Lethal oversight in group homes?

At 36, Lauren Terrazzano was diagnosed with lung cancer. In three years, she has undergone chemotherapy, surgery, radiation, a brief remission, more surgery, two more rounds of radiation and more chemotherapy. (Photo by Veronica Marino)

Charles Psoinas staggered down the stairs in the Garden Place Community Residence in West Hempstead, bleeding profusely from wounds to his chest and neck after he was stabbed with a 6-inch pocketknife.

He made it to the basement, where he found a manager of the 11-resident home for the psychiatrically disabled. She called 911. Pso- inas, 58, a schizophrenic whom family and friends called "Chuckie" and who loved the group residence that had been his home for about three years, was pronounced dead shortly afterward.

His roommate at the state-operated home, Derrick Smith, was charged with second-degree murder in last month's attack. The trigger for the violence was seemingly innocuous: According to police, Smith, 35, had accused Psoinas of telling supervisors that Smith had been making soup after hours, a violation of the group home's rules.

It is among the most recent of several deaths and violent incidents at group homes for the mentally ill and developmentally disabled on Long Island and in New York City. While advocates for the population cringe at potential stereotyping of the residents stemming from these occurrences, others wonder whether more effective supervision - higher numbers of better trained staff - is needed.

Not an isolated occurrence

The West Hempstead incident isn't an isolated case. In late January, a mentally disabled woman who lives at a Plainview group home was assaulted, and an employee of the residence is charged in the crime. Also last month, a mentally ill man in Chelsea wandered from his group home and was killed after he sat down on the subway tracks near 23rd Street. Police said he had liked to play "hide and seek" in the subway.

In August, a resident of a Melville group home died of heat exhaustion after locking himself in a car on a 91-degree day, and in February 2003, a man went missing from a state-affiliated Kings Park facility and froze to death in the woods. There have been dozens of other incidents, according to records, though many don't rise to the level of serious injury or death.

The West Hempstead killing exposed a telling knowledge gap between state and local officials, who acknowledge the void, and has raised issues of supervision among providers.

Jill Daniels, a spokeswoman for the state Office of Mental Health, said Psoinas' slaying was the first "critical" incident at the West Hempstead home reported to the state since it opened in 1992.

Newsday's examination of police records told a different story, with law enforcement a frequent presence at the home.

Since 2001, Nassau police responded 53 times to calls there. While the majority were so-called "aided" cases, often ambiguous incidents involving assistance with medical care or resolution of disputes, at least two were responses to violent incidents or property damage, according to records. There were nine missing persons reports filed since 2003, and at least one case of criminal mischief reported after a window of a car was smashed.

Told of the lengthy record of police responses to the home, Daniels said, "Just because the police are called doesn't mean it's a reportable incident."

Under state law, homes must report critical incidents to the state, but criteria vary. They are classified into a variety of categories, depending on severity, ranging from medication errors to abuse or neglect or random death. Often, the assessment of an incident's severity is left to the discretion of group home operators, who develop their own incident management plans. In such cases, homes are required to keep internal incident reports except for reportable deaths, attempted suicides, crimes, or missing clients, among other categories. Police are not required to report to the state when they respond to a home.

The West Hempstead case, however, has prompted some follow-up. The state's Commission on Quality of Care, a state-funded watchdog group in Albany, is investigating the alleged assailant's prior care and treatment around the time of the attack on Psoinas, spokesman Gary Masline said.

Homes a humane solution

The individual group residences, which house anywhere from five to 20 people with a variety of disabilities, began to grow in popularity in the 1970s and '80s as a more humane alternative to care in massive psychiatric institutions. The smaller homes were a way for the mentally ill to live in the community, in the least restrictive setting - the type of environment called for in New York state law, advocates said. The state stipulates that one person be on duty, no matter how many people live in the residence, said Daniels.

Still, violent incidents in the group homes have been few, given the thousands who live in them. Currently, close to 3,000 people are in such residences in Nassau and Suffolk counties, and about 10,000 occupy group homes in New York City. "There's no question we can find random incidents that are really terrible and tragic," said Harvey Rosenthal, director of the New York Association of Psychiatric Rehabilitation Services in Albany. "But, for the most part, these are the exceptions."

For years, Psoinas lived at Pilgrim State Psychiatric Center until doctors said he was ready to live more independently. By many accounts, he had managed his schizophrenia quite well with medication, records and interviews show. Family members said Psoinas had lived in the well-maintained, white Colonial home and was never happier.

"He followed the house rules. He was in by curfew. He was a happy, gentle person who always remembered everyone's birthday," said his sister-in-law, Dana Lee of Oyster Bay. He rode his bike to get his hair cut. He loved shopping at the local flea market.

Smith's profile was markedly dif- ferent. A paranoid schizophrenic who at times had been homeless, he had a history of assaults and had served time in the Nassau County Jail, police said. In 2001, he was convicted of felony attempted robbery.

In 1999 and prior, records show Smith had a slew of misdemeanor convictions, including criminal mischief, resisting arrest and fourth-degree criminal weapon possession, third-degree assault and criminal trespass. It is unclear why he and Psoinas were placed as roommates, given their very different histories. Daniels could not explain it, though she said that "clinical profiles are considered to determine compatibility."

More supervision needed?

Advocates for the mentally ill fear that incidents such as Psoinas' slaying will feed a latent stigma against badly needed housing for people with such disabilities.

"Should staffing be greater? Absolutely," said Mike Greenfield, director of the Mental Health Association of Nassau County. "The system is understaffed and needs staff who are more trained and adequately compensated for their work."

Lawmakers need to sit up and take notice of what is an ever more pressing community predicament, others say.

"There needs to be a sounding to our state officials that resources are needed to address the needs of an increasingly complicated group of people," said Michael Stoltz, chairman of the Suffolk Coalition of Mental Health Service Providers, who said he is troubled by the West Hempstead incident. Nearly 1,000 mentally ill people on Long Island are on a waiting list for community housing, Stoltz said.

At some homes, the supervision of residents has been an issue warranting investigation.

In August, Luis Rivera, 51, died of heat exhaustion after locking himself inside a car in the driveway of his group home in Melville. The Commission on Quality of Care still is investigating.

In February 2003, Arthur Bartoszewicz, 47, wandered from the grounds of his Kings Park residence and was found frozen to death in the woods, naked except for a boot on a sockless right foot. The home conducted a review of the circumstances leading to Bartoszewicz' death, but it wasn't examined by the commission.

Lee said she generally supports the concept of smaller residences for the mentally disabled - but with an important caveat regarding the inhabitants' security. "We feel that after all the hard work he did to live independently," she said of her late brother-in-law, "he should have been able to be safe in his own bed."

Related topic galleries: Luis Rivera, Vehicles, Mental Illness, West Hempstead, Illnesses, New York, Pharmaceuticals