The recent death of a 10-year-old disabled foster child at an Anne Arundel County group home was just the latest in a series of problems at LifeLine, the state contractor that has been paid millions in taxpayer funds to care for "medically fragile" individuals, a two-month investigation by The Baltimore Sun has found.
Even before Damaud Martin's death on July 2, LifeLine had struggled for years to provide around-the-clock care for its residents — adults and foster children often confined to a bed or wheelchair by paralysis, cerebral palsy and other disabilities. Its founder, Randall Martin Jr., is imprisoned for felony arson, the state disciplined the company for inadequate care after the death of three adult residents, and it is burdened by tax liens and other debts.
Maryland regulators were unaware of many of LifeLine's problems, including police reports alleging neglect, The Sun's investigation showed — raising concerns about state oversight of these group homes. The state has awarded LifeLine $18 million in contracts since 2010 to care for children, despite reports that warned of financial difficulties and inspections that highlighted shortcomings in care.
And it wasn't until July 3 — a day after Damaud died and weeks after the company was warned it would lose its license — that the state finished moving the last children from LifeLine's care.
Connie West, who has adopted two children living at LifeLine, said it defies common sense that two state regulatory agencies would continue to support the company despite all of its problems.
"The right hand doesn't know what the left hand is doing," said West, whose family now includes a former LifeLine resident named Ray. "It doesn't make any sense to me. The state is just so overburdened by these children that any place that says they'll take them, the state says, 'Great.'"
LifeLine, whose Laurel-area apartments had the capacity for about a dozen children, continued to operate despite these troubles:
In 2010, then-CEO Randall Martin Jr. was charged with setting fire to his former mistress' West Baltimore rowhouse while she and her young son slept inside. The Baltimore County businessman was convicted of arson and other charges and is now serving the second year of a 50-year sentence.
State officials suspended LifeLine's adult-care license in 2011 — and ultimately revoked it — after investigations at the company's other group home, in Owings Mills, found "a pattern of inadequate care of residents resulting in an imminent risk of harm to the health, safety and welfare of the medically frail individuals receiving services." The findings noted deficient care for three residents who had died.
In 2012, LifeLine filed for a reorganization under bankruptcy laws but did not notify state officials. A state audit the following year found the company "fiscally insolvent," yet in June 2013 the state invited the company to bid on a new contract for the care of foster children. That same month, the IRS hit LifeLine with a $1.2 million tax lien that state officials were unaware of.
LifeLine's apartments in the Russett Green area of Laurel were visited a dozen times in 2013 and 2014 by Anne Arundel County police and fire units for reports of abuse and injuries. State officials were not notified of those incidents by LifeLine — despite regulations requiring it to do so.
"This is unnerving," said Nancy Pineles, managing attorney for the Maryland Disability Law Center, a nonprofit that advocates for the disabled. "This convergence of events is very unusual: A serious felony [by Martin] where human life was in danger, the kind of danger that you wouldn't want this person working with children with disabilities. And the financial problems of the agency are very unusual."
In May, the court-appointed health care guardian for a 19-year-old LifeLine resident filed a complaint about the teen's infected bed sore because he had to be rushed to Laurel Regional Hospital. He was transferred to Johns Hopkins Hospital for three procedures over three weeks, said Maribeth Donohue, the guardian.
Her complaint triggered a state review that found LifeLine had not properly treated the wound and that staffing was inadequate for him and others. A separate review in February had found other problems: LifeLine had failed to properly administer medications and food, and a quadriplegic was left in her urine and feces.
Health regulators told LifeLine — which received nearly $11,000 per month for each child's care — early last month that it was not providing a safe environment for residents and that the state planned to revoke its license. LifeLine's chief executive, Theresa Martin, who is married to Randall Martin's brother, responded in a June 5 letter that she was closing the company's program.
In the letter, she said state payments did not cover the costs of care. "With the many challenges we have faced over the past few years, some far greater than we ever anticipated, LifeLine has persevered. The care provided the children cannot be simply dollars and cents, yet without adequate funding it is impossible to provide the quality level of service they deserve."
She and other company officials declined repeated requests for further comment. Randall Martin, imprisoned at Roxbury Correctional Institution in Hagerstown, did not respond to a written request for an interview.
State regulators from the Department of Health and Mental Hygiene and the Department of Human Resources defend their oversight of LifeLine, one of four companies hired by the state to provide 62 beds for foster children with "medically fragile" conditions.
Maryland Health Secretary Dr. Joshua M. Sharfstein said inspections did not reveal problems with the care of children until this year. But he acknowledged that LifeLine had not notified the state of the police and fire reports alleging abuse and injuries, or of its bankruptcy filing.
He said his agency would take steps to prevent that from happening again. All of the state's providers will be formally reminded to report incidents that involve emergency personnel, he said.
"It is very important for us to learn from situations like this anytime we wind up concluding there are problems with patient care, is there anything we could have seen earlier," he said, adding that The Sun's investigation provided information state regulators were unaware of. "Is there something that we could have done to move faster to understand the problem better?"
The nurse on duty when Damaud died said there were not enough staffers to handle the care specified for its severely disabled residents — an issue noted by state inspectors on several other occasions. Mary Zelio, who was watching over three children that night, said each of their care plans called for one-on-one nursing, but she was the only nurse assigned to the apartment.
Staffing levels will be examined as part of state investigations into the death, officials say, cautioning that it is too early to draw conclusions. An autopsy might show that the death was the long-term result of abuse Damaud suffered at the hands of his mother years ago, authorities said last week.
LifeLine's success at maintaining state contracts despite long-standing problems has perplexed advocates such as Donohue and Pineles. They say effective monitoring of group home operators has long been a problem that state officials have blamed on having too few inspectors. Still, they were shocked that LifeLine's home for youths escaped serious sanctions until after The Sun began sharing its findings with advocates and regulators.
Pineles asked, "How close to their providers are [state regulators], and do they know what's going on?"
A case of arson
The fuse that led to LifeLine's eventual implosion was lit in the pre-dawn hours of June 29, 2010.
Around 3 a.m., Randall Martin left his Windsor Mill community of modest single-family homes while his wife of three decades was still sleeping. He drove a short distance, just down Liberty Road, to one of the squat, two-story brick rowhomes in the 4300 block of Norfolk Ave. in West Baltimore. There, he had set up his longtime mistress, Kimberly Backhaus, and her 5-year-old son.
He sneaked across the tiny yard, poured gasoline on the front porch and set it afire. With a red gas can in hand, Martin darted off into the shadows illuminated by rising flames, unaware that someone was watching.
"I see you!" screamed a neighbor from an upstairs window in the home next door.
The woman, who was awake to pack for a weeklong camping trip, recognized Martin from his frequent visits to his girlfriend's house. The woman called 911 to report whom she had seen as the flames and smoke spread. She and her family fled their house but lost their cat to the smoke, and other neighbors scrambled to fight the fire with garden hoses. Backhaus and her son escaped safely from their house.
Police soon arrived at Martin's home on Bellmore Road, and after a short standoff, he surrendered.
As the proceedings shifted to a Baltimore court, Martin continued working at LifeLine while on bail. A court order restricting him to home detention said he "will be allowed to go to work with LifeLine Inc. at 8 a.m. and must return to his residence by 6 p.m., Monday through Sunday."
At the five-day trial, prosecutors outlined a years-long affair between Martin and Backhaus, one that began while he was running LifeLine and serving on the board of the Prisoners Aid Society of Maryland, a now-defunct nonprofit. He picked up the once-homeless woman and offered to get her a job filing paperwork at LifeLine. Prosecutors alleged that Martin had placed Backhaus and her son in apartments owned by the charity, moving her frequently over a number of years to avoid suspicion.
But the relationship soured when Backhaus grew tired of Martin's physical abuse, according to her testimony. She broke up with him, but he stalked her, cruising by her house in various luxury cars — a Lincoln Navigator, Cadillac Escalade or Lexus, a neighbor testified.
Prosecutors said Martin set the fire to protect his reputation. "This was a crime of a man who thought he could wash away with gasoline and incinerate with fire a woman who had become a nuisance, a woman who had become a source of humiliation for this proud pillar of his community," said Assistant State's Attorney Thiru Vignarajah.
Martin's lawyers acknowledged his relationship with Backhaus, while adding that he was "not being charged with having an adulterous affair." They said he did not set the fire but never presented an alibi. (In a post-trial petition, Martin said he was asleep with his wife when the fire took place. His wife, Arnetta Martin, did not testify at the trial.)
The jury's verdict: guilty of first-degree arson and seven counts of reckless endangerment, innocent of attempted first-degree murder.
At his February 2013 sentencing, the 58-year-old Martin stood in a white prison jumpsuit and asked for mercy for his "mistake," without admitting to the arson. "Your honor, I'm not a bad person. Just someone who used poor judgment," he told Circuit Judge Sylvester Cox.
He added, "I'm sorry, truly sorry, for what took place that night on June 29. Allow me to go home. I have a wife who needs a husband. I have children who need their dad."
Instead, Cox sided with prosecutors and imposed the 50-year maximum sentence. The judge reminded Martin that an eyewitness had spotted him fleeing with the gas can from the home of a lover he had kept secret for years.
"Mr. Martin was living the American dream by all outward appearances: family, house, cars, power, success and, outwardly, a community leader," Cox said. "It's more than just a mistake. Those things which were done in darkness have come to light."
Between 2002 and 2008, the Department of Human Resources, which oversees foster care, awarded LifeLine contracts worth $6.7 million, according to state records. Problems emerged in 2009 during a routine survey by health regulators.
Inspectors found "numerous serious deficiencies" during visits between December 2009 and February 2010 at LifeLine's apartments for adults. According to a report from the state health department, which handles inspections, LifeLine was not properly accounting for money residents received from the government for personal use, its apartments were not adequately staffed, nurses lacked proper training, and emergency procedures were not in place if residents needed to be moved or generators were required to power vital equipment.
The deaths of two adult residents at Lifeline's Owings Mills home triggered mandatory investigations that revealed "significant deficiencies that jeopardize the health and safety of all individuals served by LifeLine," according to a health department notice about the license suspension.
In late June 2010, a blind, paraplegic resident was suffering from "two open wounds" on his buttocks, the investigative report said. Officials found no documents to show that LifeLine staff had repositioned him every two hours as required by a care plan or that staff had notified his doctor about the wounds. And though the man had no bowel movement for four days — even after an enema and a suppository were given — he had not received the stimulant laxative called for in his plan.
The man was hospitalized on June 27, 2010, with multiple problems including "bowel obstruction, sepsis, acute renal failure and acute respiratory failure," the report stated. He died the next day, just 15 hours before Randall Martin's arrest.
Another male resident — who was supposed to be repositioned in his bed or wheelchair every two hours — died Aug. 7, 2010, after being hospitalized with "acute respiratory failure, aspiration pneumonia, sepsis," an investigative report stated.
Regulators found that the man's prescribed seven-day regime of an antibiotic to fight pneumonia was started four days late. "The inability to administer medications because they were not available is a repeat deficiency" discovered in the 2009-2010 review of the facility, the investigative report stated.
In both cases, LifeLine staff had not followed doctors' orders for the residents, had not properly administered medications, kept shoddy documentation of their care, and failed to address their need for "advanced medical attention," the reports found.
Seven months after the August 2010 death — and a month after a third death in February 2011 in which deficiencies in care were found — the state took action.
A March 4, 2011, email to health secretary Sharfstein from his then-chief of staff, Wendy Kronmiller, stated that while investigators had not "causally linked poor care to the deaths, there are patterns of slow follow up by [the licensed practical nurse] staff when persons show signs of a change in condition. ... In sum, we believe the medically frail consumers are at risk."
Kronmiller added that disabled children at LifeLine's Laurel-area apartments were not in danger. "The children's program has been surveyed and found satisfactory. Nonetheless, the children's program will continue to be monitored, and requested expansion of the children's program [is] not approved at this time."
On March 18, 2011, the state suspended LifeLine's adult care license, the first step toward revocation. The agency's order cited "repeat regulatory deficiencies that establish a pattern of inadequate care of residents resulting in an imminent risk of harm to the health, safety and welfare of the medically frail individuals receiving services."
Five days after the suspension order, the Department of Human Resources awarded a $15 million contract to LifeLine's children's program.
The state revoked the adult-care license on May 21, 2012, state records indicate. The following month, the state reduced the contract to $10.4 million, decreasing the number of beds for children from 59 to 12.
"I understand the concerns about the adult side closing and the child side staying open," said Ted Dallas, secretary of the Department of Human Resources. "The experts made a judgment that the kids were still safe there."
As LifeLine's troubles with regulators were mounting, Martin turned to prominent lobbyist Bruce Bereano, who said he was hired to help address the problems so Martin could continue caring for children.
Bereano, who was paid nearly $70,000 by LifeLine from 2010 to 2012, recalled that Martin was concerned Maryland officials were looking for reasons to strip him of his business because of the arson arrest. "Somehow the state officials learned of the criminal proceedings, and that created a cloud over everything," the lobbyist said.
When regulators summoned Martin for meetings to discuss problems at his facilities, Bereano said he accompanied him. "Not to be a bull in a china shop," the lobbyist said. "We'd meet and discuss it and flesh it all out, work toward a remediation plan" for issues that regulators had found.
LifeLine managed to keep its work with disabled children, but that didn't end Martin's troubles. As Bereano said, "Things were coming apart all around him."
West, the Millersville woman who adopted two LifeLine children, has worked with many foster children from group homes as a member of the nonprofit organization Mentor Maryland. As a special-education teacher's assistant in Anne Arundel County, she dealt with a number of children who lived at LifeLine and said they often arrived in ill-fitting clothes and without any of the government money allocated to residents for personal use — an issue that state regulators cited LifeLine for in the past.
"They are raking in money," West said. "Where's it going?"
She adopted Raykwan, whom she met eight years ago at the school. The boy had cerebral palsy but could stand with a walker, she recalled, providing photos to support her memory.
She said the boy and other LifeLine residents did not receive adequate attention because of staffing shortages, an issue noted by state inspectors.
Today, 16-year-old "Ray-Ray," as he's now called, spends all day and night on his back in a hospital bed in his bedroom. His body juts sharply to the left at the hip, just below the spot where a feeding tube funnels nutrients through an incision in his stomach. A ventilator heaves mechanized breaths into his lungs through the tracheostomy tube connected to his throat.
West changed his name to Ray Lewis West — a nod to the former Ravens star — "because he needed a strong name to get through this," she said.
Lewis visited the teen last summer after West wrote a letter about his condition, and "Ray-Ray's" room is decorated like any other young fan's, with posters, rugs and blankets adorned with the team's purple logo. His prized possession is an autographed "Determination" poster of Lewis lifting weights; the autograph includes a note that says, "You are my hero."
West and her husband, David, a mail carrier, have been won over by a big, beaming smile that belies Ray's condition.
When she leans down to Ray's ear to sing the alphabet, his somber face erupts with glee.
To communicate, he blinks once.
"Do you want to watch Barney?" West asked recently, offering to change the channel on the flat-panel TV donated by the Make-A-Wish organization.
"Do you want to watch music?"
Caring for a child with such severe disabilities and medical needs could be daunting, but West does it with ease and confidence. She instinctively reaches over with a rag to wipe Ray's mouth when drool gathers, changes his tracheostomy tube when it gurgles with saliva, and changes his colostomy bag. She's had practice.
West and her husband adopted a 3-year-old blind, deaf boy with cerebral palsy a decade ago from LifeLine; she also adopted two brothers who suffer from developmental disabilities. One of her sons was born with disabilities and her two other biological sons are in their early 20s and in good health.
The Wests' rancher is filled with portraits of all seven of their sons. In the front yard, a heart-shaped white stone sits in a flower bed next to a trickling fountain and a small, kneeling ceramic angel. The stone is inscribed with dates of the short life of yet another disabled infant adopted shortly after her birth on July 21, 2012. She died on Christmas that year. "Mommy's love goes with you," the stone reads.
What group homes such as LifeLine lack, West said, is the personal touch of someone who cares. "People just love to be touched. Anyone who touches him in a group home is wearing gloves."
LifeLine — which is required to remain solvent under its state contract — has had financial troubles for years, court records show.
In 2012, the company filed in bankruptcy court to restructure its debt, listing Randall Martin as "owner and sole shareholder." The company's 20 largest creditors — including American Express Travel, the state workers' compensation fund and the U.S. Department of Labor — claimed they were owed $601,000, records show. At the time, the state was paying LifeLine about $130,000 per month to care for 13 children — nearly $1.6 million for a full year, state records show.
The judge overseeing the case dismissed it on May 28, 2013 — a few months after Martin had gone to prison — because there had been no progress on devising a plan to repay the debt.
The judge expressed concern about his decision. In a footnote to his order, he wrote: "Seldom has the court encountered a more troubling situation than that presented in the case of this Debtor. It renders services to persons under 21 who cannot live independently. The care of these unfortunate individuals is a paramount consideration. It is certainly in their best interest to keep the Debtor in Chapter 11."
A month later, the Internal Revenue Service filed its $1.2 million tax lien against LifeLine.
Maryland regulators said LifeLine was obligated by its contract to alert them to the bankruptcy filing within 24 hours. It did not, they said. When they learned of the bankruptcy in October 2012, they were assured by the company that its operations were "solvent" and that there would be no change in staffing or quality of care, according to the health department and the Department of Human Resources. The human resources agency ordered an audit by its inspector general and inspectors increased their visits, finding that LifeLine was meeting residents' needs.
The audit, completed in March 2013, found that the company was "financially insolvent."
"Due to LifeLine's financial condition, there is considerable concern that LifeLine will be able to continue as a going-concern and provide services to children without securing additional funding," the audit states. Martin "received $329,246 from LifeLine in salary and loan repayment during fiscal year 2012," the audit states, though company officials had told the state he "ceased being an officer" of the company in 2011. Bankruptcy records show payments to Martin as late as December 2012, his first full month in prison.
After the audit, LifeLine was placed on the state's "Hot List," which meant it could not take on new clients until it corrected its problems.
But state officials continued to work with LifeLine. In June 2013, the state invited LifeLine and three other existing contractors to bid on a new contract to care for medically fragile children. At the time, state officials were unaware of the IRS tax lien, and the company was not removed from the Hot List until July.
Two months later, satisfied with LifeLine's financial fixes, the Department of Human Resources awarded it a contract worth $4.9 million, which was among several contracts the company had won since 2010. And in December, the health department relicensed the company so that it could take on the new work.
While state officials say their inspectors were not finding any problems with the care of residents, advocates were growing increasingly concerned that the Laurel apartments were not being staffed properly.
The Sun reviewed calls for Anne Arundel County police and fire service in 2013 and 2014 and found 10 reports of abuse allegations and injuries at the apartments. State officials were aware of just one report.
The calls cover a wide range of complaints. On Dec. 22, 2013, for example, the mother of a 20-year-old quadriplegic resident told police that a LifeLine employee had slapped the girl, yanked her arm and banged her head against a bed rail. Among other incidents: A 20-year-old female resident was taken to Laurel Regional Hospital after cutting her wrist with a razor blade, and a 15-year-old resident with cerebral palsy was transported to Hopkins Hospital after taking Oxycodone and suffering heart palpitations and breathing problems.
Financial problems quickly resurfaced.
When Maryland relicensed LifeLine on Dec. 6, 2013, for two years, the company's application listed its address as 525 Main St. in Laurel. But a recent visit to that location revealed an empty office with a "for sale" sign in the window.
Dorothy Heyman, the real estate agent who handles the building, said LifeLine stopped paying rent in January and left the office without warning in April.
The June 5 letter from LifeLine CEO Theresa Martin to state officials said state funds were not adequate to cover costs. "Simply stated, the monthly cost per child, as assessed by our annual financial audit, is $12,617 and the current contract monthly rate is $10,773, a deficit of -$1,844.00 per child which equates to -$20,284 per month," the letter said.
LifeLine's decision to stop caring for disabled children upset Ruth Quispe, whose disabled daughter lived at the Laurel-area apartments from 2009 to 2010 without issues. "I'm so sad to hear LifeLine is no longer going to exist."
But Quispe was surprised to learn that documents LifeLine submitted to the state in December listed her as the company's board secretary. "I never worked for them," the Hyattsville resident said.
Health officials had been monitoring children in the Laurel-area apartments every week since determining in late May that LifeLine had not employed sufficient staff to address the "health and safety needs of each child," according to an inspection report dated June 20. A previous inspection in February identified other problems with feeding residents, changing their diapers and administering their medications.
The June report also found that the company had failed to keep another resident "free from abuse, neglect and mistreatment" because it was "unable to manage" the resident's bed sore. Donohue, the health care guardian, said the resident was a 19-year-old foster child she has known for over a decade.
The teen whose bed sore led to the three-week hospitalization, never returned to LifeLine after being discharged, as regulators sought new homes for the remaining residents.
Still, Donohue said she knew she had to get him away from LifeLine when he mustered two words she had never heard him say before: "When leave?"