It was the fall of 2000 and state inspectors were due to arrive at Seaport Manor, an adult home for the mentally ill in Canarsie, Brooklyn. Upstairs, some of its 325 residents, bewildered and mumbling, shuffled along the dreary hallways. Downstairs, a handful of workers hastily doctored records, they said, to make it seem as if the home was providing proper care.
Seaport Manor in Brooklyn, an adult home the state once called "The New Warehouse for the Insane." (Nicole Bengiveno/The New York Times)
The workers said they concocted case notes for manic-depressives who holed up in their rooms for so long they became malnourished. They invented psychiatric evaluations for residents who went untreated and turned suicidal. They scrawled therapy plans for women who prostituted themselves in the stairwells for cigarette money and for men who shook down other residents for their $4-a-day allowance.
"We were told by the administrators at the home to be creative," said one worker, Toshua Courthan. "We were told we had to, or else we would lose our jobs. What the state wanted to see was that these people were being looked after, but they were not."
Ms. Courthan was fired after reporting the falsifying of records and other misconduct at the home to the state, and she is suing Seaport. Her account was independently supported by other current and former workers, including two who participated that evening, as well as by an examination of some of the records.
The inspectors who showed up that day in 2000, however, apparently never detected the hundreds of sham files, according to state records. Seaport, which receives more than $3.5 million annually from the government, stayed open. For its residents, life has remained as wretched as ever.
Occupying a one-acre tract, the five-story brick building sits behind a row of shrubbery at 615 East 104th Street, not far from the neighborhood piers. A generation ago the home, along with dozens like it, represented a briefly entertained hope for the thousands of mentally ill people being pushed out of state psychiatric hospitals. In these homes, residents would learn to live independently and enter a mainstream community.
Just how profoundly that vision has collapsed can be appreciated in words from the state itself, which dubbed Seaport "The New Warehouse for the Insane" in a 1997 study by the Office of Mental Health. If the state gave Seaport a cynical nickname, though, records show it did nothing meaningful to improve or police it.
A portrait of life inside Seaport was gleaned from more than 10 visits, more than 500 pages of state inspection reports and government documents obtained by The New York Times, as well as more than 50 interviews with workers and residents.
During a typical visit to the home, residents can be seen sitting for hours in the crowded smoking room, rocking back and forth, speaking only to themselves. Others can be spotted walking to the local liquor store, much to the dismay of those at the nearby day care center.
Current and former workers said two residents openly deal crack from their rooms, contributing to the drug abuse, loan-sharking, prostitution and violence that have gripped the home for years. In this predatory atmosphere, the frail quickly learn that the safest place is behind the closed doors of their rooms. Others find different ways to get by.
"It's tough around here," said a resident in her 50's who said she sells sex to workers and other residents for a few dollars. "You have to do it to survive."
Ambulances are regular visitors. In a three-month period last year, they made 93 runs to the home, city records show, sometimes to take away the dying, other times to rescue the neglected.
For years, workers said, a security guard subdued psychotic residents by beating them. Other employees are convicted drug dealers, prison records show. Several former workers said the home sometimes continued to collect the monthly disability benefits of residents after they died, or gave their Social Security numbers to illegal immigrants the home hired.
There were dozens of numbers to choose from. From 1995 through 2001, one Seaport resident died roughly every month, according to an analysis by The Times. In all, at least 79 died, including at least three who committed suicide and two others whose bodies were discovered only after workers were drawn to the smell of decay.
"This is the last stop," a resident named Jerry said in his room at the home. "They are not preparing anyone for living outside of here."
For 26 years, the state has documented problems at Seaport and then averted its eyes. Since 1998, conditions have been so bad that inspection reports concluded that Seaport, as one said, "was in serious noncompliance in all major areas of operation."
The reports cited inadequate staffing and dangerous lapses in the distribution of medication. During a 1999 inspection, investigators refused to fully examine rooms because they were so fetid. They also remarked in their records how workers at the home were able to walk past disheveled residents without even noticing them.
Only in recent months, after The Times began an investigation of Seaport by requesting government records and questioning officials, did the state say it would crack down on the home.
Its response, however, has been erratic.
Last August, the state said it would try to revoke the operators' license. Last month, it agreed to let them surrender their license, pay a $20,000 fine and close the home. But in recent days, the state, confounded by the prospect of finding new housing for the residents, indicated it might try to keep Seaport open by installing new operators.
For now, the residents remain in Seaport under the same operators who the state has known for years have run a home of squalor and neglect. In 2001 alone, at least 18 residents died, The Times's analysis shows, 10 of whom were under 60.
Seaport's operators -- Baruch Mappa, Martin Rosenberg and Emil Klein -- said through their lawyer they would not be interviewed.
Before agreeing to surrender their license, the operators asserted in a disciplinary hearing before the State Department of Health that the home had undertaken renovations, overhauled medication practices and brought in more workers to increase supervision of residents.
"Seaport doesn't take the violations or alleged violations lightly," Ronald J. Aranoff, the home's lawyer, said at the hearing.
Over the years, Seaport, like many other adult homes, has often complained that the state has asked it to take responsibility for some of the most needy people while failing to provide enough money for their care. About 15,000 mentally ill adults live in more than 100 adult homes in New York.
The Department of Health said it did not take more aggressive action against Seaport in previous years because it preferred to help troubled homes improve conditions.
"Closure of a facility is disruptive to patients and residents, especially the elderly or mentally ill, and is typically pursued as a last resort after a home's repeated failures to comply with state regulations," said Robert R. Hinckley, a deputy state health commissioner.
The failures of Seaport can be witnessed in varying degrees at other adult homes in the city. State inspection reports on many of the homes are grim and interchangeable. Even so, the state seems to have grown accustomed to slapping the homes with one hand and shielding them with the other.
For the people who still live at homes like Seaport, most of whom are too sick to grasp the notion that they are entitled to something better, life is about doing what they can to endure.
Residents and workers at the home call it payday. Once a month, Seaport's administrators hand out about $120 in allowance money to each resident from the disability checks they control. Then the pandemonium begins.
In-house loan sharks chase residents down the hall, intent on collecting their money, according to numerous current and former workers and residents. They said two crack dealers also opened for business, packing in an assortment of fellow residents, and even the police said they have made drug arrests at the home in recent years.
Those residents unwilling to take part in either enterprise run to their rooms, fearful of the opportunistic and desperately in need of their tiny allowances. Inevitably, the strong at Seaport always know when the weak are in line to get their money.
"It would be just one big mess," Angela Peters, a former housekeeper and dietary aide, said of payday. "We couldn't do any work on the floor because it was so crazy."
"They have nobody who is looking after those people," a former worker, Angela Peters, said of Seaport Manor. (Richard Perry/The New York Times)
Ideally, the home is supposed to act like a bridge, helping the mentally ill return to neighborhoods where they can attain some self-sufficiency. In reality, there is nothing rehabilitative about the place -- it rarely tries to help residents obtain proper therapy, job training or, at times, even get dressed, according to state inspection reports and interviews with workers and residents.
There is never enough staff, and administrators and workers typically have no mental health training. The state does not require it at adult homes, though their residents are deeply troubled.
According to the 1997 state mental health study, of about half of Seaport's population, more than 80 percent had histories of multiple psychiatric hospitalizations, 35 percent had histories of violent behavior, 32 percent had abused drugs and 13 percent had attempted suicide.
"It's just too sad a place to go to work," said Sherry Reiter, a social worker who was assigned in the late 1990's to a clinic in the home run by the Kingsboro Psychiatric Center. "The sadness and the violence are part of the milieu."
Left with little supervision or treatment, residents often have psychotic episodes, records show. One man tried killing himself by taking an overdose of Tylenol, burning himself with hot water and then hanging himself with a pajama top coiled into a noose. A delusional woman repeatedly stabbed herself on the back and legs.
Newcomers to the home quickly learn there is little to do. The most popular spot is the smoking room -- a cluster of worn benches, bare walls, a television (always on) and a floor littered with cigarette butts, spilled coffee, ashes and discarded food.
The recreation room could offer other possibilities, but rarely does. For much of 2001, it was closed because there was no one to run it, workers and residents said. At other times, a high school student served as recreation director. For these schizophrenics and manic-depressives, the student liked to hold screenings of "Face/Off," a violent action movie about changeable identities.
In the late 1990's, a report by a state watchdog agency, the Commission on Quality of Care for the Mentally Disabled, rated Seaport one of the worst adult homes. Yet in 1997, the state awarded Seaport $41,501.25 in bonus money intended for homes that provide quality care, state records show. The state allocated the money largely for computer training for residents. Seaport does not have computers for residents.
It barely has a laundry room. The home had a single washing machine during one inspection, and it showed. Residents had "dirty, stained or ripped clothing" and were in need of a bath or shower, the inspectors wrote in their 1999 report.
The wait to receive psychotropic medication is sometimes half an hour or more, so some residents do not even bother. The ones who do are lucky if they get the correct pills, state inspection reports show. Peering into medication boxes, one inspector encountered dead cockroaches.
Andy Cadet, who ran the medication room for several months last year until she resigned, described the consequences of the chaos. "People were getting ill," Ms. Cadet said. "It was just a disaster."
The home itself does not provide psychiatric services, but it is expected to ensure that residents obtain them, either from the Kingsboro clinic at the home or from other psychiatrists who periodically visit. But the clinic, staffed by a psychiatrist and a few other trained workers, writes prescriptions that go unfilled. It asks that fragile residents be closely watched, and they are not, according to interviews with clinic workers and their records. The home's administrators, meanwhile, have long accused clinic workers of not doing their jobs.
At nights and on weekends, the residents are largely on their own. The clinic is closed, and the home has almost no one on duty. "Nobody wanted to take responsibility for patients who went berserk at night," said Louis Rossetti, who worked as a nurse at the clinic from 1980 until 1996 and then as a volunteer. "We would come in the morning and have to go upstairs and calm them down. It just over all got worse and worse."
Ms. Courthan, Ms. Cadet and several other workers said a security guard, Lionel Harrington, used to beat residents to subdue them. For his part, Mr. Harrington said he only tried to crack down on the drug-dealing, loan-sharking and prostitution.
He said the administrators at the home knew about the goings-on, especially the crack-dealing by one of the residents. "They are well aware that this man is destroying the residents in that building," Mr. Harrington said. He said he was fired late last year after he was late for work.
Toward the end of the month, as residents start to run out of money, the atmosphere in the home turns even worse, workers and residents said. Used condoms can be found in the stairwells and hallways, as both male and female residents trade sex for spending money, drugs or cigarettes.
"Generally, it was sex for drugs or sex for money," said Angela Johnson, a former worker at the home. "If someone wanted a dollar, it was sex for a dollar. Sex for anything was a big problem."
In the early 1970's, Kingsboro Psychiatric Center in Brooklyn, one in the state's array of vast mental hospitals, began aggressively emptying its beds as New York undertook the process of what came to be known as deinstitutionalization.
Kingsboro was looking for places to relocate its patients when Mr. Mappa, a local real estate developer, was looking for another business enterprise. His brainchild was to open Seaport Manor in September 1975 and take in many of those who were being cast out of the hospital's wards.
Only three miles from Kingsboro, the new building had a kitchen, dining room, recreation room and 13 bedrooms on the first floor; and 40 bedrooms on each of the second through fifth floors.
The idea, shared by Mr. Mappa and the state, was that the home would make for a civilized alternative to Kingsboro. Mr. Mappa would also make money. Residents would sign over their monthly government disability checks for rent, and outside providers would pay fees to the home for the opportunity to treat residents.
Yet neither Mr. Mappa nor the two business partners he brought in had any mental health expertise. The money from the government never seemed enough, and the care that came to be provided by the medical professionals was never adequate.
As a result, a troubled psychiatric hospital was emptied and effectively recreated in a place even less equipped to deal with hundreds of seriously ill people.
In the late 1970's, Seaport was a focus of an investigation into adult homes by a deputy state attorney general, Charles J. Hynes, who is now the Brooklyn district attorney. A grand jury found that at adult homes in Brooklyn, the condition of residents "was permitted to deteriorate to unconscionable levels." Ultimately, no charges were brought against Seaport or its operators, and leading state officials brushed aside Mr. Hynes's damning portrait of the adult home system.
The state did make a few changes at Seaport, including opening a clinic in 1979, one run by workers who came over from Kingsboro. But over the years, the state has cut the number of clinic workers to roughly 8 from nearly 20, Kingsboro workers said.
For much of the past decade, the home -- with more mentally ill people than most psychiatric hospitals in the nation -- has been run by Esther Elizabeth Rosenberg, the daughter of one of its operators. Ms. Rosenberg, 47, graduated from Brooklyn College in 1990 with a degree in sociology and had little work experience of any kind when she took over the home, according to court records and interviews.
The state has essentially called her incompetent. "The administrator is not capable of managing this facility and correcting the problems," a 2000 inspection report said. "We recommend enforcement be pursued."
But the state's own documented dealings with Seaport show that nothing much was done. It was not until March 2001, after years of incriminating inspection reports and concerns that residents were being neglected, that the state tried to discipline the home by levying a $7,000 fine.
But while it got Seaport to remove Ms. Rosenberg, it let the operators appoint her son-in-law, Seth Fried, as administrator.
She had no mental health training yet after only a short time at Seaport, she was promoted to case manager and then director of social services, playing a pivotal role in overseeing more than 300 chronically mentally ill people.
Over her two years at the home, she said, she was pressured to commit or she witnessed a startling variety of misconduct, from the forging of records to the misreporting of deaths. She decided in her second year that she could not keep silent, she said, and began secretly telling state inspectors about problems at the home. The inspectors took her calls, but otherwise seemed uninterested, she said. The state confirmed her calls.
In early 2001, Ms. Courthan, who is black, was fired, and she sued the home in Federal District Court in Brooklyn, charging that administrators had made racially insensitive comments to her. Aaron Charles Schlesinger, a lawyer for Seaport Manor, did not respond to three phone messages seeking comment. In court papers, Seaport denied Ms. Courthan's charges.
A review of inspection reports and interviews with more than 15 current and former workers support her account of life at the home. "Seaport's thing is, `Let's fill the beds,' " Ms. Courthan said. " `We don't care if they are psychiatrically unstable.' They don't care about these people."
Ms. Courthan was hired as a receptionist at Seaport in 1999. With low salaries and mismanagement, workers were constantly quitting, and she was rapidly promoted.
Her sister, Ms. Johnson, who had worked as a clerk for the City Board of Education, was later hired and put in charge of the medication room. Ms. Johnson found this strange, she recalled, because "I knew jack-diddly about medication."
Soon, Ms. Courthan and Ms. Johnson were helping to run the place, at $8 to $9.50 an hour. They received strong evaluations from administrators and were popular with residents, according to records and interviews, but were swamped with work. They were supposed to meet with residents monthly, file reports and ensure the residents were being seen by psychiatrists. But they rarely did.
This was obvious to state inspectors. In a January 2000 inspection report, they noted that of 30 resident files they had examined, 14 did not have current annual evaluations, let alone monthly case notes.
Residents often wait in long lines at Seaport, either to receive their medication or, as in the case above, a snack. )Nicole Bengiveno/The New York Times)
Ms. Courthan and Ms. Johnson said they and other workers stayed late one night and concocted hundreds of records, making up psychiatric evaluations and signing them with the names of fictional doctors. Ms. Cadet, the former medication worker, said she witnessed the forging.
By the time the night was over, records, some of which were shown to The Times, reflected that many residents had seen a nonexistent Dr. Rollins and received the same diagnosis. "Everybody, if you looked at their charts, they were all paranoid schizophrenic," Ms. Courthan said.
While state inspectors evidently did not detect that documents were being faked en masse, they had previously criticized the home's record-keeping, noting that files were "altered or missing."
Ms. Rosenberg would not comment.
Ms. Courthan and Ms. Johnson said the deception did not end with the forged records.
One night in November 2000, a resident named Dorothy Clinton set herself on fire and later died at the hospital. Based in part on interviews with Seaport employees, the medical examiner's office ruled the death an accident. The home contended she had ignited herself while smoking crack in bed.
Ms. Courthan, Ms. Peters, the former housekeeper, and other workers say the tale of crack smoking was wholly invented; they tell a different story. Ms. Courthan said she had recommended that Ms. Clinton be hospitalized that day because she seemed delusional and suicidal, but that an administrator had blocked the request.
That night, Ms. Clinton, 48, got dressed up, putting on earrings and makeup, and then intentionally ignited herself while in bed, residents and workers said.
Ms. Courthan said she wrote in Ms. Clinton's file the next day that she should have been hospitalized. When Ms. Rosenberg found out, she ordered Ms. Courthan to remove those notes, Ms. Courthan said. "Esther told me, `If you speak to the coroner, and say anything about how depressed she was, it is going to be a problem for us and it will be a problem for you,' " Ms. Courthan said.
Ms. Clinton's death was one of the few the state has investigated at adult homes. But while it cited the home for having inadequate staffing, state records show, it does not appear that it addressed the question of whether Ms. Clinton had been suicidal and whether her death could have been prevented.
Three months later, Ms. Courthan was dismissed, and she said she tried to unburden herself to inspectors one final time. She faxed them a letter on Feb. 6, 2001, repeating and elaborating on many of her allegations. An examination of the letter shows she wrote of how she and other workers had forged the records, saying that they made up "those forms A to Z."
Again, she said, inspectors did nothing.
Asked about Ms. Courthan and Ms. Johnson, Robert Kenny, a spokesman for the State Department of Health, at first said that the two had talked to inspectors only in early 2000 and complained only about administrators' stealing money from residents. Mr. Kenny said the inspectors cited the home 18 months later for failing to manage residents' accounts properly.
Pressed further, Mr. Kenny acknowledged that the inspectors had talked to the two women more regularly and that they had received the faxed letter from Ms. Courthan.
He said her allegations "were not new to inspectors."
After Ms. Courthan was dismissed, the home had Ms. Johnson arrested and charged with stealing $200 from residents. She was fired. The charges were later dropped.
The final indignity for many of Seaport's residents comes with a shovel full of dirt at potter's field. Nearly one out of every four residents who died from 1995 through 2001 was sent to the island cemetery in the East River, without headstones to mark their graves or eulogies to recall how they weathered their troubled lives.
Seaport, after profiting from them, made no effort to find them proper burial. In a way, it was almost fitting, given that the residents' deaths came with the same invisibility that surrounded their lives at the home.
Of the 79 people who died in the seven-year period, the average age of death was 58. Twenty-four of the dead were under 50.
"People were dying like flies," Ms. Peters said. "They have nobody who is looking after those people."
It will probably never be known how many of the deaths could have been avoided. The home almost always either failed to notify the state about deaths or left out details pointing to deficient care, records show.
In turn, the State Department of Health could provide documentary evidence that inspectors looked into only three deaths at Seaport -- Ms. Clinton's and two others. Those three inquiries, in fact, were the only ones that appeared to have been done by state inspectors at 26 of the largest and most troubled adult homes in the city in the seven-year period, when at least 946 residents died, according to the Times's analysis.
Elayne Silverman, once a promising student who wanted to be a social worker, was only 39 when she took her life in April 1995 at Seaport. It was just after breakfast when she climbed the stairs to the roof, according to state records and interviews. No workers at the home noticed. Then again, it was a Saturday, and few were on duty. Either the alarm on the door to the roof was broken, or it went off and was disregarded.
Ms. Silverman walked around for a while before taking off her clothes, folding them into a neat pile and then jumping, according to a Kingsboro clinic record.
Even that failed to get anyone's attention. A neighbor eventually called the home and said a naked body was in the parking lot. When the clinic asked about the death, Seaport administrators could not explain how a home that sheltered numerous people with histories of suicidal behavior could allow such access to the roof, clinic records show.
The state never investigated her death, or those of numerous others, according to interviews and records: Stephen Willner, 60, who succumbed to dehydration and malnourishment in 1999; Lewis Howard, 45, who died of kidney failure last year after no one responded when he passed out; and Albert Jarrell, 44, who had a heart attack in 1997 and was dead before workers thought to call 911.
While residents are free to come and go from the home during the day, the home is required by law to keep track of them. Bed checks are mandatory, but rarely done, residents and workers said. If a resident is missing for more than 24 hours, a report must be filed with the state and the police.
Artie Washington had not been seen for longer than that. Not only did Seaport not fill out a form, it did not even notice his absence.
Mr. Washington was known around the home for wearing an assortment of silly hats, from a Santa's cap to a Burger King crown. He was last seen on the Friday morning before Labor Day weekend in 1998. Early Monday afternoon, workers concerned by "a foul odor" entered Room 333, according to state records. "We found him dead, just sitting in the bathtub," said Mr. Rossetti, the nurse at the Kingsboro clinic.
An autopsy determined that Mr. Washington, 54, had died of a seizure. It is unclear whether he could have been saved had he been discovered earlier. Inspectors, in one of the three death inquiries they performed, criticized Seaport for allowing him to remain at the home even though he was unstable. Yet the state took no action to safeguard against similar deaths.
So in July 2001, Rosendo Velez, 77, was found dead. Mr. Velez, nicknamed Keebler because he walked like the elves in the cookie commercial, had returned to the home in a drunken fog, workers said. He was left in his room unattended anyway, and was found drowned an hour later in his bathtub, fully clothed. It was not until three months later, in October, that the state cited the home for failing to supervise Mr. Velez.
In the meantime, Martin Rochlitz, 51, was found decomposing in his sweltering room days after dying of a heart attack during an August heat wave, according to the coroner. Unlike the deaths of Mr. Washington and Mr. Velez, Mr. Rochlitz's did not even warrant a question by the state, its records show.
Kevin Johnson sees death all around him, and fears that his will be the next.
He has seizure disorder, schizophrenia and cerebral palsy. He is mildly retarded and cannot perform basic arithmetic. At a recent lunch, he had difficulty pulling the wrapper off a straw. Yet, sadly, even he understands that at Seaport, the odds are against him.
Mr. Johnson, 39, cannot forget all the seizures that have sent him tumbling to the floor of Room 106 during the past three years. Dazed and bruised, he is eventually found by a worker and taken to Brookdale University Hospital and Medical Center.
Each time, Mr. Johnson is admitted to the hospital for a few days. In vain, it calls the home for his medical and psychiatric history. "They could not provide more information on the patient," a nurse wrote one day. As always, he is sent back to the home.
His latest wound is a jagged gash on his forehead. He needed stitches to close it after banging his head on the floor during a convulsion. Still, he considers it a minor injury.
What he dreads is a repeat of what happened on a Sunday morning in July 1999. He was left alone to shower, had a seizure and passed out. It is not known how long he lay there as he was scalded by water that inspectors have repeatedly warned is too hot. He needed two skin-graft operations to heal huge swaths on his chest, back and arms.
Seaport never notified the state about his injuries, as was required, and Mr. Johnson was once again returned to the home. Left to himself, he has devised his own way of dealing with the seizures. "I sit on the bed and try to take it easy," he said the other day.
Ill since he was a teenager, Mr. Johnson is 5-foot-8 and beefy, with a mustache, a round face and no family. He has a kindly disposition, but often reverts to long silences, as if he learned long ago that the way to make it through the day is by shutting everyone out. He sits in his room for hours, listening to oldies on the radio and worrying that if he walks around the home, someone will harass him for money, or worse.
With the turmoil over Seaport's fate, Mr. Johnson's future is uncertain. For now, he soothes himself against his surroundings by reading the paperback King James Bible that he hides in the top drawer of his dresser.
Sitting on his flimsy mattress as mice scamper by, he opens to the same chapter and mouths the words, over and over. Second Corinthians, Chapter 5: Do not despair, for there is a better place in the afterlife.