking about what happened to them at Lakeview.

Charity:                  Seventeen years of whatever, we just had to see each other.

Al:                              They picked a rest stop in Massachusetts for a meet-up.

Charity:                  Seeing her at the rest stop, not as a Lakeview client and not as a teenager but as a woman, there was an amazing connection, and the rest is just history.

Al:                              What is the rest, Amy?

Amy:                         Well, we're together now, so yeah, that's what's history.

Al:                              When Amy and I were alone, I asked her more about her new romance ... I mean I guess the question here is do you think that your relationship with her is good for you?

Amy:                         At this point, yes. In the past, no.

Al:                              At this point, you think it's healthy?

Amy:                         It's healthy as it can be given the circumstances, yeah.

Al:                              Do you think you're the best judge of whether or not this is a healthy relationship?

Amy:                         No, absolutely not. I thought this relationship was totally healthy 17 years ago, so yeah, no. Totally not a good judge. I never had closure on it, ever. Going with it is kind of my closure, you know if it fails miserably, then I can say, "All right, I'm done. Tried it, done." If not, then great.

Al:                              It's been more than 20 years since Amy's father died in the car accident. She's worked hard to put her life together. In fact, she says her time at Lakeview and everything that's happened since makes her uniquely qualified for her current job. Amy's a psychologist pursuing her PhD. She works at a residential treatment center with teenage sex offenders. But this isn't just about one person or even one facility. The neurorehab industry is often a family affair, and when one company gets in trouble, another takes over.

Speaker 7:            These places are clever and it's lucrative for them. They know how to work the system to stay in business.

Al:                              That's coming up next on Reveal.

                                    For The Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson. This hour, we've been looking into a neurological rehab center that sits on the side of a mountain in New Hampshire. Lakeview, which was shut down this summer, was supposed to help people with brain injuries and complicated severe disabilities. Jack Rodolico, our partner for this show from Hampshire Public Radio, investigated another side of Lakeview: abuse, fraud, even a patient death. Now, we're going to bring in Reveal reporter Laura Starecheski. Hey Laura.

Laura:                     Hi, Al.

Al:                              So far, we've been focusing on patients and their families. Now, we're going to turn our attention to the people in charge.

Laura:                     Right, there's basically this small group of companies across the US and this neurological rehab business that all seem to share the same DNA. They're all for profit, they're privately owned by a tight circle of people, sometimes all members of the same family.

Al:                              Literally they share DNA?

Laura:                     Yeah, and what happens is that even if one of these rehab centers get shut down, it often just pops back up with a different name, but it's the same owner. So they can weather scandal after scandal. Some of the lower level employees might get fired, but the people at the top stay in business.

Al:                              How does this relate to Lakeview in the story we just heard?

Laura:                     Well, it's a long story. Technically, it all starts a century ago when a young lady moved from Newfoundland to Boston with a gold coin sewn into her frock. But for now, let's just go back to the 1980s.

Al:                              All right, let's do it.

Laura:                     Back then, there was a facility on the same mountainside as Lakeview. It was the same buildings, the same business, but it had a different name, Highwatch, and different owners, the Brennick family. Highwatch was the blueprint for Lakeview, part of a chain where the Brennicks figured out how to make money by tapping into a new patient population.

                                    In the 1980s, about 90,000 people a year started surviving severe head trauma, a medical miracle and big news

Speaker 9:            Gone are the skills and the self that these patients used to depend on. They must start over, learning again, something as simple as how to focus your eyes.

Laura:                     These patients were mostly people who'd been in car accidents but survived them because of better emergency medicine. They ended up with paralysis, memory problems, behavior issues, and needed a place to recover. The whole new health care niche was born, brain injury rehabs, including the Brennick's family business, New Medico, a national chain with more than 40 centers. The guy at the top was Charles Brennick.

John:                        Charles Brennick was a self-made man. I don't believe he graduated from high school.

Laura:                     John Kennedy, a former business reporter at the Boston Globe, wrote a profile detailing Brennick's colorful business style.

John:                        He owned a number of sort of conventional nursing homes.

Laura:                     A business Brennick had learned from his mother. She was the one who'd emigrated from Newfoundland with a gold coin sewn into her frock, as the story goes. She opened a few homes in Massachusetts, then Charles built the business up into a nursing home chain called Medico. But in the mid-70s, things went south.

John:                        He would lug briefcases full of money to Las Vegas, sometimes a million dollars at a time, to try and gamble his way out of bankruptcy.

Laura:                     Brennick lost big. But after the bankruptcy, he reinvented the family business. He changed the name from Medico to New Medico and transformed his few dozen nursing homes into brain injury rehabs, which he marketed across the US.

Speaker 11:         Our dedication to a higher quality of life comes from a unique understand and approach to head injury rehabilitation.

Laura:                     For brain injury rehab, New Medico charged 10 times as much as nursing home care typically cost. In 1989, the company reportedly grossed a third of a billion dollars. They were seen as an industry leader, offering speech therapy, physical therapy, job training.

Sue:                          If you looked at what they were offering, or listened or read about it, it sounded like heaven. It was wonderful.

Laura:                     Sue Bessette is an independent investigator. She helps prosecute nursing home fraud and abuse cases. Back then, she was getting calls from people whose relatives were in New Medico facilities.

Sue:                          These families were rabid ... I mean, I would have been.

Laura:                     One mother named Mary Ann [Paraday 00:39:12] called Sue. She said her daughter had been in a car accident and was in a vegetative state at a New Medico facility in Massachusetts.

Mary Ann:             They wouldn't bathe them kids, so I went everyday, we went and bathed our own daughter.

Laura:                     Mary Ann says her daughter had a feeding tube in her stomach that would routinely pop out.

Mary Ann:             I can't tell you how many times I went in there and that feeding tube be laying on the floor, on the dirty floor.

Laura:                     Sue heard from a woman named Lucy Gwin, an ad writer from Rochester. Lucy told Sue she'd been in a car crash and woke up three weeks later in a New Medico facility in Courtland, New York. This tape is from an oral history Lucy recorded before she died last year.

Lucy:                        There was nothing medical, [inaudible 00:39:57] doctor, I never saw a nurse, I have been [inaudible 00:40:01] they say there's therapy here and there's no therapy, where is the [bleep 00:40:04] therapy, where is it? I want some therapy.

Laura:                     Lucy said she wanted to go home, but the staff told her she could only be signed out by the person who'd signed her in, except they wouldn't tell her who that person was.

Lucy:                        I couldn't communicate with anybody. I couldn't have stamps, I couldn't use the telephone. You don't have any money in your account, dear.

Laura:                     After a few weeks, Lucy escaped from the New Medico facility. But before she did, she snuck into the front office and photocopied everything she could find. She hauled a trove of New Medico documents out with her, which she shared with Sue Bessette.

Sue:                          We had patient files, we had billing, we had the unpublished works of New Medico.

Laura:                     The unpublished works was a company manual.

Sue:                          How they did things, how they got patients. In and of itself, it seemed to me pretty incriminating.

Laura:                     A few of the company's tactics stood out to former Boston Globe reporter John Kennedy. For one, he says the company sent marketers into intensive care units.

John:                        Essentially, salespeople in the hospitals where people had been admitted for brain injury, trolling for new business.

Laura:                     Other New Medico staff then gathered information on a person's insurance coverage.

John:                        These facilities would figure out how much private insurance coverage you had and then as soon as it was up, they would discharge you. Not what we expect from an industry that sort of dresses itself up as medical professionals who would put care over anything else.

Laura:                     Brain injury rehab grew to be a $10 billion industry, a largely unregulated industry. But by the early 90s, complaints from families, state investigators, and whistleblowers pushed the federal government to ac.

Ted:                          Some unscrupulous operators are defrauding insurance companies and ripping off Medicaid and Medicare.

Laura:                     New York representative Ted Weiss chaired this 1992 congressional hearing.

Ted:                          Patients in these facilities receive substandard care while paying thirty, forty, fifty thousand dollars a month. These institutions receive scant attention from federal and state regulators.

Laura:                     Later that year, Sue Bessette was visited by two FBI agents who wanted copies of her New Medico documents. Soon after that, she saw a picture in the paper.

Sue:                          People with FBI on their back in New Medico's office in boxes in their hands and they said they were taking their computers too. I was like, "Hurrah! We're getting somewhere."

Laura:                     The FBI was investigating possible Medicaid fraud at New Medico. The US Attorney's office was brought in, but after an intensive probe ...

Sue:                          It's like great big charge, and then nothing.

Laura:                     Charles Brennick was never indicted. Federal investigators said they had considerable indication of fraud and abuse, but they couldn't prove that senior staff were involved. Reporter John Kennedy says the investigation and the congressional hearing took their toll on the company anyway.

John:                        New Medico basically disappeared. To me, it was almost like the business, his business, was atomized.

Laura:                     Brennick gave up ownership of his facilities one by one, but many went to people who'd been his business partners for decades.

John:                        Many of the other players were friends or associates or even relatives. His sons became the listed operators of some of the facilities. It was sort of this piece of play dough that you would grab at it would sort of reshape into something different. It was kind of a brain teaser.

Laura:                     This brain teaser of shapeshifting companies was a hallmark of the nursing home industry, the Brennick family's roots. Tight circles of interconnected people who helped each other make money. It was legal most of the time, but hard for regulators to trace. Curt Decker, as executive director of the National Disability Rights Network in Washington, he's watched Brennick-style businesses morph since the 1980s.

Curt:                         These places are clever. They're alert, it's a big business, and they know how to work the system to stay in business.

Laura:                     The National Disability Rights Network is authorized by Congress to inspect any facility that serves people with disabilities. Their investigations sometimes result in shutdowns, but that's rarely the end of the story.

Curt:                         We feel like we're in a game of whack a mole, where we finally closed a big facility like the Lakeview or one of the larger institutions and it just pops up somewhere else with the same people, get recertified or changed the name.

Laura:                     They shift to serve different patients, depending on where the money is. The Brennick family started out in nursing homes, then turned those into brain injury rehabs, and now, the family business has been reinvented a third time. Joe Brennick, Charles's son took over his dad's New Medico facility in Wauchula, Florida back in 1992. It's now a rehab that caters to people with what their marketing materials call neurobehavioral problems. Besides brain-injured people, they treat a hodgepodge of patients, people with developmental disabilities, autism, mental illness, violent behavior. Joe christened it FINR, the Florida Institute for Neurologic Rehabilitation.

Speaker 18:         In a quarter mile, turn left.

Laura:                     I drove out to FINR this August. I had arranged for a tour. It's a sprawling campus in the middle of nowhere in central Florida, on hundreds of acres of gator-infested swampland.

Speaker 18:         Turn right.

Laura:                     I'm like two miles back from the main road now ... When I walked into the lobby, the first person I met was Joe Brennick, Charles's son, an imposing guy in his fifties squeezed into a wooden chair by the entrance.

                                    Hey Joe, how are you?

Joe:                           Come on over and have a seat.

Laura:                     Sure. I'm rolling ... tape, I usually just record everything.

Joe:                           Okay, well, what we're going to do is give you a tour, you can shout off and let that sit here.

Laura:                     Can I record on the tour, because it's really ...

Joe:                           You can't do that.

Laura:                     How come?

Joe:                           Because you can't. We don't do that.

Laura:                     All right, so let me just turn this off.

                                    The tour was about an hour long. First, I was led into a room with a few sets of patients and therapy aides vigorously performing exercises. Then I saw the living quarters. A few buildings had spacious lobbies with classical music piped in and sparkly chandeliers. Others were dingy cabins raised in stilt above the swamp water. When the tour ended, I sat down with Joe Brennick.

Joe:                           [inaudible 00:47:12] a few questions, I hope I answered all your questions.

Laura:                     First, I brought up New Medico, his dad's company, where Joe learned the family business. I asked him about the allegations of fraud and substandard care that led to its closing.

                                    According to the congressional investigation, it was a systematic thing, it was designed in order to function that way.

Joe:                           No, not at all. Dad always cared about the quality of care. If it had a design, then there would have been some sort of ... I mean a law that was broken or something like that.

Laura:                     Charles Brennick died in 1997. He was never convicted of fraud. Joe Brennick has fought at least four lawsuits over patient deaths. In 2012, Allstate, the insurance company, accused FINR of warehousing patients who had generous insurance policies. Some of them caused Allstate over a million dollars.

                                    In the lawsuit, it was claimed that you guys weren't even doing rehab with those patients who were here for quite a few years.

Joe:                           In a lawsuit, people accuse you of a lot of things that aren't true. That's one of the reasons why they settle things.

Laura:                     What do you say to families who need reassurance about you guys?

Joe:                           Come on down and tour. Look at your options, go tour other facilities, see what they offer you. See if they're even willing to take you.

Laura:                     Other places might not be willing to take the kind of cases FINR takes, challenging patients with aggressive and violent behaviors.

Joe:                           That's our guy, that's who calls us up. A lot of times, our clients tried out the nine local little programs and he's burnt every one of them, they won't let him back in.

Laura:                     That's why FINR stays open as a place of last resort. I wondered how Joe felt about the recent closing of Lakeview in New Hampshire. After all, back when it was called Highwatch, it was the crown jewel of the Brennick family business.

Joe:                           Very sorry to hear that. You just wanted to somehow get going again.

Laura:                     The apple orchard, the million dollar view up on the mountainside, turns out it wasn't just a business to Joe.

Joe:                           That was my weekend house.

Laura:                     Really?

Joe:                           We converted it.

Laura:                     Oh my gosh.

Joe:                           I spent my childhood there. It's got a magnificent view, it's got big, beautiful buildings, and it should be put to use.

Laura:                     Then, Joe pulled out his phone and pressed play.

Joe:                           My mother was a very good singer, so my father had to do a Christmas album.

Laura:                     He showed me the album cover, Christmas at Highwatch. Then Joe got a faraway look on his face. (music)

Al:                              Despite its legal problems, FINR in Florida continues to take on the most challenging patients, for a price. Meanwhile, a recent New Hampshire state report noted that in the wake of Lakeview's closing, patients from around the country are now ending up in nursing homes, psych wards, or prisons. Lakeview is still operating one facility in Wisconsin, which by the way is another of the Brennick family's former New Medico sites.

                                    For more of what you just heard, plus our latest stories, go to revealnews.org. Join our conversations on Facebook or Twitter. Our show was edited by Deb George and produced by Laura Starecheski, in partnership with Jack Rodolico and New Hampshire Public Radio. Reveal staff is Julia B. Chan, Delaney Hall, Peter Haden, Stan Alcorn, Michael Montgomery, Neena Satija, Ike Sriskandarajah, and Amy Walters. We had additional editing help from Sarah Ashworth, Josh Rogers, and Amy Pyle. Our lead sound designer and engineer is my man, Mr. Jay Breezy, Jim Briggs. Christa Scharfenberg is head of studio, Susanne Reber is our executive editor, and our executive producer is Kevin Sullivan.

                                    Support for Reveal is provided by The Reva and David Logan Foundation, the Ford Foundation, and the John D. and Catherine T. MacArthur Foundation. Reveal is a co-production of The Center for Investigative Reporting and PRX. I'm Al Letson, and remember, there is always more to the story.