ANOKA, Minn. (KMSP) - The Anoka Metro Regional Treatment Center is a 110-bed state psychiatric hospital, but because of a change in state law, it's also becoming a kind of de facto prison.
That’s where 132 patients were transferred in the last year from Minnesota's crowded jails. Each patient costs taxpayers $1,309 per day. And when they walk through the doors, they're no longer criminals, they become clients.
"It doesn't do justice to the really mentally ill to be mixed up with the criminal aspects," said Jackie Spanjers who worked as a nurse there for more than 20 years. "The criminals will tell you they have nothing to lose. We've had them say to staff: you’re working under my f-ing roof."
Spanjers was injured by a patient two years ago and she's not alone.
The local union documents staff who get injured and reports 55 injuries last year including incidents such as sucker punches, assaults and getting stabbed in the eye with a pencil. Staff even have a Facebook account where they share their horrifying stories. Their new slogan is "I came here to work, not to die."
Patients who have assaulted staff include, Mohamed Hassan, who last February suddenly attacked a worker. He licked her face and stuck his tongue down her throat so she couldn't scream. Police took him to jail but he was back that same day.
Rachel Nichols was another patient. She developed a fatal attraction for a nurse. She carved the nurse's name into her leg, sent love letters, called her at home, threatened to strangle and kill her family.
Human Services Commissioner, Emily Johnson Piper is promising change but that may require rewriting Minnesota law.
"Anoka's patient population is challenging, always been challenging, but it's been complicated by the increasing number of patients we are getting from the jail," said Johnson Piper.
Two years ago, the Legislature passed the so-called 48 rule, requiring jails to transfer any inmate who's not competent to stand trial to a psychiatric hospital within two days.
That usually means they come to Anoka Regional, or the state hospital in St. Peter, where security is much tighter.
"This 48 hour rule requires us to prioritize people coming from jail before coming from the hospitals," said Johnson Piper.
A recent review from CMS, the Centers for Medicare and Medicaid Services found nearly identical patient treatment plans for all patients at the Anoka facility generic and one size fits all.
CMS said $3.5 million in federal funding for Anoka Metro is in "immediate jeopardy."
"I was blown away by that report," said Sue Abderholden, a longtime advocate for the mentally ill. "I had no idea that was going on. I had no idea we had identical treatment plans for people."
One reason is that Anoka Regional is incredibly short staffed, 55 unfilled job openings. More than 5,000 hours of overtime in January alone with double shifts leading to dangerous burnout.
"Makes it a lot tougher, puts you in a vulnerable position right from the start, based on the fact you're tired," said Spanjers.
It's a complicated system, where the mentally ill get passed between courts, hospitals, jails, and back again.
"What we have is a flow problem. Some people say if we build more beds, (no) it's a flow problem," said Abderholden.
In fact, nearly half the clients at Anoka Regional no longer meet the criteria for hospitalization. They should be going back to court, jail, or a less expensive community based facility.
Instead, violent criminals are treated like clients, putting both staff and other patients in peril.
"The staff does have a safety concern but they're also really committed to helping the most vulnerable in the state," said Johnson Piper.