For Rhode Island psychiatrist Brandon Krupp, M.D., it's as simple as
this—psychiatric hospitals aren't jails, and psychiatrists aren't
That's what he told state authorities when he resigned from his position as
chief of psychiatry at Eleanor Slater Hospital in Cranston, R.I., after Gov.
Donald I. Carcieri sought continued hospitalization of a convicted sexual
predator who had completed a 17-year prison sentence.
Krupp's resignation and his declaration—psychiatrists aren't jailers,
hospitals aren't jails—have received widespread support. Even Carcieri,
in a public statement about the case, seemed to acknowledge that
hospitalization was not the ideal solution for what to do with people no one
wants in their community.
"Unfortunately, this situation demonstrates that we must strengthen
Rhode Island's criminal laws so we can better protect our children from this
type of vicious predator," Carcieri said. "As a beginning, I have
already promised to introduce a version of Jessica's Law, which requires a
minimum mandatory 25-year prison sentence, followed by lifetime electronic
monitoring, for convicted child molesters."
(Jessica's Law is named after a 9-year-old Florida girl who was raped and
murdered last year.)
As Psychiatric News went to press, 40-year-old Todd McElroy was
still in Eleanor Slater Hospital awaiting a hearing to determine whether he
belongs there. McElroy, who had been convicted of raping a minor, has
schizophrenia and had been moved from prison in 2004 to the forensic unit of
the hospital for specialized inpatient treatment not available in the prison.
He was treated successfully, according to Krupp.
"There was a point when he needed hospital-level care," Krupp
told Psychiatric News. "We provided that care, and he got
better. Some 15 months later he was stable enough that we petitioned Superior
Court to have him returned to corrections."
At that point, according to Krupp, corrections officials did not object.
But the proceedings took so long that in the ensuing period McElroy completed
his prison sentence and was due to be released.
It was only then, Krupp said, that two physicians from the corrections
department petitioned to have McElroy hospitalized.
Krupp believes it was politically motivated. "The governor wanted him
off the streets," he told Psychiatric News. "I am as
concerned as anyone about sex offenders being in the community unsupervised,
because I have treated their victims. But it makes no sense to misuse the
medical system for political ends."
A spokesperson for the governor's office told Psychiatric News
that Krupp's allegation that the state is using the hospital as a prison is"
completely false" and pointed to the fact that two physicians
from the department of corrections have indicated in their petition that
McElroy needs hospitalization.
But Paul Lieberman, M.D., president of the Rhode Island Psychiatric
Society, observed that a formal hearing to determine whether that's indeed the
case has yet to happen, and that the forensic specialist at Eleanor Slater
Hospital, as well as Krupp, had determined that McElroy did not need
"Our concern is that there was no clear assessment that this patient
needed to be in the hospital," Lieberman said. "We support Dr.
Krupp without speaking to the merits of whether this man needed to be in the
hospital. The appropriate procedures should have been followed instead of
turning to the hospital as a de facto solution."
The special circumstances complicating the case in Rhode
Island—McElroy's schizophrenia and the question of whether his
pedophilia was secondary to untreated psychosis—appear to be nuances in
a larger national drama about the role of psychiatric hospitalization of
criminals who have finished prison sentences, but who are still regarded by
the public as potentially violent threats to the community.
Sixteen other states and the District of Columbia have laws that allow the
state to detain sexual offenders in psychiatric hospitals after they have
completed their prison terms. Those laws were upheld by the U.S. Supreme Court
in 1997 in Kansas v. Hendricks.
Last year New York Gov. George Pataki (R) issued an executive order to
state corrections and mental health officials to begin assessing and detaining
some convicted sexual offenders after Pataki failed to get legislation
approved allowing the commitment of violent sexual offenders to state mental
hospitals at the end of their prison terms (Psychiatric News,
November 18, 2005).
Nonetheless, state efforts to keep potentially violent sexual predators out
of the community have conflicted with traditional conceptions of the
appropriate role of psychiatric hospitalization—and of physicians in
making determinations about who belongs in a hospital.
"The current generation of sexual predator acts, in trying to solve a
difficult and intractable problem, goes about it in the wrong ways,"
said Michael Perlin, J.D., a professor of law at New York University Law
School and director of the International Mental Disability Law Reform Project
in New York. "We are taking people who do not appear to have serious
mental disorders and treating them as psychiatric patients. It's bad for them,
and it's bad for the providers of treatment."
Though APA does not have an official statement on the Rhode Island case, in
1999 the APA Task Force on Sexually Dangerous Offenders opposed state laws
allowing commitment of sexual offenders, stating in its report that the
diagnosis of sexual predator in such laws is based on "a vague and
circular determination that an offender has a `mental abnormality' that has
led to repeat criminal behavior."
The statement continues, "Thus, these statutes have the effect of
defining mental illness in terms of criminal behavior. This is a misuse of
psychiatry, because legislators have used psychiatric commitment to effect
nonmedical societal ends."
Howard Zonana, M.D., chair of the task force, noted that psychiatry has
never defined what disorders qualify for regular civil commitment, a breadth
of latitude that most psychiatrists have been comfortable with until now.
"There may be certain severely mentally ill offenders who qualify for
civil commitment at the end of their sentences," he said. "It's
when other people start trying to decide who should be in a psychiatric
hospital that physicians get upset, especially when they use personality
diagnoses or traits that are indistinguishable from typical convicted
In Vermont Gov. Jim Douglas (D) has urged passage of the Omnibus Public
Safety Bill to establish a civil commitment process for the treatment of all
violent offenders—not only sexually violent offenders—who have
completed prison terms.
The bill is opposed by a coalition of groups that include the Vermont
Psychiatric Association (VPA), American Civil Liberties Union of Vermont,
Vermont Human Rights Commission, Vermont Association of Mental Health, and
Vermont Protection and Advocacy, among others.
"The VPA has expressed its strong opposition to the development of a
`civil commitment' program in Vermont," said child psychiatrist David
Fassler, M.D., who is the legislative and public affairs representative for
the VPA and a trustee-at-large of APA.
"We believe it's a misuse of the mental health statutes and a
diversion of limited treatment resources," Fassler told Psychiatric
News. "We've expressed this view through the local media and in
testimony before legislative committees. We've also joined a statewide
coalition of advocacy groups organized to oppose the proposal. We intend to
monitor this issue closely and to play an active role in the ongoing public
dialogue on this topic."
Jonathan Weker, M.D., who is the VPA representative to the coalition
opposing the bill, said that the discussion in Vermont, like those in Rhode
Island and New York, has been driven by publicity about heinous crimes
committed by offenders released from prison.
"The whole debate is discussed in terms of public safety," he
said. "It's almost a sham, any notion of truly providing treatment. Even
if one were to say that some of these people [in prison] do have mental
illnesses with some clinical validity, that's given very short shrift. One
review of the legislation revealed that people committed under the law would
get six hours of treatment a week.
"It's disingenuous to say that only the day after someone has
finished a criminal sentence is that person able and ready for
treatment," Weker said. "If anyone on the law enforcement side
really thought mental health treatment for sexual offenders was meaningful,
why not start treatment early on during an inmate's incarceration?"
Weker echoed others in saying that if society wants people detained longer
for violent crimes, the solution is longer sentences, not hospitalization.
"We don't mean to overlook the public safety issue," he added."
That's real, and it worries us as citizens as much as anyone else. The
problem is with sentencing. I don't think you can cure bad sentencing with
Meanwhile, Krupp appears to have no regrets about leaving his post at
Eleanor Slater Hospital. He sees patients in his private practice specializing
in geriatric neuropsychiatry and the assessment and treatment of impaired
physicians and other professionals.
"I felt like I could no longer do my job if medicine could so easily
be trumped by politics," he said. "It's important to understand
that [violent offenders] pose a danger to society, but pretending a hospital
is a prison doesn't keep anyone safe." ▪