Matthew Holschlag was restless all afternoon, rejecting offers of anti-anxiety medication and quiet time away from other patients at the State Mental Health Institute here.
Suddenly, Holschlag charged Lori Cleveland, a nurse in her early 50s, and knocked her to the ground. He started punching Cleveland in the face, battering her head against the floor. When other MHI staff intervened, Holschlag hit them too.
“I know your names and I will hunt you down and kill you and your family in your sleep!” he screamed, according to court statements.
Staff eventually restrained Holschlag, but not before he injured Cleveland so badly she was taken to the Emergency Room. Eighteen months later, employees remember Holschlag’s threats and wonder what he might do when he gets out of prison later this year.
Employees at the Mental Health Institute (MHI) in Independence were injured by patients nearly 70 times last year, with half of those injuries considered assaults, the Iowa Department of Human Services reported.
DHS wouldn’t release injury reports, saying they were part of employees’ personnel files. Officials said most of the injuries were minor with only seven referred for evaluation for workers compensation.
Assault charges filed in Buchanan County show a handful of adult MHI patients committing numerous attacks on patients and staff. Juvenile patients have also injured staff, employees say, because an unwritten hands-off policy leaves employees defenseless.
Some wonder if DHS is sacrificing employee safety to avoid criticism over use of physical restraints.
“They (staff) are not trained or permitted to act in a way to adequately deal with the population they have,” Buchanan County Attorney Shawn Harden said. “Workers were calling us and saying ‘You’ve got to do something. You’ve got to help us’.”
DHS has been under fire since last summer when the Des Moines Register reported several employees at the Iowa Juvenile Home in Toledo were terminated for using improper restraints on residents. Further complaints alleged staff placed teens in seclusion cells for long periods.
Iowa Gov. Terry Branstad ordered closure of the home last month, although state union officials are suing to keep the facility open.
The Independence MHI is one of Iowa’s four mental health facilities that provide short-term psychiatric treatment for severe mental illness. The facility has 75 beds for adults and juveniles.
The institute is considered the last resort for some of the state’s most dangerous patients. About 90 percent of the patients at MHI last year were committed involuntarily, which means a court determines they are a danger to themselves or others.
MHI employees who did not want to be named for fear of reprisal told The Gazette pressure has mounted in recent years to avoid using physical restraints on patients, especially juveniles.
“Our management tells us not to (use restraints),” said one employee who is on leave after being injured by an adolescent patient. “It’s a fine line because they can close you down if you’re doing too many restraints. It’s a Catch 22.”
Another employee said staff members fear losing their jobs if they complain.
“It’s all about data and keeping patients out of restraints at all costs,” he said.
“Management is trying to cover up injuries happening in the facility,” the employee wrote to The Gazette. “Staff is scared to speak out because they have been threatened if they talk about this ‘we can find someone that can do your job’.”
Rick Shults, mental health and disability services division administrator for DHS, said MHI staff are allowed to use restraints when patients are at risk of hurting themselves or others and when other techniques have been tried first.
“Staff are fully and completely trained in the use of restraints,” Shults said. A patient’s treatment team would decide whether restraints are necessary, he added.
That’s DHS policy, but several employees said supervisors discourage staff from using restraints on juveniles.
MHI prohibits staff from reporting assaults during their shifts, although they do receive medical care, Shults said. The delay in reporting incidents to law enforcement can cause injuries and memories to fade, Harden said.
Harden, who became county attorney in 2011, has charged five patients with assault. Four have been found competent to stand trial. He’s also lobbied to keep patients who have assaulted staff from returning to the institute.
Jolene K. Hughes was sentenced Sept. 18, 2012, to two years in prison for several assault charges at MHI. In addition to biting, scratching and kicking patients, Hughes was convicted of grabbing a nurse by the hair, pulling her to the floor and biting her arm.
Two MHI employees obtained no-contact orders against Hughes. The Iowa Attorney General’s Office argued those orders should be set aside so Hughes could return to MHI after serving her prison term.
“The department believes Ms. Hughes is best served my IMHI,” wrote Assistant Attorney General Gretchen Kraemer in an Aug. 29 motion. “They have served her before and know her and her issues. This is not to diminish the harm to the staff when she acts aggressively, but the interests of the patient must have a role in these decisions.”
Harden told the court the orders should be maintained to protect victims.
First District Court Judge George Stigler sided with the Attorney General and lifted the no-contact orders so Hughes could return to Independence.
Another dispute involved Jimmie L. Downing, a Cedar Rapids-area native charged with assaulting five MHI staff in separate incidents in 2011 and 2012.
In one case, Downing wanted to be sent to the hospital for medical treatment, but nursing supervisor Mark Lyman examined Downing and found no reason to transfer him, deputies said. Downing punched Lyman in the eye, causing cuts and bruising.
Linda Stacey was washing tables in the MHI dining room when Downing entered the room, grabbed her by the hair and pulled her to the ground, officials said. Downing then kicked Stacey in the back, causing a bruise and tenderness, before other staff pulled him off.
“The assaults… have been violent, unprovoked and in one instance may have resulted in permanent injury to the victim,” First District Associate Court Judge James Coil wrote Dec. 20, 2012.
Downing, 32, has a string of misdemeanor alcohol and drug convictions in Linn County. In 2009, he was charged robbing the Collins Community Credit Union, at 1755 First Ave. SE.
Downing was found incompetent to stand trial in October 2010. He was sent to the Iowa Medical and Classification Center in Coralville for psychiatric treatment. After a year, Downing was still found to be incompetent and was sent to Independence.
The alleged assaults started weeks later. Although Harden charged him with assault, Downing was found incompetent to face the MHI charges. A judge again ordered Downing to go to the Medical and Classification Center.
This time, IMCC balked.
“The staff at the Iowa Medical and Classification Center refused to accept custody of the defendant,” Coil wrote in December 2012.
Dr. Harbans Deol, medical services director for the Iowa Department of Corrections, argued that Downing had reached the maximum benefits at IMCC and would be better served at a long-term care facility.
“It is evident … that neither one wants the defendant to return to their facility,” Coil wrote.
Meanwhile, Downing was being held at the Buchanan County Jail in isolation because of his violent tendencies, Coil wrote. There, he received no treatment, beyond medicine, for mental illness or assaultive behavior.
Coil ruled that although Downing was dangerous, he was better off at MHI than in the prison system.
“The shortcoming of our system of criminal justice is its failure to provide for placement of individuals for their care, safety and treatment who cannot be restored to competency but who are also violent and pose a substantial danger to the public peace and safety,” he wrote.
The Iowa Attorney General’s Office agrees that Iowa needs more options for people like Downing.
“We are concerned that the state doesn’t have adequate services to most effectively accommodate people who have discharged their criminal sentence, who have been diagnosed with mental disorders and exhibit violence, and are generally more difficult to serve,” Spokesman Geoff Greenwood wrote in an email to The Gazette.
DHS issued a Request for Information in August to find placement for about 30 people ending court-ordered prison terms. About half of the people have a conviction for sex offenses, but the group could also include people who need acute care for mental illness.
“The state would consider vendor ideas for using a dedicated private facility or a privately run facility or an existing state-run facility as one of the placement options,” DHS wrote.
No one responded to the RFI. Shults said DHS is still considering all options.
An MHI employee who has been injured twice by patients in recent years said the institute needs more direct-care staff. Supervisors should also spend time working in the wards: “They have no idea what is going on,” he said.