In a pastoral setting covering over 110 acres bordering the Seekonk River on the east side of Providence, Rhode Island, is the first hospital in the state dedicated to the treatment of patients with mental disorders. Butler Hospital, with its park-like winding footpaths and stately buildings, has a rich history dating from the mid-1800s, before the advent of psychopharmacology and other modern treatment modalities. A guiding principle in its construction was the creation of a restorative environment that would provide the air and light that were thought necessary for successful mental health treatment. Opened in 1847, this new institution for mentally ill persons housed 130 patients in a very different environment from the asylums of the past. From their rooms, the patients looked through high windows onto the surrounding grounds with flowering plants and trees. Dr. Isaac Ray, one of the eminent forensic psychiatrists of that period and founder of the Superintendents Association, a forerunner of the American Psychiatric Association, was its first Medical Director. Now, 161 years later, Patricia Ryan Recupero, JD, MD, is the first woman to become President and Chief Executive Officer of Butler Hospital and Executive Vice President for Behavioral Health of the Care New England Health Group. As the newly elected 35th President of the American Academy of Psychiatry and the Law, she is also the first attorney-psychiatrist to hold the position.
When asked what it is like to walk through the hallways of this historic landmark, Dr. Recupero responded that she is ever mindful of the special significance of Ray's leadership in the history of American forensic psychiatry and that she views herself as a custodian of the rich heritage of Butler Hospital. Further, she described Ray as an insightful psychiatrist who focused on creating an environment built on mutual respect and teamwork while providing a harmonious setting for patient care. It is this opportunity to extend Ray's legacy of raising the standards of care within Butler Hospital, fighting against the stigmatization of mental illness, and working to achieve true parity for mental health and substance abuse services that she finds personally fulfilling in accepting the position as President of Butler Hospital.
Recupero's immediate predecessor, Frank Delmonico, was a strong business leader and a conscientious steward of the hospital. Building on his business initiatives, Recupero has focused her leadership on augmenting the clinical strengths of the hospital to secure its future.
A portion of the extensive campus, located in one of the most affluent residential sections of Providence near Brown University, is leased to senior citizens for independent housing. Another section of the campus has been set aside for assisted-living arrangements for seniors. The residual financial support from these initiatives helps to sustain the hospital's academic mission. The Butler Hospital campus has about 150 mental health beds, of which approximately 25 are for children. A portion of Recupero's work is in raising funds for the hospital. Under her active leadership, the hospital has completed a new building that now houses the geriatric service and a 20-bed intensive treatment unit. Through collaborative agreements with the general hospitals, Butler Hospital has been able to offer community residents access to the full spectrum of services that are not available within the general hospital. Recupero states that Butler strives to remain nimble and to update its services continually, to meet the needs of the community. For example, when the need for child patient beds decreased and the emergency rooms were overflowing, the hospital was able to make the appropriate adjustments within a few months. During the past several years, Recupero has had meetings with community residents who were interested in planning future business initiatives for the hospital. While Butler is contemplating a merger with other medical organizations, she notes that the current state of the economy and tight lending policies prohibit undertaking further construction projects at this time. The strategic planning for the hospital, however, is generally projected 5 to 10 years ahead.
Butler Hospital has grown exponentially since Ray's time, has become a leader in clinical and translational research, and is a strong educational component of Brown University. The hospital receives over $19 million in National Institutes of Health research grants, representing approximately one-third of the total research grants received by Brown psychiatry programs, and Brown is one of the top departments of psychiatry in the United States in total research funding. Recupero has a staff of over 500 full-time-equivalent personnel to carry out the mission of the hospital.
Recupero and her husband, Joe Recupero, Esq., have been married for over 36 years; they met while law students together at Boston College. Her husband, a practicing attorney specializing in real estate and trusts in Providence, encouraged her to attend medical school and continues to support her in her professional life. She noted that as a busy professional couple they are mutually supportive of each other's careers and are protective of their personal time together.
Mr. Recupero, a golfer, recruited one of his friends, Dana Quigley, known as the iron man for his tenure as the golfer with the greatest number of consecutive tournaments played on the Professional Golf Association's senior tour. Quigley has become an enthusiastic supporter of the hospital's charity tournament for the past 10 years. And, in her limited leisure time, Recupero also has become a golf enthusiast.
Recupero's introduction to the Academy of Psychiatry and the Law came as a resident attendee of the Academy's review course. Subsequently, with the encouragement of her mentor, Dr. Ronald Wintrob, she became a Rappaport Fellow, and Dr. Thomas Gutheil was assigned as her forensic mentor. Wintrob maintained contact with her throughout her training years and, at her graduation from residency, offered her a position in the residency training program at Brown. During an initial meeting with hospital staff, she introduced herself as the Assistant Training Director; however, Wintrob corrected her in front of the staff and indicated that her title was that of Associate Training Director. Recupero recalled feeling flattered and surprised by his confidence in what she considered to be her untested abilities in psychiatric education. He also encouraged her to pursue a career in psychiatric hospital administration, a path that she had not previously considered taking.
A series of events occurred in medicine that provided her with opportunities to demonstrate her keen leadership skills. During 1991 and 1992, managed care was rapidly moving across the nation and had already achieved significant penetration in the Rhode Island market. Butler Hospital asked that Recupero chair a committee to address the impact of this new insurance program on patient care. Her work on this project culminated in a new comprehensive utilization review law in Rhode Island, which later served as model legislation for other states. The law allowed patients to appeal denials of care with mandated external review of those denials, provided strict rules regarding emergency coverage, and defined requirements for peer review by credentialed reviewers.
One might ask how such a private person could become an influential public figure. At the age of four years, Recupero suffered the loss of her mother, who had taught her to read at a very young age and to enjoy what has become a lifelong pursuit of scholarship and recreation. She was raised by her paternal grandmother and her father, who eventually remarried. In high school, Recupero took an introductory psychology course and recalled learning that the essence of this field was “more than sitting on a couch and talking about your mother.” This was also her first brush with neurobiology and neurotransmitters which she recalled was “as fascinating as a novel!”
Her transition to college in 1966 at SUNY in New Paltz, New York, was a time of significant social and political unrest. The next four years were filled with student demonstrations focused on the Vietnam War, the civil rights movement, the War on Poverty, and the assassinations of Robert Kennedy, Martin Luther King, Jr., and Malcolm X. Recupero views herself as “a child of the 60s,” perhaps without the beads and bandanas, but sharing the idea that change was needed in American society. That decade was a tumultuous period in this country with many of her friends and classmates being drafted or voluntarily leaving school to serve in the armed services. Some did not return. She remembered that there was a general call among her peers for change in the social structure of the country that was congruent with her interests in civil liberties and her vision of improving the lives of others. Studying the law seemed a natural avenue toward making a real difference, but she acknowledged that this decision was also going against the grain of career choices for women at that time. Graduate schools were just beginning to see a greater number of women applying for careers in law and medicine. Recupero excelled in her work and received many awards including the Order of the Coif, a national honor society; first prizes in Moot Court Competitions, and designation as Article Editor of the Industrial and Commercial Law Review.
Moving to Rhode Island with her husband, Recupero tutored law students and engaged in an active practice as a litigator for both civil and criminal matters and as a Special Assistant Attorney General for the state of Rhode Island. While she found the didactics of law intellectually stimulating, the practice of law “did not measure up to its promise.” She wanted to do more for people and began looking broadly for a complementary professional direction. Grappling with the medical aspects of her legal cases had always seemed exciting and challenging, and with her husband's encouragement, she decided to pursue training in medicine. She recalled that the first two years of medical school at Brown University reminded her of the television show of the 1950s, Dragnet: “Just the facts ma'am.” However, the clinical training years were so much more and provided special opportunities to use her legal training to help patients in practical ways. As an older medical student and a lawyer, she acknowledged that this placed her in a different position from that of most of her younger classmates. On one occasion, after a professor came into the medical classroom and put up a slide of a naked woman (for humor and not for medical reasons) before the start of the class, Recupero responded by bringing his behavior to the attention of the medical administrators. The class was assured that this would never happen again and it did not. During residency, Recupero recalled that the female medical students and residents used the women's locker room, but had to go to the men's locker room to use the equipment for dictating notes. Few questioned the accommodations, as this was “just the way it was” in those days. Significantly, these incidents fueled academic research interests in the impact of sexual harassment in medical education.
Recupero acknowledged that she did not have a 5- to 10-year strategic plan for her career path. Initially considering specializing in internal medicine, she soon found herself drawn to psychiatry, as it incorporated many of her interests in the humanitarian aspects of the law and questions of basic human rights, competency, and the right to treatment.
Chief among her many research interests are helping doctors to manage risk and improve the quality of care; the Internet and technology and their impacts on the practice of medicine; education and ethics; bullying and school violence; and basic human and civil rights at the intersection of psychiatry and the law. Her writings have been published widely in the scientific literature. Most recently she co-authored two chapters in the Textbook of Hospital Psychiatry (Edited by Sharfstein SS, Dickerson FB, Oldham JM. Washington, DC: American Psychiatric Publishing, Inc., 2008). She has been honored at Brown with a Teaching Recognition Award for Clinical Faculty, and she serves on their Academic Executive Council.
While continuing to teach students interested in law, Recupero also maintains a small clinical practice with dually diagnosed patients and utilizes her expertise in forensic and addiction psychiatry. As President of Butler Hospital, she pursued a patients' rights case before the Rhode Island Supreme Court, In re Stephanie B. (826 A.2d 985 (R.I. 2003)), which resulted in a decision that protects juveniles from arbitrary psychiatric hospitalization. In re Stephanie B. involved a cluster of three related cases without medical testimony: a family court order had sought to prevent the hospital from discharging a patient, despite the absence of medical evidence that continued hospitalization was necessary. Finding that the family court had exceeded its authority, the state supreme court wrote that, “Absent a civil certification procedure for a mentally ill child, the Family Court is without authority to order a child's confinement in a mental health care facility…” (In re Stephanie B., 826 A.2d at 995).
During the course of her practice of law, Recupero testified in superior court related to matters such as competency to stand trial, negligence, depression, and post-traumatic stress disorders. As Special Assistant Attorney General, she worked on an important case in Rhode Island's legal history, State v. Johnson (399 A.2d 469 (R.I. 1979)), which led to the adoption of the American Law Institute's test for criminal responsibility, replacing the M'Naughten Rule.
As a practitioner, Recupero recalled that many of her “brothers of the bar” advanced in their careers to become judges. Therefore, they knew her personally and were aware of her legal background and skills before she obtained her medical school training. When the justices heard a lawsuit by the American Civil Liberties Union challenging the fairness in asking about an applicant's mental illness and substance abuse history before the applicant takes the Rhode Island bar examination, they called on Recupero to act as a Special Master. Her charge was to hold hearings and to advise the court with respect to these questions. In her Special Master's brief, she argued that the questions in their current wording violated the Americans with Disabilities Act and were discriminatory. This opinion was upheld by the court.
Recupero has served many community and professional organizations and received many awards, including the Annual Exemplary Psychiatrists Award from the National Alliance on Mental Illness. She is Past President of the National Association of Psychiatric Health Systems and is currently the Chairperson of the American Psychiatric Association's Council on Psychiatry and the Law. Recupero credits the work of the Workgroup on CyberMedicine with inspiring much of her research and writing about the impact of the Internet on psychiatry.
Recupero is currently a Clinical Professor of Psychiatry at Brown University's Warren Alpert School of Medicine. Her colleagues point to her industry, thoughtfulness, and attention to the details of the work. Although she is reserved in her demeanor, she carefully presents the arguments for her position, cannot be intimidated, and does not seek to intimidate others with her legal expertise. She is known for her wry sense of humor and always takes time to mentor young professionals. Dr. Renée Binder, the second woman president of the American Academy of Psychiatry and the Law, recalled that Recupero volunteered her time, financed her own participation in American Psychiatric Association study groups, and took on leadership responsibility for projects even though she was not a member of the APA's Council on Psychiatry and the Law. She describes Recupero as more interested in accomplishing the task than in self-promotion.
The eldest of four daughters, Recupero shares a strong commitment with her sisters to making time to be together each year with their nieces and relatives, especially during the holidays. One of her sisters, who has a doctorate in education, has presented at scientific meetings with her. Leisure time is limited, but Recupero finds time to play golf with a 30 handicap, to read, and to attend opera. She delights in the Italian operas, with her favorite being Tosca, whose central protagonist she characterizes as a “woman of substance who lives her life on her own terms and stands up for what she believes in.” This aptly describes Recupero's leadership to advocate for patients who struggle with mental illness, to challenge any inequities or discriminatory application of the law designed to thwart needed health care for patients, and to improve the practice of forensic psychiatry by utilizing her gifts as an outstanding leader and mentor in the fields of law and medicine.
Patricia R. Recupero, JD, MD
- American Academy of Psychiatry and the Law
