BOTTOM LINE

“. . . in 1987, a colleague and I started the Adolescent Sexual Addiction Program at Phoenix Memorial Hospital where we treat both adolescent offenders and victims of sexual abuse. I was there for five years as the program manager and then moved to St. Joseph’s in 1992.”

AZ vs. Ramon Escobar-Mendez, October 6, 1997.

Dr. Dutton, children, and the plethysmograph:

•On June 14, 1992 the Arizona Republic published a series of articles exposing the Adolescent Sexuality and Addiction Program at Phoenix Memorial Hospital.

•Dutton was the program manager and  state licensed therapist. Her partner was not licensed.

•For almost six years (1987 to 1992) her program “treated” over 500 boys and adolescents ages 10-to-18.

•Over a third were 10-to-12 years old.

•Approximately 75% of the boys and adolescents were administered the penile plethysmograph hundreds of times.

•While being watched through a one-way mirror, a boy would place a mercury ring around his penis and then be shown dozens of naked babies, children, adolescents and adults. The images included boys and men with erections.

•The program had the boys sniff fresh ammonia when they got erections to the “wrong” images.

•The program was a financial success, with ninety percent of the program’s funding coming from government sources.

•Dr. Farall, the inventor of the Monarch Penile Plethysmograph (PPG), had warned Emerick and Dutton for years to stop using his invention on boys and adolescents. (personal communication to Dr. Simpson). His internal research showed that the PPG had no discriminate validity – adolescents were getting erections to multiple images, with no discernable pattern.

•Dr. Simpson personally told Ms. Dutton to stop subjecting boys and adolescents to the PPG in early March of 1992, just four months before the program was exposed.

•The Arizona Republic also went on to uncover an “incestuous” relationship with the Maricopa County Attorney’s Office.  Dutton’s partner Robert Emrick was married to  Cindi Nannetti, the chief of the county attorney’s Sex Crimes Bureau . The allegation was she was requiring children and adolescents suspected or convicted of sex crimes to attend the program before a plea bargain would be considered.

•Phoenix Memorial Hospital tried to stop the damage. By the next month they installed an advisory board and would no longer perform penile plethysmographs on boys younger than 14.

•“Phoenix Memorial closed both its adult and juvenile sex-therapy programs in September, blaming adverse publicity for lack of referrals and revenues.”

•“After the Arizona Republic reported the situation, several investigations were launched, including one by Congress. The hospital closed the program before the investigations were completed.”

•Ms. Dutton switched to doing forensic child interviews at St. Joseph’s Hospital.

•Two years after the program was exposed by the Arizona Republic, Phoenix Memorial was successfully sued up to its policy limits.

DEEP DIVE

Arizona Republic, June 14, 1992, page A1

•More than 100 children each year.

Arizona Republic, June 14, 1992, page A12

•“Used on children since 1987.”

•“More than one-third of the children in the program are 10 to 12 years old, hospital officials said.”

•“And they emphasize that the device is just one part of a larger therapy program.”

•Robert Emerick, director of Phoenix Memorial’s Sexuality and Addiction Program: “I don’t think it (using the plethysmography on children) is invasive. I think that it’s responsible.”

•Critics “contend that the treatment may cause severe psychological trauma”.

•“Manufactured by Farrall Instruments of Grand Island Neb., has been on the market for about 25 years.”

•Emerick “has a master’s degree in education but is not a state-certified therapist”.

•Use of ammonia aversion on the boys. “The patient sniffs ammonia if he experiences an erection when shown nude photographs of young children.”

•“The plethysmograph is used on all boys who have reached puberty, including some as young as 10.”

•“Ammonia aversion is used in about 75 percent of the cases, Emerick said.”

•“Most of these child sex offenders are referred to the program by Juvenile Courts across the state, Child Protective Services, Indian Health Services, and a variety of Tribal Courts, Emerick said.”

•“Ninety percent of the program’s funding comes from government sources, hospital officials said.”

•“A three-day inpatient sexual assessment, which includes polygraph and plethysmograph testing, costs about $1,500.”

•“Last year, Child Protective Services referred 10 children to the program at a cost of about $192,000, most of which was covered by federal Medicaid money.”

•“Not all of these children have been adjudicated guilty of sexual abuse, DES officials said.”

•“The state Supreme Court paid $124,906 to Phoenix Memorial last year for evaluating and treating juveniles.”

•“The polygraph and plethysmograph are essential components for treatment,” Emerick said.

•“The plethysmograph is used to treat juveniles at 168 of the 755 sex-offender programs nationally.”

Arizona Republic, June 14, 1992, page A13

•Dr. Judith Becker “has been involved in three studies on the use of the plethysmograph on juveniles and believes it can be useful. But it has limitations, she said.  In those boys that had an abusive history, whether physical or sexual, they showed arousal to almost every form of stimuli we showed them. That clearly has to be taken into consideration,” said Becker, director of the University of Arizona’s sexual medicine clinic in Tucson and a board member of the Association for the Treatment of Sexual Abusers.”

•“Some of the children who had molested children show arousal to children, some did not.”

•“In all of the studies, both the child and his parent or guardian consented to the treatment.”

•“I am not aware of any scientific literature of the use of aversion therapy with children,” said Becker.

•“The use of ammonia aversion with children who have not reached their teen years would have to be considered experimental.”

•“Currently, there are no standards for the use of the plethysmograph on children, Becker said.”

•“It is my belief that the major detractors to the program . . . are in many ways co-conspirators to the victimizers of women and children,” Emerick said.

Arizona Republic, June 17, 1992, page B2

•”Incestuous” relationship with the Maricopa County Attorney’s Office.

•“The hospital’s Sexuality and Addiction Program, which evaluates and treats sex offenders is directed by Robert Emrick; his wife, Cindi Nannetti, is chief of the county attorney’s Sex Crimes Bureau.”

•“Before offering a plea bargain, prosecutors often require that a sex-crime defendant submit to a penile plethysmograph test, defense attorneys contend.”

•“If you want to get offered a probation–eligible deal, he has to be screened (with the plethysmograph) and there’s really only one show in town – Bob Emerick.”

Arizona Republic, June 18, 1992, page B1

•“A state-designated behavioral-health authority that has reviewed Phoenix Memorial Hospital’s sex offender program says it won’t refer patients there because the controversial therapies are unproved.”

•“Basically, what you have is an extremely high-paid, money-making operation it makes $30,000 per patient and every three months probably charges about $500 for a retest. And it’s based on absolutely nothing,” said Dr. John Woods, a psychiatrist who is medical director of the Pinal-Gila Behavioral Health Association.”

•“We don’t send kids there anymore, and we try to avoid having kids sent there.”

•Phoenix Memorial “Hospital officials issued a statement refusing specific comment on their program.”

•“The Sexuality and Addiction Program provides evaluation and treatment for adults and juveniles who have sexually molested children or have been involved in suspected abuse cases. In many cases, the program has provided an important alternative to imprisonment and detention for these children. The program is similar to youth sexual- offender programs in other states.”

Arizona Republic, July 18, 1992, page A22

•”Until public outrage and a legal challenge forced the hospital to rethink its procedures, the plethysmograph was used on boys as young as 10. The deviant sexual propensity of these young subjects was gauged by the response to photographs of nude men, women and children.”

•“New restrictions set the minimum age of 14, unless exceptions are approved by a new advisory council composed of healthcare professionals.”

•“Other policy changes include limiting the program to subjects between the ages of 12 and 16, and “treating” only those a court finds guilty of serious sex offenses.”

•90% of its funding is from tax-supported sources. “The courts, Child Protective Services and the Indian Health Service each year send the program more than 100 children, many of them already sexually abused.”

Arizona Republic, July 26, 1992, page 1

Arizona Republic, July 26, 1992, page 7

•“Experts around the nation disagree, though using the plethysmograph on children under 14 is almost universally condemned.”

Arizona Republic, July 26, 1992, page 8

•“Most importantly, the therapy was proved effective when he had his last plethysmograph test. ‘By the end of the month, after all the ammonia capsules, I had no arousal to anything,’ he said.”

•Regarding an 11-year-old boy – “Program officials told the parents they would need to check the older brother into the hospital for three days of assessment, including written, polygraph and plethysmograph tests. The boy, now 15, just shrugs when asked about the plethysmograph. He only saw three or four slides before becoming too aroused to complete the test. ‘The first picture is fully clothed, and they’d ask me to tell what their sex was and what they were doing,’ the boy said. ‘Then when they didn’t have clothes on, they’d ask me to tell what I could see.’ The second time the boy was given the plethysmograph, the questions became more explicit, the family said. ‘He’d ask what kind of things I could do with the picture,’ the boy said. ‘But when it got into the report, it said I wanted to do these things.’. . . “I don’t ever want to see that place again,’ the boy said.”

Arizona Republic, July 26, 1992, page 9

•“You go into an enclosed room with a one-way mirror.”

Arizona Republic, July 27, 1992, page 1 and 4

•“A month later, the hospital restricted participation in the program to children convicted of sex crimes who are at least 12 and set an age limit 14 for assessment with the plethysmograph – unless an advisory panel approves its use on younger boys.”

•“Some of the men and boys have erections,” in some of the pictures used with the plethysmograph.

•“Bill Pithers, President of the national Association for the Treatment of Sexual Abusers, said 20 to 40 percent of adults sex offenders evaluated with the device show no arousal to any stimuli. Yet many “normal” adult men can experience arousal to photos of nude children are other “deviant” material, research shows.”

•“The Republic interviewed more than a dozen psychologists, psychiatrists and therapists from several states. All expressed concern at Phoenix Memorial’s using the plethysmograph on young boys.”  “There’s something rather sadomasochistic about this kind of treatment, especially with young children,” said Dr. John Money, professor emeritus of psychiatry and pediatrics at Johns Hopkins University in Baltimore and a pioneer in the treatment of sexual deviancy. Even the state’s juvenile-correction system – which by its nature handles juveniles more dangerous than those sent to Phoenix Memorial – has barred the use of the plethysmograph.”

•“National, although there are no guidelines, therapist who use the plethysmograph generally restrict its use to boys 14 and older, the standard recently adopted by Phoenix Memorial.”

•“Below that age, ‘it’s unethical,’ said Toni Cavanaugh Johnson, a clinical psychologist, head of California’s sex-offender-treatment association and author of a new book on treating child sex offenders. ‘We do not understand the physiological arousal, the sex drive and the sex offenses in prepubescent children,’ she said. ‘These kids get erections when they’re scared, they get erections when they’re angry, and sometimes they get erections when they’re sexually stimulated.’ Johnson has included in her book mention of Phoenix Memorial’s program as an example of how the plethysmograph should not be used with children.”

•“However, Wendy Dutton, a manager with the hospital’s sex-therapy program, said the data obtained from boys under 14 have been valid.  ‘Clinically, the children tend to fall into two categories,’ she said. ‘They’re either nonresponsive or present clearly delineated arousal patterns.’ She said it is a ‘myth’ that young boys will be aroused by almost anything, disputing criticism such as Johnson’s. ‘There’s a lot of politics in the field of sexual abuse, a lot of opposing factions,’ she said. ‘Phoenix Memorial faces the same kind of criticism as Sigmund Freud or Albert Kinsey’, Dutton said.”

Arizona Republic, February 18, 1993, page 13

•“Phoenix Memorial closed both its adult and juvenile sex-therapy programs in September, blaming adverse publicity for lack of referrals and revenues.”

Arizona Republic, July 10, 1993, page 9

•“Phoenix Memorial’s use of the controversial therapy, which included showing photos of naked women, children, and men to boys as young as 10, sparked inquiries by congressional investigators last year. If the photos caused inappropriate arousal, the boys administered themselves whiffs of ammonia. The hospital closed its Sexuality and Addiction program last year.”

Arizona Republic, Sept 15, 1993, page 17

•“The therapy, used on some patients as young as 10, involve showing them photos of nude women, children and men. After the Arizona Republic reported the situation, several investigations were launched, including one by Congress. The hospital closed the program before the investigations were completed.”

Arizona Republic, Sept 15, 1993, page 18

•“Although controversial, especially with adolescents, we were unable to conclude that the treatment was outside the bounds of normal practice as to constitute a violation of Arizona law,” said Robert Schackner, chairman of the subcommittee that investigated the complaints.”

•“Phoenix Memorial…saying that the program was ‘exceptional and progressive’ and provided effective treatment for the most serious sex offenders. ‘The program help curb the thousands of sexual assaults that are inflicted on our children every year and provided an important service two sexual offenders in the course of rehabilitation,’ the statement said. It added that the hospital has no plans to reopen the program.”

Arizona Daily Star, May 14, 2006

•The allegation is that Dutton  “(a forensic interviewer at St. Joseph’s Hospital in Phoenix) had mislead attorneys and jurors for years about her academic credentials,” which included “more than 200 child sexual-abuse cases”.

•She had not taken her comprehensive exams and did not have a dissertation committee since 1998.

Listed below are presentations that Dutton made after the debacle.  Are there any cautionary statements in any of her work?  Does she mention that her program was shut down?

•”The Use of the Polygraph with Adolescent Sexual Offenders.”  Association for the Treatment of Sexual Abusers Annual Conference, Portland, OR.  October 9, 1992.

•”The Use of the Polygraph and Penile Plethysmograph with Adolescent Sexual Offenders.”  Statewide Probation Conference, Tucson, AZ.  October 29, 1992.

•”A Study of Polygraph and Plethysmography.”  Tenth National Training Conference of the National Adolescent Perpetrator Network, Denver, CO.  February 22, 1994.

•”Polygraph and Phallometric Testing of the Sexual Offender.”  Colorado District Attorneys Council, 23rd Annual Training Conference, Snowmass, CO.  September 19, 1994.

•”Current Research on Using Polygraphy and Phallometric Testing with Juvenile Sex Offenders.”  Presentation to the Providers Association for the Treatment of Sexual Abusers, Casa Grande, AZ.  May 5, 1995.

•”Use of Polygraph and Phallometric Testing with Adult and Juvenile Sex Offenders.”  Third National Colloquium of the American Professional Society on the Abuse of Children.  Tucson, AZ.  June 9, 1995.

•”Polygraph and Phallometric Testing of the Juvenile Sexual Offender.”  Working with the Juvenile Sex Offender Conference, Council on Sex Offender Treatment and the Texas Youth Commission.  Austin, TX. July 14, 1995.

Trainings

•”Use of Penile Plethysmograph in Assessment and Treatment of Sex Offenders.”  William Farrall, Ph.D.  16 hours, September 1986, Tucson, AZ.

•”Treatment of Sex Offenders.”  Robert Emerick, M.Ed.  30 hours, July – September 1984, Tucson, AZ

Association for the Treatment of Sexual Abusers

Practice Guidelines for Assessment, Treatment, and Intervention with Adolescents who have engaged in sexually abusive behavior.

2017 (Short Title: ATSA Adolescent Practice Guidelines)

(page 34)

Psychophysiological Measures

Polygraph and plethysmography are physiological measurements designed for use with adults. Their use was extended to adolescents (and younger children) without establishing the measures’ scientific validity and without full consideration of their potential for harm. In particular, no research has subjected either measurement to controlled evaluation with relevant comparison groups such as adolescents who have not offended sexually. There are, therefore, no norms against which to compare measurement results, which severely limits their interpretability. More generally, neither measurement has been shown to improve treatment outcomes, reduce recidivism, or enhance community safety. Neither measurement is regularly used outside of the United States. Indeed, some countries have banned the use of one or both measurements with minors.

Ethical concerns raised for both measurements include the potential for coercion and for engendering fear, shame, and other negative responses in adolescent clients. Further ethical concerns relate to the prospect of basing impactful decisions (including those relevant to such things as legal restrictions and/or family reunification) on the results of measurements that are largely unsupported empirically. Separately, plethysmography involves the ethically concerning practice of exposing adolescents to developmentally inappropriate sexual material. Without a clearly identified benefit and with a potential for harm, ATSA recommends against using polygraph or plethysmography with adolescents under age 18. ATSA recommends the use of valid assessment procedures as outlined throughout this section of the ATSA Adolescent Practice Guidelines.

These are presentations that Dutton has made – need the handouts for these.

“Polygraph and Phallometric Testing of the Juvenile Sexual Offender.”  Working with the Juvenile Sex Offender Conference, Council on Sex Offender Treatment and the Texas Youth Commission.  Austin, TX. July 14, 1995.

“Use of Polygraph and Phallometric Testing with Adult and Juvenile Sex Offenders.”  Third National Colloquium of the American Professional Society on the Abuse of Children.  Tucson, AZ.  June 9, 1995.

“Current Research on Using Polygraphy and Phallometric Testing with Juvenile Sex Offenders.”  Presentation to the Providers Association for the Treatment of Sexual Abusers, Casa Grande, AZ.  May 5, 1995.

“Polygraph and Phallometric Testing of the Sexual Offender.”  Colorado District Attorneys Council, 23rd Annual Training Conference, Snowmass, CO.  September 19, 1994.

“A Study of Polygraph and Plethysmography.”  Tenth National Training Conference of the National Adolescent Perpetrator Network, Denver, CO.  February 22, 1994.

“The Use of the Polygraph and Penile Plethysmograph with Adolescent Sexual Offenders.”  Statewide Probation Conference, Tucson, AZ.  October 29, 1992.

“The Use of the Polygraph with Adolescent Sexual Offenders.”  Association for the Treatment of Sexual Abusers Annual Conference, Portland, OR.  October 9, 1992.

Trainings

“Use of Penile Plethysmograph in Assessment and Treatment of Sex Offenders.”  William Farrall, Ph.D.  16 hours, September 1986, Tucson, AZ.

“Treatment of Sex Offenders.”  Robert Emerick, M.Ed.  30 hours, July – September 1984, Tucson, AZ