MOOSE LAKE SEX OFFENDER PROGRAM

Part 6: When police discovered his disturbing secret room and encrypted files, they moved fast

Trisha Taurinskas — Wed, 27 Mar 2024 12:30:00 GMT

Editor’s note: This is Part 6 in the Forum News Service investigative series looking into the disappearance of Belinda Van Lith, including an exclusive interview with the main suspect in her case. To see everything published in the investigation, visit our

Belinda Van Lith investigation page.

Listen to

The Vault podcast

for associated episodes.

MOOSE LAKE, Minn. — A secret basement room and encrypted computer files sealed Timothy Crosby’s fate.

For more than a decade, the main suspect in Belinda Van Lith’s disappearance — from a home on Minnesota's Eagle Lake in June 1974 — has been locked at a high-security facility for the state’s most dangerous sex offenders.

Crosby’s involuntary commitment to the secure Moose Lake Sex Offender Program facility came after investigators with the FBI, Wright County Sheriff’s Office and the St. Paul Police Department executed a search warrant at his home.

Investigators uncovered a locked secret room in Crosby’s basement, which contained an assortment of cameras surrounding a bed. Encrypted files discovered on his computer revealed handbooks on how to abduct, torture and kill women, among other violent and graphic material.

The discovery came on the heels of Crosby’s confession that he hired a 17-year-old girl to perform sexual acts, which resulted in a conviction for using a minor in a sexual performance.

The conviction, paired with explicit material found in his home, was the last straw in Crosby’s decades-long spree of violent and sexual crimes against women — and effectively resulted in his life sentence.

Crosby’s history of kidnapping and sexual assault was included in Belinda’s 1,200-page Wright County Sheriff’s Office investigative file, obtained in August 2023 by Forum News Service and Belinda’s family members.

The Forum News Service investigation into the Belinda Van Lith missing persons case is based on multiple interviews with family members, friends, witnesses and law enforcement officials, reports obtained from three investigative agencies, as well as an in-person interview with Crosby, the main suspect.

Crosby became a suspect in Belinda’s case six months after she went missing, when he kidnapped and sexually assaulted a young woman at his Eagle Lake cabin.

He told Forum News Service in a recent in-person interview that he sees no merit in the Wright County Sheriff’s Office’s focus on him as a main suspect in Belinda’s disappearance.

Crosby was staying alone in that cabin the weekend Belinda went missing. She was housesitting a home just down the road, roughly 100 yards from his cabin.

Belinda remains missing. Crosby was the last known person to see her.

The 2009 arrest and discovery

The series of events that led to Crosby’s 2009 arrest would arguably not have happened without the cold case review of Belinda’s case, decades after her disappearance.

The tip that led investigators to Crosby’s 2009 arrest for hiring a 17-year-old to perform sexual acts stemmed from the work of a St. Paul Pioneer Press reporter, who discovered the search warrant application.

That application named Crosby as a suspect in Belinda’s disappearance and the 1994 murder of Victoria Marie Morris. The Pioneer Press coverage exposed that information to the public for the first time.

In the wake of Crosby’s arrest for hiring a minor for a sexual performance, among other charges, another search warrant was executed on his St. Paul home. This time, investigators had free rein to search the interior of the home, including the basement.

Crosby’s 17-year-old victim told investigators Crosby had shown her a padlocked “secret room” room in the basement, which included a desk, bed, and miscellaneous cameras and video equipment. Accessing the basement was only possible through a basement near the back of the home, which she said was kept locked.

The main floor of Crosby’s home was cluttered and full of “filth,” according to the victim’s statement. The basement, though, was kept incredibly clean.

“She states that Tim Crosby keeps this basement area surprisingly clear and it has an overwhelming bleach smell,” Wright County Sheriff’s Office Lt. Mike Lindquist wrote in his report.

Crosby basement

That information was confirmed when investigators with the FBI, Wright County Sheriff’s Office and the St. Paul Police Department executed the search warrant at Crosby’s home. They used a bolt cutter to cut the padlock on the door to the secret room — and later discovered the lock could be opened by a key found on Crosby’s keychain, which was confiscated when he was arrested.

Investigators found a number of items in the basement that were later used to prove Crosby had not stopped his pattern of sexually violent behavior — and that he was likely to reoffend.

Officers collected a hacksaw blade in the trunk of his car.

“This made officers suspicious as to what this hacksaw blade was used for, as it was with pornography and other odd objects, and locked in the trunk so nobody could easily access it,” Lindquist wrote in the report.

The saw was collected for evidence in the case of Martha Bacon, whose dismembered remains were discovered in Wright County in 1993. Investigators believe a saw was used in her dismemberment, according to the report. That case is ongoing, and its filings remained sealed by a judge.

In addition to the saw, more than 30 items were collected and taken into evidence, including a number of newspaper clippings and magazine articles about rape, serial killers, homicides and sex offenders.

A Mac computer collected in the main living area was taken and sent to the Bureau of Criminal Apprehension for forensics analysis. Court records related to Crosby’s civil commitment appeals revealed the contents of encrypted files discovered on that computer.

“These files contained hundreds of images depicting a wide array of sexually explicit content, including torture, rape, bondage, abduction, child pornography, bestiality, and death. They also contained numerous articles about abduction, torture, rape, and murder of women and girls,” the court documents state.

Crosby's computer

Those documents also revealed that law enforcement found an abduction handbook, though that item was not listed in the investigative file.

“And police found a handbook that contained instructions on how to abduct, torture, and kill a woman for pleasure,” the court documents state.

All of the items collected, in addition to Crosby’s violent sexual history and his 2009 confession to using a minor in a sexual performance, led the state of Minnesota to pursue his involuntary civil commitment as a dangerous and violent sexual recidivist.

Minnesota law allows the involuntary commitment of individuals who have been deemed a sexually dangerous person with a sexual psychopathic personality through convincing evidence presented in court procedures.

The state argued the items collected at his home, in addition to his 2009 arrest, indicated he was a danger to the public and likely to reoffend.

The interview with Crosby

Nestled in a wooded area less than a mile from Interstate 35, razor wire fencing surrounds the grounds of the high-security Moose Lake Sex Offender Program facility.

In December 2023, Crosby agreed to an in-person, recorded interview with Forum News Service at that very location.

A month later, Crosby sat down with a reporter and a microphone in a meeting room at the facility — and the interview began.

Crosby told Forum News Service there was an innocent explanation for all of the material gathered by investigators. He used locks to keep his children out of dangerous areas, and other people used the computers in the house, he said.

The state’s argument was backed up by the testimony of three forensic psychologists, who testified that Crosby’s actions in 2009 — in addition to the sexually violent materials collected at his home — proved a cycle of harmful violent, sexual behavior.

“The question before the district court was whether Crosby's psychosexual condition and his course of behavior reveals a current trajectory toward reoffense and renewed danger to others,” court documents state.

According to the psychologists, it did.

Crosby’s record was central to the state’s argument in favor of his commitment. Yet in his interview with Forum News Service, he denied the accuracy of information that led to his four convictions.

“From what I’ve read from those three things, there’s data errors in the reports,” Crosby said. “Just the ones that I’ve read. That’s an error, that’s an error. There’s nothing I can do to fix the errors.”

In the same interview, he said his actions were merely a reflection of his immaturity.

“Did I do stupid things when I was younger? Yes,” he said. “Did I understand why I was doing them? No.”

Crosby’s known crimes include:

On Dec. 30, 1974, Crosby kidnapped a 19-year-old woman in St. Paul. He pointed a gun to her head. He handcuffed and blindfolded her. He took her to his cabin on Eagle Lake, where he tied her up and sexually assaulted her. She escaped — and her witness statement led to Crosby’s arrest for aggravated kidnapping with a dangerous firearm, robbery and sexual assault. He pleaded guilty to aggravated kidnapping while possessing a firearm — the sexual assault charge was dropped. He was sent to St. Peter Hospital, which at the time was the state’s top treatment facility for sexual aggressiveness.
On April 25, 1983, Crosby kidnapped and stabbed a young woman in St. Paul after offering to give her a ride. He threatened her with a knife, but she fought back and escaped. He was charged with aggravated kidnapping, but the charge was dropped. He, instead, was sent back to St. Peter Hospital.
On July 18, 1987, Crosby took a woman to his St. Paul apartment, where he tied her up, repeatedly sexually assaulted her, and kept her captive. She escaped 16 hours later by jumping out of his apartment window. He was arrested on charges of false imprisonment and sexual assault. He pleaded guilty to third-degree sexual assault and was sentenced to 41 months at the Minnesota Correctional Facility in Stillwater. After his release, he was transferred to St. Peter Hospital but voluntarily exited the program.

In his hourlong interview with Forum News Service, Crosby denied the facts of the three police reports related to the women who escaped. All three police reports included full transcripts of the victims’ statements and corresponding evidence that backed up the women’s claims.

His refusal to accept responsibility played a key role in the judge’s belief that Crosby has not taken accountability for his acts of sexual violence.

“At trial Crosby testified about his history of sexual violence in a manner that led the district court to deem the testimony incredible, finding that Crosby made excuses for his behaviors, minimized his conduct and remembered only things that made him look better,” Judge Kevin G. Ross wrote in his decision.

Is Crosby’s commitment justice for Belinda?

Timothy Crosby’s civil commitment is potentially a life sentence.

The road out of the Moose Lake facility requires commitment on behalf of the offender to attend treatment programs and therapy sessions, all of which are voluntary. If an offender is seen progressing in treatment, they are considered a candidate for the St. Peter facility.

Reintegration into society is the focus at St. Peter. An offender who is still considered dangerous, or lacks accountability for their actions, is not a candidate for reintegration.

Crosby told Forum News Service that he refuses — and will continue to refuse — sex offender treatment at the Moose Lake facility. He continues to skirt accountability for his criminal history.

That means the main suspect in Belinda’s disappearance will likely spend the rest of his days locked away from society.

But, is that justice for Belinda?

Her siblings were not informed, at the time, of the search warrant executed at Crosby’s home. They did not know Crosby was considered the main suspect, and they were not aware of his civil commitment petition and court proceedings. They learned all of this when they received the investigative file in August 2023.

Had they been kept in the loop, Crosby’s commitment might have felt like justice. Yet, they still do not have the answers they need.

“Where’s the final closure? We want 100 percent closure for us,” said Wendy, Belinda’s sister. “Where’s her body?”

Crosby still denies any involvement in Belinda’s disappearance.

When asked if he killed Belinda or had anything to do with her going missing, he gave Forum News Service a nonsensical response.

“No,” Crosby said. “There ain’t nothing I can do about anything. Can’t change, unless you guys find something after the fact. [If] somebody comes up and says, ‘Oh yeah, I was.’ You know what I’m trying to say? Unless somebody comes up. Of course Duane or Dwight can’t. But did anyone even look at maybe there was a family thing going on? Some of the family members might have been mad at her?”

The interview with Crosby also revealed new information regarding his possible involvement in Belinda’s disappearance.

In the days after Belinda went missing, Crosby told investigators she had been at his cabin on June 14, 1974 — the day before she went missing — looking for his sister, Susan. That was the extent of the information he provided at the time.

Belinda wasn’t close with Susan, but Belinda’s siblings believed she went to the cabin that day to remind Susan about Pam’s going away party, scheduled for the next day, June 15, 1974. Susan and Pam were close friends at the time.

Crosby confirmed that belief and revealed to Forum News Service that he gave Belinda a reason to return.

“I’d swear somebody had said something about a party, and that’s why somebody was looking for Susan,” Crosby said. “[Belinda asked] was she going to come up there. And I said, yeah I think Susan’s coming up this weekend.”

Susan did not go to the cabin that weekend, and Belinda did not show up to her sister’s going away party.

The release of the investigative file and statements Crosby made to Forum News Service provide more pieces to the puzzle surrounding Belinda’s disappearance.

But, the heavy weight of the unknown for the family has not been entirely lifted.

Belinda’s family members still do not know what happened to their kind, intelligent sister on June 15, 1974. They’re left with missing pieces that can be filled only with theories and likely possibilities, but they do not know where Belinda’s remains rest.

Someone has the answers they’ve longed for, though. The question is: Are they capable of taking accountability?

Editor's note: This is part 6 of Forum News Service's

investigation

into the Belinda Van Lith missing persons case. If you have information in this case, please contact Mike Lindquist with the Wright County Sheriff's Office at

763-682-1162.

Belinda Van Lith

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Charges against Duluth psychologist dropped after key witness dies

Tom Olsen — Thu, 15 Feb 2024 19:41:14 GMT

CARLTON — Charges have been dismissed against a former Minnesota Sex Offender Program psychologist accused of sexually assaulting two clients in the Moose Lake Minnesota Sex Offender Program.

The death of a "critical witness" left the prosecution unable to move forward with the case against Michelle Dawn Brownfield, according to Chief Deputy Carlton County Attorney Jeff Boucher.

Brownfield, 41, of Duluth, had been set to appear in court this week and was scheduled to face an April 30 jury trial on two felony counts of third-degree criminal sexual conduct.

The charges stemmed from allegations that the psychologist maintained inappropriate relationships with two men she was assigned to treat at the Minnesota Sex Offender Program, or MSOP. MSOP is a secure state facility that serves clients committed as sexually dangerous or with sexually psychopathic personalities.

Boucher explained to the News Tribune that the sister of one of the alleged victims died. She was described in the criminal complaint as the "go-between" for Brownfield to communicate with the client, as seen in numerous text messages retrieved by investigators.

"(Her) testimony was necessary to develop critical aspects of the case," Boucher said. "Without her presence, the available admissible evidence was insufficient to continue to trial."

The charges against Brownfield had been pending for nearly three years as several pretrial issues were litigated, including the veracity of a search warrant and access to confidential medical and mental health records.

The complaint said Brownfield developed a relationship with one victim after he was referred to her in 2016. They allegedly engaged in sexual activity in the assessment room at MSOP before he was transferred to a Minnesota Department of Corrections facility from 2017-19.

Authorities said Brownfield used the client's sister to communicate during that time. They continued to talk when he returned to MSOP, but the sexual activity did not resume, according to the complaint.

While investigating, officers said they learned of an illicit relationship between Brownfield and a second MSOP client that began in the fall of 2017. The man told authorities he was aware of her relationship with the other victim and began discussing it with Brownfield.

The client and psychologist then initiated their own sexual contact in the assessment room in February 2018, later having sex in the polygraph room, according to the complaint.

Investigators said they recovered text messages sent from Brownfield to the first victim's sister between October 2018 and August 2020. She reportedly expressed "strong romantic feelings" and also referenced a relationship with another person consistent with the allegations involving the second client.

The complaint added that Brownfield referenced both victims by initials in the text messages and continued communication even after being contacted by the Moose Lake Police Department. Investigators wrote that a review of her phone turned up a "great deal" of graphic material, including sexually explicit photos that corroborated a victim statement regarding a body piercing.

It is illegal under Minnesota law for any employee of a correctional system or secure treatment facility to engage in sexual activity with a resident who is under the institution's supervision. Consent is not a defense.

Brownfield in 2021 entered into a stipulation with the Minnesota Board of Psychology to cease practice pending further administrative proceedings. That order remains in effect.

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'Yes, I was attempting to kill somebody’: Inmate at NE Minn. correctional facility sentenced after attack

Tom Olsen — Tue, 18 Jul 2023 15:16:36 GMT

CARLTON — Nicolas Ladell Aron-Jones was desperate for a transfer to another correctional facility. So desperate that it nearly cost Mark Agurkis his life.

"It’s no less than a miracle that I’m even able to address the court today," Agurkis told a judge Monday afternoon. "I don't remember much of the attack to be honest."

Agurkis, working as a security counselor at the Minnesota Sex Offender Program in Moose Lake, suffered a traumatic brain injury and had to be airlifted to a hospital after the client bludgeoned him with an improvised weapon during the May 1 ambush — one of the most serious incidents in the three-decade history of the controversial program that holds offenders who have already completed prison terms.

Aron-Jones, who has been in a variety of local jails, state prisons, and treatment facilities since his teenage years, acknowledged that he simply wanted out of MSOP — and was willing to go to any means to make it happen.

"Yes, I was attempting to kill somebody that day," he told the court. "If I’ve got to go back, it’s going to happen again. I’m going to make sure I kill somebody so I can spend life in prison."

Judge Amy Lukasavitz sentenced Aron-Jones to 18⅓ years. The agreed-upon term falls just shy of the statutory maximum for attempted second-degree murder, but the resolution offered little satisfaction for most in the courtroom.

"It’s troublesome to the court that you’re going to get exactly what you wanted," the judge said, acknowledging the lack of alternatives for a man who has repeatedly assaulted staff members since first being sent to MSOP in 2015.

Agurkis and his partner were making their final rounds for the day when Aron-Jones approached him from behind and struck him with a pillowcase containing a fan motor, according to court documents. The employee fell to the ground and was unable to defend himself as Aron-Jones swung the weapon at his head and body several more times.

Aron-Jones reportedly kicked and stomped on Agurkis' head eight times before being pushed away by other staff and sprayed with a chemical irritant. As he retreated to his room and was transported to another area of the facility, he was heard yelling threats and making a series of comments, including: "His man saved his life because I was going to kill that motherf-----."

Agurkis indicated Monday that he was a member of a "utility pool" and was not even scheduled to work in Aron-Jones' unit that day. He said he had "very minimal contact" with the client during his time at the facility, leaving no doubt that it was a "planned, premeditated assault."

"I felt used by the defendant so he could get something he wanted: a transfer to another correctional facility," Agurkis said, indicating he still deals with headaches and mental trauma from the attack, leaving his employment future uncertain.

Aron-Jones, according to documents, was convicted of multiple sex crimes and violent offenses as a juvenile in the Twin Cities area. He has been in local jails, the state prison system, and various treatment facilities since his teenage years, and he is under indefinite commitment to MSOP as a "sexually dangerous person."

A 2015 commitment order indicates he was charged in juvenile court in 2009 with molesting 9- and 15-year-old boys, later pleading guilty to second-degree criminal sexual conduct. He was ordered to undergo treatment and subsequently admitted to a count of fourth-degree criminal sexual conduct for assaulting a female staff member at a group home.

As an adult, Aron- Jones was convicted of exposing himself to a developmentally disabled woman at a park, biting a correctional worker and violating predatory offender registration requirements.

He's been in and out of Moose Lake, returning to prison at various times for five felony convictions that involved assaulting MSOP staff, making threats and damaging property.

Public defender Tyler Hedin said he does not condone his client's behavior but asked the public to take a hard look at the state's sex offender system. The indefinite commitment process allows the state, with a judge's approval, to hold offenders well beyond after their criminal sentence is fulfilled. It is considered a treatment program, but very few clients have been successfully discharged back into the community.

"We shouldn’t have a situation where there are more staff getting assaulted than there are people graduating the program," Hedin said.

Aron-Jones claimed he was called "disrespectful names" and that staff joked about how "dying was the only way to graduate" the program. While he briefly apologized to Agurkis, he indicated clients have been left disgruntled at MSOP.

"I'm serving an indefinite sentence for something I did as a juvenile, as a kid," Aron-Jones said. "My family is hurting. My mother is hurting. I’ve got to live with it every day."

Aron-Jones will need to serve at least two-thirds of the term, a little over 11 years, before he is eligible for release from prison. However, he is likely to face a return to MSOP.

Chief Deputy Carlton County Attorney Jeff Boucher said he hopes Aron-Jones "will rethink his response to the circumstances and choose the opportunity to be rehabilitated."

"He nearly killed a staff person who had done him no wrong," Boucher said. "This calls for the most significant sentence."

Judge Amy Lukasavitz echoed the prosecutor's comments and said Agurkis was "just doing his job."

"I appreciate that you have taken responsibility," she told Aron-Jones. "But you hurt someone and their family. I don't know that two wrongs make a right in this case."

Another serious attack happened at Moose Lake in 2019, when sex offender George Mack Jr. used a razor blade to slash the throat of clinician Zachary Campbell. Officials described that as "one of the most serious attacks" in the program's history, and it resulted in Mack receiving the statutory maximum of 20 years in prison for attempted murder.

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Moose Lake sex offender charged with attempted murder of staff member

Tom Olsen — Thu, 04 May 2023 19:18:11 GMT

CARLTON, Minn. — A sex offender allegedly used a fan motor to bludgeon a security counselor before stomping on his head and bragging about the "unprovoked" attack, officials said Wednesday, May 3.

Nicolas Ladell Aron-Jones, 29, has a history as a combative client at the Minnesota Sex Offender Program in Moose Lake, having been convicted of assaulting staff, making threats or damaging property on at least five prior occasions since 2015.

However, Monday's alleged assault is believed to be one of the most serious in the facility's 27-year history, leading to a traumatic brain injury that required the 53-year-old employee to be airlifted to an advanced care hospital.

“We are deeply disturbed by such a brutal, senseless attack," Nancy Johnston, MSOP executive director, said in a statement. "I’m grateful to those who tried to intervene and protect our coworker. Our hearts are with him and his family, and we’ll be there to support him as he recovers.”

The employee was not identified in court documents, and a spokesman for the Minnesota Department of Human Services, which operates the program, said the agency is not able to offer any update on his condition due to data privacy requirements.

A criminal complaint states that the security officer was making his rounds when Aron-Jones approached him from behind and struck him with a heavy object, which was later determined to be the fan motor in a pillowcase. The employee fell to the ground and was unable to defend himself as Aron-Jones swung the weapon at his head and body several more times, the complaint states.

The defendant allegedly kicked and stomped on the counselor's head eight times before being pushed away by other staff and sprayed with a chemical irritant. As he retreated to his room and was transported to another area of the facility, Aron-Jones allegedly yelled threats and made a series of comments, including: "His man saved his life because I was going to kill that (expletive)."

The complaint states that the staff member was flown to an unspecified hospital and diagnosed with a traumatic subarachnoid hematoma, along with other injuries, including a laceration to the eye.

According to documents, Aron-Jones was convicted of multiple sex crimes and violent offenses as a juvenile in the Twin Cities area. He has been in local jails, the state prison system and various treatment facilities since his teenage years, and he is currently under indefinite commitment to MSOP as a "sexually dangerous person."

As an adult, Aron-Jones was convicted of exposing himself to a developmentally disabled woman at a park, biting a correctional worker and violating predatory offender registration requirements.

In his time at Moose Lake, he has been found guilty of third-degree assault, two counts of fourth-degree assault, making terroristic threats and first-degree damage to property — all felonies.

Court documents indicate he has repeatedly threaten to kill staff members and has punched, bit and spit on employees in previous unprovoked attacks. In one case, a worker was briefly knocked unconscious by Aron-Jones and kicked several times while he was on the ground. In another, he reportedly grabbed a female worker while brandishing a sharpened plastic object and stating that he was "in prison for life and had nothing to lose."

Aron-Jones received prison time for all five incidents at Moose Lake and has at times been moved to the custody of the Minnesota Department of Corrections. However, the sentences had little practical effect, as he remains subject to the civil commitment.

The sex offender program has been controversial for decades, allowing the state — with a judge's approval — to hold offenders well after their criminal sentence is fulfilled. It is considered a treatment program, but very few clients have been successfully discharged back into the community, and many have spent decades locked up at the Moose Lake and St. Peter facilities.

Aron-Jones reportedly cited Mack by name while threatening to stab staff members just weeks afterward.

Human Services spokesman Christopher Sprung said the agency is conducting a review of Monday's incident and offering counseling to employees. He indicated that there are hundreds of cameras across the campus and there is a "well-trained and equipped incident response team that can act quickly in emergency situations."

Sprung said the facility has two behavioral units that allow for more intensive monitoring, but only on a short-term basis while staff works to get clients "back on track." There are also single-room, high-security areas that can be used in the event of a security concern, though state law and rules limit their usage.

"Because MSOP is a treatment facility, not a prison, clients are not locked in their rooms, but have varying levels of liberty," Sprung said. "The unit where clients live and their freedom to move about the campus are based on behavior. The program uses a multi-tier system to assign clients increasing levels of movement."

He said the agency could not comment on Aron-Jones due to client privacy regulations, but added: "Safety for staff and clients is our top priority."

Aron-Jones was arraigned Wednesday on charges of attempted second-degree murder and first-, second- and third-degree assault. He faces up to 20 years in prison, if convicted.

He is being held at the Carlton County Jail, with Judge Rebekka Stumme setting his next appearance for May 15.

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Minnesota Sex Offender Program found in violation of state requirements

Laura Butterbrodt — Mon, 28 Feb 2022 23:26:17 GMT

MOOSE LAKE — The Minnesota Sex Offender Program was found by the Minnesota Department of Health to be in violation of several state requirements, including failing to have a medication control plan; to provide timely and appropriate interventions to address resident self-harm and other medical issues; and to ensure resident access to a private phone, according to a state licensing compliance report.

The lack of a medication control plan led to MSOP residents in Moose Lake selling medication to one another for illegal use and to engage in suicidal behavior using medication, the department of health reported last week.

In an Oct. 19 incident report, staff were told by a resident that another resident was "running a script store" and was allegedly threatening peers about receiving money. A staff member reported observing a client approach that resident and ask him for something, who then handed him "something small" that could not be identified.

Another incident report from January 2021 stated a resident requested to move units because he was getting high every day living with the resident mentioned in the October report. The resident making the complaint alleged that the pills they were taking came from multiple clients in the unit.

The program was required by the state to come up with a medication control plan for how administration, distribution and storage of medications at the facility will be handled. In addition, it must record the medications of each resident and periodically review those medication regimens.

The facility also failed to provide timely and appropriate interventions to address resident medical issues and routinely used chemical irritants for resident restraint and compliance.

A series of incident reports between March and December detailed at least six suicide attempts by a resident who would ingest various substances, including large quantities of pills, glass cleaner and contact lens solution. According to the report, facility staff used pepper spay on the resident five times in that period of time to extract the client from his room and gain his compliance after he made threats to himself and staff. Staff also used chemical irritants to induce vomiting after the resident was observed ingesting pills.

The resident, who had been diagnosed with antisocial personality disorder, fetal-alcohol spectrum disorder and multiple mood-related disorders, including major depressive disorder, was examined in a facility Vulnerable Adult Assessment. The assessment did not mention any of the resident's suicide attempts and concluded that the resident was not a vulnerable adult because the personality and mood disorders did not impair his cognitive awareness.

In an interview with the investigators, the resident said when he self-harms, "It always means pepper spray when they want my clothes off," the report states. The client was required to undress for visual body searches after self-harming attempts.

According to the Centers for Medicare and Medicaid Services State Operations Manual, the use of weapons, including pepper spray and mace, for restraint is not considered a safe or appropriate health care intervention. A Minnesota statute declares that pepper spray may only be used for law enforcement or military purposes, or for reasonable defense of the person or person's property.

However, the MSOP's Use of Force and Restraint Policy detailed that chemical irritants may be used to gain control of a situation when it is the safest way to maintain safety, including if there is a threat to the immediate safety of staff or clients.

Several administrative staff were interviewed by the Minnesota Department of Health about chemical irritant deployment procedures and assessment of residents. They stated that the MSOP team is trained to use the chemicals and to decontaminate after. Clients are only medically assessed after chemical deployment if there are reports of concerns from individual clients, a registered nurse said.

Another MSOP resident reported that staff was "ignoring him and making fun of him" for reporting pain for 12 days after a surgery on his genital region. According to the resident, he had to threaten to overdose on medication before he was seen by a provider in the emergency room, who discovered a problematic stitch placement.

In addition, the Moose Lake MSOP was found to violate residents' rights to communication privacy by not providing a phone from which residents could make private phone calls. Several incident reports included in the state licensing compliance report stated that residents requested or attempted to call abuse prevention lines and the Common Entry Point, which receives reports of maltreatment.

Because staff and other residents could hear communication over the phone, residents reported getting "in trouble" for reporting names, and being refused access to the phone to make reports.

The MSOP was required to submit plans for correction for all violations to the Minnesota Department of Health seven days after receiving the report, which was concluded Feb. 1.

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