As predicted by STIC and disability advocates across the state, Governor Pataki's politically-motivated pet project Hudson Valley TBI "rehabilitation center" has become a swamp of waste, neglect and abuse for people with disabilities. The Northeast Center for Special Care (NCSC) in Lake Katrine, NY was inspected this spring by state health officials. Their report showed a clear pattern of repeated serious violations, including failure to provide adequate food, basic medical care, or activities for patients; illegal use of physical restraints; frequent medication errors; severe chronic staff shortages; incompetent administrators; and employees who threatened, and carried out, retaliation ag-ainst patients who complained. The problems were bad enough that some patients were beginning to starve, several developed severe decubitus ulcers ("bedsores"), and one person had to have an amputation due to incompetent nursing care. The facility was ordered to stop accepting new Medicaid and Medicare patients, and was threatened with immediate closure in July. The report also indicated that the facility currently houses several people whose disabilities aren't severe enough to justify them being there.

Soon after the report was made public, however, State Department of Health (DOH) officials changed their tune on the facility, telling the media that NCSC was making good faith efforts to fix problems and the state was no longer contemplating closure. This sudden change was reminiscent of the facility's development process, when DOH officials who raised serious objections to the facility were directly ordered by the Governor's office to ignore DOH's consumer advisory council's opposition, override the usual application approval process, and ok the facility's creation.

Then, after several weeks of allegedly concentrated efforts to bring the facility into compliance with basic requirements, it was found that drug-resistant bacteria incubated at NCSC due to shoddy sanitation practices had leaked out into the surrounding community and was threatening patients in local hospitals. The same state health inspector who had been overseeing NCSC's alleged improvement efforts returned to the facility to investigate and was quoted by a local newspaper as saying, "there's no need for concern. We're confident that our visit will provide significant progress."

As we reported over two years ago (AccessAbility Summer '98), NCSC's construction resulted from political dealmaking. IBM was downsizing and threatening to leave NY until Governor Pataki brokered a deal wherein IBM agreed to stay and New York agreed to find buyers for vacated IBM facilities in the Southern Tier and the Hudson Valley. The state itself took over the Southern Tier plant, moving disability claims processing operations there. The Lake Katrine plant was vacant for several months. Then Healthcare Associates, the national corporation that holds most of the now-defunct and allegedly criminal NewMedico Head Injury System's facilities and is operated by some former NewMedico executives, expressed interest in converting the plant to a rehabilitation center. AccessAbility reported extensively in the early 1990s on the rampant neglect, abuse, and Medicaid fraud in NewMedico facilities nationwide that led to the corporation's decertification in New York State and eventual dissolution. DOH officials who reviewed the corporation's application for the Hudson Valley center found several problems, noting that the need for such a facility had not been demonstrated, that NYS policy was to serve people with head injuries and other disabilities in their own communities and preferably in their own homes, and that appropriate community-based services were already available across the state. About this time, NCSC President and Healthcare Associates CEO Anthony Salerno began making contributions to political campaigns, mostly to Republicans. 25% of his contributions were made "just before and after critical agency approvals" for the center, according to the Kingston Times Herald-Record. DOH officials were ordered by Pataki staffers to stop objecting and approve the project.

NCSC opened in March 1999. By June 1999 it was already clear that the facility was in trouble. The company that provided food and nutrition services to the center, Sodexho Services, was not being paid regularly, and in November they finally cancelled the contract. Then, on February 13, 2000, the Ulster County Sunday Freeman reported that staff at the facility were not being paid, that trained therapists had been laid off and replaced by lower-paid paraprofessional aides, and that chronic staff shortages were leaving units full of patients, many of whom were in comas or had severe multiple disabilities, with only 2 staff members to care for them.

DOH inspected NCSC in March and April of 2000. They studied only a small sample of the approximately 150 patients but found repeated patterns of neglect and abuse. They conducted a program audit, not a fiscal audit, but found evidence that patients often did not receive services they were supposed to get. If NCSC billed Medicaid or Medicare for those services, that would constitute the same type of fraud that was committed by NewMedico. STIC has reviewed the entire 107-page DOH report; we only have room for a few examples of what was found:

New patients were admitted but didn't get their initial assessment or assignment to activities until weeks or months later. Patients whose records indicated they participated in various scheduled activities were frequently seen wandering around their units or just sitting or lying in bed for hours at a time.

Patients were not permitted to shower more than twice a week as a matter of policy, and in practice some got showers once a week or less. Patients who missed their scheduled shower time for any reason were denied a shower until the next scheduled time.

The food service was poor and at times dangerous. Numerous complaints about the quality of the food were reported, and many of the problems with the food were directly observed by the inspectors. The food was frequently served cold after having been burned, and the menu offered little variety, with the same dishes being served day after day. Although patients were supposed to be able to request substitute meals, these substitutes were rarely provided, and sometimes the staff wouldn't let patients make the request. Several patients found the food so bad that they frequently ordered in junk food; at least one patient apparently became significantly overweight as a result. Some patients refused to eat the food but lacked the capacity to order in; they experienced life-threatening weight losses. The inspectors found that hot food was not being kept hot enough, nor cold food cold enough, to prevent bacteria growth. On one occasion the inspectors found something sitting in a pan on the stove with a temperature of 105 degrees-lukewarm. Nobody in the kitchen could even tell the inspectors what the alleged "food" was. Several patients who needed assistance to eat didn't receive it. Staff were observed standing around talking in the dining rooms as food was delivered, patients who needed assistance sat there unable to eat, and the food was taken away.

Many patients were illegally restrained without justification. In some cases restraint orders were written for people recovering from head injuries who were initially aggressive, but weren't changed and restraints continued for months after the aggressiveness ended. Several patients who had been given nothing better to do with their time than wander around and ask questions of the staff were forced into "geri chairs" (high-backed, padded chairs on small wheels with plastic or wooden trays that fasten across the person's waist) and "trayed in" for hours at a time to keep them from bothering staff. Some patients were restrained virtually all the time, in geri chairs or their beds, simply because "the family wants it."

The facility administrators often didn't investigate serious incidents, including one patient's charge that another patient sexually abused her, and an incident in which a confused patient was wandering around outside the building in the middle of the night.

Basic medical care was poor. Patients would ask to see the physician but the physician would never show up. A person being treated for opiate addiction was given an opium derivative to prevent alleged "aggression". Medication errors were frequent and went uninvestigated. Several patients who were admitted with their skin in good condition acquired severe bedsores. Sometimes sores were observed as beginning to appear but, unaccountably, no treatment was provided for several days. Sometimes nurses were seen contaminating sores with dirty dressings while "cleaning" them. Some patients were refused special air or liquid-filled mattresses, even when they specifically requested them. One person with a below-the-knee amputation was fitted with a "stump shrinker" appliance that was supposed to be worn only for an hour a day; the appliance was left on for several days, during which the patient experienced extreme pain and developed a massive systemic infection. The leg had to be re-amputated above the knee.

Sanitation practices were incredibly crude. Housekeepers were observed sweeping up dust under the feet of eating patients. Nurses and aides were seen carrying dirty laundry without wearing gloves and failing to wash their hands after changing dressings, or after leaving the rooms of patients who were quarantined. The open ends of catheter tubes were found lying on the floor.

Locked "behavioral" units had a faulty electronic door locking system with key cards that often didn't work and a central computer control that malfunctioned. Inspectors found that in the event of a fire or other emergency, residents and staff were likely to be locked in with no means of escape.

There was a lack of respect for patients and their rights. "Assessments", when done at all, were often rudimentary, containing no information about the patient's previous history, family, needs or preferences. Several patients said the staff refused to involve them in treatment planning and simply dictated to them. Some patients who were fully alert and quite independent complained that staff only contacted their families to provide information or get approval for procedures. Again reminiscent of NewMedico, one patient was kept in the facility against his will until he finally ran away. Staff claimed that his parents were his legal guardians and wanted him there, but the inspectors found that the patient was competent and had no guardian. Several patients said they were threatened if they complained. Some said that after they complained, the staff would stop responding to their requests for help. In some cases, patients who were incontinent were left in their soiled clothing for several hours. The facility's administration did not investigate these charges of retaliation.

Unremarked on by the inspectors, but evident from their report, was the fact that several of the people living in the facility had no need to be there. Several patients were described by the inspectors as being "fully alert", "independent", and able to understand information, make decisions, and move around on their own. One resident's only diagnosis was mental retardation due to Down Syndrome. Such people can easily be served in their own homes and their own communities anywhere in New York State.

As the story got out, a federal Medicare official said NCSC's problems might just be "growing pains". NCSC President Salerno told the press that this kind of thing had to be expected at a new facility that is on the cutting edge of rehabilitation therapy. DOH officials at first seemed willing to close the place, but then suddenly backed off and began an intensive effort to help the center achieve compliance, an effort that had apparently not succeeded even several weeks later, when virulent bacteria from the center began infecting the surrounding community.

The events at NCSC were predicted nearly two years ago, when Assembly Health Committee Chair Richard Gottfried and other Assembly leaders wrote to DOH Commissioner Barbara DeBuono, saying, "We are not convinced that large facilities have the ability to deliver quality care. In the past we have seen cases of fraud, overbilling, warehousing and abuse." Salerno's claim to provide new forms of rehabilitation therapy for people with head injuries echoed NewMedico promotional materials. In fact, both NewMedico facilities and NCSC provided very little therapy of any kind, and what was provided was standard OT, PT and "recreation therapy". Disability advocates across the state objected strenuously to the approval of the NCSC in 1998, citing the NewMedico precedent and DOH's own findings that the facility was unnecessary. Local papers documented the political and campaign finance aspects of the project at the time. Nevertheless, George Pataki's office strong-armed DOH and ordered the center approved. Now the responsibility for handing over millions of taxpayer dollars to a company with a shady past run by people with a track record for operating substandard facilities; for the starvation, injury, neglect, and abuse of the center's patients; and for the infection of the surrounding community by dangerous bacteria; lies squarely at his feet.