John Schroepfer’s mother waited in dread outside the psychiatric ward of St. Mary’s Hospital in Duluth.

Inside, her son lay recovering from a suicide attempt at the Itasca County jail in Grand Rapids. At any moment, sheriff’s deputies would come through the door to get him. Even though he had suffered brain damage, even though doctors had recommended treatment for depression and drug use, a judge had ordered Schroepfer back to the same jail where deputies had found him hanging by a bedsheet just weeks earlier.

And yet, because vigilant deputies spotted him last month and cut him down before it was too late, Schroepfer can be counted lucky — an outlier in a state where mental illness in jail often leads to deadly outcomes.

At least 35 inmates have committed suicide in Minnesota’s county jails since 2000 — nearly a third of them with psychiatric problems that were known to authorities before they died, according to a Star Tribune review of hundreds of jail logs and court records.

Another 27 inmates committed suicide in state prisons during the same period — including seven with known histories of mental illness — and an additional 11 committed suicide while on prison release.

In many cases, jailers and medical staff failed to take appropriate preventive measures, court records show, and in some, deputies actually altered jail records in an effort to cover up mistakes.

One symptom of the problem: Minnesota taxpayers have paid more than $1 million in the last three years to settle negligence lawsuits related to jail suicides.

“You have a nightmare scenario inside a jail filled with people who’ve tried to kill and people trying to injure themselves,” said Jim Franklin, executive director of the Minnesota Sheriffs’ Association and a former police officer. “Add the factor of mental illness … look at what you’ve got to deal with every day.”

Across the nation, suicide is the leading cause of jail deaths, and in Minnesota, some 20 percent of county jail inmates have severe psychiatric disorders — caught up in the criminal justice system because of larger breakdowns in the state’s system of mental health care.

Short of a lawsuit, however, the state has little recourse to hold county jails accountable. The Minnesota Department of Corrections, which oversees medical care in county jails, has no legal authority to levy fines or impose tough sanctions.

Against that backdrop, jail staff members often have failed to follow even basic screening and prevention protocols, according to jail and court documents.

In 2007, for example, an inmate known to be mentally ill and depressed committed suicide in the Olmsted County jail in Rochester, and then deputies falsified their watch logs to conceal surveillance lapses. In December 2010, a 28-year-old father hanged himself with a bedsheet in the Mille Lacs County jail in Milaca, Minn.; staff had not placed him on a suicide watch even though he had tried to kill himself just weeks earlier.

While the numbers are not large in a system that confines thousands of offenders each year, they signal grave failures, according to Alvin Cohn, one of the country’s foremost authorities on jail protocols.

“There is no excuse for a successful suicide in a jail,” said Cohn, a criminologist and an adviser to the U.S. Department of Justice. “If the head of a jail allows or creates a culture where policies are not implemented, you’re going to have tragedies.”

At the same time, counties have increasingly outsourced jail medical care to private contractors that promise to save money by rationing services. Today, nearly one-third of Minnesota’s jails contract with for-profit providers of mental and medical care.

Since 2010, three inmates with documented mental illness committed suicide while under the care of one of those managed care companies, records show. The physician who runs the company, MEnD Correctional Care, said that he couldn’t comment on specific cases but that he’s confident his staff provides quality care.

‘Nobody listened to me’

Perhaps no Minnesota jail has such a troubled pattern as the one in Mille Lacs County.

Between 2002 and 2010, the jail had two suicides and seven attempts. Five of the inmates who attempted suicide had documented mental illnesses, but only one was placed on a medical hold and evaluated.

In the case of Josh Holscher, jailed in 2010 in a domestic assault case, records show a series of breakdowns from the moment of his arrest. When deputies found him slumped over in his pickup truck deep in the woods near Onamia, Minn., Holscher had a faraway stare across his face and a gun and an empty pill bottle at his side.

A few days later, at his first court appearance, his mother, Debra Kickhafer, instantly saw her son slipping away.

“I kept warning the jail that he’s going to die in there,” she said in an interview. “He had a blank stare. Nobody listened to me.”

Deputies who knew of his previous suicide threats failed to tell their colleagues, court records show. At the jail, an officer noted that Holscher had been hospitalized for depression, but did not notify colleagues or ask the on-call jail nurse for an evaluation, according to jail logs and court documents. The nurse failed to assess Holscher for suicide or evaluate him for mental health problems — despite his mother’s warnings, records show.

Ten months earlier, similar breakdowns had led to another suicide in the jail. That inmate, Walter Wildhirt, 32, told jailers he had mental illness when booked into the jail, but he denied having suicidal thoughts, according to court records.

And though jailers learned that Wildhirt previously had threatened to kill himself and had told them he was on psychiatric medications, no suicide evaluation was ordered, according to records and interviews. In February, 2010, Wildhirt hanged himself in the same cellblock where Holscher would die.

Mille Lacs County Sheriff Brent Lindgren says his staff should not be blamed.

“The documents are very damning, very damaging,” Lindgren acknowledged in an interview. “But I still believe there’s nothing that anyone did that caused his death.”

Holscher’s mother remembers it another way. “I asked for the jail nurse; they said she was too busy,” she said. “I spoke to the probation officer and he said, ‘My job is to put him in jail.’ ”

Contracted medical care

The suicides of Holscher and Wildhirt took place under the watch of the jail’s for-profit medical provider, MEnD Correctional Care, of Waite Park, Minn. MEnD, which says it creates a “win-win situation” for inmates and taxpayers by providing quality care while reducing costs, has similar contracts with 10 other jails in Minnesota. The nurse who failed to give Holscher a mental health screen is a MEnD employee who still works at the jail, according to Sheriff Lindgren.

Dr. Todd Leonard, MEnD’s president, said his medical staff is “painstakingly” careful with inmates, particularly when the risk of suicide is clear.

In an interview, Leonard declined to explain why Holscher did not receive a mental health evaluation.

“As it relates to any allegations raised, MEnD is confident that its staff followed the proper medical standard of care in its treatment of Mr. Holscher,” Leonard said in a statement.

He said his company’s policy is to get professionals involved quickly if jailers identify an inmate’s mental health risks. “And we do everything we can to surmise how to prevent the next one [a suicide] from happening,” he said.

In a case under MEnD’s supervision at the Stearns County jail in St. Cloud just weeks before Holscher’s death, it appears that no psychiatric evaluation was offered to an inmate who did commit suicide weeks later.

Kyle Baxter-Jensen was arrested on drunken-driving charges in Stearns County in the fall of 2010. A day later, Jensen, 28, used a jail-issued razor to cut his neck and both wrists. “I don’t want to live,” he told the deputy who found him in his cell.

After being stitched up at a St. Cloud hospital, Jensen returned to the jail and a MEnD nurse recommended he be put on a 10-minute suicide watch, jail records show. A day later, MEnD staff lifted the order, according to the sheriff; even though his record shows that Jensen was soon making disturbing comments, there is no record that a mental health professional ever assessed him. Weeks later, Jensen stole a razor issued to his new cellmate. Soon after, he was found dead in the shower with a large gash in his neck.

Leonard, citing patient privacy laws, declined to comment on Jensen’s care.

In 2011, Leonard’s license was put on conditional status by the Minnesota Board of Medical Practice due to unprofessional and unethical conduct, prescribing a drug for other than medically accepted practices and improper management of medical records. His license restrictions were lifted in August after he completed courses in chronic pain management, records management and professional boundaries.

Jim Franklin of the Sheriffs’ Association says inmates with mental illness are the most vulnerable people under a sheriff’s responsibility, a burden already heavy with dangerous and unstable people.

Until about three years ago, a county jail was mostly the province of the county sheriff — who usually deferred medical issues to a public health nurse. Since then, Franklin and his staff have pressed for standardized, mandatory training in mental health care.

Still, Franklin admits that training is inadequate, with jailer certification at the association’s Jail Academy requiring just 11 hours of core education on suicide awareness and mental health. “We need to have 40 hours just on that issue, but we don’t have the funding,” he said.

Additionally, state corrections inspectors have little authority to punish a jail for neglect.

After the 2007 suicide of Kyle Raymond in the Olmsted County jail, for example, an inspector only sent a “letter of concern” to the county sheriff, even though records showed that jailers had tried to cover up their negligence and surveillance video showed that deputies had falsified their logs.

Last year, Raymond’s family settled a negligence suit for $900,000 and the deputies have been fired.

To this day, Sheriff Lindgren defends his jail and medical staff. He points out that after Holscher’s death, the county spent $10,000 to modify the cellblocks where an inmate might find a way to kill himself.

“Holscher was not a ‘suicide watch’ because he told the nurse he was not suicidal,” the sheriff said.

“Yes, we’ve had two suicides, but we’ve also had several ‘saves,’ and that needs to be recognized by the public,” he said. “We try our best to treat our inmates with dignity and respect — 365 days a year and about every 20 minutes.”

After Holscher’s death, Lindgren said he ordered an internal jail review. It concluded that the jail staff followed proper procedures.

And John Schropfer, who was returned to the Itasca County jail last month, is finally in treatment and receiving medications for bipolar disorder. He has a court appearance next week.

His mother, Mary Hennen, asks a question that has nagged her since that anxious day at the hospital in Duluth.

“What will we say to another mother who has to bury a child because there was a failure in the system?”