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Are Lakeview patients out of control?

Whistleblowers charge that facility is understaffed and speak out after rash of assaults, walk-aways and property damage 

By Daymond Steer
EFFINGHAM — Whistleblowers from Lakeview Neurorehabilitation Center say the center is too understaffed to prevent the people in its care from becoming a danger to themselves or others.
Their concerns are echoed by law enforcement officials and a next-door neighbor of the facility.
Last week, a Lakeview receptionist said the facility's executive director, Thomas Horan, would not take calls from the media.
Lakeview is known locally as a facility that takes care of people with brain injuries.
Its website describes the facility's purpose this way: "Lakeview Specialty Hospital & Rehab in Waterford, Wisconsin, and Lakeview NeuroRehabilitation Center in Effingham, New Hampshire, are the primary hubs in our full continuum of care for individuals with neurological, cognitive, and behavioral disabilities," states Lakeview's website. "Our programs and services offered at all Lakeview locations are state-of-the-art, focusing on the goals of each individual through the implementation of best clinical practices."
Last month, Freedom selectmen complained to Lakeview's administration that at least one violent person was being housed in a group home called Freedom House, which selectmen said the town zoning board approved with the understanding that the home was for people who were ready to reenter society.
Yet, police had to respond to the home for a reported assault by a resident on a staff member. The same resident had allegedly assaulted an Ossipee police officer just days before.
Then there was another violent altercation at the end of November at Thompson House, the other group home in Freedom.
However, selectmen couldn't find the town's approval of Thompson House and couldn't say if that home had the same restrictions as Freedom House.
Just days after The Conway Daily Sun broke the story about Freedom House, the staff member who was the alleged assault victim, Susan Gagne, stepped forward with a letter to the editor explaining what happened.
Gagne said the resident pulled her hair, threw her to the floor and kicked and punched her. Gagne said she was instructed to call 9-1-1 and the main facility in Effingham for help. Gagne said she was placed on a 90-day probationary period in November and made to feel she was a "criminal" because of the alleged assault. Gagne said by and large the residents of Freedom House are wonderful people.
But Horan told Freedom selectmen he wished Gagne had only called Lakeview's main facility.
Gagne's letter inspired Lakeview employee Mike Corthell, of Fryeburg, to go public with his concerns about similar problems that are happening at Lakeview's facilities on Highwatch Road in Effingham.
In addition to speaking with this newspaper, Corthell has also contacted Occupational Safety and Health Administration and the New Hampshire Department of Labor.

Lakeview has one large main facility and several "cabins" that house various special needs populations. For example, "Monterey Three" is a cabin for male patients who tend to be temperamental and physically powerful. He said there are about 84 people in all the Lakeview facilities "on the mountain" in Effingham and another 25 to 30 more in facilities in Freedom and Ossipee.
"It absolutely rings true," said Corthell of Gagne's letter. "I would say it's typical or standard for Lakeview management."
Corthell is a shift B supervisor in the "Main House." He has worked at Lakeview since the end of 2010. He currently supervises staff of about a half dozen direct care LNAs and rehabilitation specialists.
He also does some direct care as well — such as putting residents to bed. As a supervisor, he makes sure paperwork and scheduling are done. Corthell is a member of the Mount Washington Valley Economic Council and has started his own marketing firm called the Michael Mills Agency.
Corthell explained that "Mills" is his nickname and is easier to pronounce than his last name.

According to Corthell, Lakeview is so understaffed that it cannot keep its residents safe from themselves and other violent residents. Sometimes small female staff members are asked to put themselves at risk by working at Monterey Three, which goes by the nickname "Monty Three." He said the reasons for this is massive turnover include staff quitting and being fired. He said the labor pool in Carroll County can't support the level of turnover that's occurring at Lakeview.
"The environment is inherently unsafe because of the population we serve," said Corthell. "But if we have the proper staffing we wouldn't be in as much danger."
Corthell says Lakeview's motto, "It's about life," should read, "It's about money." Corthell would like to see the center run as a nonprofit.
Other staff members that the Sun spoke to off the record said much of the same things as Corthell.
At the end of November, there was a stabbing at Lakeview in Effingham and one man was arrested for assault, according to Effingham police chief Tim Butts and the dispatch logs provided by Carroll County Sheriff's Office.
Corthell explained that some Lakeview residents need to have a one-on-one aide by their side 24 hours per day. But most times the facilities only have a fraction of the staff it needs to handle those clients and others.
"How the hell do you do that?" asked Corthell rhetorically about trying to control residents with too few staff members. "It's absolutely impossible. If one wants to bug out and go down the driveway on Highwatch Road that's where they are going to go."
Corthell said he and his staff will hear reports over their radios stating that someone has walked away from the facility and there is no staff to follow him or her.
So, Corthell's staff members will drop what they are doing to respond. He said the vast majority of the time the facility is understaffed. On one night at Main House, there were only two staff members in the whole building to cover 33 people, said Corthell who worries about what would happen in the event of a fire.
Corthell took the job at Lakeview to learn how to better care for a loved one with a brain injury. Before working at Lakeview, Corthell managed a group home in Hampton and had also worked in a hospital decades ago. Corthell is in the process of writing a fiction book, called "Caring for God," which is based on his experiences as a direct care specialist and supervisor. He said his faith has also spurred him to write the book and expose issues at Lakeview. Corthell said all the profits from his book will be donated to his patients.
"'Faith without works is dead,'" said Corthell quoting Martin Luther.
The sheriff's office dispatch logs document incidents of walk-aways, aggressive behavior assaults, and property damage that occur at Lakeview.
For instance, on Feb. 5, Lakeview staff called dispatch out of concern for an aggressive client.
"(Redacted) advised they have a client who has been aggressive tonight, (redacted) advised since since they cannot go hands on with the clients he is concern (sic) this might get out of control," the entry states.
The next entry, time stamped less than two hours later, is a medical emergency requesting police and ambulance to respond to Lakeview for a male who is assaulted with injuries. Apparently, the injured party refused to be taken to the hospital. The sheriff's office said the two calls are related.
A log entry on Oct. 9, states that a patient alleged being raped.
Yet another log entry from July 1 reports an incident where there was an altercation between a resident and a staff member both of whom accused the other of starting the fight.
The logs show that Fish and Game and New Hampshire State Police are called in regards to searches for lost people.
When clients who walk away reach the end of Lakeview's driveway, they sometimes end up on the property of Donna Marks, who lives in a house directly across the street from Lakeview's main gate. Marks has lived across the street from Lakeview for three years but she had lived in a home near the facility for the previous 20 years. For much of her time there, living near Lakeview was no concern. Then things got weird.
"I could write a book on what's going on there," said Marks.
She says it's not uncommon for naked Lakeview residents to run down Highwatch Road and even on her property — including into her house. In July, 2011, Marks' son actually found a naked young autistic man in her home at around 4:40 a.m.
Marks said if her son had not intervened on time, the man could have been mauled by her German Shepherd, gotten injured while attempting to jump over the balcony or even shot dead. Marks said after the man went back outside, he attempted to get into her daughter's car and did get into her son's truck. Lakeview staff eventually took the man away.
In his police report, then Effingham chief Joe Collins stated the incident at Marks' home was "unacceptable and will not be tolerated."
According to Marks, just days later the same person tried to enter her home again. This time, he didn't get in and he ended up smearing feces on her son's pickup which was parked in the driveway. According to her, the man did get into a house down the street.
Marks worries that someday a Lakeview resident will be hit by car when running loose.
"You never know when these people will pop up," she said.
Collins, who became the chief of Gilmanton police earlier this year, confirmed Marks' story.
An entry in the sheriff's dispatch log states on April 28, 2011, a patient was standing in the middle of Green Mountain Road and traffic was "having to swerve to avoid him."
Marks says Lakeview staff call multiple times per week saying they need to get someone off her property. However, she says things have improved as the staff has gotten better at controlling the residents. Marks said one time she went to complain, an administration member told her to build a fence around her property.
Collins said he's also concerned about the safety of the people at Lakeview. He said patients sometimes walk all the way to Boyle's Market in Freedom, the Wolfeboro town line and Maine. Staff can't or won't restrain the clients as they run into the woods, said Collins.
"You can't make this stuff up," said Collins. "The whole place is bizarre."
Collins and Freedom police chief Josh Shackford believe such problems have become more common since Lakeview instituted a "hands-off" policy a couple of years ago. Shackford told his selectmen that he's responded to patients wandering in the middle of the road and throwing rocks at cars.
However, Butts couldn't say if Lakeview's new policy made things any worse.
Collins said patients will take off in the middle of the winter in the cold without being dressed for the winter.
Effingham selectmen said they have a working relationship with Lakeview's administration.
"The police and fire departments respond anywhere in town when there is a need," said chairwoman Susan Slack.
Butts expressed the same sentiment.
Effingham fire chief Randy Burbank said the town and Lakeview have made strides at reducing the number of false fire alarms at Lakeview. Back in 2008, the fire department had to go to Lakeview dozens of times per month but now they might go once per month, said Burbank.
Former selectman William Piekut called Lakeview "a good neighbor" and an "asset to the town."
Both Burbank and Piekut, who serves on the fire department, said Lakeview has made major improvements to its alarm systems over the years.
But Collins believes Lakeview needs to have better mechanisms in place to keep its clientele safe.
As for the "non-confrontational" policy, Horan, in November, told Freedom selectmen that taking down and restraining residents used to be the way it was done. Now, Lakeview uses a different approach called the Mandt training system.
"The training is meant to prohibit that kind of response so people are not taken down, they are not wrapped up," said Horan in November. "These are people with feelings just like you and I."
Corthell explained when Mandt training breaks down, staff must call the main facility to get a doctors order to let "the gloves come off." He said the Mandt training staff gets isn't sufficient and staff are worried they will lose their jobs if they attempt to defend themselves. Corthell believes the staff have been given an inadequate level of Mandt training for the conditions at Lakeview. There are heavier duty versions of that training system, he said.
"Some of these people are so violent, I mean off-the-wall violent, that they have to be physically held," said Corthell.
Corthell and his colleagues estimate that 60 percent the patients they serve are non-violent but can be "unpredictable." Of the remainder, 15 percent are "extremely dangerous."
Another staff member, who didn't want to be identified because she is an employee, echoed Corthell's concerns about Mandt.
"When we were able to do the restraints we were able to stop people from hurting others, we could stop them from leaving the facility and the group homes but with Mandt it says to let them go," she said.
In 2011, a man, who walked away from Lakeview, ended up in Boston. The man was missing for a matter of hours.
The staff member said it can take 20 minutes to get the doctor's permission to use force — meanwhile someone might be being assaulted by a patient with a weapon. She explained that Lakeview's administration sent a staff member to become Mandt certified and he teaches it to the rest of the staff.
She and Corthell say that Mandt helps market Lakeview because it makes the families of prospective clients feel like their loved ones will be treated gently.
She added patients who display violent behavior are not punished and are still allowed to go on fun trips outside the facility. She said the misbehaving patients need to be taught there are consequences for their actions.
As for "Monterey Three," she said it has steel doors so patients can't damage them. "When they do freak out, they can cause a lot of damage," she said of Monterey Three residents.
It appears there were about two dozen lost-person reports from Lakeview facilities on Highwatch Road between Jan. 1 and Dec. 2 of 2012. According to the dispatch logs, it appears there were more walk-away type incidents in 11 months of this year than there were in all of 2009, which is consistent with what Shackford and Collins have maintained about problems getting worse.
Corthell says other workers say the residents have been able to get farther away when they take off since Mandt replaced the previous system.
Not every staff member the Sun spoke to was so negative about Mandt. One said the "philosophy" behind it was good and in most cases it works.

"If you treat people with respect they will give you back the same respect," said the staff member who agreed Lakeview is too understaffed.

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