A mountain of misconduct

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.