2016 IL App (5th) 130573
Ill. App. Ct.2016Background
- Respondent Debra B., with a long history of psychiatric hospitalizations, was admitted to a forensic unit in October 2013 after being found unfit to stand trial on aggravated battery charges.
- Treating psychiatrist Dr. Patil filed a petition to involuntarily administer psychotropic medication; a November 5, 2013 hearing followed and the court authorized medication for 90 days.
- At the hearing Dr. Patil diagnosed bipolar disorder, manic with psychotic features, described grandiose delusions and intrusive interactions with other patients, and testified Debra was "suffering" and had deteriorated in functioning.
- Dr. Patil testified he provided written information about the proposed medications and alternatives if those drugs failed, but did not testify that he provided written (or oral) information about nonmedication alternatives; the petition form containing checkboxes was filed but not admitted into evidence.
- Debra denied having bipolar disorder, said she was willing to participate in therapy, and testified the emergency medications caused excessive sedation; she said any suffering was due to being hospitalized and concern for her family, not symptoms treatable by psychotropics.
- The trial court found Debra was suffering, had deteriorated in ability to function, and lacked capacity to make a reasoned decision; the appellate court reviewed the expired 90-day order under the public-interest mootness exception.
Issues
| Issue | Plaintiff's Argument (State) | Defendant's Argument (Debra) | Held |
|---|---|---|---|
| Whether procedural requirement to inform respondent of reasonable alternatives to medication was met | Dr. Patil provided required information (petition form checked) and testified he provided written info about medications | Dr. Patil did not provide written information about reasonable nonmedication alternatives; the petition form was not admitted into evidence | Reversed: State failed to prove respondent received required written information about alternatives; noncompliance requires reversal |
| Whether evidence established respondent lacked capacity to make a reasoned decision about medication | Dr. Patil testified Debra did not acknowledge bipolar disorder and could not make a reasoned choice; he provided written med info (per him) | Debra was educated, capable of reviewing materials, and no proof she was informed about alternatives; presumption of competence requires full information to find incapacity | Reversed: Capacity finding unsupported because required information about alternatives was not shown to have been provided |
| Whether evidence showed respondent was "suffering" from mental illness sufficient to authorize involuntary medication | Dr. Patil testified Debra was "suffering" and described symptoms and written delusional letters | Mere description of symptoms without testimony linking them to emotional or physical distress is insufficient; Debra’s expressed distress related to hospitalization/family, not psychiatric symptoms | Reversed: Expert testimony about symptoms alone, without showing emotional/physical distress or behavioral manifestations, did not meet clear-and-convincing standard for "suffering" |
| Whether evidence showed deterioration in respondent's ability to function sufficient to authorize involuntary medication | Dr. Patil opined functioning had declined, citing intrusive behavior toward peers and grandiosity | Intrusive nonthreatening interactions and participation in therapy indicate ability to function; State must show deterioration affecting basic functioning (not mere nuisance behavior) | Reversed: Testimony about nonthreatening intrusive conduct and grandiose beliefs did not establish the required deterioration in basic functioning |
Key Cases Cited
- In re Wendy T., 406 Ill. App. 3d 185 (Ill. App. 2010) (upholding involuntary medication where disorganized thinking caused inability to communicate and perform simple tasks)
- In re Lisa P., 381 Ill. App. 3d 1087 (Ill. App. 2008) (suffering found where respondent displayed rage, paranoia, and demeanor showing distress)
- In re Alfred H.H., 233 Ill. 2d 345 (Ill. 2009) (mootness doctrine exceptions in mental-health appeals; case-by-case analysis)
- In re Mary Ann P., 202 Ill. 2d 393 (Ill. 2002) (short duration of involuntary-medication orders and public-interest considerations)
- In re C.E., 161 Ill. 2d 200 (Ill. 1994) (constitutional liberty interest in refusing psychotropic drugs; concerns about invasiveness and misuse)
- In re Joseph M., 398 Ill. App. 3d 1086 (Ill. App. 2010) (clear-and-convincing standard and expert testimony requirements for involuntary medication)
- Mills v. Rogers, 457 U.S. 291 (U.S. 1982) (patients retain right to be free from unwarranted intrusions into body and mind)