Where Do Repeat Sex Offenders Go?

When a repeat sex offender neared parole after serving 16 years for raping a boy, Rhode Island's governor directed state officials to put the man in a different institution: the state mental hospital.

Dr. Brandon Krupp, who ran the hospital's psychiatric services, opposed the decision, saying it would not protect the public and could put other patients at risk. Other doctors backed him up, arguing the plan would be expensive and likely ineffective.

When Krupp's protest went unheeded, he quit.

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

Krupp's resignation is an extreme reaction to a growing problem: no one knows what to do with potentially dangerous sex offenders. About 5 percent of sex offenders commit another sex crime within three years of their release from prison, according to the U.S. Department of Justice. Other studies show that proportion increases with time.

Seventeen states have laws that allow holding sex offenders who have completed their prison terms. Governors in other states also have tried to use mental health laws to keep sex offenders in psychiatric hospitals once their prison terms end.

New York Governor George Pataki used such a law to order a dozen sex offenders held when their sentences ended. Doctors released one after a psychiatric review last month. The others remain hospitalized while an appeals court reviews their case.

In Rhode Island's case, Governor Don Carcieri asked that Todd McElroy be committed 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 and had been staying in the hospital's prison unit, moved to a regular ward voluntarily and awaits a court hearing on whether he will be freed.

The governor's spokesman, Jeff Neal, acknowledged that mental health laws are not an ideal way to handle sex offenders but declined to discuss McElroy's case. McElroy and his attorney also declined comment and have not said whether they will fight his confinement.

H. Reed Cosper, Rhode Island's mental health advocate who was once McElroy's lawyer, said he supported the move. McElroy is mentally ill and dangerous, and he would benefit from continued treatment, Cosper said.

But Krupp said McElroy's schizophrenia is under control, and he doesn't belong in a hospital.

McElroy now lives in a 16-bed ward and has access to a day room, nurses' station and the outside. Because McElroy is free to wander, Krupp said he worries about the safety of other patients and the public.

Among Krupp's supporters is the Rhode Island Psychiatric Society, which has denounced the state's plan.

The American Psychiatric Association has opposed civil commitment programs, 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.

"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."

Studies show a significant percentage of prisoners have anti-social personalities, but not all of them belong in psychiatric hospitals, said Howard Zonana, who teaches forensic psychiatry and law at Yale University.

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

Critics also say the cost of hospitalization is a problem. The 17 states with sex offender commitment laws spend US$224 million (euro190 million) per year to keep them in separate, secure buildings, according to the Washington State Institute for Public Policy. Holding them in a psychiatric hospital would cost even more because of the additional medical care, Zonana said.

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

Krupp, who is looking for another job, said he hopes his resignation will stir public debate.

"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."