In re Clinton S., 78 N.E.3d 413

Background

Respondent Clinton S., with a long psychiatric hospitalization history and diagnosed schizophrenia, was admitted to Elgin Mental Health Center after being found unfit to stand trial. He also has end-stage kidney failure and had been recommended hemodialysis three times weekly.
The treating psychiatrist, Dr. Mirella Susnjar, petitioned under 405 ILCS 5/2-107.1 for involuntary administration of several psychotropic medications and, additionally, for authorization to require regular hemodialysis, which she said was essential to safely administer the drugs.
Evidence showed respondent’s symptoms improved while on medication and while receiving hemodialysis; he later refused both medications and dialysis and became delusional and occasionally violent. Susnjar testified dialysis was required to prevent toxic accumulation of medication and possible coma.
The trial court found, by clear and convincing evidence, that the statutory factors were met, that benefits of medication outweighed harms (in light of dialysis), and authorized the medications and hemodialysis for up to 90 days.
Respondent appealed, arguing (1) the State failed to prove benefits outweighed harms and that the court improperly relied on dialysis in that balancing, and (2) section 2-107.1 does not authorize ordering invasive procedures like hemodialysis. The appellate court affirmed.

Issues

Issue	Plaintiff's Argument (State)	Defendant's Argument (Clinton S.)	Held
Whether benefits of involuntary psychotropic medication outweighed the harms under 405 ILCS 5/2-107.1(a-5)(4)(D)	Benefits (control of psychosis, improved decisionmaking, increased likelihood of accepting dialysis) outweigh risks when dialysis is provided; testimony supported balancing.	Absent guaranteed dialysis, medication risks (toxic accumulation, kidney damage) outweigh benefits; court improperly relied on a contingency beyond Code authority.	Court upheld trial court: totality of evidence may include presence/absence of treatment for comorbid physical conditions; finding that benefits outweighed harms (given dialysis) was not against manifest weight.
Whether section 2-107.1 authorizes ordering hemodialysis as "testing and other procedures" essential for safe administration (G)	Section permits testing and other procedures essential to safe administration; here dialysis was shown essential to prevent toxic accumulation—so authorization is proper.	Statute allows blood testing/monitoring but not invasive procedures like dialysis; ordering dialysis improperly intrudes on medical/guardian decision frameworks.	Court held section 2-107.1 can authorize procedures beyond noninvasive testing when proven essential for safe/effective administration; ordering dialysis was permissible here given clear-and-convincing proof.
Whether physician failed to define treatment plan sufficiently	State: treating psychiatrist detailed medications, alternatives, side-effect mitigation, and consulted nephrology; plan was sufficiently defined.	Respondent: regimen not precisely defined, preventing meaningful risk/benefit analysis.	Court found the petition and testimony sufficiently specific; trial court did not err.
Whether alternative legal vehicles (guardianship/surrogate) should have been used instead	State: even if guardianship/surrogate were available, they might not ensure safe administration; §2‑107.1 petition was an appropriate means to secure dialysis assurance for medication safety.	Respondent: court should have used guardianship or Health Care Surrogate Act rather than ordering medical treatment via Mental Health Code.	Court rejected the suggestion; held §2‑107.1 was a permissible route here to ensure safe/effective treatment.

Key Cases Cited

In re C.E., 161 Ill. 2d 200 (describing parens patriae interest and safeguards for involuntary psychotropic medication)
In re Robert S., 213 Ill. 2d 30 (recognizing severe liberty and health impacts of involuntary psychotropic drugs)
In re Mary Ann P., 202 Ill. 2d 393 (treatment authorized under §2‑107.1 must be the physician’s recommended plan in its entirety)
In re Alfred H.H., 233 Ill. 2d 345 (capable-of-repetition exception for mental-health appeals affecting the same respondent)
In re Val Q., 396 Ill. App. 3d 155 (trial court must have adequate medical consultation/evidence about physical risks before authorizing psychotropic treatment)
In re Floyd, 274 Ill. App. 3d 855 (§2‑107.1 authorizes blood testing/monitoring essential to safe administration of psychotropic drugs)
In re Jill R., 336 Ill. App. 3d 956 (recognizing implied authority to order periodic blood testing under §2‑107.1)
In re Larry B., 394 Ill. App. 3d 470 (statutory safeguards against misuse of psychotropic medication)
In re Jonathan P., 399 Ill. App. 3d 396 (mootness exceptions and review standards in mental-health involuntary-medication appeals)
In re Williams, 305 Ill. App. 3d 506 (treatment order invalid if regimen so poorly defined the expert could not meaningfully weigh risks/benefits)