Beyond the call of duty

When 15-year-old James Stout arrived at Topeka State Hospital in June 1996, he had four shirts, three pairs of jeans, six sets of socks, a silver necklace with a wooden cross pendant, and a lot of emotional baggage from shuttling among foster parents, group homes, and mental hospitals all over Kansas since he was 6. Stout’s transfer from another mental hospital, Larned State Hospital, was facilitated so he could be closer to his mother, who worked at a McDonald’s in Beloit. It was an unremarkable event. The psychologist assigned to his case, Dr. Cynthia Turnbull, later recalled that she thought of Stout as a “garden-variety patient.”

Stout was average looking and average size for a male in his midteens — 5’9″ and 155 pounds, with short, dark hair. He had a low-average IQ of 84 and a slight speech impediment. His records showed he could be quiet and reserved at times, or act pleasant and helpful, then turn loud and aggressive.

The Stouts had a family history of alcohol abuse and drug abuse, and Stout’s father had been discharged from the U.S. Army in Germany after a psychotic episode and later was sent to prison for molesting two little girls. Stout talked a lot about his older sister’s 1989 death, and he told his doctors she had died of back injuries from being hit with a baseball bat, though family history showed it was rheumatoid arthritis. Stout would sometimes sink into deep depression about her death and would try to slit his wrists. Other times he would make weapons out of whatever was available, swinging a lock inside a sock or brandishing a leg brace. His mother never could handle him.

At the time of Stout’s transfer, Turnbull, then 38, was one of two psychologists on a volatile adolescent unit. She normally handled male patients because her colleague was uncomfortable with them. When Turnbull flipped through Stout’s thick files, the diagnosis from Larned seemed wrong to her.

Stout’s release summary said he had “oppositional defiant disorder,” which means he was just a mouthy, contrary teenager but was basically harmless. Turnbull read that Stout had threatened, hit, and cussed at Larned staff and peers, often yelling “Fuck you!” and threatening to “go off.” He had destroyed windows, kicked a pet-assisted-therapy dog, taken a gun to school and threatened a teacher with it at age 11, run away from various homes, and once mugged an elderly woman for $40 before hitting her with her purse. Turnbull changed Stout’s diagnosis to “conduct disorder,” the juvenile version of a sociopath.

“That would indicate that he would consistently violate social norms, that there would be little or no conscience, that there would be a history of legal involvement, typically that would involve torturing animals, torturing children, other people,” Turnbull later said.

But the adolescent ward was treating more and more dangerous future sociopaths, many patients who should have been in a correctional facility instead of a mental hospital. So Stout’s past behavior seemed relatively mild to both Turnbull and her colleague on the adolescent unit, Dr. Laura Talley. Stout certainly didn’t stand out next to the many gang-banger wannabes on the unit who would go ballistic, riot, and assault the staff, and he didn’t look physically intimidating. Some patients on the unit were 6 feet tall and 240 pounds and were covered in tattoos. One gargantuan teen had swastika symbols all over his arms.

But ultimately it would be Stout who was the greatest threat to Turnbull’s safety.

In the year before Stout’s arrival on the unit, Turnbull had complained to administrators several times that members of the mostly female staff, who worked one-on-one with patients, feared for their safety. Conditions had begun to deteriorate in 1995, when, in response to staffing shortages, walls were torn down to combine four adolescent units (one male, one female, and two coed) into one large coed unit. After that, there were two full-scale patient riots, and Topeka police had to be called in with shields, tear gas, and police dogs. One patient punched a nurse and broke her nose, and another patient stabbed a nurse with a ballpoint pen, aiming for the jugular vein. Some nurses were afraid and would huddle near the nurses’ station. The staff received MANDT training, named for its creator, David Mandt, but it was nothing more than a system of gentle holds and verbal techniques used to calm a violent patient and was useless against many attacks. The hospital provided no self-defense classes for staff members, though a Topeka State Hospital (TSH) staff psychologist, Dr. Carol Adams, told a group of colleagues she had requested that type of training.

Stephen Feinstein, who was superintendent at Osawatomie State Hospital from 1994 to 1998 and is now retired and serves as president of the National Alliance for the Mentally Ill-Kansas, says mental hospitals should “absolutely not” provide self-defense classes to their employees because it would pose a risk of harm to the patients.

“This is a medical facility, and the objective is not to get in combat with a patient. The objective is to defuse the situation and deal with the patient in as soft and gentle a manner as possible,” Feinstein says. “We have (patients) who are extraordinarily vulnerable given into our care. It doesn’t translate into that we don’t care about our staff, but staff are in a better position to control their own lives than these people who have already had so much taken away from them.”

Some of the state’s female mental health staff, however, wished the state would give them the tools to protect them by any means necessary from assault and rape. Turnbull tried to address the problem at the root, though, hoping violence could be averted by calming the situation on the unit.

At an April 5, 1995, meeting with administrators, Turnbull represented the adolescent unit, taking the opportunity to voice safety concerns to TSH Superintendent Randy Proctor, Director of Psychology Magdalene Kovach, and other administrators. Turnbull later recalled that she spoke about the “gang mentality” that was pervasive on the unit. She said having more male staff would help because male staff members often had a “calming” effect on some of the male adolescents.

“I pointed out how dangerous the unit was becoming, that women on the adolescent unit felt like they did not have control of the unit, that we were getting some very inappropriate admissions, admissions that would have been better placed in a facility that could handle — like a detention facility — that could have handled the more gang-type aggressive patients,” Turnbull later recalled. “The female staff were frightened.”

On April 6, program nurse Janet Metz wrote Turnbull a note congratulating her on her presentation. “Just wanted to let you know I thought you presented yourself beautifully in our meeting with the superintendent yesterday. You were the epitome of professionalism,” Metz wrote in careful cursive on lined notebook paper. Metz would later recall the content of Turnbull’s presentation in a pretrial deposition, after Turnbull filed a lawsuit against the hospital and the state. But after meeting with the state’s attorneys, Metz would deny in court that she remembered what Turnbull had said. The same day Metz wrote the note, the minutes of the meeting were distributed, and Turnbull showed them to an intern, Nancy Denman. Turnbull was surprised and pleased that her comments had been accurately reflected. The next day, a new “sanitized” set of minutes came out with instructions on the front page to destroy the first set of minutes. The new minutes did not detail Turnbull’s presentation, Turnbull and Denman later said.

“(The second set of minutes) were very sugarcoated, vague. They said pretty much nothing. They were completely different than the first set of minutes,” Denman said in a deposition. In May, when Turnbull saw no improvements, she talked to colleagues about wanting to write a memo to Proctor. She got a phone message, which she kept, to call Kovach on May 18, and she made notes from the conversation on the message form. “Relax about unit safety” is printed on the message, along with a note that “R. Proctor” is concerned “that female psychologists are stirring up trouble.” Turnbull later said Kovach told her during that conversation that Proctor had threatened to “come down on troublemakers like a ton of bricks.” Kovach denied that account. Turnbull kept both sets of minutes from the April meeting tacked to the bulletin board in her office, but they vanished when a colleague later packed up her office for her after she abruptly left the hospital.

After Stout’s arrival at the hospital, the explosiveness on the adolescent unit continued to escalate. Even a visit from Proctor, at Turnbull’s request, yielded no results. Turnbull interviewed Stout before she began individual therapy with him, and she noted in his file that his “reliability is questionable.” She saw that he bragged about unsubstantiated incidents that were too fantastic to be believable or simply weren’t detailed in his record. But bravado and “dramatic embellishments” were common among male adolescents, and Turnbull didn’t think much of it.

But Turnbull jotted notes about Stout’s lies in his file: “At intake, he told the physician he had used marijuana a couple of times and (he) denied alcohol use. When I inquired, he responded that for the past three years he has regularly used marijuana, LSD, and cocaine with his father, even stating that he and his father would have alcohol drinking contests in which friends would ‘bet $200 to see who could go the longest without passing out…. I can usually drink a fifth (!)…. I always won.’ He also gave unsubstantiated reports of extensive gang involvement, stating that he would regularly ‘use baseball bats and chains, taking kids’ money, beating up candy and pop machines, destroyin’ property at school…. I would do whatever they (gang members) told me to.'”

Turnbull asked him whether he would hurt her or another staff member if his gang buddies told him to, and he said, “Well, sure I would.” He said he had “touched girls” and had even raped two. Alarmed, she searched through every page of his records and found no reports of any sexual assaults or rapes. So she wrote the statements off as more of the usual macho talk — Stout’s “wanting to maintain his tough image.”

Turnbull was also skeptical when Stout told her that that he saw colors in the air, had special powers in the form of premonitions, and even had been hearing voices that told him to do things. He said he had been hearing the voices for as long as he could remember. He said the voices would command him to “go kiss somebody … go feel somebody” and he would obey. Turnbull made a note on his file that it was “unclear” whether he was in “the early stages of a psychotic disorder.” But she doubted it.

One thing that bothered Turnbull about Stout, though it was fairly common among male adolescents, was that he had “boundary problems” and the “potential for sexual acting out.” Like many patients, he had tried to brush up against Turnbull and had asked her for a hug.

Turnbull had experienced worse — many male patients had made vulgar sexual comments to her since she started at Topeka State Hospital in 1993. One had reached up under her skirt and grabbed her thigh during a group therapy session while three other male patients backed up and just watched. Another patient had grabbed her breast, but she pulled away and escaped into the nurses’ station. Another time, a patient grabbed her arm and held her, smiling and leering at her. She later said Kovach had discouraged her from writing up an incident report when the patient grabbed her thigh, and because she was an intern at the time, she complied. Kovach denied ever discouraging her from reporting such behaviors.

Turnbull had had many conversations with her immediate supervisor, Dr. Lou Hoover, which were, Hoover later recalled, about being uncomfortable about the males’ “sexual acting out” and feeling unsafe. Hoover said she and Turnbull tried to brainstorm solutions, but nothing really changed. Many hospital employees said understaffing was a persistent problem, so the most logical solution — to have another staff member present during therapy at all times — was impossible. Turnbull and her colleague, Talley, conducted a twice-a-week therapy group for about a year, and they requested a male staff member to be present every time the group met. A male staff member showed up only about five times out of more than 80 sessions. Turnbull also conducted another group with the clinical director of the hospital, but supervisors later admitted he consistently failed to show and that they did not know why. At the time, Turnbull expressed her frustration with the situation, but she often had to conduct the group alone.

Turnbull always had safety worries in mind, and knowing what had happened to arts and music therapist Stephanie Uhlrig in 1992 added to her anxiety. On the hospital grounds, Turnbull often walked past a memorial bench dedicated to Uhlrig, who was sexually assaulted and murdered one evening after taking a group of patients to see The Addams Family movie. Uhlrig was returning a violent sexual predator, Kenneth Waddell, to his unit when he went into a building to go to the bathroom. After Waddell failed to come out, Uhlrig went in to check on him. Her body later was found leaning on a toilet in the men’s bathroom, her shirt and bra lying on the floor next to her. She had been strangled.

The Uhlrig family lost a lawsuit against the state, and the state contended that Uhlrig had been told about Waddell’s sexually violent tendencies. Uhlrig’s family said she would never be able to say whether she had known or not. Wint Winter Jr., a former state senator who acted as an attorney for the Uhlrig family, believes she did not know.

“There were two failures. He probably should have been sent back to Larned based on his past, and there was no warning to patients and staff. They put a shark in the minnow tank, if you will,” Winter says. “I’m not saying they should have stamped something on his forehead and put him in an orange jumpsuit, but they didn’t even tag his file. Stephanie just didn’t have a clue.”

Winter says the murder was not a surprise, because it came at a time when the hospital was under a tight budget and needed to address federal regulation and certification issues. “It all kind of went together into a pretty sad witches’ brew of a situation,” he says. Topeka State Hospital staff members later said in court that supervisors had consistently told them not to talk to the accreditation body about staffing shortages.

Before Uhlrig was killed, Waddell had been a resident of the Awl Unit, which housed court-committed patients, many of whom were violent. When the unit was closed earlier in the year, some of the patients were sent to Larned, a more secure facility, but Waddell was put on another unit, where he sexually assaulted a female patient. He was put on a different unit and quickly earned full privileges despite protests from the staff of his previous unit. One psychologist, Dr. Cyd Schnacke, who was an intern at TSH at the time, says she complained bitterly about the hospital’s haphazard closure of the unit and failure to notify staff that some of the patients who were sent to other units were coming from Awl.

“I was told to shut up, just shut up,” says Schnacke, who later worked at Osawatomie State Hospital for seven years, where, she says, safety precautions were no better and that even forensic staff, who dealt with criminal patients, did not have personal alarms, small pagerlike devices known as “screechers” that when activated emit a 120-decibel alarm. After Uhlrig’s murder the state legislative postaudit committee, which reports directly to the legislature, found that Awl’s closing had been careless, and the committee made recommendations for better safety procedures. The legislature later allocated money to be used to increase safety at Topeka State Hospital.

In the 1992 legislative postaudit survey, 80 percent of the nursing staff said they received notice that Awl patients would be coming to their unit and that transfer notes were placed in patients’ files, but 50 percent of the nursing staff said they got insufficient or no information at all about the diagnoses, problems, or behaviors of the specific Awl patients transferred to their areas. In the committee’s survey of all staff, 48.7 percent said they found out through rumors that Awl patients would be transferred to other wards. Only 18.4 percent said they got sufficient information about the Awl patients who would be transferred to their areas.

“What they did was they mainstreamed this population, like maybe 20 patients, into the general hospital population, and I raised a lot of hell about that,” Schnacke says. “I talked to as many people as I could. My argument was, ‘You are taking extremely violent people who you know are violent and putting them — locking them — on the units with other mentally ill patients and staff. Everybody should know that. The other patients’ families should be informed. The staff certainly should be informed. And they did none of that.”

After the Uhlrig murder, the hospital hired additional temporary security staff, who worked for several months and then were dismissed. The hospital also improved lighting and rekeyed some locks. After the following legislative session, the hospital spent $116,812.52 that the legislature had allocated for improved security. Some staff, however, later complained that only $149.75 was spent directly on staff safety, in the form of personal alarms, putting only four or five alarms on each unit. The rest was spent on gadgets for security guards — two-way radios, body armor, nightstick rings, police-size Mace, sirens, spotlights, and baton carriers.

Turnbull felt the hospital should have learned a lesson from Uhlrig’s murder. Turnbull did not feel safe at TSH and was reminded of that fact whenever she looked at Uhlrig’s memorial.

“It was frightening. It was … really sobering. It was something I never forgot, because, especially as things got worse and worse on the unit … you became aware of what could happen. You became aware of what the consequences could be,” Turnbull later said.

She later experienced those consequences firsthand.

Because of Turnbull’s safety concerns, she would not take male patients to her office, which was in an isolated area of the hospital. In fact, there weren’t many places in the hospital that she could conduct individual therapy sessions in an environment that afforded some privacy without being isolated. Turnbull later said that she had spoken to supervisors to request a therapy room on the unit with a Plexiglas viewing window, which would provide both privacy and safety, but none was built.

When Turnbull noticed Stout’s “boundary issues,” she made sure to make a note in his file to warn other staff members. Stout had never groped Turnbull, but she wrote in his file that staff members should not go alone into small, enclosed areas with him. For that reason, when the weather was nice, she conducted her individual therapy sessions with Stout outside, walking on the grounds where the security guards were visible. There were sometimes only two security guards patrolling the 360-acre campus, but none were on the units, so the grounds felt safer. However, the hospital’s chief of security, Bradley Richter Bulk, later testified that the security guards often would sit in their favorite spots with radar guns, trolling for speeders, whenever there “was nothing else to do.”

In his first months at Topeka State Hospital, Stout had some problems and threatened another patient, who had insulted his sister. A few times, staff members put him in a straitjacket or used restraints. He was placed on assault precautions — meaning that he might assault peers or staff — a few times in June and July, but he was taken off at the end of July and put on supervised off-grounds status, so he could go on trips with staff. The staff had even made phone calls about placing Stout in a less restrictive group-home setting. In August, he attended several field trips, and the staff wrote positive comments in his files:

Aug. 21, 1996 — a rehabilitation therapist wrote: “James attended the zoo trip, train ride, and the carousel. James did a good job with his peers and staff. He enjoyed himself and did a good job and was very appropriate.”

Aug. 22, 1996 — a staff member wrote: “James went to Shawnee Lake fishing. He was very helpful loading and unloading the van, getting ice, (getting) fishing equipment ready. Appeared to enjoy being out fishing, though we didn’t catch any fish. He was very pleasant with all on the outing for the entire trip.”

Aug. 23, 1996 — a mental health aide wrote: “Patient went to Kansas Museum, came back with no problems.” Later that same day, a nurse wrote, “James was off grounds with staff to purchase school clothing — $150 worth, withdrawn for Kmart shopping trip.” Files also show that Stout had begun work therapy, performing office work and stuffing envelopes on campus.

On Aug. 27, 1996, when Turnbull took Stout out of the Ray Building, where he lived, to conduct therapy with him out on the grounds, he was excited about a pizza party he hoped to attend that Friday. It was a warm, sunny day, and staff members were outside on porches in groups, chatting and smoking cigarettes. They walked past the rambling Romanesque redbrick Center Building, where the administration was housed. They walked past the Feldman Building, another administrative building, and toward the baseball field. They passed maintenance workers and heard the buzz of a lawnmower in the distance. The pungent smell of freshly cut grass was in the air.

Three and a half years later, in February 2000, Turnbull would stand in federal court, recounting to a jury the events that followed that August morning just after 11:

“We were walking side by side, and he had gotten just a little bit behind me, and I glanced over at him and I just saw — I just saw a look in his eye. I mean, I knew it,” she told the jury, faltering. Something had changed, and there was murder in his eyes.

“I tried to take, I tried to take — a step. My thought was, just I could see by the look in his eye, I was in trouble.” It was a look she would later describe, in a therapeutic piece of writing used to prevent “blocking out” of disturbing memories, as “a glimpse of rage.”

Stout grabbed Turnbull by the neck and waist and threw her slim body with such force that she remembers seeing her feet fly up in the air. He yanked her shirt and bra up and pulled down her skirt and underwear.

“I was trying to fight him. I was trying to fight him — and he — it’s like he was shoving my head down. It was like somehow he got — I remember looking over at his zipper and he got my head down between his legs,” she told the jury. Terrified, she thought he might try to force her to perform fellatio on him.

“He, he was groping at parts of my body, he was — he was biting me. I remember him biting me,” she said. Stout then got his legs around Turnbull’s neck.

“He kept — he kept, it was like he kept squeezing (his legs) and they would close around my windpipe and I was trying to … twist my head so that — I was trying to twist my head so that I could breathe. I was trying to just wrench my neck so that I could get my jaw between his thighs instead of, instead of my windpipe. He kept closing down on my windpipe and I couldn’t breathe,” she said.

She was thinking, she later wrote, that his hands “felt like one hundred hands” and she felt an overwhelming sense of revulsion at feeling his mouth on hers. She wrote that she felt she “had no more power than a rag doll.” Thoughts were flashing through her mind in rapid succession: why she hadn’t taken self-defense classes, where the other staff members were. She thought that maybe she could calm him, not believing this could be happening to her, with the birds singing and people everywhere. She fought fiercely and felt herself weakening, but she somehow continued to talk to him.

He screamed, “Give me some pussy!” and repeated over and over, “I’m going to have to kill you.”

She panicked as he pulled her shirt up over her eyes and felt a searing pain as he raped her with his fingers. She later learned that he had cut a knuckle on his right hand on a tape dispenser the day before, and six months after the attack she had an HIV test, which came back negative. But while he was strangling her, she could think only that she was going to die at that moment.

With Stout’s thighs tightening around her windpipe, Turnbull felt, as she later wrote, that “it was a moment of stark realization, the simple reality that my life could be ended so effortlessly. Some bizarre humor that my death could be so simple.” She wrote that as her air was cut off, her thoughts seemed to flow clearly, effortlessly. “Time was distorted. There was no possible way a human could think so many thoughts in so many dimensions.”

Finally, Turnbull began to lose the battle. She saw in her mind the spot where the hospital would put her memorial bench, just like the bench she had gazed at the day before, the bench placed “In Memory of Stephanie Uhlrig,” the redheaded activities therapist whose life was strangled out of her one night by a male patient. Turnbull thought that her moments by the bench had been “premonition-like.”

“Why was I now so calm?” she wrote. “The blue of the sky and the branches of the trees seemed more beautiful than I can express in words. As if I had never really experienced beauty before. I had ceased to care about breathing. The blue, the blue, the blue, the blue. I wanted nothing but the blue. I was moving up and into the blue. It was over and only the blue had any power over me.”

Then Stout moved slightly, letting up a bit off her windpipe, and from some “alien part” of her, Turnbull was able to speak. Still hearing the distant hum of the lawnmower, she said, “The lawnmower man … be careful, James, the lawnmower man sees you…. Run, James.” He got up to flee, then hesitated, confused, not sure whether she had tricked him. She stumbled to her feet, pulling her clothes back on, thinking that she would rather be found dead and clothed than alive and half-naked. She pulled her slip up over her skirt and didn’t even realize it until later. Her legs folded under her, and she looked up to see clearly the faces of two women watching her from inside the Feldman Building.

“By their expressions, I knew they had watched the event,” she wrote. “I also knew I was entirely on my own. Not looking back, I began to crawl…. I crumpled again. I saw shoes, women’s shoes, four shoes, two women, at least two women.” One of the women who witnessed the attack, a social worker employed by another state agency, later came forward and testified that she saw “arms and legs all akimbo” and was not sure what she was watching. She said she thought that maybe it was two teenagers wrestling.

Stout ran off and was later captured by Topeka police. An ambulance arrived to take Turnbull to the emergency room of Stormont-Vail HealthCare. She was scratched and bruised; her ribs were sore and her cheek and lower lip were tingling, possibly from blows to her ear and jaw from Stout’s elbow. Her neck and back hurt, and she had twisted her right knee in the struggle. The injuries would require months of physical therapy. Talley, Turnbull’s friend and co-worker, rushed to the emergency room as soon as she heard about the attack, and she found Turnbull with “messed up” clothes and a tear-stained face, clutching her keys so tightly that Talley had to work them out of her hand.

“She was just kind of moving her head from side to side and seemed really disoriented…. She was really just in shock. She was very distraught,” Talley later said in court. Turnbull, from her hospital bed, tried to tell Talley about the attack in “snippets,” only sometimes making sense. Turnbull was released and Talley went with her to her apartment. Turnbull stood in the hot shower for a long, long time.

Turnbull’s boyfriend at the time, Jack Brian Meisner, got a phone call from Turnbull the night of the attack. He told the jury she sounded “halting, faltering … hard to understand.” Meisner immediately drove from his home in Kansas City to Turnbull’s apartment in Lawrence, where he learned she had been attacked but did not press her for details. The next day, Turnbull went with Meisner to his home, where she stayed for nine months. She changed after the attack, Meisner told the jury, and the couple later separated, though Meisner said he had wanted to marry Turnbull.

During the first weeks after the attack, “Cynthia cried sometimes without any provocation whatsoever. She lay curled up on the couch covered with an afghan. When I’d get home from work, she couldn’t concentrate, couldn’t read, sometimes wouldn’t even watch TV or couldn’t watch TV or would watch something totally innocuous like QVC (a home shopping network), which is totally out of character for Cynthia,” Meisner told the jury.

That was a contrast to the “old Cynthia,” a person Meisner described as “active, interesting, busy, goal-directed, and talkative.” When she met Meisner on a blind date at the Fine Arts Theater in Mission the previous spring, she had just returned from a trip she took by herself to London. She loved to travel and had been to Belgium, Turkey, and Tblisi, in Russia, with a nonprofit group in 1992 to deliver medical supplies to an area devastated by civil war. Before the attack, she made jewelry and rode horses, a hobby she had been passionate about as a child growing up in North Kansas City. Before the attack, friends said, she loved to go out for dinner and coffee and just talk about life. For a long time afterward, Talley and other friends said, she was afraid to even leave the house to meet them at a café. Her boyfriend and her mother would drive her places, and if she had to drive somewhere alone, she would talk on her cell phone the whole way. She had nightmares about rapists.

“During the entire nine months,” Meisner testified, “she always had trouble sleeping, getting to sleep, staying asleep, nightmares, flashbacks, woke up screaming quite often.” One day, she asked Meisner to walk with her to the mailbox because she wanted to get over her terror of walking on mowed grass. The smell took her back to the day of the attack, which had taken place on a freshly mowed lawn.

“It took us about 45 minutes to get a hundred yards and back,” Meisner said. “She could take eight to 10 steps, have to stop, hold onto me, cry, shake, tremble. I’d tell her it was okay and tell her I’d take care of her, it was okay, we’d be safe, let’s go on. We finally got to the mailbox and back to the house.”

Turnbull’s psychotherapist, Nancy Jenkins, testified that Turnbull was suffering from post-traumatic stress disorder (PTSD), a condition common in war veterans, accident victims, and rape victims. Jenkins said Turnbull was “numb” and “terrified” and described being so fearful that she would barricade her door with furniture or was unable to do simple tasks. Jenkins said Turnbull described being unable to make a phone call or heat up a cup of coffee in the microwave. Jenkins said that in the six months following the attack, Turnbull left her house only when she “absolutely had to” and would react to “triggers,” such as the six-month anniversary of the attack or watching a television program about the Boston Strangler. One day she almost drove her car off the road when she saw highway workers in orange uniforms that reminded her of the hospital. Medication helped during that time, and Turnbull made some progress. Jenkins said her reactions were severe, but normal for the victim of such an attack.

In the weeks following the attack, Turnbull found out about two things that left her numb. While she was being attacked and strangled, four or five screecher alarms were sitting unused in a drawer on the adolescent unit. Turnbull had never heard of a screecher before but would have gladly bought one of the $5.99 devices if she had known they existed. The hospital had bought a few screechers after the Uhlrig murder, but staff quickly grew lax and stopped using them. By the time Turnbull started work at Topeka State Hospital, new hires were not routinely told to use them. After Turnbull was attacked, supervisors circulated a memo about the forgotten screechers, reminding staff to use them.

Turnbull, on finding out about the screechers, pleaded with Talley to get one and wear it whenever she worked with a male patient. Talley attempted to get one of the screechers from the unit.

“The screechers were kept in what was called sharps,” Talley said in court. “And that was a box that was locked away, as it had knives and things in it that were dangerous and needed to be out of the patients’ reach. I asked the nurse to get me one, and she kind of acted like I was funny, but … she went ahead and got them out and I think there were four, maybe five, of them in there. We tested several of them that didn’t work, but we did find one that worked, so I took it to my office with me. I ended up purchasing one for myself, though, just because it would be easier.” She said no supervisor at Topeka State Hospital ever encouraged her to wear a screecher.

Proctor, who is now superintendent at Osawatomie State Hospital, says Osawatomie does not currently have screechers but that if a staff member were to request one, the hospital would purchase it for him or her. He also says Osawatomie does not provide self-defense training, only MANDT, which he finds adequate.

The other revelation that left Turnbull numb was that the state knew Stout was a sexual predator before her attack, but that information was not on his transfer documents from Larned. Minutes from a Sept. 18, 1996, meeting of the TSH risk management committee show that TSH’s attorney phoned the legal department at Larned after the attack, and they indicated he had “done similar things” to two female staff members at Larned. Stout’s mother told the attorney the same thing.

“When the administrative transfer was made there was no mention of these incidents in the discharge/transfer summary,” the minutes note. The risk management committee (RMC) never interviewed Turnbull about the attack. “Although this is an extremely unfortunate incident, the RMC considers the case closed, as there was no way to predict something like this would happen in broad daylight,” the minutes say. The minutes also mention the screechers. “Screechers were provided several years ago following the murder but are seldom used anymore. Staff throughout the hospital are getting lax.” The minutes also note that “sister institutions need to give us the appropriate information on administrative transfers; we need to keep this in mind as well when transferring patients.”

After the attack, Turnbull and Jenkins testified that Turnbull’s trauma was worsened by her interactions with supervisors, especially Kovach, who was on vacation when the attack occurred and called Turnbull about two weeks afterward.

While trying to recount the attack in a psychotherapy session about two months after the attack, Turnbull kept seeing Kovach’s face. Turnbull testified that Kovach told her “women in Bosnia are raped all the time and they get right back on with business” and told Turnbull that the two state employees who watched the attack probably thought she and Stout were two teenagers wrestling because of her “long hair, trim figure, and nice wardrobe.” Turnbull told the jury that Kovach also would tell her “gruesome stories … about a murder in which a woman had had her head wrapped in duct tape and was suffocated to death.”

Kovach contends that Turnbull twisted her words, but other witnesses testified that Kovach had expressed the opinion that Turnbull was exaggerating her symptoms and needed to “get back on the horse.”

“Even if I said it the way she said I said it, there’s nothing illegal about that. But I did not say it that way,” Kovach, who is now retired, says, her words coated in a thick Eastern European accent. “I said, ‘You’re lucky to have a supportive family — when I think of all these poor women in Bosnia who get raped and then are ostracized by their families, you’re really lucky.'”

Turnbull’s friend Dr. Lois VanderKooi, a former Topeka State intern who was no longer at the hospital at the time of the attack, wrote a letter to TSH staff on Jan. 12, 1997, expressing her concerns about Kovach’s treatment of Turnbull and claiming that Kovach was violating a psychologists’ code of ethics.

“In her role as the psychology department director,” VanderKooi wrote, “Magdalene called Cynthia a few days after Cynthia was physically and sexually assaulted and almost killed. She told Cynthia she was on the wrong medication and should take a couple of mgs. of Ativan and that she should return to work within a couple of days after being assaulted, similar to combat veterans who return to battle. She also said that she had serious doubts about the PTSD syndrome, as she had interviewed supposed PTSD sufferers and they were all ‘antisocials.'”

In personal notes titled “Recollections re Cynthia Turnbull, Ph.D. (based on notes and memory),” written by Kovach after the attack, Kovach recalled using the example of her son’s return to the swimming pool after a first lesson that scared him and noted that the example shows that one should face one’s fears right away to get over them. Kovach also wrote: “The second thing I noted, and which afterwards disturbed me quite a bit, was with how much hatred she talked about the youth who had assaulted her (after all, her former patient whom she had wanted to help): ‘Magdalene, he had his slimy, gunky hands in my body…. I have not stopped menstruating since…. My doctor said it was stress and if it did not stop in 2 weeks, we are going to start hormones…. I got a bladder infection right after this…. Who knows what gunk he had on his hands.’ … To me it appeared that she now saw the cause of everything (to be) the attack.”

Turnbull testified that Kovach had told her that “Americans are pampered” and that because they have not been through a war, they have a more difficult time getting over trauma. Kovach later denied saying that. “She said she had a Hungarian friend in New York City … (who) had woken up and found a man in her bed and had somehow woken up and blown a whistle and escaped and got back to work in three days,” Turnbull told the jury.

Turnbull didn’t return to work at Topeka State Hospital before it closed in the spring of 1997, and the belief that the hospital was responsible for the attack led Turnbull to retain a Kansas City attorney, Paul Pautler of Blackwell Sanders Peper Martin, and sue Topeka State Hospital, the State of Kansas, and several administrators in their official capacities for violation of the Civil Rights Act of 1964 in creating a “hostile work environment” for female employees.

In February 2000 an eight-member jury heard testimony on the case in the courtroom of Judge Thomas VanBebber in federal district court. Turnbull’s attorney contended that state employees were responsible for the attack because they left out essential information from Stout’s files, did not act on Turnbull’s complaints about the unsafe work environment, and failed to follow their own security recommendations made following the Uhlrig murder.

“(The hospital) didn’t take reasonable precautions to eliminate the risk of sexual assaults. They didn’t put alarms into the offices or other therapy areas. They didn’t construct therapy rooms that had been requested. They had only temporary security,” Pautler told the jury. “(Turnbull) had no idea that (Stout) had previously sexually assaulted two female staff members at Larned State Hospital. The folks at Larned had transferred this patient, had turned their heads, and hoped the problem would go away.”

But the state maintained that Turnbull had known the patient was dangerous, citing the warning she had written in his file about “boundary issues.” They showed an employment contract Turnbull had signed, acknowledging that the risk of physical assault by a patient existed. And they said the conditions at Topeka State Hospital were the same for men as they were for women.

The jury deliberated for more than a day in the case but ended in a deadlock, with seven jurors finding for Turnbull and one holding out. The holdout agreed that the attack had happened, but he could not find the state liable, according to another juror, Linda Sutton.

“We really felt devastated that it worked out that way. We really felt we had let her down in some way,” Sutton says of herself and the other jurors who favored an award for Turnbull.

Sutton says she had been deeply affected by the fact that the previous assaults were not on Stout’s record and that Turnbull was never given a screecher or even told that the hospital had the devices.

“It was horrible, what happened to her,” says Sutton, who is from Paola. “Nobody there had any self-defense training, and I felt they should have. There should have been more security guards and a better place for a psychologist to go talk with a patient.” Sutton also says she felt state witnesses were coached by state attorneys to change their stories, because several gave testimony that conflicted with their depositions but failed to make changes to the depositions when given the opportunity.

“I think things had been rehashed with them and they did change their testimony,” Sutton says.

When the jury came backed deadlocked, VanBebber did not encourage them to deliberate more, which surprised some in the courtroom. The judge then threw the case out on lack of evidence, rather than calling for a new trial. Turnbull has filed an appeal in the case and, for that reason, declined to speak on the record about the case, as did many state witnesses.

Three and a half years after the attack, Turnbull is 42 and recovering slowly. But she probably will never be the same person she was before. She doesn’t find much joy in the things she used to love to do, like riding horses and making jewelry. She cannot work with male patients alone, especially teenagers, without becoming terrified, so she limits her work at 909 Associates, a private psychology practice in Topeka, to women. She panics sometimes when she is walking in the mall or another public place and sees a group of male adolescents walking toward her. She would never travel to Europe alone now. She always carries a screecher. She is engaged to an attorney she met through her former riding instructor and will set a date for the wedding when the legal proceedings on her case are finished. And she now provides free counseling for rape victims and advocates for those victims’ rights.

As for Stout, he is now in the juvenile correctional system in Topeka. He was able to plea bargain his charges down from rape and was convicted on one count of attempted rape and one count of sexual battery. The warden there would not allow him to be interviewed about the attack because of “unstable behavior.”

Contact Allie Johnson at 816-218-6783 or

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