The New Lisbon Report

Assistant U.S. Attorney General Threatens NJ with Legal Action over Conditions at State-Operated Developmental Center.

In a 35-page document, dated April 8, 2003 and addressed to NJ governor Jim McGreevey, Assistant Attorney General Ralph F. Boyd, Jr. reports the results of an investigation conducted by his office into conditions at the New Lisbon Developmental Center. The report concludes that "there are numerous conditions and practices that violate the constitutional and statutory rights of New Lisbon residents." Serious and, sometimes life-threatening, deficiencies were noted in the areas of

	Protection from Harm
	Psychological Services and Restraints
	Psychiatric Care
	Habilitation
	Health Care
	Nutritional/Physical Management and Therapy
	Placement in the Most Integrated Setting

Below are a few excerpts from the report. (Pseudonyms are used throughout)
The full report can be viewed or printed here.

"New Lisbon fails to protect its residents from harm or risk of harm."

	From January 2001 to May 2002, there were over 500 incidents classified as moderate or major, including resident-on-resident assaults, abuse or neglect, and deaths.
	Anthony, 3/25/02, fell out of his wheelchair, and suffered abrasions on his finger, ear, head, a bruise on his back, and a fractured thumb; a few days later, on 4/3/02, it was also determined that he had a fractured right clavicle.
	Matthew, 2/9/02, a resident who is required to have constant supervision, was found by staff with a large shoe-shaped bruise on his chest.

"Substantiated allegations of staff physical and verbal abuse against residents, as well as neglect, are ongoing. Below are a few examples, occurring in the weeks before our tours, demonstrating the facility's systemic failure to protect its residents from harm:"

	Robert, 4/17/02 - staff member punched resident in the chest.
	Jennifer, 3/1/02 - staff member called resident degrading and undignified names.
	Adam, 2/27/02 - staff member forcefully pushed Alfred into his room, causing him to collide with a chair on the other side of the room.
	Henry, 2/27/02 - staff member took Henry and other residents to her house to clean up dog waste in her backyard.
	Angela, 2/24/92 - staff member was seen holding Angela's faceguard and shaking her head up and down while yelling at her.
	Wilson, 2/9/02 - staff member intentionally smeared glue on Wilson's face, and failed to remove the glue before it dried; removal of the dry glue was "painful."
	Paula, 1/25/02 - staff member slapped Paula in the face, and pinched her "because she is a 'dark-skinned black person' and bruises don't show up on her"; there were "2 large bruises on right breast"; staff member also struck "the heal of her hand on Paula's forehead"; staff member directed profanity at the resident and verbally threatened her.
	From January 1, 2002 through the time of our tour in early May 2002, over a half-dozen New Lisbon staff were caught sleeping while on duty.

"New Lisbon fails to provide adequate and appropriate psychological services to meet the individualized needs of its residents with behavior problems."

Despite the recent increase in psychology staff, the facility's current behavior programs do not contain all of the required components and do not comport with generally accepted practice.

During our on-site tour, some New Lisbon staff could describe correctly how to respond to problem behaviors, but many other staff members' descriptions of how to respond to behaviors did not correspond to the behavior program. This can lead to a lack of progress or even an escalation in resident outbursts, possibly resulting in injury or restraints. Many staff members implemented their own interventions regardless of what was written in the programs.

Restraints

	New Lisbon residents have a right to be free from unreasonable use of restraints. New Lisbon reports that between January 1, 2001 and April 15, 2002, there were over 1,000 instances in which the facility restrained a resident using four-point wrist and ankle restraints.
	In June 2002, New Lisbon characterized its restraint usage as "continuing to remain low and may be trending downward ... the rate of mechanical restraint in the last three months is lower than any other time since this data has been recorded." However, substitute restrictions, i.e., psychotropic drugs, may have emerged to take the place of the four and five-point mechanical restraints.
	New Lisbon also engages in the restrictive practice of "personal control" of residents, which involves manual contact by staff to restrict the residents' freedom of movement either partially or totally. Facility policy requires that staff review the use of personal control and record its use in a database. However, it was evident that it is not being recorded properly (if at all) and it is not tracked anywhere in the facility's databases. Thus, personal control does not appear in the facility's restraint reports or in the list of behavior programs that have restrictive components. There is no data on the use of personal control and little monitoring, training, and examination of how to reduce its usage. As a result, it is impossible to determine how often this restrictive practice is being used at New Lisbon. However, we know from house managers that the practice is being used. We also are troubled that this form of restraint may be hidden within the behavior programs that call for the use of "facility approved procedures."

"New Lisbon provides inadequate and inappropriate psychiatric care and services to its residents with mental illness."

It appears that the psychiatrists have only just begun to consider resident behavioral and other data and the elements of their behavior programs in developing psychiatric interventions.

over 30 percent of the residents on psychotropic drugs receive three or more medications. This is of concern as most of the individuals on four and five medications have a history of high and chronic use of restraint as well as many incidents and injuries due to behavior problems. The use of polypharmacy without strong justification and intense oversight is inconsistent with currently accepted practice.

"New Lisbon fails to provide its residents with adequate habilitation services and supports and New Lisbon's individualized planning process fails to meet current professional standards."

During our on-site visit, we also discovered a low level of engagement among the residents even though staffing was often adequate and the residents had the capability to learn. Too often, residents were not engaged and the staff did not attempt to engage them. We found several examples where nothing was happening with residents - they were all sitting idly in chairs - even though staff were present.

there are hundreds of New Lisbon residents who do not receive any off-residence day programming or vocational opportunities that would meet their needs. This is problematic because many residents are not given enough to do during the day and this can cause regression and exacerbate problematic behaviors due to boredom.

"New Lisbon is failing to meet the individualized health care needs of some of its residents. This is especially true of residents with bowel obstructions and residents with nutritional and physical management concerns."

Most troubling, several New Lisbon residents have died recently following the rupture of their intestines related to the onset of a bowel obstruction. For example, last year, resident Brian suffered with prolonged abdominal pain caused by an undetected small bowel obstruction that eventually led to a bowel perforation. Specifically, Brian had a perforated ileum, collapsed colon, and three small tears in his small bowel secondary to bowel obstruction. He needed surgery to repair the perforation. In spite of the surgery, Brian died approximately one week later. New Lisbon had failed to note and recognize that in the days immediately preceding the hospitalization, Brian was not only constipated but obstipated to the point where bowel obstruction was imminent. There have been other similar cases: Ryan died following a small bowel rupture secondary to a bowel obstruction; and Jonathan died secondary to a perforated viscus (ruptured bowel).

Serving Persons in the Most Integrated Setting Appropriate to their Needs

In construing the anti-discrimination provision contained within the public services portion (Title II) of the ADA, the Supreme Court held that "[u]njustified [institutional] isolation ... is properly regarded as discrimination based on disability." Olmstead v. L.C., 527 U.S. 581, 597, 600 (1999). Specifically, the Court established that States are required to provide community-based treatment for persons with developmental disabilities when the State's treatment professionals have determined that community placement is appropriate, provided that the transfer is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities. Id at 602, 607. As set forth below, the State is failing to comply with the ADA with regard to placing persons now living in New Lisbon in the most integrated setting appropriate to their individualized needs.

New Lisbon's treating professionals have identified approximately 200 residents who are not currently living in the most integrated setting appropriate to their needs. In an effort to meet the needs of these residents, the State instituted and funded the Transition Initiative, a program designed to move residents into more integrated, community-based settings. In fiscal year 2001, New Lisbon conducted a lottery and, from the approximately 200 eligible residents, selected 45 for inclusion in the Transition Initiative. In fiscal year 2002, a second lottery was held and another 55 residents were selected for inclusion in the Transition Initiative. Thus, in fiscal year 2001 and 2002, New Lisbon identified 100 residents that it intended to prioritize for placement in the community. At the time of our first tour in May 2002, however, only 15 of the 100 residents who were selected for inclusion in the 2001 and 2002 Transition Initiative had been placed in the community (11 from fiscal year 2001 and 4 from fiscal year 2002). The pace with which New Lisbon places residents in the community is inadequate.

"In the unexpected event that the parties are unable to reach a resolution regarding our concerns, we are obligated to advise you that the Attorney General may initiate a lawsuit pursuant to CRIPA, to correct deficiencies or to otherwise protect the rights of New Lisbon residents, 49 days after the receipt of this letter."

("CRIPA" is an acronym for the Civil Rights of Institutionalized Persons Act.)

View or Print the Full 35-Page Report on New Lisbon Here (PDF format)

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