25 years after Ladd Center closed, R.I. still struggles to serve people with developmental disabilities

EXETER — The last lunch had ended when five residents of the Ladd Center, the state’s lone institution for people with developmental and intellectual disabilities, were escorted into a van. The driver took them off into the brightness of a pleasant spring day.

It was March 25, 1994.

After nine decades that began with compassion but included years of the worst neglect and abuse ever for many of Rhode Island’s most vulnerable residents, Ladd was closed.

“The beast is dead,” said Robert L. Carl Jr., the administrator who played a leading role in making Rhode Island the first state to shutter such a place. “Nazi Germany killed these people. Rhode Island made a commitment to treat them with dignity and respect. Nobody will ever be able to throw away a human being again.”

A community system years in planning had brought people then described as “retarded” out of back wards in buildings that resembled warehouses into the everyday world that most Rhode Islanders inhabited. Into the light, too, had come other individuals from private residences where families struggled with care and suffocated under the crush of stigma and shame.

The beast really was dead, Carl recalled when The Journal visited him at his Jamestown home recently. A new day really had dawned.

“Nobody had ever set up a policy that said, ‘We're not going to institutionalize; we're going to take care of everybody in the community,’” Carl said. “Nobody. Nobody had ever tried to do that in the country, in the world.”

Ironically, in light of what would follow, humane care was the philosophy behind the General Assembly’s 1907 decision to establish a safe place for individuals deemed unable to care for themselves. At the time, many had been locked away in attics or basements, or were homeless, or incarcerated at the state poorhouse at the Howard complex in Cranston, where Eleanor Slater Hospital and the Adult Correctional Institutions stand today. There, they were further victimized.

“For a long time it had been apparent to educators and officials of the State, the conduct of whose offices brought them into contact with the defective, dependent and delinquent classes, that there was a great need of an institution in Rhode Island where boys and girls, or even young men and young women, who were classed under the general head of ‘feeble-minded’ could be cared for, properly trained and instructed, and in the end made as far as possible self-supporting …” The Journal wrote on Feb. 2, 1908, the day after Ladd opened.

Set in one building on the Hoxsie Farm, which had acres of land for future expansion, the center was called the state School for the Feeble-Minded. Its first superintendent was the young Dr. Joseph H. Ladd, who came to Rhode Island from Massachusetts.

The Ladd School, as it was later renamed, did provide sanctuary, for a time. It also served an ugly, if not officially proclaimed, purpose: it prevented its residents from marrying and having children, in accord with the national eugenics movement, which supported laws and policies aimed at preventing people judged “inferior” from reproducing, a policy implemented by Hitler. In other states, developmentally disabled women were forcibly sterilized, but Rhode Island had no such law and there is no confirmed record of it happening, according to University of Vermont Prof. Lutz Kaelber, a scholar who has researched eugenics and Nazi killings of disabled children.

By the 1950s, Ladd’s turn-of-the-century promise of safety and care had devolved into purgatory — almost literally, as a shocking photo exposé would demonstrate.

Ladd Center residents in 1977. Deplorable conditions in the 1970s at the state-run facility prompted legal action and advocacy that eventually led to its closure. [The Providence Journal, files]

By 1956, when The Journal published the first investigation of deplorable conditions at Ladd, the old Hoxsie Farm was a sprawling complex of overcrowded red-brick buildings where lives had been swallowed, its residents’ identities often erased. Tangible evidence of that can be found at Ladd’s forgotten cemetery, where small tombstones contain only serial numbers, no names or dates of birth or death. So, too, at the potter’s field for the nameless deceased from another now-closed Rhode Island institution for the mentally ill, the Institute of Mental Health.

In their March 1956 investigation, “The Forgotten Two Per Cent,” Journal writers Selig Greenberg and George F. Troy Jr. chronicled horrors that could be traced to the early days of Ladd, when its first superintendent lobbied the General Assembly for increased financial resources — and was met with legislative disinterest, and worse.

“Dr. Ladd recalls that when he appeared before a state budget committee in 1913 to request an appropriation for teachers, he was told bluntly that ‘instead of teachers there should be established an asphyxiation chamber’ at Exeter School,” Greenberg wrote. Nazi Germany, as Carl later noted, did establish them for the developmentally disabled.

Ladd returned to Exeter after his 1913 State House appearance, The Journal wrote, “for a long and lonely siege of waiting and wrestling with inertia and neglect.”

Some progress eventually was made, but by 1956, during an era when Ladd’s population peaked at more than 1,000, The Journal found that “the legacy of gross neglect in the past and continued skimping on appropriations” had created a situation involving “the anguish of blighted lives, of the failure to salvage human material that is not beyond saving — a failure for which no dollar and cent yardstick can ever be devised.”

Remedial efforts led to improvements, but by the late 1970s, Ladd was still more warehouse than home. In the wake of scandals in many states and the landmark 1966 exposé by Burton Blatt, “Christmas in Purgatory,” which included photographs of abused and neglected Ladd residents, a consensus was emerging across the U.S. that institutions had to be closed. Publication in 1972 of Wolf Wolfensberger’s revolutionary “The Principle of Normalization in Human Services” also proved instrumental.

Onto the local scene came James V. Healey, an advocate behind a 1978 federal class-action human-rights lawsuit against the state; Ladd superintendent George W. Gunther Jr., father of a woman who lived at the center; and Carl. Gunther and Carl worked for the Department of Mental Health, Retardation and Hospitals (now the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals), headed by Joseph J. Bevilacqua and his successor, Thomas D. Romeo.

The first steps in building a community system were taken, with the support of Gov. J. Joseph Garrahy and the General Assembly, where Rep. Paul V. Sherlock championed people with developmental disabilities. Time and again, voters approved bond issues to build community homes and programs.

The movement received a significant boost with publication of “The Ladd School,” a 1977 Journal series by staff writers Peter Perl, Bruce DeSilva and Thomas E. Walsh. The series documented “serious deficiencies in medical and dental services, inadequate staffing and poor training, overcrowding in some wards within the institution, improper medication, poor sanitation and physical plant,” among other conditions. Some buildings were deemed fire traps.

“A Ladd School physician has been fired for allegedly stitching wounds of two medical patients without using an anesthetic,” was but one result of the investigation.

Convinced that the very existence of Ladd was intolerable, Gov. Edward DiPrete, who followed Garrahy in office, announced in 1986 that the institution would close.

The beast is dead — but the model community system of the 1990s that replaced Ladd is inadequate a quarter of a century later, as a Journal investigation three years ago documented. Joseph Ladd’s “waiting and wrestling with inertia and neglect” are words that ring true today, albeit within a different context.

Anthony A. Antosh, director of Rhode Island College’s Paul V. Sherlock Center on Disabilities, and state Sen. Louis DiPalma, a champion for people with developmental and intellectual disabilities who describes his ambition as being “a voice for the voiceless,” are among those leading the campaign for change.

Both praise Behavioral Healthcare, Developmental Disabilities and Hospitals Director Rebecca Boss and her staff for their efforts in addressing the 2014 federal Department of Justice consent decree requiring Rhode Island to more thoroughly integrate individuals into the community and away from the post-Ladd model of sheltered workshops and other isolated settings. But both assert that the system remains underfunded and stuck in policies and a philosophy from an earlier century.

Antosh supports moving away from old-fashioned “person-centered planning” toward “person-centered thinking,” which he defines as ways to allow people with developmental or intellectual disabilities to have the same choices and chances that anyone has. One’s life is not fulfilled when only employment and housing needs are met, Antosh says.

He summarizes the new approach as “three big concepts.”

First, he said, is, “The person ought to be much more in charge of their own life than they now are.

“Two, think about all of life, not just work,” he said. Entertainment, recreation and relationships fit that category.

“Three, because there's so much of life that should be spent in the community doing all of those things, we need to think about how we engage the community in a very different way than we currently do," Antosh said.

A key to getting there, says DiPalma, is work by the General Assembly’s Project Sustainability Commission, which he chairs. Antosh belongs, as do Boss, state Medicaid director Patrick Tigue, and other government and private officials involved with the developmentally disabled.

“The system at a macro level needs to radically change from what we're doing today,” DiPalma says. “We can't look at this from the perspective of pruning the tree.”

“In the institution days, the institution was totally in control of every minute of a person’s life,” Antosh says. “As we have gravitated toward more community services, the service provider is still largely in control of major portions of the person’s life. The revolution to me is to put the person and their family or their immediate contacts — whoever are their primary people in their lives — more in control.”

Jimmy Isom, who was born in Cranston in 1946, was sent to Ladd at the age of 6. He stayed 22 years. Retired now and living in an apartment in North Providence, he enjoyed a long career working for Stop & Shop and other grocers after leaving Ladd.

“I thought I’d never get out,” he recalled of his decades in Exeter in a recent interview. “It was no good. It was like getting locked up, almost like a prison.”

Isom is one of the former Ladd residents who is featured in the upcoming documentary “Best Judgment: Ladd School Lessons,” directed by filmmaker Jim Wolpaw.

“I’m glad I got out of Ladd School,” he says. “I don’t want to go back.”  

A resident in her room at the Ladd Center in 1977. [The Providence Journal / Anestis Diakopoulos]

One 'beast' slain, but barriers remain for those with disabilities

After bearing witness to the Ladd Center's final years, writer G. Wayne Miller reflects on how treatment has evolved for those living with mental and developmental disabilities.

EXETER — It is rare to have a front-row seat to history, but I had one 25 years ago Monday, when the last residents left the Ladd Center and it closed for good. Rhode Island was the first state to no longer have a public institution for the developmentally and intellectually disabled, and watching those five men ride off to a better life gave us the chills.

“Us” was me; the late James V. Healey, an advocate who never accepted no for an answer; George W. Gunther Jr., father of a daughter with special needs who became Ladd superintendent vowing to one day shutter the place; and Robert L. Carl Jr., the colorful state official whose nickname, “Wolfman,” ostensibly was for his resemblance to the legendary DJ but really spoke to an almost supernatural ability to get things done. Good things, in Carl’s case.

When the van carrying the final five had disappeared into the real world — never again to be chained to their beds, have their teeth drilled without anesthetic, or be hosed down naked en masse in what purportedly constituted bathing — we gathered in Gunther’s office.

“The beast is dead,” Carl said.

I can still hear him — still remember the look on his face, a mix of elation and fatigue — for the road to March 25, 1994, had been long and hard. In my four decades as a journalist, those four words remain my favorite quote.

Together with the efforts of Carl, Healey, Gunther and many others, Providence Journal exposés of Ladd’s barbarism starting in the 1950s had played a role in killing the beast. Thanks to retired Journal editor Joel P. Rawson, who assigned me to a beat that also included the now-closed state Institute of Mental Health, another place of shame, I had covered Ladd since 1983.

By then, the age of abuse was ending.

But I had come to know that story well, from newspaper clippings and lawsuits and many hours spent with Healey and the boss of Gunther and Carl: Thomas D. Romeo, director of the state Department of Mental Health, Retardation and Hospitals, now the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

And also, of course, the hundreds of hours I spent getting to know Ladd people and former residents who had moved into the community.

My first experiences came during the year-long reporting behind my six-part series “Building new lives: A revolution in care — How Rhode Island became a leader in moving mentally ill, retarded out of state hospitals and back into the real world,” which began on Nov. 25, 1984.

Many more stories followed as the Ladd population dwindled and the community system grew. In 1990, four years after Gov. Edward DiPrete had announced that Ladd would close, I lived for a week in one of Ladd’s remaining residences to write the July 19, 1990, piece “Lorraine's world: As Ladd Center prepares to close, a new day dawns for the profoundly disabled.

Similarly, as residents of the IMH in Cranston — another place of long-standing abuse and neglect — left for the community, I was allowed to live a week there for a Journal story.

Mental-health and developmental-disability writing had become my journalistic passions; they remain so today. And while one beast is dead, a look around reveals that other beasts are very much alive.

If only Ladd and the IMH had served as true cautionary tales.