In re John N.

No. 3--06--0512
(Consolidated with No. 3--06--0513)
_________________________________________________________________
Filed June 8, 2007.
IN THE
APPELLATE COURT OF ILLINOIS
THIRD DISTRICT
A.D., 2007
In re JOHN N., JR., ) Appeal from the Circuit Court
a Person Asserted to be ) of the 10th Judicial Circuit,
Subject to Involuntary ) Peoria County, Illinois,
Admission and Treatment )
)
)
(The People of the State of )
Illinois, ) No. 06--MH--41
)
Petitioner-Appellee, )
)
v. )
) Honorable
John N., Jr., ) Stephen A. Kouri &
) Joe R. Vespa,
Respondent-Appellant). ) Judges, Presiding.
_________________________________________________________________
PRESIDING JUSTICE LYTTON delivered the Opinion of the court:
_________________________________________________________________
The trial court issued orders that the respondent, John N.,
Jr., was subject to emergency involuntary admission to a mental
health facility (405 ILCS 5/3--600 (West 2004)) and involuntary
administration of psychotropic medication (405 ILCS 5/2--107.1
(West 2004)). Later, the court denied the respondent's petition
for discharge (405 ILCS 5/3--900 (West 2004)). On appeal, the
respondent argues that the court erred by entering these three
orders. We affirm the court's orders concerning involuntary
admission and discharge, and reverse the involuntary administration
of medication order.
FACTS
Initially, we note that this is the respondent's fifth appeal
to this court concerning separate involuntary admission and
involuntary administration of medication orders. In In re John N.,
No. 3--02--0354 (2003) (unpublished order under Supreme Court Rule
23), we reversed the trial court's involuntary administration of
medication order on the basis that the order did not clearly define
how two alternative medications were to be administered. In In re
John N., Jr., No. 3--04--0043 (2004) (unpublished order under
Supreme Court Rule 23), this court affirmed the trial court's
involuntary admission and involuntary administration of medication
orders.
In In re John N., 364 Ill. App. 3d 996, 848 N.E.2d 577 (2006),
we reversed the trial court's orders on the basis that the version
of a statute in effect at the time the emergency petition was filed
required the police officer who brought the respondent to the
hospital to sign the petition, which the officer had not done.
Recently, in In re John N., Jr., No. 3--06--0267 (2007)
(unpublished order under Supreme Court Rule 23), this court
affirmed the trial court's involuntary admission order, but
reversed its involuntary administration of medication order on the
basis that the order failed to designate the persons authorized to
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administer the involuntary medication (405 ILCS 5/2--107.1(a--5)(6)
(West 2004)).
In the present case, on June 12, 2006, members of the
Methodist Medical Center (Methodist) staff in Peoria filed
petitions asking the trial court to find the respondent subject to
(1) emergency involuntary admission; and (2) involuntary
administration of psychotropic medication. The petition for
involuntary admission alleged that the respondent was (1)
reasonably expected to inflict serious physical harm upon himself
or others in the near future (405 ILCS 5/1--119(1) (West 2004));
and (2) unable to provide for his basic physical needs (405 ILCS
5/1--119(2) (West 2004)). The petition contained handwritten
comments that his son had found him wandering the streets. The son
reported that the respondent had manic behavior and disorganized
speech, and had threatened to harm strangers. The son said the
respondent had driven long distances for no apparent reason. The
respondent also had threatened members of the hospital staff.
The court held hearings concerning both petitions during a
proceeding on June 14, 2006. At this proceeding, the trial court
first considered the involuntary admission petition. Dr. Ghassan
Bitar testified that the respondent had been admitted to Methodist
on June 9, 2006. The respondent previously had been committed to
the Singer Mental Health Center (Singer) in Rockford. The doctor
did not know how much time elapsed from the time the respondent was
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released from Singer to the date that he was admitted to Methodist.
Bitar said that the respondent had recently traveled to
Springfield, where he acted aggressively "in a couple of hotels or
motels." Then, the respondent returned to Peoria and was
aggressive toward his family. Because of the respondent's
psychotic and aggressive behavior, his family called the police,
who brought the respondent to the Methodist emergency room.
Bitar had observed the respondent every day beginning on the
day after the respondent was admitted to the hospital. The doctor
stated that the respondent was suffering from schizoaffective
disorder. The respondent's speech was pressured and was sometimes
difficult to understand. Bitar said the respondent became
irritable "quite easily." At night, the respondent often would
become manic and did not sleep well.
According to Bitar, the respondent experienced delusions,
grandiose thoughts, and hallucinations. The respondent claimed to
hear the voice of God, and believed that he was the son of God and
that he was invincible.
The doctor noted that the respondent was refusing to take his
prescribed oral psychotropic medications, except for Seroquel to
aid sleep, because he believed that he did not need the
medications. On a few occasions since the respondent was admitted
to Methodist, Bitar had treated the respondent with injections of
Haldol to calm him down. The doctor testified that the
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respondent's mental illness impaired his ability to function and
that he did not have any insight into his mental illness. As a
result of his mental illness, the respondent was refusing to take
psychotropic medication.
Bitar stated that the respondent would be unable to attend to
activities of daily living if he was not taking his medication.
The respondent had been prescribed medications for a prostate
condition, stress incontinence, hypertension, and neck strain.
According to Bitar, the respondent was only taking these
medications erratically. The doctor said that the respondent's
mental illness was preventing him from consistently taking the
medications for these conditions.
Bitar stated that because of the respondent's delusions, he
was unable to guard himself against the normal dangers of daily
living. The doctor also said that the respondent had a history of
physical aggression. The hospital staff told Bitar that the
respondent had previously broken a television set. The respondent
was reasonably expected to inflict serious physical harm to himself
or others based on his belligerent behavior and speech.
Bitar said that he had considered less restrictive
alternatives for the respondent, such as a nursing home, rather
than commitment to a mental health facility. In Bitar's opinion,
less restrictive alternatives were not possible because of the
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respondent's erratic behavior caused by his refusal to take
medication.
Angie Leary testified that she was a mental health clinician
at Methodist. According to Leary, the respondent had been a
patient at Methodist for approximately 90 days beginning in
November 2005. Since that 90-day period, the respondent had been
committed to the Department of Mental Health (DMH) on two
occasions. On both occasions, the respondent had been transferred
to Singer, but then was discharged within two or three weeks. Each
time, within a few days of the respondent being discharged from
Singer, he had been readmitted to Methodist.
The trial court found that the respondent was subject to
involuntary admission. The court ordered the respondent to be
committed to the DMH, but that he was not to be placed at Singer
again. The court ordered the respondent to remain at Methodist
until he could be placed in a facility other than Singer.
The court then proceeded directly to the hearing on the
petition for involuntary administration of medication. Bitar
testified concerning the basis for the petition. At the conclusion
of this hearing, the court issued a written order that specified
the medications and doses that should be involuntarily administered
to the respondent. On one page of the order, the court authorized
the medications to be given by "members of the clinical staff at
Methodist Hospital and/or Dept. of Mental Health, whose license(s)
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allows them to administer the treatment pursuant to Illinois law."
On another page of the order, which specifies the doses of the
medications, the order "authorizes the administration of ***
medications under the supervision of Dr. Batar [sic], the Methodist
Medical Center staff[,] and the Department of Human Services."
On June 27, 2006, the respondent filed his petition for
discharge from Methodist. On the petition, the respondent wrote
the heading, "John [N.,] JR[.] v.s. The People of This World." In
the body of the petition, the respondent stated, "I proclaim thet
[sic] I am the Antichrist son of God and son of man. Note: Doctor
is giving me medicines that I am alleged/to."
The court held a hearing on the petition for discharge on June
28, 2006. The respondent testified that he had been at Methodist
for two weeks. He asserted that he was "all right" when he arrived
at Methodist and that he was allergic to the medicine he was being
forced to take in the hospital.
When the respondent's attorney asked him what he meant when he
wrote "son of God son of man" on the petition, the respondent
replied, "Heavenly father son of the devil female." On cross-
examination, the respondent contended that the only medicines he
needed were Seroquel and Tylenol. He asserted that Seroquel helped
him sleep. At first, he claimed that the Tylenol was for his knee,
but then changed his answer to "bowel movement."
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Bitar testified for the State in rebuttal. The doctor's
testimony was substantially similar to his testimony regarding the
petition for involuntary admission. Additionally, Bitar said that
the respondent had broken a window with a chair at 3 a.m. on June
21, 2006. In Bitar's opinion, the respondent was not allergic to
his prescribed medications.
After Bitar's testimony, the court asked the respondent what
he meant by his statement in his petition that he was the anti-
Christ. The respondent explained, "half brother of Jesus Christ."
The court denied the respondent's petition for discharge. The
respondent appealed from the court's involuntary admission order,
involuntary administration of medication order, and order denying
his petition for discharge.
ANALYSIS
I. Involuntary Admission
The respondent submits that the State failed to prove that he
was subject to involuntary admission to a mental health facility.
Any adult may petition the court to involuntarily admit an
individual on an emergency basis. 405 ILCS 5/3--600; 3--601 (West
2004). In order to involuntarily admit an individual, the State
must show that the individual is mentally ill and that he (1) poses
a reasonable risk of inflicting serious physical harm to himself or
another, which may include threatening behavior or conduct that
places another individual in reasonable expectation of being harmed
8
(405 ILCS 5/1--119(1) (West 2004)); or (2) is incapable of
providing for his basic physical needs so as to guard himself from
serious harm (405 ILCS 5/1--119(2) (West 2004)). Additionally,
"the court may consider evidence of the person's repeated past
pattern of specific behavior and actions related to the person's
illness." 405 ILCS 5/1--119 (West 2004).
The State must prove its basis for involuntary commitment by
clear and convincing evidence. 405 ILCS 5/3--808 (West 2004). "If
any person is found subject to involuntary admission, the court
shall consider alternative mental health facilities which are
appropriate for and available to the respondent." 405 ILCS 5/3--
811 (West 2004).
A trial court does not have to wait until someone has been
harmed before ordering a respondent's involuntary admission. In re
M.A., 293 Ill. App. 3d 995, 689 N.E.2d 138 (1997). The trial
court's decision to involuntarily admit an individual will not be
reversed on appeal unless it is manifestly erroneous. In re
Rovelstad, 281 Ill. App. 3d 956, 667 N.E.2d 720 (1996).
In the present case, the record shows that the respondent
suffers from schizoaffective disorder, which is a serious mental
illness. Because of this mental illness, he was refusing to take
the medications necessary to alleviate the symptoms of the mental
illness. The respondent exhibited a past pattern of aggressive and
threatening behavior when he was not taking his medication, such as
9
threatening motel staff members, his family, strangers, and members
of the hospital staff. Such behavior showed that the respondent
posed a reasonable risk of inflicting serious physical harm to
himself or another because of his mental illness. The trial court
was not required to wait until the respondent hurt someone else
before ordering him to be involuntarily admitted. See M.A., 293
Ill. App. 3d 995, 689 N.E.2d 138.
Additionally, the record shows that the respondent was not
capable of providing for his basic physical needs so as to guard
himself from serious harm. His son had found him wandering the
streets. His mental illness caused him to take medications
erratically for other serious health problems such as a prostate
condition and hypertension. The respondent's grandiose delusions
and hallucinations prevented him from guarding himself against
serious harm because of his belief that he was the son of God and
was invincible.
The State proved by clear and convincing evidence that the
respondent was mentally ill. The State also showed that because of
this illness, he posed a reasonable risk of inflicting serious
physical harm to himself or another. Bitar testified that no less
restrictive alternative was appropriate for the respondent. The
trial court's order for the respondent to be involuntarily admitted
to a mental health facility was not manifestly erroneous.
II. Petition for Discharge
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The respondent contends that the trial court erred by denying
his petition for discharge.
Any person admitted to care and custody as having a mental
illness on a court order may file a petition for discharge. 405
ILCS 5/3--900 (West 2004). Upon receipt of the petition, the court
shall set a date for a hearing. 405 ILCS 5/4--706(a) (West 2004).
If the court finds at the hearing that the client continues to meet
the standard for admission, the court may continue its original
order. 405 ILCS 5/4--706(b) (West 2004).
The party seeking discharge has the burden of establishing a
prima facie case for discharge. In re Katz, 267 Ill. App. 3d 692,
642 N.E.2d 893 (1994). The State then has the burden of proving by
clear and convincing evidence that the petition for discharge
should be denied. Katz, 267 Ill. App. 3d 692, 642 N.E.2d 893. We
review a court's decision concerning a petition for discharge to
determine if it was against the manifest weight of the evidence.
In re Commitment of Sandry, 367 Ill. App. 3d 949, 857 N.E.2d 295
(2006).
In this case, the respondent failed to establish a prima facie
case for discharge. The delusional statements in the respondent's
petition and in his testimony during the hearing showed that he
continued to suffer from a serious mental illness. He failed to
produce evidence that he was no longer a danger to himself and
others, or that he was capable of providing for his basic physical
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needs so as to guard himself from serious harm. His allegation
that he was allergic to the medications that he was involuntarily
taking was irrelevant to the issue of whether he continued to meet
the standard for admission.
Even if the respondent had established a prima facie case for
discharge, Bitar's testimony showed clearly and convincingly that
the petition for discharge should be denied. Additionally, Bitar
dispelled the respondent's allegation that he was allergic to his
prescribed medications. The record showed that the respondent
continued to meet the standard for involuntary admission.
Therefore, it was not against the manifest weight of the evidence
for the trial court to deny the respondent's petition for
discharge.
III. Involuntary Treatment
The respondent argues that the trial court erred by ordering
that he was subject to involuntary administration of psychotropic
medication. Among other things, the respondent submits that the
court's order did not designate the persons authorized to
administer the medication.
The trial court's involuntary administration of medication
order shall designate the persons authorized to administer the
involuntary treatment. 405 ILCS 5/2--107.1(a--5)(6) (West 2004).
Cases concerning involuntary administration of medication require
strict compliance with procedural safeguards because of the liberty
12
interests involved. In re Louis S., 361 Ill. App. 3d 774, 838
N.E.2d 226 (2005). An appellate court will reverse a trial court's
order to involuntarily administer psychotropic medication only if
it is manifestly erroneous. In re Dorothy W., 295 Ill. App. 3d
107, 692 N.E.2d 388 (1998).
In Jennifer H., 333 Ill. App. 3d 427, 775 N.E.2d 616 , the
trial court's order stated that the psychotropic medication was to
be administered by the staff of the Zeller Mental Health Center.
In Jennifer H., we reversed the trial court's order for involuntary
administration of medication because, among other reasons, the
order did not specify the persons authorized to administer the
involuntary treatment.
In In re Gloria B., 333 Ill. App. 3d 903, 776 N.E.2d 853
(2002), the trial court's order said that the involuntary
medication was " 'to be administered by members of the clinical
staff at Zeller Mental Health, whose license(s) allows them to
administer the treatment pursuant to Illinois law.' " Gloria B.,
333 Ill. App. 3d at 904, 776 N.E.2d at 855. In Gloria B., we
likewise reversed the trial court's involuntary administration of
medication order because the order did not designate the persons
authorized to administer the involuntary treatment.
In the instant case, the first page of the trial court's order
authorized the relevant staff members of Methodist and DMH to
administer the medication. The second page of the order, however,
13
read literally, authorized the medication to be administered under
the supervision of (1) Bitar; (2) the staff of Methodist; and (3)
the Department of Human Services (DHS). The second page of the
order does not say that Bitar is to supervise the members of
Methodist, the DMH, and the DHS. Also, the second page does not
state how it relates to the first page. Moreover, there is nothing
in the order to explain the conflict between the two sets of
persons authorized to administer the medications in the two pages
of the order.
We find that the trial court's order in this case was
substantially similar to the orders in Jennifer H. and Gloria B.
Once again, the court's order in this case does not designate the
persons authorized to administer the involuntary treatment. See
405 ILCS 5/2--107.1(a--5)(6) (West 2004). We cannot say that such
an order strictly complies with the statute by designating the
persons authorized to administer the involuntary treatment. See
405 ILCS 5/2--107.1(a--5)(6) (West 2004); Louis S., 361 Ill. App.
3d 774, 838 N.E.2d 226. Therefore, based on our previous rulings
in Jennifer H. and Gloria B., we hold that the trial court's order
to involuntarily administer psychotropic medication was manifestly
erroneous.
We are sympathetic to the challenges faced by trial courts in
attempting to follow the statutory mandate. The court must
construct an order for involuntary medication that is neither so
14
narrow that it is impractical, nor so broad that it fails to
comport with the demands of the statute. However, we are
constrained by the plain language of the statute as written by our
legislature, and by the necessity of strict compliance because of
the liberty interest involved. See Louis S., 361 Ill. App. 3d 774,
838 N.E.2d 226.
We find In re Robert S., 341 Ill. App. 3d 238, 792 N.E.2d 421
(2003), rev'd in part on other grounds 213 Ill. 2d 30, 820 N.E.2d
424 (2004), to be instructive concerning a trial court order that
complied with the requirements of the statute. In Robert S., the
trial court's order stated that " 'ROBERT S[.] shall receive
psychotropic medication to be administered by DR. NAZARENO (or
designee whose license and credentials permit) at Elgin Mental
Health Center for a period not to exceed 90 days.' " Robert S.,
341 Ill. App. 3d at 249, 792 N.E.2d at 429. The appellate court
ruled that this order complied with the requirements of section 2--
107.1(a--5)(6). The Illinois Supreme Court was not asked to
consider this precise issue, but it affirmed that portion of the
appellate court's decision concerning the applicability of the
criteria in section 2--107.1. See Robert S., 213 Ill. 2d 30, 820
N.E.2d 424.
CONCLUSION
For the foregoing reasons, we affirm the Peoria County circuit
court's orders (1) that the respondent is subject to involuntary
15
admission to a mental health facility; and (2) denying the
respondent's petition for discharge. We reverse the court's order
for involuntary administration of psychotropic medication.
Affirmed in part and reversed in part.
SCHMIDT and WRIGHT, JJ., concurring.
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