People v. Maria T. , 371 Ill. App. 3d 318 ( 2007 )

THIRD DIVISION
JANUARY 31, 2007
No. 1-06-0170
In re M.T., Alleged to be a Person ) Appeal from the
Subject to Involuntary Treatment With ) Circuit Court of
Psychotropic Medication ) Cook County.
)
(The People of the State of Illinois, )
)
Petitioner-Appellee, ) No. 06 COMH 130
)
v. )
)
Maria T., ) Honorable
) Nathaniel R. Howse,
Respondent-Appellant). ) Judge Presiding.
JUSTICE GREIMAN delivered the opinion of the court:
Respondent, Maria T., appeals from an order of the circuit
court of Cook County authorizing her involuntary treatment with
psychotropic medication. She contends that the order should be
reversed because the State failed to prove by clear and
convincing evidence that the benefits of the medication
outweighed the harm.
The State, through Dr. Joanna Poniaquwicz of Lutheran
General Hospital, petitioned the court on January 11, 2006, to
begin the involuntary treatment of respondent with psychotropic
medications pursuant to section 2-107.1 of the Mental Health and
Developmental Disabilities Code (Code) (405 ILCS 5/2-107.1 (West
2004)). In the petition, Dr. Poniaquwicz stated that respondent
suffered from paranoid schizophrenia, that she was currently
psychotic and unable to function, and sought to medicate her with
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Proloxin Decanoate (12.5- to 25-milligram injection every two
weeks), and alternatively with Risperidone1 Consta (25- to
50-milligram injection every two weeks), oral Proloxin tablets
(up to 40 milligrams per day), and oral risperidone tablets (up
to 8 milligrams per day).
On January 13, 2006, Dr. Poniaquwicz responded to a routine
bill of particulars, stating that respondent had been
involuntarily admitted to Chicago Read Hospital in December 2004,
received Proloxin Decanoate, and responded "well," as she was
able to care for herself and be discharged from the hospital in
March 2005. However, because respondent became noncompliant with
her medication, she was readmitted to Swedish Covenant Hospital
in November 2005.
On January 20, 2006, a hearing was held on the State's
petition. Nancy S., respondent's daughter, testified regarding
the series of events leading to respondent's present
hospitalization. During the first two weeks of November 2005,
respondent told her that she owned at least one other home, which
she did not, and that when she went there to bathe herself, the
police came and took her to Swedish Covenant Hospital. She also
told her that she was the Virgin Mary, that she was rich, and
that banks owed her money. On December 22, 2005, when Nancy took
1
"Risperidone" and "Risperdal" are used interchangeably
throughout the record.
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respondent to a grocery store, respondent was reluctant to
purchase fruits, vegetables, and milk for fear of contamination.
On January 5, 2006, respondent told Nancy that she had not been
eating because her food was being poisoned, which statement
respondent had made to her at least six times during December
2005. Nancy had also noticed that respondent had lost about 15
pounds from October 2005 to the time of the hearing.
On January 6, 2006, respondent was admitted to Lutheran
General Hospital and continued to express that her food was being
poisoned. She also told Nancy to cover herself to prevent
people from inserting objects into her orifices and that she had
inserted tampons "in her behind." In addition, respondent told
Nancy that her home was "fine" and that she had been using the
heat; however, when Nancy visited there five days later, she had
to crawl through a broken window to enter the house because the
entrance was barricaded, the refrigerator was unplugged and in
the living room with a chain around it, the furnace was turned
off, the oven was turned on and opened, and a waffle iron was
turned on to heat the basement. Respondent subsequently told
Nancy, on January 8, 2006, that she could not eat the hospital
food because it smelled "funny" and because voices had told her
not to do so.
Nancy further testified that respondent had been on long-
term psychotropic medications in the past, most recently from
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October 2004 through February 2005, when she was involuntarily
admitted to Read Hospital. At that time, respondent was
prescribed Risperdal, among other things, and after receiving
this medication, respondent was more rational, did not
hallucinate as often, and talked more about everyday life.
Although she experienced some side effects from the medication,
they were able to be controlled. When respondent was discharged,
she was still "a little paranoid," but she was better able to
care for herself and her home, i.e., she bought a wider variety
of foods, gained weight, cleaned her house, and used space
heaters. Nancy acknowledged that she "probably" told Dr.
Poniaquwicz that Risperdal had not done respondent "a lot of
good" in the past.
Dr. Poniaquwicz, an expert in the field of psychiatry and
respondent's attending physician, testified that respondent was
admitted to Lutheran General Hospital on January 6, 2006. Dr.
Poniaquwicz first examined respondent on January 7, 2006, and
about six days a week thereafter. Based on her inquiry into
respondent's social history, including talking to Nancy,
reviewing respondent's medical records, and discussing the case
with her peers, she opined that respondent suffered from paranoid
schizophrenia and had done so for 26 years. Respondent was
currently symptomatic and experiencing paranoid delusions, i.e.,
her food was being poisoned and voices were telling her not to
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eat. She was also displaying disorganized behaviors, i.e., she
attempted to tie a stocking around her neck and knelt on her bed
with the covers over her head. In addition, respondent was
displaying isolating behaviors and talking to herself. Based on
respondent's condition, i.e., her inability to keep her house
safe or eat properly, Dr. Poniaquwicz believed that respondent's
ability to function had deteriorated.
On January 9, 2006, Dr. Poniaquwicz observed respondent
attempting to tie a stocking around her neck and concluded that
respondent presented a threat to herself and that she lacked the
capacity to make decisions regarding her treatment. She
therefore administered two separate, 10-milligram emergency doses
of Proloxin to respondent. Although respondent became calmer
after receiving the medication, she complained that she was tired
and that her tongue felt large after the second dose was
administered on January 13, 2006. Dr. Poniaquwicz explained that
respondent had experienced a dystonic reaction to the medication,
a side effect which caused her tongue muscle to tense up, so Dr.
Poniaquwicz issued a "stat" order for Cogentin to relieve the
side effect. Because the Cogentin did not completely resolve the
issue, Dr. Poniaquwicz subsequently ordered Benadryl, which
completely resolved the problem. Dr. Poniaquwicz then
discontinued the administration of Proloxin for two reasons: the
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side effects and her uncertainty regarding the amount of time she
could administer the medication under the circumstances.
Despite respondent's reaction, Dr. Poniaquwicz still sought
permission to treat respondent with Proloxin Decanoate and,
alternatively, with Risperdal Consta, oral tablets of Proloxin,
and oral tablets of Risperdal, in the dosages indicated in the
petition, for 90 days. Dr. Poniaquwicz based her request on the
fact that respondent had historically responded best to Proloxin,
as she had taken it during her last inpatient hospitalization and
in the 1990s during a hospitalization in Montana. Moreover,
Nancy had told her that when respondent had previously taken
Proloxin for an extended period of time, her symptoms markedly
diminished and that she was able to function independently and be
discharged from the hospital. With regard to the risperidone,
Dr. Poniaquwicz testified that Nancy had informed her that
respondent had responded well to the medication in the past and
that she would have to further explore Nancy's statement that it
had not done respondent "much good."
Dr. Poniaquwicz acknowledged that the possible side effects
of Proloxin, as well as the alternative medications listed in the
petition, included tardive dyskinesia, extrapyramidal symptoms,
dystonia, tremor, akinesia, neuroleptic malignant syndrome (NMS),
and diabetes. She further acknowledged that respondent's age and
gender put her at an increased risk of developing tardive
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dyskinesia, i.e., abnormal movements, and NMS, which was
potentially, but rarely, fatal. Nevertheless, Dr. Poniaquwicz
opined that the anticipated benefits of administering the
proposed psychotropic medications outweighed the possible harm
because the side effects could be "remedied with appropriate
medications," and she "hoped" and "believed" that the requested
medications would enable respondent to function independently,
eat regularly, and be discharged from the hospital. She
conversely believed that, if left untreated, respondent's
symptoms would worsen, her condition would further deteriorate,
and she would be unable to live independently. Dr. Poniaquwicz
further opined that a less restrictive treatment was
inappropriate for respondent's condition.
Dr. Poniaquwicz finally testified that due to respondent's
most recent reaction to Proloxin, she would start her on a low
dose, closely monitor whether she experienced any side effects,
and if so, administer the "appropriate medications" to counter
them. She also stated that she would be available daily to
monitor respondent's response to the medications, would ensure
that the medications were safely and effectively administered
though various tests requested in the petition, e.g.,
electrocardiograms, metabolic profiles, and vital signs, and that
a psychiatrist would be available to intervene on an emergency
basis if respondent experienced adverse side effects. At the
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conclusion of the hearing, the circuit court found that the State
had proved the factors necessary to grant the petition by clear
and convincing evidence. The court specifically found:
"[A]lthough there were some side
effects, they were completely abated by the
administration of counteracting drugs. The
alternative for this individual is her not
[being] able to live a normal life in her
home the way she wants to live it. With the
medication she can go back to living her
life. The physical harm can be abated by the
counteracting drugs, and, therefore, the
petition is granted."
The court then entered an order allowing Dr. Poniaquwicz to
administer Proloxin Decanoate (12.5- to 50-milligram injections
every two weeks) to respondent for 90 days. The order
alternatively granted Dr. Poniaquwicz the authority to administer
Risperidone Consta (25- to 50-milligram injections every two
weeks), Proloxin tablets (up to 40 milligrams per day), and
risperidone tablets (up to 8 milligrams per day).
In this appeal from that order, respondent asserts that the
State failed to prove by clear and convincing evidence that the
benefits of the medication outweighed the harm. She thus
requests that the order of the circuit court be reversed.
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Initially, we observe that this case is moot. The order
authorizing the administration of respondent's involuntary
treatment was effective for no more than 90 days, and thus
expired on April 20, 2006. 405 ILCS 5/2-107.1(a-5)(5) (West
2004). Nevertheless, review of this appeal is appropriate under
the "public interest exception" to the mootness doctrine. In re
Mary Ann P., 202 Ill. 2d 393, 401-02 (2002).
Authorized involuntary treatment, i.e., the forced
administration of psychotropic medication, shall not be
administered to an adult recipient unless the State proves seven
specific factors, including that the benefits of the treatment
outweigh the harm, by clear and convincing evidence. 405 ILCS
5/2-107.1(a-5)(4) (West 2004); In re C.E., 161 Ill. 2d 200, 208,
221 (1994). Clear and convincing evidence is deemed to be more
than a preponderance, but does not reach the degree of proof
necessary to convict a person of a criminal offense. In re John
R., 339 Ill. App. 3d 778, 781 (2003). On review, we give great
deference to the circuit court's factual findings and will not
reverse its decision merely because we may have reached a
different conclusion; instead, reversal is warranted only if the
circuit court's decision is manifestly erroneous, i.e., the error
is clearly evident, plain, and undisputable. In re Jeffers, 239
Ill. App. 3d 29, 35 (1992). For the reasons that follow, we do
not find this to be such a case.
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The record before us discloses respondent's history and
deteriorating condition, i.e., her 26-year diagnosis of paranoid
schizophrenia, and her recent behaviors and delusions which
prohibited her from safely and properly caring for herself.
Based on these behaviors and respondent's inability to conduct a
reasonably safe existence, Dr. Poniaquwicz determined that the
benefits of administering psychotropic medications, primarily
Proloxin, outweighed the harm of the side effects. She
anticipated that if treated with the proposed psychotropic
medications, respondent would be able to function independently,
eat regularly, and be discharged from the hospital. She
conversely believed that, if left untreated, respondent's
symptoms would worsen, her condition would further deteriorate,
and she would be unable to live independently.
Dr. Poniaquwicz based her opinion, in part, on Nancy's
report of respondent's positive response to Proloxin in the past.
When respondent had previously taken this medication for an
extended period of time, her symptoms markedly diminished, and
she was able to function independently and be discharged from the
hospital. Nancy specifically told her that when respondent was
treated at Read Hospital with Proloxin (and Risperdal) from
October 2004 through February 2005, she was more rational, did
not hallucinate as often, talked more about everyday life, and
better cared for herself and her home upon discharge from the
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hospital. Nancy also reported that although respondent had
experienced side effects from the medications, they were able to
be controlled.
The evidence further showed that despite respondent's
dystonic reaction to the second 10-milligram dose of Proloxin on
January 13, 2006, Dr. Poniaquwicz was able to relieve the side
effects with Cogentin and Benadryl, and would be available daily
to monitor respondent's response to the medications and to
administer "appropriate medications" to counteract any side
effects. In addition, the circuit court approved Dr.
Poniaquwicz's request for laboratory tests to ensure that the
psychotropic medications were administered safely and
effectively. We thus conclude that the State provided clear and
convincing evidence that the benefits of administering
psychotropic medications to respondent outweighed the harm (405
ILCS 5/2-107.1(a-5)(4)(D) (West 2004)), and that the court's
order to that effect was not manifestly erroneous.
In so finding, we reject respondent's arguments that the
circuit court's order should be reversed because the "side-
effect-relieving" medications were not requested in the petition
or authorized by the court, and because such medications posed
the risk of side effects. A petitioner is not required to set
forth the specific medications she seeks to administer. In re
Miller, 301 Ill. App. 3d 1060, 1071 (1998). Moreover, while an
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order "shall *** specify the medications and the anticipated
range of dosages that have been authorized and may include a list
of any alternative medications and range of dosages" (405 ILCS
5/2-107.1(a-5)(6) (West 2004)), we have not found, and respondent
has not provided, any case law where an order entered under
section 2-107.1 was reversed because a medication used to quell
the side effects of a psychotropic medication was not listed in
the court's order.
Rather, reviewing courts have reversed circuit court orders
where the order, and the court's oral ruling, failed to specify
the psychotropic medications and the range of dosages requested
in the petition. See, e.g., In re Gwendolyn N., 326 Ill. App. 3d
427, 430-31 (2001); In re Williams, 305 Ill. App. 3d 506, 511-512
(1999); In re Len P., 302 Ill. App. 3d 281, 285 (1999). Here,
the circuit court heard the harm and benefits associated with all
of the medications listed in the petition, and its order properly
enumerated each of those medications and ranges of dosages. In
re Mary Ann P., 202 Ill. 2d at 405. In addition, the circuit
court's ruling made it clear that the side effects of the
psychotropic medications were to be relieved with "counteracting
drugs." Thus, we find no cause for reversal based on
respondent's argument with regard to the auxiliary medications.
We further find that reversal is not warranted where
respondent failed to object to the omission of the counteracting
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drugs when the court entered its order, and where the record
shows that Dr. Poniaquwicz was intimately familiar with
respondent's treating protocol. Dr. Poniaquwicz treated
respondent when she experienced side effects from Proloxin, acted
as respondent's attending physician for weeks before the hearing,
and intended to continue in that role when the requested
medications were administered.
Moreover, respondent has failed to argue or demonstrate that
she was prejudiced by the omission of the counteracting
medications from the order. In re Miller, 301 Ill. App. 3d at
1072. Instead, she merely asserts that Dr. Poniaquwicz lacked
the authorization to administer counteracting medications to her
in the event that she experienced side effects from the
psychotropic medications. This argument is clearly refuted by
the record.
Finally, we refuse to consider respondent's argument, raised
for the first time on appeal, that Cogentin and Benadryl may
cause side effects. In re Jeffers, 239 Ill. App. 3d at 37.
Accordingly, we affirm the order of the circuit court of
Cook County.
Affirmed.
THEIS, P.J., and KARNEZIS, J., concur.
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