For Mentally Ill, Death and Misery By CLIFFORD J. LEVY Published: April 28, 2002 Randolph Maddix, a schizophrenic who lived at a private home for the mentally ill in Brooklyn, was often left alone to suffer seizures, his body crumpling to the floor of his squalid room. The home, Seaport Manor, is responsible for 325 starkly ill people, yet many of its workers could barely qualify for fast-food jobs. So it was no surprise that Mr. Maddix, 51, was dead for more than 12 hours before an aide finally checked on him. His back, curled and stiff with rigor mortis, had to be broken to fit him into a body bag. At Anna Erika, a similar adult home in Staten Island entrusted by the state to care for the mentally ill, three other residents had previously jumped to their deaths when a distraught Lisa Valante, 37, sought help. But it was after 5 p.m. and, as usual, the residents, some so sick they cannot tie their shoes, were expected to fend for themselves. No one stopped Ms. Valante, then, from flinging herself out a seventh-floor window. Sometimes at these homes, the greatest threat can be the person who sleeps in the next bed. Despite a history of violent behavior, Erik Chapman was accepted at Park Manor in Brooklyn. After four years of roaming the place with a knife, Mr. Chapman stabbed his roommate, Gregory Ridges, more than 20 times. At last, Mr. Chapman was sent to a secure psychiatric facility. Mr. Ridges was sent to Cypress Hills Cemetery at the age of 35. Every day, New Yorkers come face to face with the mentally ill who have ended up on the streets since the state began closing its disgraced psychiatric wards more than a generation ago. Mr. Maddix, Ms. Valante and Mr. Ridges were among thousands more who ended up in dozens of privately run and state-regulated adult homes in New York City. A yearlong reporting effort by The New York Times, drawing upon more than 5,000 pages of annual state inspection reports, 200 interviews with workers, residents and family members, and three dozen visits to the homes show that many of them have devolved into places of misery and neglect, just like the psychiatric institutions before them. But if The Times's investigation found that the state's own files over the years have chronicled a stunning array of disorder and abuse at many of the homes, it discovered that the state has not kept track of what could be the greatest indicator of how broken the homes are: how many residents are dying, under what circumstances and at what ages. The Times's investigation has produced the first full accounting of deaths of adult home residents. At 26 of the largest and most troubled homes in the city, which collectively shelter some 5,000 mentally ill people, The Times documented 946 deaths from 1995 through 2001. Of those, 326 were of people under 60, including 126 in their 20's, 30's and 40's. At two of the largest homes, Leben Home in Queens and Seaport Manor in Brooklyn, roughly a quarter of the 145 residents who died were under 50. The Times's analysis of the deaths used Social Security, state, court and coroner's records, as well as psychiatric and medical files. The analysis shows that some residents died roasting in their rooms during heat waves. Others threw themselves from rooftops, making up some of at least 14 suicides in that seven-year period. Still more, lacking the most basic care, succumbed to routinely treatable ailments, from burst appendixes to seizures. Some of the hundreds of deaths undoubtedly stemmed from natural causes and were unavoidable. Studies have found that the mentally ill typically have shorter life expectancies than the general population, because they have difficulty caring for themselves and are more prone to health problems. The average age of death in the overall survey was 63. There are few extensive studies on death rates of the mentally ill in facilities like adult homes. But Dr. E. Fuller Torrey, a psychiatrist who is a nationally recognized expert on mental illness and mortality, called The Times's analysis disturbing. ''It would certainly suggest a fair number of deaths that were premature,'' said Dr. Torrey, who is executive director of the Stanley Medical Research Institute in Bethesda, Md., and is familiar with the adult home system in New York City. ''There is no question that if these people were getting better care and more skilled care, they would be living longer. And this poor care leading to death is going to cut right across the age population. It also means that people who are 70 are dying prematurely.'' In the end, whether the residents were in their 20's or 70's, it is impossible to know just how many of their deaths could have been prevented. The only other accounting of the dead seems to be on Hart Island in the East River, where scores of adult home residents are buried in the mass graves of potter's field. Officials at the State Department of Health, which regulates the homes, acknowledge that they have never enforced a 1994 law that requires the homes to report all deaths to the state. Asked for records of any investigations into deaths at the homes, the department produced files on only 3 of the nearly 1,000 deaths. None of the suicides were among the three. Even the fatal stabbing of Mr. Ridges at Park Manor went unexamined by the department. The city medical examiner's office said it had not received a single inquiry in recent memory from state inspectors regarding an autopsy of an adult home resident. Neither Gov. George E. Pataki nor his health commissioner, Dr. Antonia C. Novello, would comment on The Times's investigation. Their aides said a deputy health commissioner would speak for the administration. Presented with The Times's findings, the deputy health commissioner, Robert R. Hinckley, said the department would examine ''ways to better investigate those deaths that are reported to us.'' To that end, Mr. Hinckley said the state would issue a regulation alerting the homes that it would strictly enforce the 1994 law on reporting deaths. ''We want facilities to follow the law, and we are redoubling our efforts to get them to report all deaths,'' he said. As of Friday, seven weeks after Mr. Hinckley's promise, the department had still not issued the regulation. About 15,000 mentally ill adults -- most of them poor, many of them black and Hispanic -- reside in more than 100 adult homes in the state, the majority in the city and its suburbs. Some are now larger than most psychiatric hospitals in the nation. The reality of the homes is far from what was envisioned. In the 1960's, New York, like other states, decided to shutter or sharply scale back its psychiatric wards, where patients often languished for decades. When the profit-making adult homes offered to shelter the discharged patients, the state embraced the idea. Federal disability money was used to pay the homes, which would provide meals, activities and supervision. The homes would bring in outside providers for psychiatric and medical care. The state was responsible for making sure it all went well. But from the start, problems surfaced. No one knew about them better than the state itself, which for 30 years has issued damning inspection reports and then all but ignored them. State investigators across those three decades described many of the homes as little more than psychiatric flophouses, with negligent supervision and incompetent distribution of crucial medication. At one, Brooklyn Manor, the staffing was so sparse that a resident was put in charge of the entire place on one evening, a routine 2001 state inspection report shows. In more than 100 inspection reports from 1995 through 2001, investigators frequently noted filthy and vermin-ridden rooms in some homes, and disheveled and unbathed residents in others. They cited administrators for poor, sometimes fraudulent, record-keeping involving residents' money and care. A 2001 state inspection of Garden of Eden in Brooklyn found the operator to be ''routinely threatening residents.'' In a 1990 overview of adult homes, the Commission on Quality of Care for the Mentally Disabled, a small state watchdog agency, rated half of the homes that it surveyed in the city as poor. Ten years later, the agency came to the same conclusion. But the formal reports get at only part of the system's failures, according to The Times's investigation. The investigation reveals several of the homes to be medical mills where the operators and health care providers pressure residents to undergo treatment -- even surgical operations -- they neither need nor understand in order to earn Medicaid and Medicare billings. The homes are typically run by businessmen with no mental-health training. A 1999 audit by the State Comptroller's Office aimed at evaluating the regulation of adult homes found that the Department of Health had done little to scrutinize the people it licensed to run them. The homes are staffed largely by $6-an-hour workers who dispense thousands of pills of complex psychotropic drugs each day. At one home, Ocean House in Queens, social workers said a medication worker was basically illiterate. The homes are not required to have professional staff on duty overnight. Multiple visits reveal that often only the janitors, and possibly a guard or two, remain. Nathaniel Miles, a former porter at Surf Manor, a 200-bed home in Coney Island, recounted two scenes last year that he called typical: on one night, he had to stanch the heavy bleeding of a resident who had had a seizure and fallen in a bathtub.