Second of four parts
Looking back on it now, Jeffrey Sees believes he was lucky to have been beaten so badly. It was his ticket into a hospital - and out of hell.
"I don't think I would have lasted much longer," he says. "I think they would have killed me."
Sees, a Vietnam veteran with mental-health problems, had spent two tortured months at the privately run, state-regulated Reaching Out Personal Care Home in Palmyra, Pa.
Savagely kicked and manhandled at the home, overdosed with psychotropic drugs, Sees, then 56, arrived at a local veterans hospital in February 2005 with fractured ribs, a broken arm, and bruises over 60 percent of his body.
It wasn't just the physical abuse that made life at Reaching Out miserable for the 20 or so residents, a criminal investigation later found. The couple who ran the facility, Tina and Clifford Fake, kept Sees and other residents isolated from their families. They forced them to do unpaid menial labor. They fed them spoiled food retrieved from Dumpsters, stole their money, and beat them when they complained.
Two residents died after failing to get emergency medical attention.
But all of that, even the deaths, failed to generate action by the state Department of Public Welfare, whose job is to protect residents of personal-care homes.
Not that officials hadn't been warned. Four times in 2003 and 2004, state records show, state regulators looked into detailed complaints about the Reaching Out home and rejected them as unfounded when, in fact, they were largely accurate.
The case is a stark example of what an Inquirer investigation has found to be a years-long record of failure in Pennsylvania's program of monitoring residential facilities known as personal-care homes.
State regulators missed the beatings, the neglect, the psychological abuse.
Even the wreckage of Sees' broken body didn't register: A state bureaucrat accepted Tina Fake's assurances that Sees had somehow harmed himself. He marked the case "no action," state records show.
In an interview, Karen Kroh, who took over as the state's top regulator of personal-care homes after the case came to light, said the department would do things much differently today.
At the time, she said, many investigations were haphazard: "A short visit to the home, in and out, interview people at the home, and we were done.
"Now we would interview all the staff and all the residents, separate from the home if need be. . . . I just told one of my staff I don't care if they have to fly to Hawaii to interview a doctor, if that is what's required."
Luckily for other victims - including a wheelchair-bound woman locked in a basement - the U.S. Department of Veterans Affairs reported Sees' injuries to Michael A. Dipalo, a Lebanon County detective.
After Dipalo and his federal counterparts gathered a mountain of evidence, the Fakes pleaded guilty to state and federal crimes involving the beating of Sees, the deaths of three elderly people, and myriad other felonies.
"You just couldn't make these things up if you were writing a script for a horror movie," Lebanon County District Attorney David J. Arnold Jr. said at a recent hearing.
Founded in deception
The Fakes' operation was founded in deception.
Tina Fake, now 43, was a high school dropout with a history of what authorities say is exploitative relationships with older people.
According to Dipalo's sworn statements, before Fake opened the Reaching Out home, she befriended an 88-year-old man named Clarence D. Shucker.
In April 2000, Shucker moved into the Fakes' home and named Tina Fake his sole heir.
One night, Shucker fell in the garage and broke his hip. Tina Fake left him in bed for 10 days, manipulating his legs in a torturous attempt at physical therapy.
Fake's daughter-in-law told authorities that Shucker had "moaned like an animal wanting to be put out of his misery."
When Fake finally took him to the hospital, he had bruises on his arms and pressure sores on his back and buttocks. He told doctors that he was in agonizing pain. He died three weeks after surgery.
In 2002, when Fake applied for a license to open Reaching Out in a suburban three-story house near Hershey, state regulators did not know about Shucker.
On paper, the home listed other administrators - not Tina Fake. Initially, she did not have the high school diploma required by the state, although she later earned a GED. But even the welfare department, state records make clear, knew she ran the place.
Her husband controlled the finances and was a near-daily presence in the home, investigators later found. But Clifford Fake's name was not on any document shared with state regulators - with good reason.
He had served four years in jail after being convicted in 1986 of aggravated assault and attempted murder. It's against state rules for violent felons to work in a personal-care home.
Tina Fake quickly became a favorite among some local social-services agencies because she accepted residents with mental-health issues who were difficult to place.
The Fakes exploited their residents from the beginning, Dipalo found.
In violation of assisted-living regulations and federal labor law, they made residents work without pay - cleaning toilets, changing adult diapers, mopping floors and walking dogs.
Each Tuesday, the Fakes ordered boarders to gather in an unheated garage and stuff newspapers and advertising circulars - 4,300 in all - into plastic bags. Clifford Fake was paid $1,500 a month to deliver them.
"She had the guests cleaning all the time," said Lucinda Dietz, a Navy veteran with a mental disability who lived at the home from June 2003 to February 2004. "I had the job of keeping the door windows clean. She made it seem like, 'Well, that's the least you can do.' "
When residents balked, Tina Fake threatened them, Dietz, 59, said.
"She used to tell people, 'We'll send you to a nursing home, and you know what they do to people in nursing homes. You'll be dead within a week.' "
When one elderly man refused to participate, one resident told authorities, Tina Fake punched him in the head.
The Fakes bought date-expired and spoiled food from an outlet in Harrisburg, Dipalo found. In addition, "bread and dessert items were routinely gathered from a local grocery store Dumpster," the detective reported.
Residents told him that they suffered nausea, stomach cramping and diarrhea.
State regulators missed several chances to uncover the abuse.
The first came in a complaint dated Aug. 6, 2002, three months after Reaching Out got its license. It concerned Arlene Klingler, placed in the home by the county mental-health agency.
In a letter to the welfare department, her daughter-in-law, Beth Klingler, wrote of finding Arlene, then 74, in a decrepit house on a weedy lot with a swimming pool half full of dirty water.
In the kitchen, she and her husband, Robert, found food and pill boxes on the counter and bugs crawling on the floor.
"I remember seeing holes in the doors and not much lighting. . . . I saw no one there that appeared or identified themselves as a caregiver," she wrote. "Bob was appalled by the fact that his mother was in this place."
Tina Fake phoned later and "was quite upset and hollering" because they had shown up unannounced, Beth Klingler wrote to regulators. Fake later sent a letter to the Lebanon County Area Agency on Aging accusing the Klinglers of being abusive.
The Klinglers' complaint led Rebecca F. Miller, a supervisor at the county mental-health agency, to stop placing clients with the Fakes. She also filed complaints with the welfare department and the county agency on aging.
At the welfare department, caseworker Kathryn Wilson-Rulli investigated the complaint by speaking to Tina Fake and the Klinglers on the phone. She didn't visit the home. Her report did not mention the concerns raised by the mental-health supervisor, and painted the matter as a dispute between Fake and an "abusive family."
"The complaint could not be substantiated," wrote Wilson-Rulli, who declined an Inquirer request for an interview.
A month later, Wilson-Rulli performed an annual inspection and found no deficiencies, granting a 12-month license.
A death and a cover-up
Dietz will never forget Tina Fake's bone-chilling shriek.
It was December 2003, and Fake was yelling at Stanley Bruzda, 74.
"You get your s- ass out of that bed now!" Dietz recalled Fake screaming.
"Tina, I can't move," he responded.
The night before, Bruzda had fallen down the stairs in a thunderous crash, Dietz told The Inquirer.
Instead of taking him to the hospital, Fake put him to bed. He woke up covered in his own feces.
"Fake was screaming at Bruzda to get up and get in the shower," Dipalo wrote.
Bruzda said he was having trouble breathing. An employee, Patricia Remlinger - who was charged as an accomplice but is cooperating with authorities - urged Fake to get the man to a hospital, noting that he may have a dislocated knee. Fake screamed back that he needed to be cleaned up first. "They aren't going to come back on me for neglect!" Remlinger quoted her as saying.
Clifford Fake moved Bruzda to the shower, where he collapsed and died.
Later that day, the home sent a mandatory "unusual incident report" to the welfare department, saying Bruzda had died of a heart attack - but leaving out the fall.
According to Dipalo, Fake also told Remlinger, if asked, to say Bruzda had a heart attack and fell down the stairs.
Three months later, another resident, Kathryn Fritz, died - again, in unnecessary agony.
When authorities exhumed her body under court order, they determined that she had died of diverticulitis, a painful bowel condition that develops over time.
Tina Fake had told paramedics that Fritz, 79, suffered a sudden stomach pain.
Lucinda Dietz told authorities - and The Inquirer - that Fritz had been complaining for months about digestive problems. She had requested prune juice, bran cereal and laxatives. Tina Fake had refused.
"She would say, 'If I give you special cereal, I'll have to give everybody else special cereal,' " Dietz recalled.
A week before her death, Fritz complained to Fake of constipation and stomach pain, another witness told the detective. "It's all in her mind," Fake was quoted as saying.
On Feb. 8, 2004, Fake finally sent Fritz to the hospital after two employees said Fritz "was very pale and her pulse was low." She died the next day.
The home faxed an incident report to the welfare department saying Fritz had resisted going to the hospital.
In April 2004, the welfare department got another warning about Reaching Out - this time an anonymous call describing in detail the Bruzda and Fritz deaths.
The caller also said Tina Fake had for four days denied medical attention for Dietz, who broke an ankle in February.
Wilson-Rulli visited the home April 9 to investigate. She reviewed the home's records and interviewed Tina Fake, her staff and residents.
Residents say they were afraid to tell the truth.
Whenever an outsider would speak to them, "Tina would sit right there in the room with us," said John Bauer, 52.
Wilson-Rulli's report indicates no attempt to find Dietz, who had left the home, or contact the hospitals where Bruzda and Fritz had died.
She and supervisor Alan Owens accepted Tina Fake's assertions, finding no violations.
"All the residents said that they have always been treated with dignity and respect," her report says.
Owens did not respond to several phone calls and a written request for comment.
Five months later, a Veterans Affairs social worker, Christopher Leahy, sent the state a five-page complaint detailing mistreatment of one of his clients, another disabled veteran.
Leahy, a registered nurse, touched on some of the abuses that would result in criminal prosecution, including forced labor, financial improprieties and neglect.
Accompanying that complaint, a VA psychiatrist sent the state her own memo telling of a "highly disturbing" discussion about that veteran with Tina Fake.
"I began to question her mental and emotional stability," wrote the psychiatrist, C.E. Zupanick, saying Fake "expressed intense contempt and dislike of this patient."
This time, Owens went to the home himself.
After interviewing Tina Fake and residents, he found each allegation unsubstantiated. Nobody complained of ill treatment, his report said. Residents called the newspaper-stuffing voluntary.
He never spoke to the veteran Leahy had written about; he was unavailable, the report said, concluding: "There appears to have been unmet expectations on both sides."
A detective's discovery
The Fakes might still be running the Reaching Out home if VA officials had not called police in February 2005 about Sees, the badly beaten Vietnam veteran.
When Sees said he had hurt himself, doctors didn't believe him.
"I don't want to get anybody in trouble," Sees said when Detective Dipalo spoke to him.
By tracking down victims the state had never interviewed, Dipalo quickly learned the truth that had eluded regulators for years.
A month after he began his investigation, Dipalo served a search warrant on another home owned by the Fakes - one small enough that it was exempt from welfare department regulation. He walked in and found 43-year-old Paul A. McGovern slumped in a recliner, clad only in urine-soaked diapers and a T-shirt. McGovern seemed to be having seizures.
He discovered Janet Weaber, 64, in a wheelchair in the basement. She had been partially paralyzed by a stroke.
Weaber, who had been living in the basement for years, had been barred from seeing relatives. Her phone, which she was paying for, had been removed.
McGovern and Weaber were alone in the house.
Dipalo would find that the beneficiaries on Weaber's pension had been changed to Clifford Fake and the Fakes' two children.
"I was thinking, how could this have gone on this long?" Dipalo said.
In April 2005, after Dipalo told them that he was launching a criminal investigation, welfare officials moved to close Reaching Out.
The residents have been relocated, some to other personal-care homes, some to private residences. Most are doing well, Dipalo said.
After the debacle, the state Office of Inspector General investigated what had gone wrong and prepared a report critical of the welfare department, according to a government official who has read it.
Gov. Rendell refused The Inquirer's request for that report. In a statement, spokeswoman Kate Philips said those reports were kept secret to ensure that state workers were being open with investigators.
"Would you say your boss was a crook if he could see your name in the newspaper after the investigation into his crookedness was reported?"
In August, Clifford Fake was sentenced to 22 to 58 years after pleading guilty to a slew of felonies, including criminal neglect in the deaths of Shucker, Bruzda and Fritz.
As Fake stood meekly in an orange prison jumpsuit, District Attorney Arnold said: "In our opinion, Judge, Mr. Fake should not be eligible for parole until he's at the point where he needs a personal-care or nursing home - and he should pray that he is not treated the way he treated these victims."
On Feb. 15, Tina Fake received 15 to 25 years in prison. It took Lebanon County Judge John C. Tylwalk nearly 20 minutes to run through the charges: assault, neglect of care-dependent persons, recklessly endangering other persons, theft, forgery, false imprisonment, and unlawful restraint.
At her sentencing, she addressed victims and their families: "If my sentence today eases your pain and suffering, then justice has been served."
Legal experts say they believe the sentences are some of the stiffest penalties for dependent-care abuse in Pennsylvania history.
"You would have been more merciful to some of these people," Tylwalk told Tina Fake, "if you had just taken a gun and shot them."