By Heather Vogell, ProPublica

Once again, government actions against a controversial for-profit company’s chain of group homes for the disabled may have come too late to protect a child. ProPublica has learned that Maryland had begun pulling about 30 children out of homes owned and managed by AdvoServ in August, but hadn’t yet relocated a teenage girl when she died a month later after being manually restrained by staff.

Maryland’s Department of Human Resources had also stopped placing children in AdvoServ homes, following inspections that identified deficiencies in quality control, record-keeping, and conditions in residential and common areas. Last year, ProPublica chronicled AdvoServ’s long record of problematic treatment, its use of mechanical restraints, and its efforts to weaken regulation as it took in more people with developmental or intellectual disabilities and behavior challenges.

Maryland, which plans to terminate its contract with AdvoServ at the end of this month, isn’t the only state to have increased its scrutiny of the company since the ProPublica series. In March, Delaware placed the company on probation, a spokeswoman for the state’s Department of Services for Children, Youth and Their Families said. In June, Florida officials said they had begun moving clients out of the company’s facility in the state, and stationed an investigator there.

Through a spokesman, the company declined to comment on the decisions by Maryland and Delaware regulators. AdvoServ’s shortcomings add to the growing concerns about for-profit companies taking over delivery of human services, from prisons to hospice care, that were traditionally provided by government or non-profit agencies. The teenager’s death, in particular, points to the limits of state officials’ ability to safeguard the disabled people they place in group homes run by private contractors — even when such care is paid for with public money.

Kevin Huckshorn, a national behavioral health consultant, said it matters less whether care providers are public or private — and more whether the public agency paying for services is keeping a close enough watch. “It’s out of sight, out of mind,” she said. “If you’re not able to do due diligence on oversight and monitoring, anything can happen.”

She added that, because of the problems that have surfaced publicly, regulators should have been on alert for issues at AdvoServ homes. “That should have upped the ante,” she said.

Fractured authority and multiple players — which at times have included as many as a dozen government agencies — have clouded oversight of the company’s operations. AdvoServ has expanded in the past two decades despite a stream of complaints of abuse and neglect. As far back as the 1990s, the state of New York pulled its children from AdvoServ’s predecessor, Au Clair, because its inspectors had found children living in trailers that reeked of urine and feces.

Officials elsewhere have repeatedly backed off from sanctioning the company, which is aided by well-connected lobbyists that include prominent former state legislators. In 2012, for example, Florida reneged on plans to bar an AdvoServ home, where both adults and a child had allegedly been punched and kicked, from accepting new clients for a year.

Now owned by a private equity firm, Delaware-based AdvoServ reported last year that it cared for about 700 children and adults in that state, Florida, and New Jersey, and was expanding into Virginia. The company said then it had about 60 people age 21 or younger in its Delaware program. When Delaware officials put AdvoServ on probation in March, they established a new oversight committee with representatives from several state agencies. They also increased visits by state workers to the company’s facilities, strengthened requirements for reporting complaints involving children, and tightened rules about documenting when a child left AdvoServ grounds, Delaware spokeswoman Dawn Thompson said in an email.

Eight Delaware youth remain in AdvoServ homes, Thompson said. She did not provide details on why the company was placed on probation. The state has received eight complaints this year regarding alleged abuse of children at AdvoServ, as well as two complaints that resulted from the teenage girl’s death, Thompson said. Most of the complaints were filed by the company.

Maryland is one of several states that send difficult cases to AdvoServ homes in Delaware when they cannot find beds and schooling closer to home. Maryland’s contract allows the state to pay AdvoServ up to $7.5 million a year to care for children referred either from its foster care program or after their parents had sought the agency’s help.

This past June, a lawsuit was filed against AdvoServ in state court in Delaware, alleging that a teenage boy from Maryland was left unsupervised and raped repeatedly by other clients during more than four years in the company’s homes. His neck was injured during a restraint performed by workers, according to his lawyer, Chris Gowen. The case is pending.

In early August, Maryland assembled a team of officials to make an unusual unannounced visit.

The inspections, conducted on three days, prompted the pull-out of children and moratorium on new placements. As of this week, Maryland officials had moved 20 people under age 21 to new placements, with nine remaining at AdvoServ homes. Officials expected to move most of them by the end of this week and will have all removed before the state’s contract ends October 31.

About a month after the inspection, a 15-year-old girl from Hyattsville, Maryland, became unresponsive while being restrained at a group home in a quiet stretch of old Delaware farm country southwest of Wilmington pocked with new housing developments. The girl, whose name has not been released, died in a Delaware hospital two days later. Maryland then ordered its staff to visit AdvoServ homes every day.

The girl was not the first teenager to die at an AdvoServ home. In 1997, a 14-year-old autistic boy with epilepsy was found dead in his bed with low levels of anti-seizure medicine in his blood. In 2013, a 14-year-old autistic girl died at the company’s Florida home after a night in which she was restrained — at times fastened to a bed and chair — while she vomited repeatedly.

“The safety of our children is DHR’s top priority and we are taking this case very seriously,” Maryland spokeswoman Katherine Morris said in an emailed statement, referring to the 15-year-old girl’s death. The company said in a brief statement last month that it was “heartbroken over the loss of a young woman in our care.”

To Learn More:

Maryland’s Move to Pull Children from Group Homes Came Too Late for Teenager Who Died (by Heather Vogell, ProPublica)

Florida Takes Action against Home for Disabled with History of Patient Abuse and Neglect (by Heather Vogell, ProPublica)

Connecticut Oversight Agencies Failed to Investigate Years of Abuse and Neglect in Group Homes for Disabled (by Joaquin Sapien, ProPublica)

FDA to Ban Electric Shock Devices Used for Decades on Disabled Boston Residents (by Heather Vogell, ProPublica)

Court-Freed Documents Show 13 Deaths at Developmentally Disabled Facilities (by Ken Broder, AllGov California)

3 State Facilities for Developmental Disabled Face Funding Loss after Patients Found in “Immediate Jeopardy” (by Ken Broder, AllGov California)