On the afternoon of Dec. 3, workers at the Oceanview Manor Home for Adults found resident Ann McGrory, 58, lying on the floor, lifeless, with her pants down around her ankles. She had cuts and bruises on her hands, head and face. By her side, seated atop his bed in Room 512, was resident Frank Thompson, 64, her sometimes-boyfriend who had a reputation at the home as a heavy drinker with a short temper. The aides called police. Thompson was brought into custody for questioning later that day and placed under arrest on Wednesday.

He is charged with second-degree attempted murder rather than murder because the medical examiner has not yet determined the cause of death to be a homicide, according to a law enforcement source. McGrory also had serious preexisting medical issues, including brain cancer. The criminal complaint, however, lays out evidence that McGrory was severely beaten. She was found with a bruised, swollen eye, blood on the back of her head, broken fingernails and what appeared to be blood beneath them. Thompson has not yet entered a plea. Brooklyn Defender Services, which is representing him, declined to comment because the case is in such an early phase.

The incident is the latest in a decades-long string of controversy at Oceanview Manor and other adult homes throughout New York City, which are occupied primarily by impoverished adults with mental illness but are gradually taking on seniors in need of assisted living.

In the spring of 2017, a ProPublica reporter spent parts of several weeks at Oceanview, where ill and unkempt residents could be seen eating from garbage cans and using outdoor dumpsters as toilets. They complained among themselves of thievery and predation, as well as failed intervention from state regulators. There were two deaths in a matter of weeks and police responded to several emergency calls there, including one related to a resident who had slashed another. At the time, an attorney for the home denied any stabbing, attributed the deaths to natural causes and said that comparing the current state of the homes to their scandalous history was unfair.

In 2002, a New York Times investigation found that adult home residents had been exploited for profit and received subpar health care. Disability rights advocates sued the state, arguing that mentally ill people had been warehoused in Oceanview and other adult homes in New York City, violating their rights under the Americans with Disabilities Act. After more than a decade of litigation, a federal judge ordered the state to assess and move out residents capable of living independently.

In 2017, lawyers representing the adult home industry sued the state on behalf of a single former resident at Oceanview, who allegedly decided to move into his own apartment under the new state program and then changed his mind, wishing to move back into Oceanview because he missed life there. Rather than allow the man alone to move back, the state agreed to temporarily suspend a rule limiting the number of mentally ill adults who can live in the homes. The state has reinstated that rule.

In spite of its problems, the home, like at least a dozen others, is moving into a state-sanctioned business model to care for the elderly and infirm. ProPublica reported this year that hundreds of mentally ill residents have been certified as assisted living recipients, which allows home operators to bill more for their care.

According to the complaint against Thompson, video surveillance footage at the home shows him and McGrory entering his room together at 2:35 p.m. At 2:50 p.m., McGrory opened and then closed the door to his room, but no one else entered the room. At 3:48 p.m., workers entered the room and later told police that they saw Thompson trying to remove McGrory’s pants. It is unclear whether McGrory was asking for help when she opened the door or what prompted the workers to ultimately enter the room.

McGrory was pronounced dead by Emergency Medical Services at 4:57 p.m.

“We are shocked and saddened by these horrifying allegations and are investigating,” said Jonah Bruno, a spokesman for the New York Department of Health, which oversees the home. He would not say whether the home’s administration had properly reported the incident, which would be part of the department’s investigation.

Asked what McGrory’s fate says about the home’s ability to care for people with such extensive medical and psychiatric needs, Bruno said, “Adult homes are capable of providing varying levels of care based on levels of need and are required under state law and regulation to only accept residents for whom they can provide appropriate care.”

Lisa Vider, the home’s administrator, did not return a phone call for comment on this story. But Jeffrey Sherrin, an attorney who represents Oceanview, said, “The incident is under investigation, and so far as we know, no cause of death has been determined. We are unable to comment, and we must also respect resident privacy.”

Fellow residents say both Thompson and McGrory had recently struggled at the facility.

Patricia Rosetti, 68, said she had shared a room with McGrory in the group home since 2014. “She was so lonely all the time,” Rosetti said. “She was divorced and had a son and it drove her nuts that she couldn’t see her family.” ProPublica made efforts to reach her next of kin but was unsuccessful.

Rosetti said McGrory had been repeatedly hospitalized for a variety of psychiatric and physical issues. Over the summer, Rosetti said McGrory had gone to the ocean wearing nothing but her underwear and came back scratched and bruised by the rocks. She spent the next couple of months in a mental hospital and was scheduled for an operation on her brain in January.

Rosetti said that McGrory had struck up a kind of relationship with Thompson, which worried the roommate because of his drinking. “I told her not to hang around with him,” she said.

Thompson’s roommate, Rufus Lane, 74, and his friend Johnny Lide, 69, sat across from Rosetti on a bench in a smoking section outside the home. They nodded as a fellow resident described Thompson’s temper but then came to his defense. “He would talk shit to me all the time,” Lide said, “but I never paid him no mind.”

Lane and Lide said that Thompson liked to drink but was not a violent person. They were surprised that he had been accused of hurting McGrory.

“That girl was his heart and soul,” Lide said. “I can’t see him doing no shit like that. That shocked the shit out of me.”

After about 30 minutes last Wednesday, workers at the adult home asked a reporter to leave the premises, saying it was private property.

“Nothing happened here last night,” one said.

This story was originally published by ProPublica.

Advocates for people with intellectual disabilities are concerned that those with Down syndrome, cerebral palsy, autism and other such conditions will be denied access to lifesaving medical treatment as the COVID-19 outbreak spreads across the country.

Several disability advocacy organizations filed complaints this week with the civil rights division of the U.S. Department of Health and Human Services, asking the federal government to clarify provisions of the disaster preparedness plans for the states of Washington and Alabama.

The advocates say the plans discriminate against people with intellectual disabilities by deprioritizing this group in the event of rationing of medical care — specifically, access to ventilators, which are in high demand in treating COVID-19 cases. More than 7 million people in the U.S. have some form of cognitive disability.

Some state plans make clear that people with cognitive issues are a lower priority for lifesaving treatment. For instance, Alabama’s plan says that “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.” Another part says that “persons with severe or profound mental retardation, moderate to severe dementia, or catastrophic neurological complications such as persistent vegetative state are unlikely candidates for ventilator support.”

Other plans include vague provisions, which advocates fear will be interpreted to the detriment of the intellectually disabled community. For instance, Arizona’s emergency preparedness plan advises medical officials to “allocate resources to patients whose need is greater or whose prognosis is more likely to result in a positive outcome with limited resources.” Between a person with cognitive difficulties and a person without them, who decides whose needs come first?

Medical triage always forces hard decisions about who lives and dies. For instance, older people with shorter life expectancy or those with severe dementia are often deemed less deserving of scarce medical resources than younger, healthier individuals. The state plans make clear that the fate of those with intellectual disabilities is part of the wrenching debate.

HHS officials said they were opposed to rationing care for people with any kind of disability.

“Persons with disabilities should not be put at the end of the line for health services based on stereotypes or discrimination, especially during emergencies. Our civil rights laws protect the equal dignity of every human being from ruthless utilitarianism,” said Roger Severino, the director of the agency’s civil rights office.

“What we’re seeing here is a clash between disability rights law and ruthless utilitarian logic,” said Ari Ne’eman, a visiting scholar at the Lurie Institute for Disability Policy at Brandeis University. “What this is really about at the end of the day is whether our civil rights laws still apply in a pandemic. I think that’s a pretty core question as to who we are as a country.”

Advocates and families of those with intellectual disabilities say their community is especially vulnerable to the disease because many of those with significant impairments live in group homes or other congregate settings.

It can sometimes be difficult for people with intellectual disabilities to understand the pandemic and its demands, such as the need to wear masks and heightened protocols for social distancing and hand-washing.

The death of Emily Wallace, a 67-year-old with Down syndrome in a group home in Georgia, was an early warning sign of the dangers facing the community, advocates say.

Wallace was a woman of firsts. She and her husband, Richard, were the first couple with intellectual disabilities to marry in the state. They were the first to live independently in their own home in Albany, a small town in the southwestern part of the state. In mid-March, Emily was the first person with an intellectual disability in her community — and possibly one of the first in the nation — to be diagnosed with COVID-19.

She was taken to a local hospital where she died alone.

“Mrs. Wallace is once again the first, but this isn’t what we wanted to celebrate,” said Stacey Ramirez, state director for The Arc of Georgia, a nonprofit advocacy group that serves people with intellectual disabilities.

Emily and Richard Wallace were married for 18 years. A 1992 story in the Albany Herald depicted their life as happily domestic, mentioning that Richard hated to vacuum, while Emily didn’t like to dust, and that she did most of the cooking while he raked the leaves. They made payments on their home and both held down jobs. After Richard, who also had Down syndrome, died in 2018 at 65, Emily moved to a group home operated by The Albany Arc.

After a caregiver apparently brought the coronavirus into the home, Wallace fell ill. So did another resident, who was hospitalized.

Emily Wallace had a do not resuscitate order, so a ventilator would not have been an issue even if care were being rationed, said DeAnna Julian, executive director of The Albany Arc.

But as more people are getting sick, Julian said she worries that not enough testing for the virus is being done in Albany. She’s seeing individuals — both with and without intellectual disabilities — who appear to have mild symptoms of COVID-19.

“They’re just turning them around and sending them home, they’re putting them on” antibiotics, she said. “We live here in southwest Georgia where right now, all the cars are covered in yellow pollen and everyone has some kind of seasonal allergies. … Is it just your springtime cold or is it COVID-19?”

Julian doesn’t have masks, gloves or other safety equipment. She doesn’t have enough staff.

“It’s a difficult and critical situation here,” she said.

But no, Julian said, she didn’t see Wallace or the other group home resident receive treatment any different than anyone else. She said she wouldn’t stand for it.

“I’d take it all the way to the top, to the governor! They have every right to be treated like human beings,” Julian said.

With the Americans with Disabilities Act celebrating its 30th birthday this year, activists are questioning whether policymaking has come far enough in what some consider to be the final battle in the fight for civil rights.

In a March 18 letter to Wisconsin Gov. Tony Evers, the Survival Coalition, a group of advocacy organizations, wrote, “‘Quality of life’ has long been a pretext for denying treatment, including life-sustaining treatment, to vulnerable populations, particularly people with intellectual disabilities.”

Michael Bérubé and his wife, Janet, live in State College, Pennsylvania, with their son Jamie, who is 28 and has Down syndrome. Bérubé, a professor of literature at Pennsylvania State University and the author, most recently, of the book “Life as Jamie Knows It,” studies disability. He was not surprised to learn about state rationing plans that single out people with intellectual disabilities and other cognitive conditions.

“It would be a very rare person who sees a person with Down syndrome as innately as valuable and as able to contribute to society as anybody else,” Bérubé said.

Pennsylvania is among those states now scrambling to write up guidelines to determine who will have access to ventilators in case of medical rationing, according to media reports.

“In two weeks, when the resources get truly stressed out, we’ll see how much of this draconian stuff goes into practice,” he said.

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• Health Care

In internal correspondence beginning in 2014, Purdue Pharma executives discussed how the sale of opioids and the treatment of opioid addiction are “naturally linked” and that the company should expand across “the pain and addiction spectrum,” according to redacted sections of the lawsuit by the Massachusetts attorney general. A member of the billionaire Sackler family, which founded and controls the privately held company, joined in those discussions and urged staff in an email to give “immediate attention” to this business opportunity, the complaint alleges.

ProPublica reviewed the scores of redacted paragraphs in Massachusetts’ 274-page civil complaint against Purdue, eight Sackler family members, company directors and current and former executives, which alleges that they created the opioid epidemic through illegal deceit. These passages remain blacked out at the company’s request after the rest of the complaint was made public on Jan. 15, 2019. A Massachusetts Superior Court judge on Monday, Jan. 28, 2019 ordered that the entire document be released, but the judge gave Purdue until that Friday to seek a further stay of the ruling.

The sections of the complaint already made public contend that the Sacklers pushed for higher doses of OxyContin, guided efforts to mislead doctors and the public about the drug’s addictive capacity, and blamed misuse on patients.

Citing extensive emails and internal company documents, the redacted sections allege that Purdue and the Sackler family went to extreme lengths to boost OxyContin sales and burnish the drug’s reputation in the face of increased regulation and growing public awareness of its addictive nature. Concerns about doctors improperly prescribing the drug, and patients becoming addicted, were swept aside in an aggressive effort to drive OxyContin sales ever higher, the complaint alleges.

Among the allegations: Purdue paid two executives convicted of fraudulently marketing OxyContin millions of dollars to assure their loyalty, concealed information about doctors suspected of inappropriately prescribing the opioid, and was advised by global consulting firm McKinsey & Co. on strategies to boost the drug’s sales and burnish its image, including how to “counter the emotional messages” of mothers whose children overdosed. Since 2007, the Sackler family has received more than $4 billion in payouts from Purdue, according to a redacted paragraph in the complaint.

“The payments were the motivation for the Sacklers’ misconduct,” the complaint says. “And the payments were deliberate decisions to benefit from deception in Massachusetts, at great cost to patients and families.”

In 1998, two years after OxyContin was launched, Dr. Richard Sackler, a son of Purdue co-founder Raymond Sackler, instructed executives in an email that its tablets were not merely “therapeutic” but also “enhance personal performance,” like Viagra. Fifteen years later, he complained in another email that a Google alert he set up for OxyContin news was giving him too much information about the drug’s dangers.

“Why are all the alerts about negatives and not one about the positives of OxyContin tablets?” he asked a company vice president. Staff immediately offered to replace Sackler’s alert with a service that supplied more flattering stories, according to the complaint.

The redacted paragraphs leave little doubt about the dominant role of the Sackler family in Purdue’s management. The five Purdue directors who are not Sacklers always voted with the family, according to the complaint. The family-controlled board approves everything from the number of sales staff to be hired to details of their bonus incentives, which have been tied to sales volume, the complaint says. In May 2017, when longtime employee Craig Landau was seeking to become Purdue’s chief executive, he wrote that the board acted as “de-facto CEO.” He was named CEO a few weeks later.

In a statement in response to questions about the redacted material, the company said that Massachusetts “seeks to publicly vilify Purdue, its executives, employees and directors by taking out of context snippets from tens of millions of documents and grossly distorting their meaning. The complaint is riddled with demonstrably inaccurate allegations.”

Purdue acknowledged in the statement that it was considering acquiring the rights to sell drugs that combat addiction or reverse the effects of an overdose. It criticized the state for “casting in a negative light” the company’s exploration of a potential acquisition of an addiction treatment that was already on the market, “even though the company never actually made the acquisition.”

Purdue also pointed out that OxyContin is approved by the Food and Drug Administration. It said that most opioid overdoses “now result from heroin and illicit fentanyl.”

The Sackler family was once best known for its philanthropy. Its name is engraved on museums and university buildings across the world. A group of activists has called on organizations to stop accepting Sackler donations and for the family name to be stripped from some institutions. Aggressive marketing of OxyContin is blamed by some analysts for propelling the crisis that has resulted in 200,000 overdose deaths related to prescription opioids since 1999.

After its 1996 launch, OxyContin rapidly became a top seller. But reports of patients abusing the drug soon followed. OxyContin contained more pain relief medication than older drugs, and crushing and snorting it was a simple way to get high fast. In 2007, Purdue pleaded guilty to federal charges of understating the risk of addiction and agreed to pay $600 million in fines and penalties. Still, the company argued publicly that OxyContin has “done far more good than harm,” and it sought to place responsibility for the bad acts on “certain of its supervisors and employees.”

Privately, the complaint suggests, the Sacklers were concerned about alienating two executives, then-CEO Michael Friedman and then-legal counsel Howard Udell. Friedman and Udell each pleaded guilty in 2007 in U.S. District Court in Abingdon, Virginia, to a misdemeanor charge of misbranding OxyContin, as did a former executive. The board signed off on the three executives’ decisions to plead guilty. No member of the Sackler family pleaded guilty.

Purdue paid $5 million to Udell in November 2008, and up to $1 million in November 2009, the complaint states. In February 2008, the company paid $3 million to Friedman. The complaint doesn’t mention any payments to the former executive.

“The Sacklers spent millions to keep the loyalty of people who knew the truth,” the complaint alleges.

Udell died in 2013. A person answering a phone number listed to Friedman declined comment.

The plea deals did little to hinder OxyContin sales or the Sacklers’ hands-on management. At the direction of the board, Purdue repeatedly increased its sales force, which pushed doctors to prescribe higher opioid doses.

In 2008, the same year that Purdue paid Udell and Friedman, Richard Sackler advised other family members that it was important to select a new chief executive who was loyal to the family. “People who will shift their loyalties rapidly under stress and temptation can become a liability from the owners’ viewpoint,” he allegedly wrote. A defendant in the Massachusetts lawsuit, Richard Sackler served in a number of different positions at the company before being named president in 1999 and then co-chairman of the board in 2003.

The company did install five new, non-family board members in the wake of the federal investigation. But in hundreds of board votes, the new directors never opposed the family, according to the complaint. Although Purdue does not operate outside the U.S., board meetings took place at a castle in Ireland as well as in Bermuda, London, Portugal and Switzerland.

When sales results disappointed, Sackler family members didn’t hesitate to intervene. In late 2010, Purdue told the family that sales of the highest dose and most profitable opioids were lower than expected, according to the complaint. That meant an expected quarter-end payout to the family of $320 million was at risk of being reduced to $260 million and would have to be made in two installments in December instead of one in November.

That news prompted a sharp email question from Mortimer D.A. Sackler, whose late father, also named Mortimer, was a Purdue co-founder. “Why are you BOTH reducing the amount of the distribution and delaying it and splitting it in two?” he asked. “Just a few weeks ago you agreed to distribute the full 320 [million dollars] in November.” The complaint doesn’t say how much was ultimately paid.

From 2009 until at least 2014, McKinsey helped Purdue shape its message for selling OxyContin and overcoming concerns about addiction and overdoses, according to redacted passages. The consultant told Purdue in a slide presentation that it could increase prescriptions by convincing doctors that opioids provide “freedom” and “peace of mind” and give patients “the best possible chance to live a full and active life.”

Purdue staff, according to the complaint, told the Sacklers that McKinsey would study “patient pushback” to encourage hesitant doctors to prescribe opioids. In a meeting with Purdue executives, McKinsey planned how to “counter the emotional messages from mothers with teenagers that overdosed in [sic] OxyContin” by recruiting pain patients to talk about the need for the drugs.

In a 2013 report, McKinsey recommended directing sales representatives to focus on the most prolific opioid prescribers because that group writes “25 times as many OxyContin scripts” as less prolific prescribers. Because prescription rates rose in tandem with visits from sales reps to doctors, McKinsey recommended increasing each salesperson’s quota from 1,400 visits a year to closer to 1,700. McKinsey estimated that targeting the most frequent prescribers could boost OxyContin sales by hundreds of millions of dollars. The quotas rose, as did total visits, the complaint states. Purdue said it planned to decrease visits relating to opioid products, and any increase was due to promoting a laxative.

McKinsey also recommended Purdue fight back against efforts by a major pharmacy chain, the U.S. Drug Enforcement Agency and the U.S. Department of Justice to stop illegal opioid prescribing, the complaint states. These new rules were cutting into sales of the highest doses, which were also the most profitable, it says. The complaint doesn’t say if Purdue followed McKinsey’s recommendation. Purdue said the recommendations “actually relate to ensuring continued access to pain medicines for appropriate patients.”

A McKinsey spokesman declined comment.

In September 2014, Purdue embarked on a secret project to join an industry that was booming thanks in part to OxyContin abuse: addiction treatment medication. Code-named Project Tango, it involved Purdue executives and staff as well as Dr. Kathe Sackler, a daughter of the company co-founder Mortimer Sackler and a defendant in the Massachusetts lawsuit. She participated in phone calls and told staff that the project required their “immediate attention,” according to the complaint.

Internally, Purdue touted the growth of an industry that its aggressive marketing had done so much to foster.

“It is an attractive market,” the team working on the project wrote in a presentation. “Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”

While OxyContin sales were declining, the internal team at Purdue touted the fact that the addiction treatment marketplace was expanding.

“Opioid addiction (other than heroin) has grown by ~20%” annually from 2000 to 2010, the company noted. Although Richard Sackler had blamed OxyContin abuse in an email on “reckless criminals,” the Purdue staff exploring the new business opportunity described in far more sympathetic terms the patients whom it now planned to treat.

“This can happen to any-one – from a 50 year old woman with chronic lower back pain to a 18 year old boy with a sports injury, from the very wealthy to the very poor,” it said.

Company documents recommended becoming an “end-to-end pain provider.” Initially, Purdue intended to sell one such medication, Suboxone, which is commonly retailed as a film that melts in the mouth. When Kathe Sackler asked staff members to look into reports that children might be swallowing the film, they reassured her. They responded, according to the complaint, that youngsters were overdosing on pills, but not the films, “which is a positive for Tango.”

In 2015, Purdue turned its attention to another potential product, the overdose reversing agent known as Narcan, calling it a “strategic fit.” Purdue executives discussed how its sales force could promote Narcan to the same doctors who prescribed the most opioids. Purdue said in the statement Wednesday that it decided against acquiring the rights to sell Suboxone and Narcan.

While those initiatives appear to have stalled or ended, Richard Sackler received a patent last year for a drug to treat addiction, according to the complaint. The patent application states that opioids are addictive and refers to people who suffer from substance use disorders as “junkies.”

Besides being a defendant in the Massachusetts case, Richard Sackler was deposed in a lawsuit against Purdue in Kentucky, which the company settled. It’s believed to be the only time a member of the family has been questioned under oath about OxyContin and its addictive properties. The Kentucky Court of Appeals has ordered the release of his deposition, in response to a motion by STAT, but Purdue is asking the state Supreme Court to review the ruling. Hundreds of other lawsuits filed by states, cities, counties and tribes against Purdue have been consolidated in a pending case in federal court in Ohio.

The Massachusetts complaint cites multiple incidents of Purdue allegedly sitting on information, sometimes for years, about doctors it had reason to believe were inappropriately prescribing OxyContin. In 2012, a Purdue employee appealed to the company’s head of sales to alert health insurers to data the company collected about doctors suspected of abusing or illegally prescribing OxyContin. The list of doctors was code-named Project Zero.

“At a basic level, it just seems like the right and ethical thing to do,” the employee wrote. “Doing so could help those companies identify those physicians that may be of a concern, not just with respect to our products, but also other” pain medications. “As a result, if it reduces abuse and diversion of opioids then it seems like something we should be doing.”

The idea was rejected and the employee left the company a month later, according to the complaint.

Update, Jan. 31, 2019: The day after this article was published, a judge rejected Purdue’s request for a further stay, and the entire complaint was made public.

This story was originally published by ProPublica on January 30, 2019. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.