The Iowa State Appeal Board approved a $4.16 million settlement on December 2, 2025, following Conrad Colombo’s catastrophic brain injury during prone (lying flat on stomach) restraint at a University of Iowa Hospital.

Colombo, 38, sought emergency psychiatric help in April 2022 after days without sleep or medication for bipolar and schizoaffective disorder. After striking a security officer during a psychotic episode, 16 University of Iowa Health Care employees restrained him face-down while administering the sedatives droperidol and midazolam. During this time, hospital staff failed to consistently monitor his breathing. When he was finally rolled over, his lips were blue and he had no pulse. Resuscitation took eight minutes and left permanent brain damage.

Such tragedies aren’t isolated. A patient died in Virginia in 2023 during prone restraint at a psychiatric hospital, resulting in an $8.5 million settlement. In Toronto General Hospital, a patient suffered fatal brain injury from restraint asphyxia in 2020.

Instead of prone restraint, experts recommend supine (lying flat on back) positioning, verbal de-escalation, and trauma-informed systems, which can reduce the use of restraints by up to 99%. In 2024, Colorado passed HB 24-1372, which restricts prone restraint.