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Alleging “Dickensian” conditions, Maryland’s Attorney General has sued a group home provider that has long faced allegations in multiple states of abusing children with severe developmental disabilities and behavioral challenges.

The for-profit company, which in recent years changed its name from AdvoServ to Bellwether Behavioral Health, ran group homes in Delaware that took in residents from Maryland. Maryland removed the last of its children from the homes in October 2016, after inspections found filthy conditions and a teenage girl from Maryland died after being restrained.

A ProPublica investigation in 2015 detailed problems similar to those over which Maryland is now suing. We found that AdvoServ fended off regulators’ scrutiny for decades despite a long track record of clients being abused. The company continued to use controversial methods such as so-called mechanical restraints – devices such as chairs with straps – to hold down uncooperative residents when most other similar facilities had long abandoned such measures.

State regulators have begun taking a harder line in recent years.

Maryland’s lawsuit accuses the company of failing at some of its most basic responsibilities, including administering medication properly and staffing its facilities adequately, as well as covering up incidents where staff injured residents. The company charged Maryland more than $230,000 per child annually. The state paid more than $13 million over little more than a year for what it says was substandard treatment.

In one case, a girl suffered a broken nose and injured elbow while being physically restrained by staff. She complained that a staff member had hit her, but workers didn’t get medical help or take other action until prompted by her grandfather, the lawsuit said. The staff member eventually pled guilty to criminal charges.

In another case, a Maryland child ran away with a staff member who engaged in a sexual relationship with the child, the lawsuit alleged. Other workers had seen the employee spend time in the child’s bedroom but had done nothing. Another time, it said, staff watched but didn’t intervene as a girl prone to self-injurious behavior banged her head against a wall eight times.

In the lawsuit, Maryland Attorney General Brian Frosh claims the company’s group homes and schools were understaffed, and that workers received inadequate training and pay.

The legal action also asserts what critics have long suspected: that workers routinely defaulted to restraining children instead of trying more therapeutic, less physical methods of managing their difficult behaviors.

Efforts to reach a spokesperson for Bellwether were unsuccessful.

The company has provided care and schooling for hundreds of children and adults with severe developmental disabilities and mental illnesses in its homes in Delaware, New Jersey, Virginia and Florida.

In New Jersey, where Bellwether has been the largest provider of group homes, the financially distressed company is moving residents out after the state announced in May that it was terminating the company’s contracts.

In Florida, the last of nearly 200 residents with disabilities moved out of the company’s sprawling Carlton Palms campus northwest of Orlando in October. The now-shuttered compound was the site of the 2013 death of another teenage girl who was tied to a bed and chair while vomiting overnight. She was found dead of dehydration the next morning.

At the time, company executives denied there was a pattern of abuse and said employees who mistreat residents are disciplined.

The company was bought by the private equity firm Wellspring Capital Management in 2015. The firm was not named in the Maryland lawsuit. A call to Wellspring was not immediately returned.