In Need of Therapy

Robert Komarenski is a convicted pedophile who says he wants to escape his dark urges. But since his release from a state psychiatric hospital last month, he has been unable to obtain the drugs he says curb his destructive desires.

Jobless, he has been turned down for the medication by the government-funded clinics he visited. Wandering the streets of the San Fernando Valley for weeks, unable to afford the expensive prescription drugs, Komarenski worried that he would lose control and commit another crime.

Komarenski’s unusual case has revealed a flaw in California’s efforts to control would-be child molesters, psychiatrists say: Many released sex offenders have nowhere to turn to obtain the effective but expensive drugs.

Thousands of sex offenders are paroled in California each year; there are 20,000 registered in Los Angeles County. Beginning in 2002, some child molesters will be required to submit to testosterone-reducing drugs while on parole under a state law that is the first of its kind in the nation.

The drugs are said to reduce recidivism, and will eventually be provided free to paroled child molesters who qualify. In the meantime, people who want to submit to the drug regimen face huge challenges, both because of the costs and because many mental health professionals are not familiar with the medications.

It was only after repeated inquiries from The Times that officials pledged to continue Komarenski’s drug treatment. He received his first shot at a county mental health clinic Wednesday.

“The drugs are accessible in the sense that they’re sold in pharmacies and, theoretically, if you have the money and a prescription, a person could have access to them,” said Dr. Gabrielle Paladino, a staff psychiatrist at Atascadero State Hospital, which houses the state’s sexually violent predators.

“The problem is that you don’t have a lot of doctors out there that treat sex offenders. Your average psychiatrist in the field wouldn’t prescribe it in his lifetime.”

The drug treatment is still highly specialized because it is generally seen as punishment, not therapy, according to Dr. Fred Berlin, founder of the Sexual Disorders Clinic at Johns Hopkins University in Baltimore.

“We still don’t have a general acceptance that this is as much a mental health matter as a criminal justice matter,” Berlin said. “It doesn’t make sense, particularly if someone doesn’t have money, that they should have to commit a crime to get this medication.”

Ironically, committing a new crime would practically guarantee access to the drugs--after a long prison term. Starting in 2002, California law will require many repeat child molesters to be “chemically castrated” upon parole.

So-called chemical castration is a reversible drug therapy involving regular doses of antiandrogens: drugs that stop the body’s production of testosterone, the hormone primarily responsible for the male sex drive. By reducing sexual desire, psychiatrists say, the drugs quiet the sexual fantasies and urges that plague many sexual deviants, particularly child molesters.

They do not eliminate a person’s sexual attraction to children, experts caution, but they can help such a person keep from acting on those deviant tendencies.

Both of the drugs used for this purpose in the United States are manufactured and marketed for other uses: Depo Provera for birth control and Lupron for treatment of prostate cancer, experts said. Both are expensive, with monthly dosages running as much as $100 for Depo Provera and nearly $600 for Lupron.

They are not widely prescribed or widely understood in the psychiatric community.

Only California’s maximum security psychiatric hospitals routinely treat mentally disordered sex offenders with testosterone-reducing drugs, authorities said. Patients at Atascadero who agree to a conditional release program can continue the drugs through a special program outside hospital walls, said Paladino, a staff psychiatrist, and the state Department of Mental Health.

The drugs are not offered to convicted sex offenders in California prisons, nor are they offered to parolees, according to the Department of Corrections. Because the chemical castration law is not retroactive, the first felon who may be forced to take the drug would be released in 2002.

“We just follow the law,” said Terry Thornton, a Department of Corrections spokeswoman. “If someone wanted it, they’d have to do it on their own.”

Obstacles to Treatment

It is difficult to know how many offenders want the treatment. Corrections officials say no one has ever requested it, but Berlin of Johns Hopkins said it is foolhardy to expect someone to tell jailers they are considering committing a crime. “Most people aren’t going to put themselves at risk of going to jail to get treatment,” Berlin said. State and local mental health officials said there is no public treatment center in California set up to provide the specialized drug therapy to sexual deviants in the community.

Someone who wants treatment for the first time is in a tougher situation. Dr. Maurice Weise, medical director for adult services for the Los Angeles County Department of Mental Health, said he does not know whether his department would fulfill that request.

“There’s absolutely a hole” in the system, Weise said. “But it’s generated partly by the fact that most of these people don’t seek treatment.”

If Komarenski’s story shows anything, however, it is that even those most determined to get help may not get it.

Komarenski said he has suffered from sexual fantasies about elementary school girls since he was 19.

The urges have been such that he has never been able to get a steady job, he said, and has been arrested many times for exposing himself to children, child annoyance, molestation and sexual assault.

After an arrest in 1992 for grabbing a 10-year-old girl who was on her way home from school and asking her to have sex with him, the 51-year-old felon said, he decided he wanted to stop.

“I hated what I did,” he said. “I kept seeing her face playing over and over again in my mind. It made me sick with myself.”

He pleaded guilty to the charges and was sentenced to the maximum of six years in prison. He was released after serving half the time, Komarenski said, but was imprisoned again for more than a year after telling his parole officer he was afraid he would cave in to his urges and commit a crime.

When his sentence ran out last year, Komarenski said, he wasn’t on the street long before he decided he couldn’t handle it. He walked into a mental hospital and told the staff he was afraid he was going to assault a child. He was admitted to Olive View-UCLA Medical Center in Sylmar under laws allowing the confinement of someone who is a danger to others.

He said staff at the hospital tried to find a place where he could get testosterone-reducing drugs but the efforts proved fruitless. He said he was told that the treatment was not available outside the maximum security psychiatric hospitals that house the most dangerous mentally ill. Many of them are there in connection with a criminal case, typically because they are unable to stand trial or have been found not guilty by reason of insanity.

So Komarenski told a judge he could not care for himself because of his mental problems and got himself committed to Patton State Hospital in San Bernardino County, where he finally began testosterone-reducing treatment with Lupron. The results, he said, were startling.

“My sex drive is practically zero,” he said. “It works. It really works.”

On His Own Again

At a mandatory court review on Aug. 24, a psychiatrist testified that Komarenski could provide food, shelter and clothing for himself and had done so in the past with government aid. Komarenski contends that he has never held a steady job and has survived on disability benefits for his mental illness.

Dr. George Proctor, Komarenski’s psychiatrist at Patton, said he thought Komarenski still posed a threat to society and therefore should continue treatment in a hospital setting. But because of the nature of his initial voluntary civil commitment, whether Komarenski posed a threat was irrelevant, he said. Komarenski was released two days later.

Proctor said Patton tried to find an outpatient clinic in Los Angeles that would continue Komarenski’s testosterone-reducing treatment, but found none.

The psychiatrist said he told Komarenski to contact local mental health authorities, and gave him a list of his prescribed medications before he left Patton.

Once freed, Komarenski again found that he could not get the drug treatment he sought.

As he saw doors closing and fewer and fewer days remaining before he needed his monthly Lupron shot, Komarenski said his deviant sexual cravings returned.

“I don’t want to live like this. This is not who I am,” Komarenski said a few days before he finally received the shot. “I just want to be normal.”