By John Abraham-Watne, Guest Contributor
As a mother, protecting your children is possibly the most important issue one can face in your life. But what happens when you need protecting from your own child because of lapses in their mental health? How could you separate your need to protect from your need for safety, and how could you build a life around that every day? For Kathy Swanson of St. Louis Park, her entire life was a dichotomy of this magnitude.
On November 15, 2010 Kathy’s seventeen-year old son Michael walked into the Crossroads Convenience Store in Algona, Iowa wearing a mask. He told the cashier, Vicky Bowman-Hall, to empty the cash drawer. When Bowman-Hall said she couldn’t understand him, Michael removed his mask. She began to taunt him, laughing about the inept manner in which he was robbing the store of the little money it contained. As he was about to leave with the cash, Bowman-Hall said she’d be calling the police. Michael then turned and shot the 47-year old cashier with the Beretta pistol he’d brought with him. After leaving the scene, Swanson realized he didn’t have enough money to head down to Mexico to hide out, so he traveled next to Humboldt. There he robbed the Kum and Go convenience store on 8th Street, where again he shot the cashier, 61-year old Sheila Myers. Swanson’s spree finally ended when police caught up with him at the McDonald’s in Webster City, Iowa. He remained in jail in Kossuth County until his murder trial in summer of 2011, which garnered national attention due to the seeming lack of remorse Swanson displayed in front of the jury and the media. One of the most famous pictures from that time, captured by Andrea Melendez of the Des Moines Register (and shared with the Minneapolis Star Tribune) showed Swanson laughing in front of jury members as the judge read his guilty verdict. This apparent lack of remorse sent shockwaves throughout the Midwest, causing many anguished friends and family of the victims to lash out against this young man who, they said, clearly understood what he was doing and did not care.
Was Michael simply dead to the emotional current many of us would have felt in this horrific instance? Did he, as the prosecution argued in his murder trial, fully know and understand the consequences of his actions and carry them out anyway? After the incident, as news outlets looked into Swanson’s past and his family situation, more information came to light regarding his mental health. Yet in all the anguish shed over this young man’s terrible decisions, including the Iowa jury’s 45-minute deliberation to put him away for life without the possibility of parole, some important signs were missed in the rush to judgement. A closer look at Michael’s history shows that this young man indeed suffered from mental health issues, most prominently bipolar disorder. More important is how many times a system set up to provide relief to families dealing with these issues failed repeatedly. Also of note is the help that Michael could have received from psychiatrists at the University of Minnesota, who instead of treating him attempted to place him into a clinical drug trial instead. The possible ethical lapses in judgement within the U’s Psychiatry Department, led by Charles Schultz, have received much attention over the past year, with recent spotlights being shone by former Governor Arne Carlson and the Minnesota Office of the Legislative Auditor, whose chief Jim Nobles released a report in March 2015 on all of this.
Unfortunately, these problems are symptoms of a larger problem that indicts our society and its approach to mental health. The fact of the matter is many people knew that Michael Swanson had potentially problematic mental health issues, and if these were left untreated they could cause damage to people around him and the public. Yet nothing was ever done to provide him the kind of long-term care that would be required for such a disease, which the National Institute of Mental Health describes as “a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.” These failures culminated with that fateful trip to Iowa, the state where Michael now resides in prison for the remainder of his life. While there is no excuse for his actions on that November day, there is also no doubt that the system failed this young man. I was fortunate enough to conduct some communication with Mike Swanson from his incarceration at the Coralville Correctional Facility in Iowa to attempt to piece together some of his story. In one letter Mike stated that “I deeply regret what happened in Iowa. I think it could’ve all been prevented had I been medicated properly or perhaps (been) given adequate counseling.”
In one of several interviews, I asked Kathy Swanson when she first noticed signs of mental illness in her son. She said it began when he was just three years old, that she couldn’t get him to sleep and he was already having nightmares. By five, he was having night terrors and had to sleep with his parents when they’d be at a cabin up north. Attending kindergarten he had a rough time, doing “weird stuff” like spitting in the hall. By second grade Mike was being tested for autism. She recalled Mike always having difficulty making friends and that those he did interact with were troublemakers; others were disabled or had autism. In a letter from prison Mike seemed to confirm this: “I don’t really have any friends I am still on good terms with.”
Michael Swanson was described to me as a “nice kid, polite and friendly” by Andrea Turgeon, an IT Systems Analyst who has known the Swanson family for a few years. Turgeon told me she noticed Mike’s mental health “got worse every year” and would conclude with a big episode every six months. Ronda Wubbena-Tomasko and her husband Brandon have known the Swansons since the days when both their boys played hockey together in school. Ronda said when Mike was around eleven she would “keep my eyes on him” and “didn’t trust him one hundred percent.” She also told me Mike could never understand why he couldn’t have what he wanted all the time, and that they “never knew which Mike” they were dealing with most days. Bob Windels, Youth Ministry Director with Gethsemane Lutheran Church in St. Louis Park, who has known the Swansons for nearly a decade, described Mike as “quiet” but said he could always get him to smile. He told me Mike “liked to laugh” and “didn’t act better than others” when he attended Windels’ confirmation program. All of the people who knew the Swanson family told me they witnessed the family’s multiple attempts to get help through the mental health system, and none of them seemed surprised that an incident like this finally took place. Why was this allowed to happen?
The immediate questions surround where Michael was placed in the months leading up to the incident: Hennepin County Home School. Described as “a state-licensed residential treatment center for juveniles ages 13 to 20 who have been committed by the court,” where these young people can experience “a safe, secure, and healthy environment on a 167-acre rural setting,” Michael was first sent here in July of 2010 after several incidents in which he stole valuable items from his parents. When his parents first met with administrators, they shared Michael’s previous instances of manic behavior, including hiding potential weapons around their home and stealing their car to make an out-of-state trip. Michael’s mother Kathy related how she felt the need to sleep with a stick in her bed at night out of fear of her own son. She and her husband asserted that they did not want their son coming home. Michael O’Malley, the probation officer Mike had at the time, expressed his surprise that Mike was being placed at the Home School rather than in long term care. O’Malley also backed up the fact that Michael’s parents did not want him to return home anytime soon.
Michael was enrolled in the Short-Term Adolescent Male Program (STAMP) at the Home School, which is termed as “a 90-120 day intervention program for low to moderate risk youth.” Despite having a previous stayed court order mandating long-term treatment for this young man, he was enrolled in a shorter program nonetheless. A soft-spoken woman in her fifties with sandy-brown hair and glasses, Kathy Swanson declares that when it came to identifying or treating her son for bipolar disorder they “never did anything,” but were worried about his chemical use, which is common in people with the disorder as they self-medicate. Michael did have a history of using various substances, marijuana being the most prominent, but these issues paled in comparison to his mental health. This would not be the only misdiagnosis. As we sat at her kitchen table in St. Louis Park, Kathy related to me another instance, in August of 2010, when Michael reported heart palpitations. Instead of understanding this as an anxiety attack, the Home School sent him to Hennepin County Medical Center twice; Mike returned the second time with a halter monitor strapped to his chest. This sight came as a shock to his parents, who met with him that same month at a barbeque the school was hosting, as they had not been told anything about it.
I contacted the Hennepin County Home School to discuss procedures and policies surrounding the STAMP program. I spoke with Randy Bacon, acting superintendent to discuss how the facility works with youth and their families. He confirmed that youth need a court order to attend its programs, and told me the Home School has its own contract for medical services through Corizon, which covers an on-call psychiatrist and a “mid-level mental health professional.” Bacon told me that most of the youth here are between the ages of 14-17, and said that “almost all” of the youth that come here are already under probation, but may still be active in their community or going to school.
At the Home School, Michael was given a “Rule 25” evaluation for chemical dependency. His marijuana use was documented, as was his self-reported “poor impulse control” and “challenges with making decisions.” He also reported “poor insight, lack of awareness, no relapse prevention plan,” and that “most of his friends use.” Other documents from the Home School indicate that staff there worked with Michael to help him learn how his actions were affecting people in his life and to understand and control his chemical dependency. In one piece of writing Michael stated that “if I do not stay sober, I’ll send up dead, homeless, or locked up in a group home.” Mike was given a separate analysis for chemical dependency by Dr. David Frenz of St. Joseph’s hospital in October of 2010. In his report Dr. Frenz stated that Mike had cannabis dependency issues, noted that he had a “giddy mood, and an affect notable for frequent smiling and laughing.” Frenz also stated his impression that Mike had bipolar disorder and ADHD, which has symptoms described by NIMH as “difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity.” Frenz recommended outpatient help for Mike’s chemical dependency and wrote “for his other mental disorders, I defer management to the child and adolescent psychiatry service.”
No one at the Home School deemed any of this worthy of follow up until counselors discovered what Kathy described as “weird writings” that Michael had been compiling in a notebook. By this point Mike was, according to Kathy, “breezing through the program” and had a few days remaining in his 90-day program. Michael stated to counselors that they were song lyrics that, while disturbingly sexual and violent, were mostly copied from his memory. This incident was what finally got the Home School to understand her son was dealing with some serious mental health issues and therefore would need a psychological evaluation.
The recommended medication was Abilify, which Kathy understood at the time to be an add-on medication for depression and did not know it was being used off-label as an anti-psychotic. A social worker with the Home School claimed Mike told him he’d “never had a sober day,” which according to Kathy was completely untrue; he had gone months without touching any kind of drug. When she met with Senior Counselor Dan Lehnherr to review Michael’s chemical use chart they discussed what Michael had said. Kathy asked him if this could be part of a manic episode. She indicated that she was still afraid to have Michael home and reiterated to him again the bizarre behavior he had shown and how she had to sleep with a stick. She told him that Michael had indicated to her that he was not on any medication and asked him why he was not on the Abilify that was recommended. Lehnherr was not aware Michael was not on the medication, and stated that they would need to discuss this with the psychiatrist at a meeting scheduled for November 3rd, when they would go over the evaluation, treatment plan and medication.
Kathy and her husband Bob were set to meet with the psychiatrist evaluating her son at the Home School on November 3rd. They met with Dr. Jonathan Jensen, Associate Professor at the University of Minnesota and Director of the Residency Training and Education Program in Child and Adolescent Psychiatry. While his first concerns were with Michael’s drug use and his bipolar disorder, in an addendum to his evaluation he clearly stated that after discussing the situation with staff at the facility Jensen felt that Michael “poses a risk to society if unmedicated and even if medicated he is still somewhat unpredictable.” Jensen further stated his concern that Mike may repeat past behaviors such as stealing guns and robbing people. He also mentioned in the evaluation his recommendation that “Abilify would likely be helpful at around 10 mg a day.”
Kathy Swanson told me that when she met Dr. Jensen for the first time he came unprepared, bringing no prior psychological evaluations on her son. When Kathy asked if her son should be put on Abilify, Jensen claimed he had no idea of her son’s history and that he had not performed the evaluation. He stated that Dr. Katie Cullen (who was with Jensen during the initial psychological evaluation) had done the evaluation and that he was only involved to observe for her board exams. Later in the meeting, when Lehnherr stated it was to talk about putting Michael on Abilify, Jensen responded that he didn’t know anything about Mike and warned that he could go psychotic on this medication if not properly monitored. Instead, he offered to place Michael in a clinical study at the U run by Dr. Cullen. While Jensen’s actual psychological evaluation declared Michael a “risk to society,” at this duplicitous meeting it certainly seemed like he was attempting to recruit Michael for a study he’d have a hand in overseeing, a blatantly unethical move. It is Kathy’s belief that Dr. Jensen may have even been withholding a prescription of Abilify in order to place Mike into this study. I reached out to Dr. Jensen directly to see if he would be willing to speak with me. He referred me to the Communications Office at the Academic Health Center, but despite repeated requests for comment, I never received a response. In a letter I received from Mike he wrote that “Dr. Jensen diagnosed me as having bipolar disorder. Then he told me he was going to start me on Abilify. Three weeks later I met with him and he said that he is not my treating psychiatrist. So I left the home school unmedicated – basically a loose cannon. He even wrote a report that said if I remain unmedicated I would be at risk of hurting/robbing other people.”
This would not be the first time a professional associated with the university had wandered into this kind of territory. Carl Elliott, a professor with an MD and PhD who works in the Bioethics Center at the U of M, told me he’s witnessed this type of behavior for over a decade. A simple Google search pulls up this man’s prolific career as a lone voice in the wilderness calling for the reforms needed at this institution. Maura Lerner of the Star Tribune covered his contentious opposition with the university last year, Science Magazine profiled his “lonely crusade”, and he upholds a blog devoted to “fear and loathing in bioethics.” He has also written numerous papers and articles, and a book on these subjects. In a phone interview Mr. Elliott said he perceives “serious problems” with “patients who were severely ill” in clinical trials like the one Dr. Jensen was trying to put Michael into. Elliott covered the Dan Markingson case extensively, telling me that young man was “pressured to be enrolled in studies.” He spoke of extensive “coercion of patients” in these drug trials and about the “financial pressure of the U” on the psychiatrists responsible for these trials. He was also very critical of the number of pharmaceutical dollars “sloshing around,” and said there was a “big oversight problem” at the university. I asked Carl why the U seems to be immune from oversight, and he said there is “very little external policing of research.” Combine that with a lackluster Internal Review Board that essentially rubber stamps the previous doctor’s findings and you get to a point of “untouchability,” as he characterized it. In May the FDA concluded a second look at part of the Markingson case but still refrained from placing blame on the U of M psychologist who recruited him for the study.
Mike Howard, a friend of the Markingson family, had similar things to say in an interview conducted before the Legislative Auditor’s report was released. An ex-retail consultant who has assisted Markingson’s mother Mary Weiss in the wake of her son’s death in a clinical trial over ten years ago, Howard described to me the web of deceit this family encountered at the Psychiatry Department. The university is “hiding behind statutory immunity,” he told me as we sat around Ms. Weiss’s kitchen table in Cottage Grove. He said that in the ten years since Dan’s death, the U has found “zero” new information on treating mental health. He believed Charles Schulz, the former head of the department, was brought in as a “cash cow” for Big Pharma’s research, saying that “money is what drives them.” Howard said the biggest problem here was patient safety, which the U simply didn’t consider in the Markingson case. He said despite repeated denials by the U, there was never an official exoneration by the Medical Review Board or the state Attorney General’s office.
Niki Gjere, a Registered and Advanced Practice Nurse who has worked at the U of M Hospital for years, told me much the same from her experience. Ms. Gjere was someone whom other nurses would go to for ethics and clinical practice concerns and has since turned into a whistleblower, alerting the media to these unethical practices. She told me Fairview, the hospital where she works, was pressured by the university’s Psychiatry Department to use their patients for clinical trials. She also told me staff at the hospital don’t always know about these studies and therefore “can’t help patients be safe.” Ms. Gjere is also on one of the university’s Institutional Review Boards, but said it relies on the integrity of the researcher to follow the protocols. It had “very little oversight” of the Psychiatry Department and its former head, Dr. Charles Schulz. She said those who bring up these problems “get punished.” She described the university as having unlimited resources to protect itself from challenge and that “tons of money” is at stake in these trials. (In the wake of an external review and the Legislative Auditor’s report, Dr. Schulz stepped down from his position as chairman, but will still do clinical work for the department.)
Mr. Elliott and other critics of the U would see vindication in a landmark report prepared by the Minnesota Office of the Legislative Auditor. Jeremy Olson, a reporter with the Star Tribune who has also reported on the Swanson case, covered the release of the report. In his story he noted that the report recommended the university cease all drug trials until previous “lapses in patient protections and ethical oversight are addressed in its psychiatry department.” Olson quoted Jim Noble’s staff as saying “We are especially troubled by the response of University leaders … they have made misleading statements about previous reviews and been consistently unwilling to discuss or even acknowledge that serious ethical issues and conflicts are involved.” University President Eric Kaler, while still disputing some of the report, nevertheless said his school would “suspend enrollment in current and upcoming psychiatric drug studies until an independent board reviews them and informs university administrators that they can safely proceed.” Arne Carlson, the former Minnesota governor who has been a tireless advocate for patients’ rights in these cases, penned a recent OpEd for the StarTribune calling for Kaler’s resignation, a point he also raised in a wide-ranging interview with Susan Perry of MinnPost.
In May, the U of M offered some proposals from a panel convened by President Kaler to thoroughly alter the recruitment and research procedures within the Department of Psychiatry. Olson reported that the oversight mechanisms proposed for overhaul include the Institutional Review Board and that “the U also would create a new panel specifically to evaluate studies that recruit vulnerable patients whose capacity to consent to research might be limited or fluctuating.”
All of this came too late for Michael Swanson. The fact of the matter was that Dr. Cullen’s study had wrapped up by this November 2010 encounter. Dr. Jensen made no mention of this at the meeting, which was the only time Kathy Swanson said she ever spoke with him. It is her belief that Dr. Jensen was attempting to steer Mike into Cullen’s trial for his own benefit rather than any help it could have provided for her son. My later research into this study revealed that Cullen’s trial wasn’t even receiving bipolar patients, and that she filed the results a month after Michael’s fateful trip to Iowa.
Concluded in Part 2.
John Abraham-Watne is a published author and freelance journalist located in the Twin Cities, where he lives with his wife Mary and their two cats. He is the author of two novels published by North Star Press. John conducts freelance journalism on local government issues for the news/entertainment website MinnyApple. His work has also appeared in the Southwest Journal and the Hill & Lake Press.