In re LINDA B. (The People of the State of Illinois, Appellee, v. Linda B., Appellant).
No. 119392
Supreme Court of Illinois
September 21, 2017
November 20, 2017
2017 IL 119392
CHIEF JUSTICE KARMEIER
Appeal from the Appellate Court for the First District; heard in that court on appeal from the Circuit Court of Cook County, the Hon. David Skryd, Judge, presiding. Judgment Affirmed.
Lisa Madigan, Attorney General, of Springfield, and Kimberly M. Foxx, State‘s Attorney, of Chicago (Alan J. Spellberg and Matthew Connors, Assistant State‘s Attorneys, of counsel), for the People.
Cheryl R. Jansen, of Equip for Equality, of Springfield, amicus curiae.
CHIEF JUSTICE KARMEIER delivered the judgment of the court, with opinion.
Justices Freeman, Thomas, Kilbride, Garman, Burke, and Theis concurred in the judgment and opinion.
OPINION
¶ 1 The overarching issue presented in this appeal is whether a timely petition was filed, seeking immediate, involuntary admission of respondent for inpatient psychiatric treatment in a mental health facility pursuant to article VI of the Mental Health and Developmental Disabilities Code (Mental Health Code) (
BACKGROUND
¶ 2 Proceedings in this case were initiated on May 9, 2013, when Connie Shay-Hadley, the mental health facility director at Mount Sinai Hospital (Mt. Sinai), filed a petition alleging that respondent, Linda B., was a person subject to involuntary admission
¶ 3 The petition was supported by certificates submitted by Dr. Medela Gartel, who examined respondent on May 9, 2013, and Colleen Kurtz, a licensed clinical social worker who examined respondent later that same day. Both checked form boxes stating that respondent was mentally ill and required “immediate hospitalization” for the prevention of harm to respondent or others. Both stated that respondent was in need of treatment to prevent deterioration of her condition and that she could not understand the nature of her illness or the need for treatment. Gartel added, via handwritten notation, that respondent had exhibited “multiple psychiatric symptoms including paranoid delusions,” she had been violent with medical staff, and she had been wandering and defecating in the hall. Kurtz corroborated that observation as well as Gartel‘s suggestion that respondent suffered from paranoid delusions. Kurtz added that respondent was refusing both medical and psychiatric medications.
¶ 4 On June 11, 2013, the trial court held a hearing addressing the matter of involuntary admission.1 At that hearing, Dr. Elizabeth Mirkin, a board-certified psychiatrist, testified that respondent‘s hospitalization at Mt. Sinai began on April 22, 2013, when she was admitted to a “medical floor,” where she was also “treated psychiatrically.” With respect to the circumstances prompting respondent‘s admission, Mirkin volunteered:
“She actually was board—agitated and very angry behaviors before she was admitted in medical floor because she was tachycardia and found to be severely anemic.2 She was admitted to the medical floor. She was followed by a psychiatrist throughout her stay on the medical floor.”
Mirkin also stated that respondent had sitters “throughout her stay on the medical
¶ 5 Mirkin testified that she first saw respondent on the medical floor on May 25, 2013. She had previously spoken to other staff members and had reviewed “other people psychiatry progress notes, nursing notes, doctors notes.” Mirkin stated that respondent was hospitalized for “both” psychiatric and medical treatment. Mirkin noted that this was not respondent‘s first hospitalization. She had been admitted to Mt. Sinai‘s psychiatric unit in January 2013 “with similar presentation.” According to Mirkin, respondent was admitted again in April. There had been “multiple prior hospitalizations.” Mirkin diagnosed respondent as suffering from schizophrenic disorder, stating that respondent had suffered from that malady for years.
¶ 6 Mirkin described, in detail, the symptoms respondent had exhibited: “[S]he was very delusional, very aggressive, agitated and threatening, labile and did not sleep, threatened staff, did not take medications for psychiatric and medical reasons.” Mirkin said that respondent was “much less symptomatic” at the time of the hearing because, pursuant to court order entered May 14, 2013,3 respondent was taking prescribed medications. Though Mirkin acknowledged that respondent was “less symptomatic,” she maintained that respondent was still delusional, easily agitated, aggressive, and subject to rapid mood swings. Mirkin observed that respondent had a history of noncompliance in taking medications, particularly whenever she was discharged from the hospital. Mirkin rendered her opinion, based upon a reasonable degree of psychiatric certainty, that respondent was unable, because of her mental illness, to provide for her basic physical needs without assistance and thus should be treated on an inpatient basis. Mirkin recommended that respondent be treated at Park Shore Nursing Home.
¶ 7 In her cross-examination, counsel for respondent asked: “Is [respondent] recommended for nursing home placement because of mental health reasons or because of medical reasons?” Mirkin responded:
“Because of combination of mental health reasons and medical reasons. In her case, her mental health conditions prevents her from taking care of her medical condition. When she has exacerbation of her mental illness, then she doesn‘t take care of herself, including her many medical conditions.”
Inquiries by counsel regarding Park Shore Nursing Home revealed that Mirkin had very limited knowledge thereof. However, when asked whether Park Shore Nursing Home provided “behavioral mental health care or whether they primarily provide[d] medical care to elderly senior citizens,” Mirkin replied: “Because [respondent‘s] diagnosis is schizoaffective disorder, she could not be admitted to the nursing home, which does not provide care for behavioral health.”
¶ 8 Upon further examination of Mirkin by respondent‘s counsel, the following colloquy ensued:
“Q. Doctor, according to the chart, you‘ve indicated as of approximately May 28th, the respondent was ready for discharge from Mt. Sinai, correct?
A. I had a note there. I saw her on the unit and I didn‘t say that she is ready for discharge. I said that she does not need inpatient level of psychiatric care.
I said this is her baseline, but I never indicated that she could be discharged home. There was a process going on while she was on medical floor for her to be admitted to the nursing home; and by
my note, I stated that she does not need to be transferred to inpatient psych unit. Q. So all this time, from April 22nd to the present day, [respondent] has been on a medical unit and not a psychiatric hospital [sic] at the hospital?
A. She was cleared medically only as of last Saturday. *** At that time we found out we‘re going with a nursing home placement. There‘s no point of her to be transferred to six—the transfer to Six East mainly because on the medical floor, she‘s been on one-to-one supervision; and the nursing home will not accept anybody to the nursing home unless their 24 hours of supervision and psychiatric unit is more appropriate for her.
She hasn‘t been on supervision here unless she was admitted there last night. She hasn‘t been put on one-to-one supervision.
While on medical floor, she needed one-to-one sitter. *** Constantly, she needed to have supervision all of the time.
Q. That‘s one of the conditions for Park Shore to accept [respondent], that she goes 24 hours without having a sitter?
A. Yes. Any nursing home inpatient, yes.”
¶ 9 Following cross-examination and after the State rested, respondent‘s counsel moved to dismiss the petition for involuntary admission “based upon the petition having been filed well beyond the 24 hours after [respondent‘s] admission.” Counsel argued that the petition was untimely filed where respondent was admitted to the medical floor of Mt. Sinai on April 22, 2013, but was also being treated psychiatrically from that date.
¶ 10 Over counsel‘s objection, the court allowed the State to reopen its case in order to adduce evidence pertinent to respondent‘s motion. Speaking to the procedures the hospital generally employs with respect to involuntary admission, Mirkin explained:
“We have—when patient is admitted to medical floor, if medical team feels that psychiatric treatment needed or psychiatrist needs to be seen, we feel and I feel and consults every day, four or five patients.
We don‘t submit any petitions for any other patients unless we start believing that patients need, either psychiatric admission or patient needs treatment against their will.
Patients are on typical medical floor without—even now at this moment, I see like every day, I see four or five patients on medical floors. We do not do petitions unless we think the patient needs to go to court because the patient is noncompliant with treatment.”
Counsel for the State asked: “Was the decision made when it was determined that she needed inpatient psychiatric treatment?” Mirkin responded:
“At that time she was still on medical floor. I was not in service at that time, but I reviewed the chart. I thought it was appropriate when the doctor went to court on May 14 because it was considered that she needed psychiatric treatment and she was not taking medications.”
Counsel for the State then asked: “So initially, the primary purpose for [respondent‘s] hospitalization was for medical treatment?” Mirkin responded: “For both, but she was on medical floor, so we never start petitions while patient is on medical floor, unless we think that she needed more psych, more structured environment. It is not at all appropriate. We never do this.”
¶ 12 After closing argument, the circuit court granted the petition for involuntary admission. In its written order, the court found respondent subject to involuntary admission on an inpatient basis because (1) respondent‘s mental illness rendered her unable to provide for her basic physical needs and to guard herself from serious harm and (2) respondent‘s mental illness resulted in (a) her refusal of necessary treatment, (b) her inability to understand the need for such treatment, and (c) a reasonable expectation that, if respondent was not treated, she would suffer further mental or emotional deterioration. The written order also provided that respondent be treated at Park Shore Nursing Home, based on Dr. Mirkin‘s recommendation, for a period of hospitalization not to exceed 90 days.
¶ 13 In respondent‘s ensuing appeal, the appellate court first noted that respondent‘s 90-day period of hospitalization had expired, rendering the appeal moot, as the appellate court could no longer grant respondent effectual relief. 2015 IL App (1st) 132134, ¶ 11. However, the appellate court considered and applied the public interest exception to the mootness doctrine to address the merits of the issues raised by respondent. Id. ¶ 13.
¶ 14 On the merits, the appellate court appears to have resolved this case on the bases of two premises: (1) respondent‘s “physical” admission to the hospital was not synonymous with “legal” admission under article VI of the Mental Health Code (2015 IL App (1st) 132134, ¶ 19), and (2) the medical floor of the hospital, arguably, was not a “mental health facility” within the meaning of the statute, irrespective of whether psychiatric treatment was rendered there (id. ¶ 23). Thus, the appellate court affirmed the judgment of the circuit court, concluding that the petition for involuntary admission was timely filed.
ANALYSIS
¶ 15 Initially, we note that this appeal is moot because respondent‘s underlying 90-day admission period has expired. See In re Andrew B., 237 Ill. 2d 340, 346 (2010). Consequently, we must determine whether an exception to the mootness doctrine applies. Id. One exception to the mootness doctrine allows a court to resolve an otherwise moot issue if the issue involves a matter of substantial public interest. Bettis v. Marsaglia, 2014 IL 117050, ¶ 9. Respondent argues that exception applies to questions posed in this appeal.
I. Public Interest Exception
¶ 16 The public interest exception permits review of an otherwise moot appeal when three requirements are met: (1) the question presented must be public rather than case-specific in nature; (2) an authoritative determination is needed to guide public officers in future cases; and (3) there is a likelihood the issue will recur. People v. Holt, 2014 IL 116989, ¶ 47; Andrew B., 237 Ill. 2d at 347. This exception must be construed narrowly and established by a clear showing of each criterion. Andrew B., 237 Ill. 2d at 347.
¶ 17 We believe the requisites for application of the public interest exception are satisfied in this case. “‘[T]he procedures which must be followed *** before a
II. Pertinent Statutes
¶ 18
¶ 19
“When a person is asserted to be subject to involuntary admission on an inpatient basis and in such a condition that immediate hospitalization is necessary for the protection of such person or others from physical harm, any person 18 years of age or older may present a petition to the facility director of a mental health facility in the county where the respondent
resides or is present. The petition may be prepared by the facility director of the facility.” 405 ILCS 5/3-601(a) (West 2012).
¶ 20
¶ 21
¶ 22 Finally,
“Within 24 hours, excluding Saturdays, Sundays and holidays, after the respondent‘s admission under this Article, the facility director of the facility shall file 2 copies of the petition, the first certificate, and proof of service of the petition and statement of rights upon the respondent with the court in the county in which the facility is located. Upon completion of the second certificate, the facility director shall promptly file it with the court. The facility director shall make copies of the certificates available to the attorneys for the parties upon request. Upon the filing of the petition and first certificate, the court shall set a hearing to be held within 5 days, excluding Saturdays, Sundays and holidays, after receipt of the petition. The court shall direct that notice of the time and place of the hearing be served upon the respondent, his responsible relatives, and the persons entitled to receive a copy of the petition pursuant to Section 3-609.”
405 ILCS 5/3-611 (West 2012).
III. Merits
¶ 23 The parties’ arguments concerning the timely filing of the petition focus on two questions. First, under the circumstances, did the medical floor of Mt. Sinai qualify as a “mental health facility” as specified in article VI of the Mental Health Code? Second, what constitutes “admission” for purposes of
A. “Mental Health Facility”
¶ 24 Respondent contends that the appellate court erred when it failed to find that the medical floor of Mt. Sinai—where she was treated for medical and psychiatric conditions—qualified as a “mental health facility,” as defined by the Mental Health Code. Respondent observes that the Mental Health Code broadly defines a “mental health facility” as a private facility, or a section thereof, or a facility operated by the State or its political subdivisions, that (1) is licensed by the Department of Public Health and (2) provides treatment for persons with mental illness. See
¶ 25 Respondent takes issue with the appellate court‘s reliance upon In re Moore, 301 Ill. App. 3d 759, 766 (1998), arguing that Moore‘s narrow construction of the term “mental health facility” with respect to hospitals, meaning only “[t]hose sections or units” specifically dedicated to the treatment of mentally ill patients—is not consistent with the “current reality,” in which psychiatric services are provided in diverse venues offering both medical and psychiatric treatment. Respondent notes, for example, that the Illinois Department of Human Services website directs that those suffering psychiatric emergencies go, or be taken, to the emergency room at their local hospital.5 Respondent also points to
¶ 26 Respondent concludes: “To construe the Code as applying only to distinct psychiatric units would result in disparate treatment of individuals with mental illnesses based on the location of their treatment. *** If this court affirms the appellate court‘s decision in In re Linda B., people could be held in scatter beds8 on medical floors or in emergency rooms without their consent and without the legal
¶ 27 As we understand the State‘s position—or positions—the State first advocates for a bright-line rule, relying upon Moore, arguing that the legislature intended that
¶ 28 However, the State also appears to concede that the type of treatment provided to a patient is relevant in determining the kind of facility in which the patient receives treatment. The State acknowledges, for example, that “section 5/1-114 implicitly suggests that an emergency room could be considered a mental health facility as a ‘section’ of a private hospital when used ‘for the treatment of persons with mental illness.‘” Notwithstanding, the State submits “[t]hat does not alter the calculus here, where Dr. Mirkin‘s testimony made clear that respondent was admitted for medical care, and in addition to that care, received psychiatric care.” By that acknowledgment, the State appears to retreat from espousing a bright-line rule, such as that announced in Moore, seemingly advocating for a primary-purpose-of-treatment test and minimizing the significance of the medical venue where psychiatric treatment is provided.
¶ 29 We note, initially, that it is far from “clear,” based upon the only testimony at the hearing—Dr. Mirkin‘s—that it was respondent‘s medical condition alone that brought her to someone‘s attention and resulted in her hospitalization or even that her medical condition was the primary factor in her hospitalization and treatment. The certificates filed in support of the petition for involuntary admission do not suggest a contrary inference. Though the State, at the hearing in this matter, attempted to solicit Mirkin‘s acquiescence to the proposition that, “initially, the primary purpose for [respondent‘s] hospitalization was for medical treatment,” Mirkin responded—contrary to the State‘s suggestion otherwise in its brief9—that respondent
¶ 30 It would seem to us that respondent‘s psychiatric treatment and supervision on the medical floor were at least as comprehensive and structured as anything she might have received in the psychiatric unit, which the State has to concede is a “mental health facility.” We think most people of ordinary sensibility would agree with the application of abductive reasoning in this instance and conclude that a facility, or section thereof, capable of providing mental health services, that does in fact provide the individual mental health services, is a mental health facility.10 To find otherwise is to exalt a facility‘s self-designated nomenclature over its actual function. We decline to do so.
¶ 31 And there is no reason to do so. The legislature made the definition of “mental health facility” extremely broad so as to encompass any place that provides for “the treatment of persons with mental illness.”
¶ 32 As this court has repeatedly acknowledged, the administration of involuntary mental health services involves a “‘“‘massive curtailment of liberty.‘“” In re Robert S., 213 Ill. 2d 30, 46 (2004) (quoting In re Barbara H., 183 Ill. 2d 482, 496 (1998),
¶ 33 In today‘s era of integrated, holistic health care, we believe it is unrealistic to think that medical personnel on a medical floor or in an emergency room or anyone for that matter—would not recognize and report someone with psychiatric symptoms as striking as respondent‘s and that psychiatric specialists and structured treatment would not be brought to bear, irrespective of the medical environment wherein the patient is housed. On the other hand, one might well understand how a patient could be treated psychiatrically, involuntarily, in facilities not specifically designated as “mental health facilities” and thus be deprived of the Mental Health Code‘s safeguards. It could well have happened here.
¶ 34 However, we do not know it happened here because the record does not reflect that, prior to the filing of this petition on May 9, 2013, respondent was an involuntary recipient of psychiatric services in the hospital. We can readily assume, at some point in time, she resisted psychiatric treatment, but we do not know for certain when that occurred. Here, we address the second question posed at the outset of our analysis: What constitutes “admission” for purposes of
¶ 35 There is no dispute that respondent was physically admitted to the hospital as a patient on April 22, 2013. The petition for involuntary admission states as much.11 However, nothing in this record identifies the capacity in which respondent was admitted, i.e., whether she was a voluntary or involuntary recipient of treatment. At oral argument, counsel for respondent conceded as much, but she argued that the evidence suggested that respondent was there involuntarily. Counsel for the State countered that the issue of consent to treatment was not developed at the June 11 hearing and that it was unclear on what date respondent became noncompliant or treatment became involuntary. Pressed upon this point at oral argument, counsel for respondent noted that she tried at the hearing to ask Dr. Mirkin by what legal authority treatment was provided to respondent—consensual or otherwise—but the trial court sustained the State‘s objection that the question was beyond the scope of direct examination. Counsel explained to this court: “Then there was a decision that that was not needed to be covered in any kind of case-in-chief, because of trial strategy.” Counsel did not elaborate on, and we cannot conceive, what the aim of that strategy would have been.
¶ 36 What we are left with is bare-bones evidence of physical admission to the hospital, with some evidence of communication between hospital personnel and unidentified family members of respondent. Respondent‘s daughter was specifically identified in the petition for involuntary admission. There was no evidence as to the exact means by which respondent came to
¶ 37 During oral argument, counsel for respondent was asked whose responsibility it was to show respondent was previously in the hospital involuntarily. Counsel for respondent would place that burden on the State, but we believe it is respondent‘s burden. It is well established that, on appeal, the party claiming error has the burden of showing any irregularities that would justify reversal. Flynn v. Vancil, 41 Ill. 2d 236, 241 (1968). Error is never presumed by a reviewing court; it must be affirmatively shown by the record. Id. at 241-42. It is the appellant‘s burden to present a sufficiently complete record of the proceedings at trial to support a claim of error, and any doubts that may arise from the incompleteness of the record will be resolved against the appellant. Williams v. BNSF Ry. Co., 2015 IL 117444, ¶ 31.
¶ 38 Counsel for respondent was aware of the significance of respondent‘s legal status prior to the filing of the petition; she attempted, unsuccessfully, to cross-examine Mirkin on that very point during the June 11 hearing. She could have revisited that issue in her portion of the case, but she informed us during oral argument that she decided not to do so. In order to establish untimely filing of the May 9 petition, respondent had to establish that her initial period of hospitalization and psychiatric treatment was involuntary. Whether she could have done so or not, respondent‘s counsel did not make that record.
¶ 39 If the initial treatment was not rendered against respondent‘s will, which is entirely possible—it is reasonable to infer that some change in respondent‘s volitional disposition might have prompted the filing of the petition, after weeks of treatment—then we have a situation governed by this court‘s analysis in Andrew B., as the State contends. In that case, this court acknowledged what would seem obvious: that a patient‘s legal status within a facility may change while the patient is a resident there.
¶ 40 In Andrew B., respondent voluntarily entered the facility for treatment but later expressed a desire to leave. A petition for involuntary admission was filed but was later voluntarily dismissed by the State. The court ordered respondent‘s discharge; however, respondent was not physically released. Instead, the next day a petition was filed for respondent‘s emergency admission by certificate under
¶ 41 The appellate court affirmed, rejecting respondent‘s argument that the petition seeking his involuntary admission was untimely filed under
¶ 42 We reached the same result. In upholding the order of the circuit court and rejecting respondent‘s contention that the emergency petition was untimely filed, we noted that “the Code refers to ‘admission’ in a legal sense to describe the individual‘s legal status” within a facility. Andrew B., 237 Ill. 2d at 350. “In other words, section 3-611‘s reference to ‘admission’ is not always limited to the individual‘s original physical entry.” Id. Andrew entered the facility on a voluntary basis, but while there, his legal status changed pursuant to the filing and granting of an emergency petition for involuntary admission.
¶ 43 The takeaway, for our purposes, is that legal status may change while one is in a mental health facility—and that could well be the case here. Respondent has not demonstrated that her physical entry into the facility, and her initial treatment there, were involuntary. Thus, she has not demonstrated that error occurred, that the petition for involuntary commitment was not timely filed.
¶ 44 This court is not bound by the appellate court‘s reasoning and may affirm on any basis presented in the record. People v. Williams, 2016 IL 118375, ¶ 33. We apply that principle here.
¶ 45 For the foregoing reasons, the judgment of the appellate court is affirmed.
¶ 46 Affirmed.