The Recruit

In a closet in his dorm room at Richmond State School, Trevor Falk keeps his one nice suit.

The 24-year-old with Down syndrome wears it on Sundays when he attends church services, and he usually makes the five-minute walk to the school's chapel with the two roommates he calls friends.

During weekdays, Trevor is often alone, free to walk the 240-acre campus delivering mail to other residents. He also works in the administration building answering phones, and with paychecks from the two jobs, he's saved a little more than $1,500, according to his mother, Linda Falk.

It's a big leap for Trevor, who was sometimes restrained with a straitjacket when he first came to the school two and a half years ago.

One afternoon in May, Trevor left his dorm room planning to pick up mail for other residents, but saw his mother outside. She was visiting that day, but Trevor hadn't known when she was coming. The two saw each other and embraced.

"What do you want to do today Trev?" Linda Falk asked.

Without missing a beat, he said, "Go to a group home."

Trevor's answer surprised his mother, but then again, maybe it shouldn't have. Several times a year, a horde of representatives from the hundreds of privately owned group homes in Harris and Fort Bend counties visit the state school to promote their private facilities. Patients at Richmond often wear T-shirts and carry tote bags displaying names of group homes, picked up with other free swag at the promo fairs.

The effort pays off. The population of disabled residents in group homes in Texas has grown to about 14,000, and the industry generates about $896 million in revenue from state funds alone, according to the state's figures from 2008.

Private providers are paid about $4,700 per month per client, so for a place like Four J's Community Living Centers, which serves about 80 clients near Sharpstown Mall, that's $366,600 per month. Most providers also own residential homes, and to pay for room and board, clients sign over their Social Security checks.

As the private system has grown, the knock against Richmond and the state's other 12 mental facilities has become easier to make.

In 2005, the United States Department of Justice visited Lubbock State School and during the 18 months that followed, even with federal investigators in and out of the school, 17 patients died while employees attempted to cover up some of the deaths.

A couple of years later, the Justice Department investigated Denton State School, involved in its own scandal after Kevin Miller, a state school employee, admitted to almost beating to death a mentally retarded man. Later, Miller told investigators about rampant neglect and drug use by the school's staff.

And in March of this year, a cell phone was found at the Corpus Christi state school containing video of disabled residents in fights — nationally publicized as "fight club" fights — apparently set up by school employees. In the worst cases, the employees kicked and slapped already-injured patients.

More abuse at Corpus Christi has come out since the videos were released. According to The Dallas Morning News, school records show a worker falling asleep while driving patients, causing the van to roll over; an employee whipping a patient in the face with a belt; a staff member restraining a patient by flipping over his wheelchair; and an employee using a walking cane to beat a patient.

In May, a 15-year-old girl hung herself with her shoelaces at San Angelo State School, and according to an article in the San Antonio Express-News, the girl's mother had previously received more than a dozen letters in one year from the Department of Aging and Disability Services about complaints her daughter made alleging abuse from the school's staff. Only one case of neglect was confirmed and an employee was fired.

Richmond State School has not been without incidents itself.

State documents show at least one confirmed case of neglect during 2008. It happened after a staff member was watching TV instead of his patient, who fell down getting out of bed. Despite finding him with blood running from his nose, the employee did nothing. A checkup the following morning revealed the patient had fractured his face in three places.

Almost all other reports were marked "unsubstantiated," ranging from allegations that employees dispensed the wrong medications, to urine and fecal matter on furniture, to clients having sex in front of buildings.

Those complaints, according to investigators, didn't warrant citations.

A Justice Department report released in December 2008 cited 36 deficiencies at Richmond, including "failure to ensure clients' rights were protected, including the right to be free from abuse, neglect and mistreatment" and "failure to show that all allegations of abuse, neglect, or mistreatment were thoroughly investigated."

There were cases of neglect at every state school in Texas, according to the report, and before the state legislature kicked off its session this spring, Governor Rick Perry declared protection of state school residents a "legislative emergency."

At the same time, equal attention wasn't being paid to the private community-based homes in Texas. And actually these homes operate under far less stringent state regulations than state institutions do.