"I was really shocked when I heard about this," Sundwall said. "I am quite willing to take the heat personally for overstepping my bounds because I believe this in the public interest."

Dr. Lindsey Kerr, a urologist with the University of Utah health system, said erectile dysfunction medication for sex offenders raises an "ethical dilemma," but the issue may be overblown — from a medical standpoint.

"Unlike testosterone injections, which may actually increase aggression, Viagra . . . doesn't generate arousal. From a behavioral standpoint, it thankfully may not have that much of an impact."

But the issue has left even those advocates who work closely with Medicaid beneficiaries a bit puzzled.

"Viagra is not high on our list of drugs we should be spending our tax dollars on," said Judi Hilman, a health policy analyst for Utah Issues. "I don't know if sexual functioning is within Medicaid's purview, but certainly it should not be given to sex offenders."

Nationally, the Department of Health and Human Services has said it wants to take steps to prevent sex offenders from receiving erectile dysfunction medication — without jeopardizing other Medicaid beneficiaries' ability to get the medication.

Reacting to the audit, a New York senator said he plans to sponsor legislation to stop the practice and in a letter to Health and Human Services Secretary Mike Leavitt, the New York auditor demanded immediate action.

Officials said that prior to the audit, they were unaware of the loophole and said a sex offender's ability to get the medication was an "unintended consequence" of federal mandates.

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E-mail: amyjoi@desnews.com