Each month, about a dozen jail inmates, usually escorted by sheriff’s deputies and still wearing handcuffs, are dropped off at Anoka-Metro Regional Treatment Center, the state’s second-largest psychiatric facility.

The inmates come from county jails across the state, and their growing numbers have transformed a once-sleepy state hospital into a tinderbox of increasingly volatile patients.

The share of Anoka-Metro’s population coming from jails has nearly tripled since 2013, according to state data released last week, and they pose a significant risk to the future of the 110-bed hospital as it struggles to fix safety problems identified by regulators and retain millions of dollars in federal funding.

In 2013, reacting to reports that inmates with mental illness were filling up Minnesota’s county jails, the Legislature passed a law requiring state psychiatric hospitals to admit such inmates within 48 hours of a judge’s order. Since the “48-hour rule” took effect, the percentage of Anoka-Metro patients coming from jails jumped from 14 percent to 36 percent, while those admitted from hospitals has dropped by almost half, according to the state Department of Human Services, which oversees the hospital.

Many of these inmates have been jailed for violent crimes and arrive at Anoka-Metro in a highly volatile state, having gone days or even weeks without their medications, employees say. In addition, employees say, they often arrive without the medical paperwork describing their psychiatric conditions, treatment history and therapeutic needs. Lacking this basic information, hospital staff members are frequently on edge, unsure of how to handle the new patients and what might trigger a violent episode, employees say.

“It’s safe to say that we are caring for a more challenging population overall, as more people come to us from jails than from the hospitals,” Human Services Commissioner Emily Piper said.

Since early last year, the hospital has adopted a series of measures to better manage volatile patients and to fix deficiencies cited by federal health regulators. There are now regular “safety huddles” among hospital leadership, and managers make daily rounds to identify possible security problems. The hospital has also accelerated hiring — adding 75 employees in the past year — which has improved the therapeutic environment and increased observation of potentially dangerous patients.

Partly as a result of these changes, aggression-related injuries at the hospital dropped from 55 in 2015 to 36 last year, according to state records.

Still, health and safety problems persist. Last November, a female patient was found screaming for help from her room after another patient stabbed her twice in the leg and once below the eye. Federal regulators later found that the assailant had a history of violence and, just the previous day, made several phone calls to police, threatening to “blow them up,” records show. Despite this behavior, the patient’s supervision level was not increased, which might have prevented the stabbing, inspectors found.

In a separate incident last summer, the hospital was cited for failing to protect a patient who twice attempted suicide with bedding from his room, and then repeatedly injured himself and staff while being transported to a hospital.

And last month, Anoka-Metro was cited by federal regulators for failing to administer medications properly to five patients. While none of the patients suffered negative reactions, inspectors found that staff at times administered drugs without any assessment of the patients’ vital signs, in violation of physician orders.

“We have some of the sickest people in our state who are still not getting the help they need, because [Anoka-Metro] is not meeting basic standards for patient care and safety,” said Sue Abderholden, executive director of the National Alliance on Mental Illness of Minnesota.

Funding was at risk

The urgency to fix these problems is high. After conducting on-site reviews, the federal Centers for Medicare and Medicaid Services (CMS) determined in 2015 that Anoka-Metro’s quality problems placed it at risk of losing Medicare and Medicaid payments, a significant share of the hospital’s budget. Although CMS has since withdrawn the threat, the hospital continues to operate under heightened scrutiny. Federal inspectors are expected to make two unannounced visits before May of next year; poor marks could cost the hospital its federal funding, officials said.

Passing muster with federal health regulators has become such a priority that state officials recently took the unusual step of withdrawing from a widely used private-sector accreditation program run by the Joint Commission, a nonprofit that accredits more than 21,000 health care organizations and programs in the United States. In a memo, Piper said the decision would give the hospital “breathing room” to concentrate on the more rigorous federal standards.

“We have not taken this step lightly, and it is important that everyone understands we are not lowering our standards,” Piper wrote in a Jan. 27 memo to direct care staff.

This month Jackie Spanjers retired after two decades working as a nurse at Anoka-Metro. She would have stayed longer, she says, but nursing became impossible after a 2014 assault by a patient left her with a ruptured biceps and a torn rotator cuff. Despite surgery, Spanjers said she still has difficulty lifting her arms and doing basic chores or cutting wood at her small farm in Princeton, Minn.

Looking back, Spanjers said the “48-hour rule,” and the resulting influx of jail inmates, stands as the most significant change during her 21-year career at the hospital. It could take years, she said, for the facility to adjust to the increasingly aggressive patient mix. If trends continue, Anoka-Metro may become less like a hospital and more like a prison, with security counselors on every unit, she warned.

“It’s hard to turn a ship that big,” Spanjers said. “People are doing their best, but all too often they’re flying blind, reacting to people who are dropped off in handcuffs and have little interest in actual treatment.”


Twitter: @chrisserres