Angela Timmerman, Olivia Berger, and Lora Smith say they have all paid a high price for working at MHI Independence, one of the state’s two inpatient mental health facilities.
Timmerman, who worked as a nurse at the facility from 2012 to this year, suffered permanent neck injuries and PTSD after an unsupervised patient threw her down and repeatedly stomped on her.
Berger, a nurse there from 2022 to 2024, said she quit after being physically and sexually assaulted by patients and is no longer working in nursing. She stated that her experience at Independence has altered her entire personality, had an impact on her family life, and cost her her sense of security, and that she is unsure whether she will be able to return to the career she enjoyed.
Smith, who worked at MHI Independence from 2023 to 2024, paid perhaps the highest price of all: the life of her unborn child, who was conceived after months of in-vitro fertilization treatments. She miscarried after being struck in the stomach by an out-of-control juvenile patient, and she claims the loss has left deep scars on her entire family.
In an interview, all three women stated that the attacks that resulted in their injuries were preventable and that senior managers at MHI Independence and the Iowa Department of Health and Human Services failed to provide a safe workplace. They have filed tort claims against the state, which is a legal requirement for bringing lawsuits, alleging “co-employee gross negligence” against nearly a dozen state officials.
DHHS, which runs the facility, declined to comment on the nurses’ allegations, citing pending litigation. However, spokesperson Alex Murphy stated that patient and employee safety are the department’s “top priority.”
“These facilities serve the most vulnerable clients when other options are not available or when a significant level of expertise is warranted,” according to an email he sent.
State mental health hospital has history of complaints
Independence Mental Health Institute, located about a half-hour east of Waterloo, has wards for both adult and juvenile patients, as does its sister institute, Cherokee Mental Health Institute in northwest Iowa. During their time there, the three nurses said they typically cared for around 60 patients.
Staff members have previously expressed safety concerns about the facility. In 2018, a nurse was beaten unconscious and required surgery before being terminated after her federally mandated leave expired, prompting her to claim she was fired for “not healing quickly enough.” In a two-week period in 2019, at least four more employees were injured due to violent outbursts by patients.
According to documents filed with the nurses’ tort claims, the Occupational Safety and Health Administration fined the facility nearly $73,000 in the same year for a variety of violations. The problems included insufficient emergency response plans and communication protocols.
Timmerman, the longest-tenured of the three, said she noticed an increase in safety concerns starting in 2018 as the state transferred more seriously ill patients to Independence.
She stated that they worsened during the COVID-19 pandemic, the 2022 merger of the Department of Public Health and the Department of Human Services to form DHHS, and the subsequent accelerated staff and leadership turnover that followed.
Facility reportedly lacks security, cameras, locks
In interviews, the three women described numerous flaws in the facility’s policies and leadership that jeopardized patient and staff safety.
They stated that MHI Independence does not have any security cameras or on-site security. The exits are not secured, allowing patients moving between areas of the facility to simply run out the door. Staff radios frequently fail or seize up in emergency situations, a complaint that is similar to those expressed by workers at the state prisons.
They also stated that the facility, which is over a century old, is unsuitable in other ways. It has drop-panel ceilings that allow patients to access pipes, wiring, and other building mechanicals that can be used to create weapons.
(Smith claimed that the injury that cost her her baby occurred while attempting to prevent a patient from accessing the ceiling. Patients have also repeatedly obtained concrete fragments or shards of glass from outdoor recreation areas and used them to injure themselves or others.
In addition to the building’s physical flaws, the nurses reported that it was severely understaffed, with many of the employees lacking crisis intervention training. When a crisis occurs, the workers’ only backup is each other, and if that is insufficient, they call 911, they said.
Except that the nurses said it was recently forbidden. Following a series of incidents that resulted in calls to the Buchanan County Sheriff’s Office, top managers emailed employees in 2024 to inform them that they were no longer permitted to call emergency services and that senior leaders would decide which incidents warranted the involvement of law enforcement.
While the nurses were unable to provide a copy of the email to the Register, this would not have been the first such directive. The $73,000 OSHA fine imposed in 2019 included $12,000 for precisely such a directive, which inspectors stated “delays employee access to professional assistance in the event of a fire or serious injury.”
Three former nurses recount patient assaults, lack of support
Smith, Berger, and Timmerman claimed that their shortcomings were directly responsible for their injuries.
Timmerman claimed that on the day she was attacked, she was removed from her normal assignment and transferred to a different ward to provide “one-to-one” supervision for a patient who required the undivided attention of a single staff member.
There were only two staff members in the dining area, both responsible for a one-on-one patient, so there was no one else to intervene when another patient, who was not supposed to be there, became disruptive and eventually confronted Timmerman.
Timmerman, unable to leave her assigned patient, claimed she could not escape when the other patient pinned her against the window, threw her to the floor, and tore out patches of her hair.
She claimed she curled up in a fetal position as the patient repeatedly stomped on her head and neck, causing injuries that necessitated spinal fusion surgery. She now works for another mental health provider, but she says her PTSD makes it difficult to work with combative patients.
“I am scared. I am always anxious. “I have nightmares,” she explained. “Trust is a big deal. It is difficult to trust people.
Smith claimed that her situation was exacerbated by a lack of staff. On the day she was attacked, she was serving as charge nurse, or shift team leader, and stated that when it came time to send her ward out for recreation, there was no one else who could stay behind with her except a 17-year-old patient who was not permitted to leave.
The youth began acting out, overturning furniture, and Smith sought refuge in a nurse’s station before having to emerge to prevent him from reaching the ceiling. That is when he attacked her, she explained.
“I have replayed my situation about a million times. “There was nothing I could have done differently to save our son,” she explained. “I could not have avoided the situation. The policies that could have saved him were simple: security and training.”
Berger claimed she was assaulted by multiple patients. The final straw came when she was working on the ward floor, filling in for another worker, when a patient “that I had a good rapport with” approached and repeatedly sucker-punched her in the head.
If their claims are pursued in court, all three women expressed hope that the case will result in a security overhaul at MHI Independence as well as accountability for senior leaders who they believe failed them. They warned that continuing on the current path would endanger more care workers and patients.
“We have got to step up security and do the right thing and protect the workers that are trying to help the people who are not safe enough to be amongst the general population,” Smith said…. If you do not protect your workers, how are we going to continue to care for these patients?”