Sunday, December 04, 2005

Psychiatrist Quits Over Sex Offender Controversy

PROVIDENCE, R.I. --With a repeat sex offender about to be released from prison after serving 16 years for raping a young boy, Gov. Don Carcieri directed state officials put him in a different institution: the state mental hospital.

Dr. Brandon Krupp, who ran the hospital's psychiatric services, opposed the plan, saying it would not protect the public and could put other patients at risk. When his protest went unheeded, he quit.

"Doctors aren't jailers," Krupp said in an interview shortly after leaving the job. "Hospitals aren't prisons."

Krupp's resignation is an extreme reaction to a growing problem: no one knows what do with sex offenders who seem likely to commit more crimes.

Seventeen states have laws that allow them to hold sex offenders who have completed their prison terms. More recently, governors in other states have tried to use mental health laws to keep sex offenders in psychiatric hospitals once their prison terms end.

New York Gov. George Pataki used his state's mental health law to order a dozen sex offenders held when their sentences ended. Doctors released one after a psychiatric review last month, but the others remain hospitalized while an appeals court reviews their case.

In Rhode Island, Carcieri directed state officials to commit Todd McElroy to the Eleanor Slater Hospital in October, shortly before he was due for parole on a 42-year sentence for kidnapping and raping a 10-year-old boy.

McElroy, who is schizophrenic, had been held for more than a year in the hospital's forensic unit, which has prison-like security. But Krupp says McElroy's schizophrenia is now under control, and he no longer belongs in a hospital.

As his parole date neared, McElroy moved voluntarily to a regular unit at the hospital while he awaits a court hearing to determine whether he will be freed. He shares a 16-bed, coed ward with patients who have done nothing wrong. He has access to a day room, nurses' station and the outside.

Krupp and other doctors say McElroy's confinement is a gross misuse of medical facilities. The Rhode Island Psychiatric Society took the unusual step of calling a news conference to oppose the state's plan to commit McElroy.

The American Psychiatric Association has opposed similar plans, saying government officials seem more intent on punishing sex offenders than treating them. Medical guidelines require that a person be mentally ill, dangerous because of the illness and capable of being treated before they are committed to a hospital.

Most sex offenders don't meet that criteria, said Roxanne Lieb, director of the Washington State Institute for Public Policy, a state-funded think tank. Washington passed the first sex offender commitment law in 1990 and holds them in a secure, separate facility.

"Typically, they are not mentally ill by a traditional definition of the word," Lieb said. "They don't have a mental disorder, they don't have a thinking disorder, they are not psychotic."

Howard Zonana, who teaches forensic psychiatry and law at Yale University, said the problem is really "how you separate the mad from the bad." Studies show a significant percentage of prisoners have anti-social personalities, but not all of them belong in psychiatric hospitals, he said.

"Why not put in every murderer in a hospital after they've served time for manslaughter?" he asked.

But H. Reed Cosper, Rhode Island's mental health advocate and McElroy's former lawyer, said it's silly to split hairs over why sex offenders commit their crimes. If they are mentally ill and dangerous, they should be confined, he said.

Another problem with hospitalization is cost. The 17 states with sex offender commitment laws spend $224 million per year to keep them in separate, secure buildings, according to a study by the Washington State Institute for Public Policy. Holding them in a psychiatric hospital like Slater would cost even more because of the additional medical care, Zonana said.

That's one reason why members of the National Association of State Mental Health Program Directors do not want sex offenders in the hospitals they run. Sex offenders draw limited resources from other patients, the group's spokesman Roy Praschil said.

And, many doctors disagree about whether people can even be treated for pedophilia and other violent behavior. From the 1930s to about 1970, 26 states had laws letting sex offenders opt for psychiatric treatment rather than prison, Zonana said. But those programs died after graduates raped, or even killed, again.

Jeff Neal, Carcieri's spokesman, declined to discuss McElroy, but acknowledged that mental health laws are not an ideal way to handle sex offenders. He said the governor plans to introduce a bill to increase prison terms and set up electronic monitoring for people who assault children.

McElroy and his attorney declined to discuss his case.

Krupp said he hopes his resignation will stir public debate and lead to a better solution.

"This isn't about me wanting this or any other sex offender unfettered, free on the streets," he said, but "to think that the quick fix for this is to shove them in the hospital is absolutely wrong. It's neither appropriate nor will it actually get you the safety you want, because we're not a prison."


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