In re Steven T.

NOTICE
2014 IL App (5th) 130328
Decision filed 09/24/14. The
text of this decision may be NO. 5-13-0328
changed or corrected prior to
the filing of a Petition for
Rehearing or the disposition of
IN THE
the same.
APPELLATE COURT OF ILLINOIS
FIFTH DISTRICT
________________________________________________________________________
In re STEVEN T., Alleged to Be a Person ) Appeal from the Circuit Court of
Subject to Involuntary Treatment With ) Randolph County.
Psychotropic Medication )
) No. 13-MH-84
(The People of the State of Illinois, Petitioner- )
Appellee, v. Steven T., Respondent-Appellant). ) Honorable Richard A. Brown,
) Judge, presiding.
________________________________________________________________________
JUSTICE CATES delivered the judgment of the court, with opinion.
Justices Spomer and Schwarm concurred in the judgment and opinion
OPINION
¶1 The respondent, Steven T., appeals from an order of the circuit court of Randolph
County finding him subject to involuntary administration of psychotropic medications
according to section 2-107.1(a-5) of the Mental Health and Developmental Disabilities
Code (Code) (405 ILCS 5/2-107.1(a-5) (West 2012)). The respondent argues that (1) the
circuit court's finding that he met the statutory criteria for forced administration of
medication was against the manifest weight of the evidence, and (2) he was not afforded
effective assistance of counsel. The State has filed a confession of error. We find the
respondent's contentions and the State's confession to be well-taken. For the reasons that
follow, we reverse the order of the circuit court.
1
¶2 BACKGROUND
¶3 The respondent was admitted to Chester Mental Health Center (Chester) on May
1, 2013, after having been found unfit to stand trial on a charge for domestic battery. He
had no previous hospital admissions. Prior to being admitted to Chester, the respondent
allegedly killed the family dog and then threatened to kill his family. Upon admission to
Chester, he displayed aggressive behavior. On May 30, 2013, the respondent became
agitated and threatened to harm others, which required restraints and the administration
of emergency medication. On June 6, 2013, the respondent's treating psychiatrist at
Chester, Dr. Sudarshan Suneja, filed a petition for the authority to administer involuntary
psychotropic medication and the necessary, supportive medical testing. The petition
indicated that the respondent had been given a list of side effects of the medication in
writing. As the primary medications that Dr. Suneja sought to administer, the petition
listed risperidone, risperidone consta, olanzapine, benztropine, lorazepam, and
divalproex, with corresponding dosage ranges for each. The petition also listed
alternative medications and their dosages should the primary medications prove to be
ineffective. The petition also sought the authority to administer testing and procedures
such as the use of a nasogastric tube should it become necessary.
¶4 The court held a hearing on the petition on June 12, 2013. Dr. Suneja testified for
the State as follows. He diagnosed the respondent as suffering from schizophrenia,
disorganized type, with psychotic features. Since May 31, 2013, the respondent had been
on emergency medication because he had become agitated and had threatened to hurt
2
staff at Chester. The emergency medication had improved the respondent's symptoms by
60%.
¶5 Dr. Suneja testified that the respondent lacked the capacity to make a reasoned
decision about his treatment and medication. He stated that the respondent was given a
written list of the benefits and side effects of the requested medication, which was also
attached to the petition. Dr. Suneja testified that the staff at Chester had tried activity
therapy, milieu therapy, and individual and group counseling with the respondent, but the
respondent did not benefit from those forms of treatment. However, Dr. Suneja did not
testify as to whether the respondent received any written information about the risks and
benefits of nonmedicinal forms of treatment.
¶6 Next, with respect to the testing and other procedures, Dr. Suneja did not testify or
even confirm that he was asking the court for the authority to conduct testing or other
procedures. On cross-examination, Dr. Suneja said that the respondent would be tested at
regular intervals, and "[t]here's a protocol that pharmacy monitors and automatically the
tests are done." The tests would be done within a month of starting the medication. No
mention was made, either during direct examination or cross-examination, about Dr.
Suneja's request for the use of a nasogastric tube.
¶7 The respondent testified that he did not believe he needed the medication. He
explained that he would rather be in restraints than be forced to take medication. Since
starting the emergency medication, he felt that the medication adversely affected his
ability to communicate and he was unable to say words clearly. He felt sleepy and less
vibrant.
3
¶8 The court entered an order for the administration of authorized involuntary
treatment, finding that the respondent had a serious mental illness, had exhibited
deterioration in his ability to function, and had exhibited threatening behavior. In
addition to authorizing the involuntary administration of psychotropic medication, the
court ordered specific testing and procedures when necessary to administer the
medication and that the medication be administered via a nasogastric tube should the
respondent's medical condition be at risk from worsening psychosis. This appeal
followed.
¶9 ANALYSIS
¶ 10 We begin by noting that this appeal is moot because the 90-day period authorized
by the circuit court's order has expired. Nevertheless, we will address the questions
raised in this appeal because they are capable of repetition yet might evade review
because of the short duration of the orders and the respondent's continuing mental health
issues and unwillingness to take medication. See In re Joseph M., 405 Ill. App. 3d 1167,
1175 (2010).
¶ 11 The respondent argues, and the State concedes, that the State failed to prove by
clear and convincing evidence that (1) the respondent lacked the decisional capacity to
make a reasoned decision about the proposed treatment (405 ILCS 5/2-107.1(a-5)(4)(E)
(West 2012)), and (2) the tests and other procedures that the court ordered, which
included the use of a nasogastric tube, were essential for the safe and effective
administration of the medication (405 ILCS 5/2-107.1(a-5)(4)(G) (West 2012)). The
respondent further argues that he was denied the effective assistance of counsel.
4
¶ 12 The Code states that a recipient of mental health services shall be provided with
adequate and humane care and services in the least restrictive environment, pursuant to
an individual service plan. 405 ILCS 5/2-102(a) (West 2012). Section 2-102(a-5) of the
Code states that if the services include the administration of psychotropic medication, the
physician shall: (1) advise the recipient, in writing, of the side effects, risks, and benefits
of the treatment, as well as alternatives to the proposed treatment, to the extent such
advice is consistent with the recipient's ability to understand the information
communicated, and (2) determine and state in writing whether the recipient has the
capacity to make a reasoned decision about the treatment. 405 ILCS 5/2-102(a-5) (West
2012). If the recipient lacks the capacity to make a reasoned decision about the
treatment, the treatment may be administered only pursuant to section 2-107 or 2-107.1
of the Code. 405 ILCS 5/2-102(a-5) (West 2012).
¶ 13 Medication may be administered to a recipient without his consent if and only if it
has been determined by clear and convincing evidence that, inter alia, (1) the recipient
lacks the capacity to make a reasoned decision about treatment, and (2) if the petition
seeks the authorization for testing and other procedures, such testing and procedures are
essential for the safe and effective administration of the treatment. 405 ILCS 5/2-
107.1(a-5)(4)(E), (G) (West 2012). Whether there was substantial compliance with a
statutory provision is a question of law, which we review de novo. In re Tiffany W., 2012
IL App (1st) 102492-B, ¶ 10. A reviewing court will not reverse a circuit court's
determination about the sufficiency of the evidence unless such determination was
against the manifest weight of the evidence. Id. A judgment is against the manifest
5
weight of the evidence only where the opposite conclusion is apparent or where the
findings appear to be unreasonable, arbitrary, or not based on the evidence. Id.
¶ 14 A patient's decisional capacity to make treatment decisions for himself is based
upon the conveyed information concerning the risks and benefits of the proposed
treatment and reasonable alternatives to treatment. In re John R., 339 Ill. App. 3d 778,
785 (2003). The failure to provide the respondent with the statutorily mandated written
information about the risks and benefits of the proposed treatment as well as the
alternatives to the treatment amounts to reversible error because the respondent has not
received all of the information necessary to make a rational choice. In re Bobby F., 2012
IL App (5th) 110214, ¶ 18. The failure to provide the respondent with information about
alternative nonmedicinal forms of treatment amounts to reversible error. In re Laura H.,
404 Ill. App. 3d 286, 291-92 (2010).
¶ 15 In this case, the petition listed the medications Dr. Suneja sought to administer and
indicated that the respondent had been advised in writing as to the benefits and side
effects of those medications. At the hearing on the petition, Dr. Suneja testified that the
respondent was given a written list of the benefits and side effects of the medications he
sought to administer. However, the petition did not contain any information about the
alternative, nonmedicinal forms of mental health treatment available to the respondent,
nor did Dr. Suneja testify that the respondent received written information about those
methods of treatment. While Dr. Suneja did testify that the staff at Chester had tried
different nonmedicinal forms of treatment with the respondent, it was necessary for the
respondent to be provided with written information about those methods available to him
6
so that he could make a fully informed decision about his treatment. This is especially
important considering the respondent indicated that he would rather be restrained than be
on forced medication.
¶ 16 When seeking the involuntary testing of a mental health patient, the State must
prove by clear and convincing evidence that such testing is essential for the safe and
effective administration of the treatment. 405 ILCS 5/2-107.1(a-5)(4)(G) (West 2012).
The State must present specific testimony about the requested testing and procedures. In
re David S., 386 Ill. App. 3d 878, 883 (2008). This court has reversed an involuntary
medication order where the testifying physician simply confirmed at the hearing that he
wanted to conduct testing to ensure that the administration of the medication was safely
and effectively done. In re Larry B., 394 Ill. App. 3d 470, 478 (2009). With no other
evidence presented about the administration and testing methods, we found that the
physician's testimony "fell far short of clear and convincing specific expert testimony in
support of a request for testing." Id.
¶ 17 Here, the State did not present evidence about the necessity of the requested
testing or procedures. Dr. Suneja simply testified that the testing would be conducted at
regular intervals and would be done within a month of starting the medication. Further,
the petition mentioned a nasogastric tube, yet no information about that procedure was
given at the hearing, and the information in the petition simply stated that the testing and
procedures were essential for the safe and effective administration of the medication.
The State did not present any evidence to support this claim. Without more than a mere
conclusion that the requested testing and nasogastric tube were necessary, the State failed
7
to provide the clear and convincing evidence required by the Code to administer tests,
and potentially the nasogastric tube, without the respondent's consent.
¶ 18 The respondent also contended that his appointed counsel provided ineffective
assistance. Because of the resolution of the preceding issues and our determination that
the order granting the petition must be reversed, we need not consider the respondent's
allegations of error regarding his counsel's representation. See In re Larry B., 394 Ill.
App. 3d 470, 479 (2009).
¶ 19 CONCLUSION
¶ 20 For the foregoing reasons, the judgment of the circuit court of Randolph County
ordering the involuntary administration of medication for the respondent is reversed.
¶ 21 Reversed.
8
2014 IL App (5th) 130328
NO. 5-13-0328
IN THE
APPELLATE COURT OF ILLINOIS
FIFTH DISTRICT
________________________________________________________________________
In re STEVEN T., Alleged to Be a Person ) Appeal from the Circuit Court of
Subject to Involuntary Treatment With ) Randolph County.
Psychotropic Medication )
) No. 13-MH-84
(The People of the State of Illinois, Petitioner- )
Appellee, v. Steven T., Respondent-Appellant). ) Honorable Richard A. Brown,
) Judge, presiding.
________________________________________________________________________
Opinion Filed: September 24, 2014
________________________________________________________________________
Justices: Honorable Judy L. Cates, J.
Honorable Stephen L. Spomer, J., and
Honorable S. Gene Schwarm, J.,
Concur
________________________________________________________________________
Attorneys Veronique Baker, Director, Barbara A. Goeben, Staff Attorney,
for Legal Advocacy Service, Guardianship and Advocacy Commission,
Appellant Metro East Regional Office, 4500 College Avenue, Suite 100,
Alton, IL 62002
________________________________________________________________________
Attorneys Hon. Jeremy R. Walker, State's Attorney, Randolph County
for Courthouse, Chester, IL 62233; Patrick Delfino, Director, Stephen E.
Appellee Norris, Deputy Director, Patrick D. Daly, Staff Attorney, Office of
the State's Attorneys Appellate Prosecutor, 730 East Illinois
Highway 15, Suite 2, P.O. Box 2249, Mt. Vernon, IL 62864
________________________________________________________________________