In re Catherine M. , 2020 IL App (5th) 160126-U ( 2020 )

NOTICE
2020 IL App (5th) 160126-U NOTICE
Decision filed 12/21/20. The This order was filed under
text of this decision may be
NO. 5-16-0126 Supreme Court Rule 23 and
changed or corrected prior to may not be cited as precedent
the filing of a Petition for by any party except in the
Rehearing or the disposition of IN THE limited circumstances allowed
the same.
under Rule 23(e)(1).
APPELLATE COURT OF ILLINOIS
FIFTH DISTRICT
________________________________________________________________________
In re CATHERINE M., Alleged to Be a Person ) Appeal from the
Subject to Involuntary Administration of ) Circuit Court of
Psychotropic Medication ) Madison County.
)
(The People of the State of Illinois, Petitioner- ) No. 16-MH-30
Appellee, v. Catherine M., Respondent- )
Appellant). ) Honorable Donald M. Flack,
) Judge, presiding.
________________________________________________________________________
PRESIDING JUSTICE BOIE delivered the judgment of the court.
Justices Cates and Barberis concurred in the judgment.
ORDER
¶1 Held: We reverse the judgment of the circuit court granting the State’s petition
seeking the involuntary administration of psychotropic medication to a
mental health patient where the collateral-consequences exception to the
mootness doctrine applied to patient’s appeal and the judgment was not
supported by clear and convincing evidence that patient was suffering or had
experienced a deterioration in her ability to function.
¶2 Catherine M., the respondent, appeals from the March 10, 2016, order of the circuit
court of Madison County, finding her subject to the involuntary administration of
psychotropic medications pursuant to section 2-107.1 of the Mental Health and
Developmental Disabilities Code (Code) (405 ILCS 5/2-107.1 (West 2016)). Respondent
argues that the trial court’s finding that she met the statutory criteria for forced medication
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was against the manifest weight of the evidence and that there was insufficient testimony
that the benefits of the proposed treatment outweighed the risk of harm to the patient. She
seeks the reversal of the circuit court’s order. For the following reasons, we reverse.
¶3 I. Background
¶4 Respondent was 58 years old at the time of the proceedings in this matter. She had
attained her bachelor’s degree in nursing and had a valid nursing license in four states.
Respondent had been living with her father prior to her admission. While the record does
not contain the history of respondent’s admission to Alton Mental Health Center (Alton),
Dr. Ahmad, her treating psychiatrist while at Alton, testified that respondent was brought
to the hospital on January 29, 2016 and admitted on “what they call a detention and
evaluation order.” Dr. Ahmad testified that respondent had previously failed to appear for
a court-ordered outpatient evaluation for fitness to stand trial. Dr. Ahmad evaluated
respondent, consulted with other professionals involved in her care, assessed her, and
reviewed all available records. Dr. Ahmad diagnosed respondent as suffering over the past
two years from a psychotic disorder, not otherwise specified, causing respondent to have
delusions.
¶5 Respondent refused to voluntarily take psychotropic medication or participate in
any other treatment offered at the hospital as she did not believe that she was suffering
from a mental illness. On February 19, 2016, Dr. Ahmad filed an involuntary medication
petition. Dr. Ahmad alleged that because of respondent’s mental illness she was exhibiting
deterioration in her ability to function, suffering, and threatening behavior. Dr. Ahmad
sought authorization to administer seven primary medications (paliperidone, paliperidone
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sustenna, haloperidol, haloperidol decanoate, benztropine, and lorazepam (orally and
through intramuscular injection)) as well as six alternative medications (aripiprazole,
aripiprazole maintaina, fluphenazine, fluphenazine decanoate, diphenhydramine, and
hydroxyzine).
¶6 A hearing was held on March 10, 2016. Dr. Ahmad testified that respondent was
experiencing delusions, in that she believed that she was born in the Netherlands and
abducted as a child, only to be sold on the black market to her father. Dr. Ahmad testified
that respondent was criminally charged with spitting on her father, whom she had lived
with while unemployed. However, respondent believed there were no charges against her
because they were dismissed. Respondent believed that she was abducted from her home
by the police and brought to the hospital illegally, despite Dr. Ahmad attempting to explain
and show her court documents showing that she was charged with a crime. Respondent had
also sued numerous potential employers for illegally refusing her employment. Respondent
had been unemployed for about a year and a half and was let go from her prior employment.
She believed someone made a false allegation against her at her previous employment but
did not know what the allegation may have been.
¶7 Regarding the criteria for involuntary medication, Dr. Ahmad testified that because
of respondent’s mental illness she was suffering and had experienced deterioration of her
ability to function. Dr. Ahmad testified that respondent’s mental illness was preventing her
from being able to work. Dr. Ahmad further testified that her family relationships had been
affected because she continued to accuse her father of not being her father. Dr. Ahmad
testified that respondent was charged with a crime for spitting on her father’s head, and
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that she was not able to meaningfully participate in the criminal process as she believed
the charges were dismissed when they were not. Respondent believed she was being
victimized constantly by the hospital staff, judges, the police, her father, and employers.
According to Dr. Ahmad, respondent paced back and forth and refused to participate in
any treatment provided while at the hospital.
¶8 Dr. Ahmad stated that, after being admitted to Alton, respondent had not required
emergency medication, restraints, or to be placed in seclusion. She had not been physically
aggressive or threatening while in the hospital setting. Respondent was able to take care of
her activities of daily living, such as sleeping, eating, and maintaining cleanliness, and was
civilized to everyone during her hospital stay. She was in good physical health other than
a finger that was injured when a door was shut on her. For that injury she refused an x-ray
and oral antibiotics and refused to see a surgeon despite medical recommendations. There
was pus present and the doctors were concerned about her finger, but at the time of the
hearing it was mostly healed.
¶9 Dr. Ahmad testified about the proposed primary and alternative medications
requested to be administered to respondent over her objection, their dosage, and their side
effects. Dr. Ahmad did not specifically testify about the benefits of diphenhydramine and
hydroxyzine, but he testified about their side effects and testified that they were alternatives
to two side-effect-relieving medications. Dr. Ahmad testified that the benefits of the
requested medications outweighed their risks, explaining that they would produce some
improvement, even remission, of respondent’s symptoms.
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¶ 10 There were two antipsychotic medications listed in the “primary medications”
section of the order, paliperidone and haloperidol. Dr. Ahmad did not testify about the risks
or benefits of the combination of these two antipsychotic medications, but did testify that
it was not his intention to administer those two drugs at the same time. When asked, “Are
you going to administer both [haloperidol and paliperidone] at the same time?” the doctor
answered, “No. One at a time. No. Just one at a time.” He went on to explain that his
preference was to administer the paliperidone, but that particular medication was not
available in a short-acting injectable form, and if the patient was uncooperative he would
have to choose haloperidol as it does have a short-acting injectable form.
¶ 11 Respondent testified that she was sleeping “OK,” had no physical illness other than
her hurt finger, and felt neither pain nor suffering, other than for her loss of employment.
She explained that she had filed five lawsuits pro se to redress her employment issues but
that they were all dismissed, and she needed a qualified attorney to help her get to the
bottom of what had happened. She believed that people had made false allegations against
her, in both her pending criminal and civil cases. Respondent testified that she had no desire
to harm herself or others, that she was not placed in restraints or seclusion, and that she had
not been given medication on an emergency basis during her 41-day stay at the hospital.
¶ 12 Respondent testified that she did not want to take the medications because she had
no pending criminal charge. Respondent believed she was brought to the hospital after
being abducted, the date of her criminal charge was incorrect and based on a false
allegation, she did not fail to appear, and she was perfectly healthy and did not need to take
an antipsychotic medication because she had never been psychotic.
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¶ 13 The trial court found that there was clear and convincing evidence that due to
respondent’s mental illness, she was suffering and had exhibited a deterioration of her
ability to function compared to her ability to function prior to the current onset of her
symptoms. The trial court found that respondent had not been able to function on her own
without assistance since the onset of her symptoms and had been unable to maintain
employment. The trial court went on to find that the benefits of the treatment would
outweigh any risk of harm. The trial court found that despite respondent’s intellectual
ability to understand the medications and potential side effects, respondent’s psychosis was
preventing her from having the capacity to make a reasoned decision about her treatment.
Less restrictive services had been explored and found inappropriate in the absence of
medication, and the diagnostic testing requested by the doctor was found to be essential for
the safe and effective administration of the medication.
¶ 14 The circuit court entered a written order on March 10, 2016, allowing respondent to
receive psychotropic medication over her objection for a period not to exceed 90 days. The
respondent filed a notice of appeal on March 28, 2016.
¶ 15 II. Analysis
¶ 16 A. Mootness
¶ 17 We first acknowledge that this appeal is moot, as the March 10, 2016, 90-day
involuntary medication order has expired. Our decision in this case will not grant
respondent effective relief from the order allowing involuntary medication. In re Joseph
M., 398 Ill. App. 3d 1086, 1087 (2010). Generally, courts of review do not decide moot
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questions, render advisory opinions, or consider issues where the result will not be affected
regardless of how those issues are decided. In re Barbara H., 183 Ill. 2d 482, 491 (1998).
¶ 18 Respondent concedes that the issue is moot but argues her appeal falls within all
three of the exceptions to the mootness doctrine. The three recognized exceptions to the
mootness doctrine are (1) the public-interest exception, (2) the capable-of-repetition-yet-
evading-review exception, and (3) the collateral-consequences exception. In re Beverly B.,
2017 IL App (2d) 160327, ¶ 19. The State agrees that the collateral-consequences
exception applies to this appeal because the involuntary medication order could affect
respondent’s nursing license and, therefore, her future employment.
¶ 19 In determining whether a mootness exception applies, a court must conduct a case-
by-case analysis and “consider all the applicable exceptions in light of the relevant facts
and legal claims raised in the appeal.” In re Alfred H.H., 233 Ill. 2d 345, 364 (2009). While
Illinois courts ordinarily lack jurisdiction to decide moot questions, most mental health
cases fall within one or more of the recognized exceptions to the mootness doctrine. Id. at
351-55.
¶ 20 We agree with the parties that the collateral-consequences exception to the mootness
doctrine applies here. This exception applies where the involuntary medication order at
issue could cause harm to the respondent in the future and where such potential harm is
likely to be redressed by a favorable judicial determination. Id. at 361. In Alfred H.H., our
supreme court held that the collateral-consequences exception can be applied in mental
health cases. Id. at 361-62. The reversal of an order of involuntary administration of
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medication over objection could affect the ability of a respondent to seek employment in
certain fields. Id.¶ 21 The record reveals that prior to her admission, respondent was let go from her
employment as a nurse but continued to seek employment in that field before her
involuntary admission for mental health treatment. Respondent testified that she wished to
continue her employment search upon her release. Respondent had no prior involuntary-
treatment orders and no criminal history other than the pending charge which alleged she
spit on her father.
¶ 22 While respondent had no prior involuntary orders under the mental health code, this
fact standing alone would not invoke the collateral-consequences exception to the
mootness doctrine. However, respondent’s license to practice as a nurse and her ability to
gain future employment could be affected by an order for involuntary medication. Pursuant
to section 70-5 of the Nurse Practice Act, “[t]he [Illinois] Department [of Financial and
Professional Regulation] may refuse to issue or to renew, or may revoke, suspend, place
on probation, reprimand, or take other disciplinary or non-disciplinary action as the
Department may deem appropriate, including fines not to exceed $10,000 per violation,
with regard to a license for any one or combination of the causes set forth in subsection (b)
below.” 225 ILCS 65/70-5(a)(30) (West 2016). Section 70-5(b)(30) of the Nurse Practice
Act indicates that grounds for disciplinary action include: “[p]hysical illness, *** mental
illness, or disability that results in the inability to practice the profession with reasonable
judgment, skill, or safety.” Id. § 70-5(b)(30). Respondent has pointed to specific concerns
resulting from the order, including her ability to seek employment similar to that she has
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held in the past. Therefore, based on a case-by-case analysis of the particular facts and
circumstances of this case, the collateral-consequences exception applies here, and we will
address the merits of respondent’s substantive arguments.
¶ 23 B. Sufficiency of the Evidence
¶ 24 The respondent contends that the circuit court’s order authorizing the involuntary
administration of psychotropic medication must be reversed. She argues that she was
denied due process by the State’s failure to present clear and convincing evidence to
support of the granting of the petition for involuntary treatment. On appeal, we review the
circuit court’s factual findings to determine whether they are against the manifest weight
of the evidence. In re Debra B., 2016 IL App (5th) 130573, ¶ 24. However, we conduct a
de novo review of the circuit court’s rulings on questions of law. In re Robert M., 2020 IL
App (5th) 170015, ¶ 37.
¶ 25 The Illinois Supreme Court has held that the involuntary administration of
psychotropic medication involves a massive curtailment of liberty. In re Robert S., 213 Ill.
2d 30, 46 (2004). The Code serves, in part, to protect patients from the potential misuse of
psychotropic medication by medical staff to restrain, manage, or discipline patients, rather
than to treat their mental illness. In re C.E., 161 Ill. 2d 200, 215-16 (1994). For these
reasons, Illinois courts recognize that mental health patients have a constitutionally
protected right to refuse psychotropic medications. Id. at 214-15.
¶ 26 However, the State also has a legitimate parens patriae interest in furthering the
treatment of mentally ill patients who are incapable of making reasoned decisions
regarding their treatment. Id. at 217. The procedures in the Code were enacted by our
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legislature to ensure that Illinois citizens are not improperly subjected to involuntary
mental health services. Robert M., 2020 IL App (5th) 170015. Given the potential serious
side effects of psychotropic medication, courts must be cautious in the entry of orders
allowing hospital staff to involuntarily administer these drugs to persons suffering from
mental illness. In re David S., 386 Ill. App. 3d 878, 883-84 (2008). Section 2-107.1 of the
Code delineates the nonemergency circumstances under which psychotropic medication
may be administered against the wishes of the recipient. In re Wendy T., 406 Ill. App. 3d
185, 191 (2010), overruled on other grounds by In re Rita P., 2014 IL 115798. Under this
section, psychotropic medication may be administered to one who is receiving mental
health services, provided that the standards and procedures set out in the section are
satisfied. C.E., 161 Ill. 2d at 204. These guidelines are in place in order to provide the
respondent with due process. David S., 386 Ill. App. 3d at 881. Section 2-107.1(a-5)(4) of
the Code directs that the forced administration of psychotropic medication is authorized
only if the court finds evidence of each of the following elements, by clear and convincing
proof:
“(A) That the recipient has a serious mental illness or developmental
disability.
(B) That because of said mental illness or developmental disability, the
recipient currently exhibits any one of the following: (i) deterioration of his or her
ability to function, as compared to the recipient’s ability to function prior to the
current onset of symptoms of the mental illness or disability for which treatment is
presently sought, (ii) suffering, or (iii) threatening behavior.
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(C) That the illness or disability has existed for a period marked by the
continuing presence of the symptoms set forth in item (B) of this subdivision (4) or
the repeated episodic occurrence of these symptoms.
(D) That the benefits of the treatment outweigh the harm.
(E) That the recipient lacks the capacity to make a reasoned decision about
the treatment.
(F) That other less restrictive services have been explored and found
inappropriate.
(G) If the petition seeks authorization for testing and other procedures, that
such testing and procedures are essential for the safe and effective administration of
the treatment.” 405 ILCS 5/2-107.1(a-5)(4) (West 2016).
¶ 27 In determining whether respondent meets these criteria, we may consider
respondent’s history of serious violence, repeated past pattern of specific behavior, actions
related to her illness, and past outcomes of various treatment options. Id.¶ 28 1. Suffering
¶ 29 Respondent first argues that the State failed to prove by clear and convincing
evidence that, due to her mental illness, respondent displayed symptoms sufficient to
warrant involuntary treatment because she was suffering. The term “suffering” is not
defined in the Code and must therefore be afforded its plain and ordinary meaning. Debra
B., 2016 IL App (5th) 130573, ¶ 38. To prove that a respondent is suffering, the State must
show that she is experiencing physical pain or emotional distress. Id. In Debra B., this court
described the type of evidence that would support a finding of suffering. We explained:
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“Although we do not believe that evidence of physical manifestations of
depression is necessary to meet the clear-and-convincing standard, we do believe
that the State must provide some factual basis for an assertion that a respondent is
suffering. For example, the medical expert might testify that the respondent has
reported feeling sorrow, frustration, anger, anxiety, or some other intense negative
emotion, or that the respondent has behaved in a manner that indicates she is
experiencing some sort of emotional anguish.” Id. ¶ 44.
¶ 30 Respondent relies on our holding in Debra B. to support her claim that the court’s
reliance on her symptomology was, in essence, a finding that she was subject to the
involuntary administration of psychotropic medications based solely on the fact that she is
mentally ill.
¶ 31 In Debra B., the respondent’s symptoms included racing thoughts, pressured
speech, increased psychomotor activity, florid mania, and grandiose delusions. Id. ¶ 4.
Debra’s treating psychiatrist explained at her trial that “ ‘[a]ll the symptoms that she
exhibited is a suffering basically.’ ” Id. ¶ 7. He testified that Debra was incessantly writing,
and he opined that her writings indicated suffering. Id. Dr. Patil described the contents of
Debra’s writings, none of which gave any obvious indication that Debra was angry, sad, or
fearful. Id. ¶¶ 8-10. Debra testified that she was suffering based on her involuntary
admission, because she missed her daughter, and because she worried about her mother
and pets. Id. ¶ 8. The trial court found this evidence to be sufficient to prove that Debra
was suffering by clear and convincing evidence. Id. ¶ 18. In reversing the ruling on appeal,
this court considered the dictionary definitions for the word “suffering” and held that, “to
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prove that a respondent is suffering, the State must show that she is experiencing physical
pain or emotional distress.” Id. ¶ 38.
¶ 32 We further addressed the type of evidence that would lead to a finding of suffering
in Robert M., 2020 IL App (5th) 170015. Robert suffered from delusions; he believed that
his fever was “cooking his brain” and that his dental infection was spreading throughout
his bloodstream. Id. ¶ 47. Further, he believed that members of the staff at Alton were
conspiring against him. Id. The court noted, as we had previously in Debra B., that paranoid
delusions might “cause anyone to feel isolated and fearful.” Id. Robert also refused pain
medication based on his paranoia, which would have alleviated the suffering from his tooth
pain. Id. Further, Robert behaved angrily and reported feeling severe anxiety. Id. ¶ 48. This
court found the evidence the State presented to be precisely the type to support a finding
of suffering, and found that it was sufficient to support the court’s finding that Robert was
suffering.
¶ 33 In determining that Robert met the criteria for suffering, this court considered two
previous Illinois appellate decisions that addressed the question of suffering—In re Wendy
T., 406 Ill. App. 3d 185 (2010), overruled on other grounds by In re Rita P., 2014 IL
115798, ¶¶ 33-34, and In re Lisa P., 381 Ill. App. 3d 1087 (2008). Robert M., 2020 IL App
(5th) 170015, ¶ 44. In Wendy T., the respondent often became angry because she was
unable to communicate effectively or perform basic tasks. Wendy T., 406 Ill. App. 3d at
188. The appellate court found that this evidence was sufficient to support the trial court’s
finding that respondent was suffering. In Lisa P., the Second District found that the State
proved suffering, along with a deterioration in ability to function, because of the
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respondent’s demeanor (the trial judge commented that he observed the respondent to be
suffering) and belief system (she thought she was a victim, that the world was evil, and that
her entire family was after her; she also experienced rage, an intense negative emotion).
Lisa P., 381 Ill. App. 3d at 1090.
¶ 34 In Robert M., this court found two significant distinctions in both Lisa P. and Wendy
T. Robert M., 2020 IL App (5th) 170015, ¶ 45. Both cases included at least some evidence
that the respondents were suffering beyond a mere recitation of their symptoms and that
the symptoms experienced by both respondents led more readily to an inference that they
were suffering than the symptoms did in Debra B. Id. We reasoned that if there is a clear
nexus between the symptoms themselves and a respondent’s suffering, the symptoms
themselves may be enough to support a finding of suffering. Id.¶ 35 In the present case, respondent was diagnosed with psychotic disorder, not
otherwise specified. Dr. Ahmad testified that respondent’s condition had persisted for at
least two years. No emergency medication was needed during her hospitalization.
Respondent was in good physical health, she was eating and sleeping adequately, she was
adequately grooming, and she had not been aggressive and had in fact been “quite civilized
to everyone.” Respondent had not been placed in restraints or seclusion while at Alton.
¶ 36 Dr. Ahmad testified to respondent’s symptomology, including paranoid delusions
that she was kidnapped when she was a baby, taken to another country, raised by people
that were not her parents, fired from her job based on false allegations, unable to gain
employment based on false allegations, falsely charged with a crime, kidnapped by police,
and falsely imprisoned in the mental health facility. As discussed in Robert M., some
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paranoid delusions are of such a nature as they would cause anyone to feel isolated and
fearful. However, the delusions in Robert M. were that his fever was cooking his brain and
his bloodstream was being poisoned by an infection. Robert had behaved angrily and
reported experiencing severe anxiety. The State, in this matter, did not present any evidence
to support a finding that respondent’s delusions, while unpleasant, were of the type likely
to cause any person extreme emotional anguish, nor that they were in fact causing
respondent extreme emotional anguish. While respondent had been observed pacing in the
hospital, she repeatedly denied suffering.
¶ 37 The facts of the present case are more akin to the facts described in Debra B., where
respondent’s doctor testified that she was suffering based on her symptoms. In Debra B.,
respondent’s doctor described her symptoms by recitation: racing thoughts, pressured
speech, increased psychomotor activity, florid mania, and grandiose delusions. Debra B.,
2016 IL App (5th) 130573, ¶ 4. While the respondent in Debra B. may have experienced
suffering from those symptoms, more specific testimony relating to how the symptomology
was causing the suffering or would lead to an inference of suffering was absent in that case.
The doctor failed to describe how the patient’s symptoms caused her to feel grief, anxiety,
depression, or any other type of emotional distress. We concluded in that case that the
evidence was insufficient to support a finding that the respondent was “suffering.” Id. ¶ 45.
¶ 38 Likewise, here, respondent displayed paranoid delusions; however, the only
testimony that she was suffering included that she was feeling victimized and that she was
pacing while in the hospital setting. She was able to conduct herself well at the hearing and
explicitly denied that she was suffering. There was no testimony that respondent exhibited
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the physical manifestations of suffering, such as crying, lying in a fetal position, lashing
out, or that she experienced feelings of hopelessness, guilt, or worthlessness that may
legitimately be interpreted as suffering. While some symptoms may more readily be the
basis for a finding of suffering, here the State did not present sufficient evidence to show a
nexus between respondent’s suffering and her symptoms to support a legally sufficient
finding of suffering. For the foregoing reasons, we find that the trial court’s conclusion that
respondent was suffering was against the manifest weight of the evidence.
¶ 39 2. Deterioration of Ability to Function
¶ 40 Respondent’s next argument is that the State failed to prove by clear and convincing
evidence that, due to her mental illness, she had experienced a deterioration in her ability
to function. The trial court found that respondent had exhibited a deterioration in her ability
to function, as compared to her ability to function prior to the current onset of her
symptoms. In order to meet its burden to show deterioration in ability to function, the State
must demonstrate that the patient’s ability to function on a basic level had deteriorated. Id.
¶ 35. The State must show more than the fact that the respondent suffers from a mental
illness. Id. ¶ 36. In Debra B., we reversed the trial court’s finding that Debra B. exhibited
a deterioration in her ability to function, explaining that she was able to function reasonably
well, at least in the environment of the facility, because of her ability to participate in
therapy sessions and shower. Id. ¶ 52.
¶ 41 Additional cases that have considered the type of deterioration in ability to function
that supports an order for the involuntary medication of a mentally ill patient include:
Wendy T., 406 Ill. App. 3d at 194 (upholding a trial court’s finding of a deterioration in the
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respondent’s ability to function where there was evidence that she was unable to “carry on
everyday conversations, accept and process what other people say, make decisions, or
execute simple tasks”), overruled on other grounds by Rita P., 2014 IL 115798, ¶¶ 33, 34;
and In re Perona, 294 Ill. App. 3d 755, 766 (1998) (affirming the trial court’s finding of a
deterioration in ability to function where the evidence showed that the respondent was
unwilling to keep his clothes on, that he was depressed, and that he was not eating
regularly).
¶ 42 In In re Bontrager, 286 Ill. App. 3d 226 (1997), the testimony supported that
respondent had become agitated and physically aggressive, and that she went from a
college educated, employed, married woman, to one who is unemployed, moves from place
to place, and will not comment on her marital status. Id. at 231. These were found to be
characteristics that did not, standing alone, constitute clear and convincing evidence of
respondent’s deteriorating ability to function. Id.¶ 43 Here we conclude that the evidence was insufficient to show a deterioration in
respondent’s ability to function. While respondent had been charged with a crime, and had
become homeless and unemployed, she was doing well in the hospital setting. Respondent
was eating properly and was not threatening staff or patients. She was pleasant in her
interaction with other patients and staff. She was sleeping well, grooming well, and
adequately addressing her activities of daily living. She had also not been subject to
emergency medication or restraints while at Alton. For the foregoing reasons, we find that
the trial court’s conclusion that respondent was experiencing a deterioration of her ability
to function based on her mental illness was not supported by the evidence. The State failed
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to prove a required element of the Code, that respondent exhibited either (i) deterioration
of her ability to function, as compared to respondent’s ability to function prior to the current
onset of symptoms of the mental illness for which treatment is presently sought,
(ii) suffering, or (iii) threatening behavior.
¶ 44 C. Benefits of Treatment Outweigh the Risk of Harm
¶ 45 Respondent’s final argument is that the State failed to provide clear and convincing
evidence that the benefits of the proposed treatment outweighed the risk of harm to
respondent. Although respondent failed to raise this issue in the trial court, it affects a
substantial right and, therefore, we review it for plain error. See Ill. S. Ct. R. 615(a) (eff.
Jan. 1, 1967); In re Cynthia S., 326 Ill. App. 3d 65, 68 (2001).
¶ 46 Given the invasive nature of psychotropic medications, and the possibility of
significant side effects associated with the medications, courts must be cautious in entering
orders allowing hospital staff to involuntarily administer these medications. David S., 386
Ill. App. 3d at 882. The State may not administer psychotropic medication to a recipient of
mental health care services unless it proves by clear and convincing evidence that,
inter alia, the benefits of the enforced medication outweigh the harm that might stem from
the medication, the recipient “lacks the capacity to make a reasoned decision about the
treatment,” other less restrictive treatment modalities have been explored and found not to
be appropriate, and the proposed tests necessary to ensure that the treatment for which
permission of the court is sought will be safe and effective. 405 ILCS 5/2-107.1(a-5)(4)(E)-
(G) (West 2016).
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¶ 47 A testifying expert must support his opinions with specific facts or testimony
regarding the bases of those opinions. In re Larry B., 394 Ill. App. 3d 470, 475 (2009). The
statutory scheme of the Code requires specific evidence of the benefits and risks of each
medication sufficient for the trial court to determine that the benefits of the proposed
treatment outweigh the potential harm. Id. at 476.
¶ 48 Dr. Ahmad testified that the proposed medications’ benefits outweighed their
potential harm to respondent. He detailed the risks and benefits of the requested
medications. Respondent argues that Dr. Ahmad failed to testify to the benefits of both
diphenhydramine (commonly known as Benadryl), which was requested as an alternative
medication for benztropine (commonly known as Cogentin), and hydroxyzine, which was
requested as an alternative medication for lorazepam (commonly known as Ativan). Both
of these medications are side-effect-relieving medications, not psychotropic medications.
See In re Suzette D., 388 Ill. App. 3d 978, 985 (2009).
¶ 49 Section 2-107.1 of the Code governs the administration of psychotropic medication.
See 405 ILCS 5/2-107.1 (West 2016). The Code does not require that an involuntary
treatment petition or an involuntary-treatment order set forth proposed nonpsychotropic
medications. Id. However, the State is not prohibited from requesting such medication and
the trial court is not prohibited from including the medication in the treatment order,
provided that there is evidence to support it. Id. In In re M.T., 371 Ill. App. 3d 318 (2007),
we rejected the argument 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,
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finding that there was no authority reversing a medication order because a side-effect-
relieving medication was not listed in the court’s order. Id. at 324.
¶ 50 Here, Dr. Ahmad detailed the benefits of the primary side-effect-relieving
medications, Cogentin and Ativan. Dr. Ahmad testified that Cogentin would be used, as
needed, for “side effects caused by antipsychotics like tremors, restlessness, akathisia,
those kind of things ***.” Ativan would be given as needed for relief of anxiety. As the
alternative medications, it is clear from the testimony that the benefits of Benadryl and
hydroxyzine would be used to substitute for and provide the same benefits as the
medications for which they were proposed as an alternative.
¶ 51 Respondent did not object to the administration of the alternative side-effect-
relieving medications at her hearing. Further, she does not allege in her petition that she
was not aware of the potential benefits of the alternative side-effect-relieving medications.
If the State’s failure to include side-effect-relieving medication in its petition or order at all
was not a basis for reversal, we cannot see how failing to explicitly recite the benefits of
two alternate side-effect-relieving medications would be cause for reversal, especially
where the benefits can be ascertained from the context of the testimony.
¶ 52 Respondent next argues that she will be treated with two antipsychotic medications
and the State presented no evidence of the potential harm to respondent based on the
interaction of these medications. The court order entered authorized two primary
antipsychotic medications (paliperidone and haloperidol). While Dr. Ahmad did not testify
about any increased risk based on the combination of the administration, at the same time,
of the two antipsychotic medications ordered, Dr. Ahmad testified under oath that he would
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only administer one antipsychotic medication at a time. His first-choice antipsychotic
medication was paliperidone; however, paliperidone was not available in a short-acting
injection. If the respondent refused oral medication, Dr. Ahmad testified that he would
have to begin treating respondent with haloperidol, as it did come in a short-acting
injectable form. While haloperidol should have been more accurately listed in paragraph B
of the order relating to alternative medications, the testimony of Dr. Ahmad made clear
that haloperidol was an alternative medication for paliperidone in respondent’s medication
protocol. Section 2-107.1 of the Code vests the physician authorized to administer the
involuntary treatment “complete discretion” not to administer the treatment. 405 ILCS 5/2-
107.1(a-5)(6) (West 2016). Dr. Ahmad demonstrated through his testimony that he was
well versed in respondent’s treatment plan. Dr. Ahmad made clear that the second
requested antipsychotic medication was requested as an alternative to the primary
antipsychotic, which would only be administered if respondent refused to take the oral form
of his primary choice. As such, the evidence deduced from the order, and the transcript
from the March 10, 2016, hearing, are sufficient to have appropriately informed the court
that there was not a risk of drug interaction between the two antipsychotic medications.
Based on the above, the trial court had sufficient evidence upon which to determine that
the benefits of the treatment protocol outweighed the risk of harm to the patient.
¶ 53 III. Conclusion
¶ 54 Based on the foregoing, the involuntary-treatment order entered by the circuit court
was not supported by evidence that the respondent was exhibiting suffering or a
deterioration in her ability to function, sufficient to justify an order for involuntary
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medication. Accordingly, we reverse the judgment of the circuit court granting the State’s
petition for the involuntary administration of medication. A remand is not necessary since
the administration of the medication has been terminated according to the terms of the
circuit court’s order. See In re Richard C., 329 Ill. App. 3d 1090, 1094 (2002).
¶ 55 The judgment of the circuit court of Madison County is reversed.
¶ 56 Reversed.
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