Florida Ended Death Probe at Private Brain Rehab Center

State regulators ended inquiries into a patient’s death and alleged abuse at the Florida Institute for Neurologic Rehabilitation last year over doubts about their legal authority.

The 196-bed institute, a closely-held company known as FINR, is one of the largest brain-injury centers in the U.S. and draws patients from around the country.

The Florida Department of Health brought an end to inquiries over the February 2011 death of Melinda Jakobowski, a mentally ill Connecticut woman sent to FINR, after other state regulators had already concluded there were care lapses in her case, according to inter-agency e-mails reviewed by Bloomberg News.

The e-mails also showed a top Department of Health official believed FINR was operating outside its brain-injury license in treating Jakobowski and others who didn’t have such injuries at its facility in Wauchula, 50 miles southeast of Tampa. The department has taken no action against FINR over the alleged unlicensed care.

The state’s decision not to further scrutinize the brain-injury company preceded a second death in Wauchula last year and charges of criminal abuse of FINR residents by employees.

Patients’ families or state agencies have alleged abuse or care failures in five FINR residents’ deaths since 1998, as reported by Bloomberg News last week.

FINR denied the allegations in three of those cases, which led to lawsuits. One resulted in a $5 million verdict against the company and the other two ended in settlements. FINR has declined to comment on the Jakobowski case or the later death, which have not been the subject of any lawsuits.

‘Proactive Approach’

Officials from three Florida agencies will meet tomorrow to discuss cases at FINR, said Victor Johnson, a state Department of Health Official who oversees its brain-injury program.

“All of us have to change the way we have done or responded to these issues in past,” Johnson said. “We want to go with a more proactive approach to respond to these issues with one state response.”

Wayne J. Miller, a lawyer for FINR, said “there is probably no health care provider in the state that has as much oversight.” He said the facility is subject to inspections and regularly visited by police, state agencies, disabled-protection groups, guardians, family members and others. When a problem is identified at FINR it is “immediately evaluated and corrected,” Miller said.

Jakobowski, 24, died five months after the state of Connecticut sent her to FINR. She was found unresponsive in her bed with her hair wrapped around her neck and died later at a Tampa hospital in what was ruled a cardiac arrhythmia.

E-mails Released

Florida released internal e-mails in that case and others to Bloomberg News under an open records law request. Although her name was redacted, Florida officials confirmed Jakobowski is the person referenced in the e-mails.

Three Florida agencies that deal with FINR -- the Department of Children and Families, the Agency for Health Care Administration and the Department of Health -- passed their findings in the case around internally, the e-mails show. None of the agencies believed it had authority to take regulatory action.

An AHCA investigation found that FINR failed to maintain proper supervision of Jakobowski and that she was left alone despite a history of trying to hurt herself. It said in an e-mail that it had no authority to regulate patient treatment -- and sent a request for further investigation to the Department of Health.

Reimbursement Sought

William Reineking, the administrator for the brain-injury program in that department, responded in April 2011 that he might not investigate the case unless his office was reimbursed for its costs.

The case provided evidence “again” that “FINR is treating people not covered by the license,” Reineking said in another e-mail to AHCA the following month.

Although Jakobowski was suffering from mental illness, she was not brain-injured. The health department says it only has the authority to regulate the care of FINR patients under a “transitional living facility” license covering those suffering from traumatic-brain or spinal-cord injuries.

Both the health department and AHCA, which licenses health-care facilities, declined to say why the state has permitted FINR to treat patients at its brain-injury center when they don’t have brain injuries.

Regulatory Gap

Other cases of alleged abuse involving patients who were severely mentally ill or autistic, but not brain-injured, also have fallen into the regulatory gap, the e-mails show.

When the children and families agency later forwarded an abuse allegation of an unnamed patient at FINR to Reineking, he quickly responded that there was nothing he could do.

“The patient was not admitted with a TBI” -- or tramautic brain injury -- “as defined in law and rule,” he wrote in an August 2011 e-mail. “We do not have authority or jurisdiction to intervene. Thank you for sharing this information.”

One month after that e-mail, a 21-year-old autistic patient at FINR was allegedly abused over a two-hour period by two staffers who took turns elbowing, punching and slapping him. The staffers face pending charges of abusing a disabled person.

In December 2011, a second autistic man was allegedly knocked to the floor by an employee who also has been charged by prosecutors. All three staffers were fired. They have pleaded not guilty to the criminal charges.

Another Death

The same month, just after Christmas, another FINR patient died. Reginald Hicks was taken to the cafeteria by a FINR employee and given solid food that lodged in his lungs and killed him, according to his daughter, Heather Hicks. Her father, who was injured in a car accident, had a care plan that called for tube feeding because he couldn’t swallow, she said. Autopsy findings cited aspiration of food and pneumonia as causes of death.

William Dartland, executive director of the non-profit Consumer Federation of the Southeast, called for state and federal officials to take immediate action to protect patients at FINR.

“If authorities need to take over control of the facility to ensure the patients are safe, then that’s what needs to happen -- now,” said Dartland, a former deputy attorney general in the state.

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