People v. Barbara H.People v. Barbara H.
delivered the opinion of the court:
This case is a consolidated appeal. The State filed two petitions concerning Barbara H. First, the State sought to admit Barbara H. to a mental health facility involuntarily pursuant to the Mental Health and Developmental Disabilities Code (Code) (
At a hearing at which the respondent was not present, the trial court granted the State’s petition to involuntarily admit her to Elgin Mental Health Center (Center) for a period not to exceed 90 days. Further, the court found that the benefits of psychotropic medication outweighed any harm and allowed the Center to administer psychotropic medication to Barbara H. for a period not to exceed 90 days.
The record shows that, on August 2, 1996, the trial court held a joint hearing on the State’s petition to involuntarily admit Barbara H. and the State’s petition to involuntarily administer psychotropic medication to the respondent. At the beginning of the hearing, the trial court noted that the respondent was absent and asked the respondent’s attorney, an assigned public defender, if he was waiving his client’s presence. The public defender stated that an investigator and a student law clerk attempted to speak with Barbara H., but that Barbara H. refused to talk to them. The public defender added that Barbara H. stated that she was represented through the "Catholic Charities Association” and told the investigator and the student that she refused to come to court. The public defender then stated that if he was "in fact going to represent her today [he] would then waive her presence based upon that.”
At that point, the trial court interrupted the public defender to ask again whether he was waiving his client’s presence. The public defender added that he believed that having Barbara H. in court "would be detrimental to her physical and emotional well-being.” The trial court again requested the public defender to answer "[y]es or no” to whether he was waiving his client’s presence. The public defender then stated that he waived Barbara H.’s presence.
Only one witness testified at the hearing. Dr. Farsana Husain testified that she is a staff psychiatrist at the Center. Dr. Husain stated that she was unable to perform a psychiatric examination of Barbara H. because on three occasions Barbara H. refused to talk to her. Accordingly, her diagnosis of the respondent was based on her review of the medical records, conversations with the staff, personal observations, and her past experience with the respondent when Barbara H. was her patient for a six-month period ending in May 1996.
Dr. Husain diagnosed Barbara H. with schizoaffective disorder, bipolar type. Dr. Husain explained that the respondent’s disorder had two components to it: psychotic disturbance and mood disturbance. Overall, Dr. Husain said that Barbara H. "is not in touch with reality. She is delusional.” Dr. Husain added that the respondent’s mood ranged between being depressed, getting angry, and becoming agitated.
Dr. Husain testified that Barbara H. had been living "at placement” in association with Northwest Community Mental Health Center. Dr. Husain explained that Barbara H. was returned to the Center because she refused to take her medication, she believed people were poisoning her, and she falsely thought she was pregnant. Dr. Husain stated that upon returning to the Center Barbara H. was "very filthy and poorly dressed and groomed.” Dr. Husain added that in a structured environment Barbara H. takes care of herself with some prompting, but independently she has not been able to care for herself.
Dr. Husain testified that Barbara H. has diabetes. Dr. Husain stated that the respondent voluntarily takes medication for her diabetes, but refuses to take medication for her mental illness.
Dr. Husain said that she did not believe that Barbara H. could manage her financial affairs if she were discharged because "historically” Barbara H. had been unable to manage her financial affairs on her own. Dr. Husain stated that she "had no knowledge” of whether Barbara H. would be able to find food for herself on her own if she were discharged. Overall, however, Dr. Husain acknowledged that she believed the respondent to be mentally ill and because of her illness she was unable to provide for her basic physical needs so as to guard herself
Finally, Dr. Husain testified that Barbara H.’s ability to function had deteriorated. Dr. Husain stated that the respondent did not understand her illness and had "very poor insight” into her illness. Dr. Husain said that Barbara H. had been admitted 11 times since 1980 and that within the last four to five years her condition had been deteriorating.
Dr. Husain next testified to Barbara H.’s history with psychotropic medication. Dr. Husain stated that when taking psychotropic medication in the past the respondent had never experienced side effects. Dr. Husain added that when taking the medication Barbara H. became more sociable and her mood became stable. Further, while on the psychotropic medication, Barbara H. was able to care for herself and did not need prompting. Accordingly, Dr. Husain stated that in her opinion the benefits of psychotropic medication outweighed the harm.
Dr. Husain then added that she believed that due to her delusional state Barbara H. did not have the capacity to make a reasoned decision about the psychotropic medication. Dr. Husain explained that the respondent had "decompensated” and that her judgment and insight were "very poor.” Dr. Husain acknowledged that Barbara H. understood that she had the right to refuse medication, but stated that she did not believe that Barbara H. understood the benefits of the medication. Additionally, Dr. Husain described the psychotropic medication that had stabilized Barbara H.’s condition in the past and stated that she would administer those same drugs to the respondent.
On cross-examination, Dr. Husain acknowledged that her diagnosis was not based on counseling sessions or interviews with Barbara H., but through her review of charts and her personal experience. Dr. Husain explained that Barbara H. had been involuntarily committed in the past but was discharged several times because the medication had stabilized her. Finally, Dr. Husain described that the last time she treated Barbara H. it took six months before Barbara H. stabilized because she refused to take her medication.
On appeal, Barbara H. argues that the trial court’s orders granting her involuntary admittance to the Center and the administration of psychotropic medication should be reversed. Primarily, Barbara H. contends that the orders should be reversed because section 3 — 806 of the Code, which governs the waiver of a respondent’s presence at a hearing, is unconstitutional because it allows a hearing to proceed in a respondent’s absence without the respondent having been told that the hearing may proceed without him or her. See
We note also that Barbara H. alleges that the court’s authorization of psychotropic medicine was erroneous because the State failed to prove by clear and convincing evidence all the factors listed in the Code regarding administering psychotropic medicine against a respondent’s will. See
As the constitutionality of
When deciding whether a statutory procedure affords procedural due process, courts must take three factors into account: the private interest that will be affected by
At issue in this case is section 3 — =806 of the Code, which outlines the procedures regarding a respondent’s presence at a hearing.
"(a) The respondent shall be present at any hearing held under this Act unless his attorney waives his right to be present and the court is satisfied by a clear showing that the respondent’s attendance would subject him to substantial risk of serious physical or emotional harm.
(b) The court shall make reasonable accommodation of any request by the recipient’s attorney concerning the location of the hearing. If the recipient’s attorney advises the court that the recipient refuses to attend, the hearing may proceed in his or her absence.
(c) No inference may be drawn from the recipient’s nonattendance pursuant to either subsection (a) or (b) of this Section.”405 ILCS 5/3 — 806 (West Supp. 1995).
When approving the defense attorney’s waiver of Barbara H.’s presence at the hearing, the trial court did not state under which subsection of
Barbara H. contends that
It is undisputed that a significant due process liberty interest exists to be free from unjustified civil commitment and to refuse unwanted, nonemergency psychotropic medication. See Ingraham v. Wright,
In the present case, both parties acknowledge that the due process clause of the fourteenth amendment applies to involuntary commitment proceedings. Barbara H. argues that
Under
A recent decision concerning the constitutionality of another section of the Code provides some guidance to our analysis. In In re Branning,
The Branning court determined that this procedure violated due process because it did not provide sufficient protections to a respondent. The court explained that the statute did not specify, among other things, the level of evidence by which anything must be proved, exactly what needed to be proved, input from a healthcare professional, or proof that the respondent was unable to make a rational choice for himself. Instead, the statute’s only requirement for the administration of ECT was that the guardian consented and that the guardian believed that the ECT was in the ward’s best interest. See Branning,
The most significant omission in
Several federal court decisions involving similar statutes in other states support our conclusion that
Similarly, in Suzuki v. Quisenberry,
Moreover, in Bell v. Wayne County General Hospital,
"Under Illinois v. Allen,397 U.S. 337 ,90 S. Ct. 1057 ,25 L. Ed. 2d 353 (1970) a criminal defendant may be removed from trial where his conduct is so disruptive that the proceeding cannot continue in any reasonable manner. In our view a respondent may be removed from commitment proceedings under similar circumstances, but to exclude the respondent as provided above violates due process. *** While a committing court may exclude a respondent where his presence makes it impossible to reasonably conduct the hearing, it may not decide in advance of hearing and based solely on the certificate of physicians, that he shall not be allowed to appear. Where his removal to the courthouse would be 'improper and unsafe,’ some method alternative to total exclusion must be attempted first ***.” Bell,384 F. Supp. at 1094 .
Similarly, in Kendall v. True,
Finally, the United States Supreme Court has stated that to afford sufficient protection to a liberty interest to a prisoner being transferred to a mental hospital, the prisoner must receive notice of the commitment hearing and have an opportunity to be present at the hearing. See Vitek,
We find the Doremus, Kendall, Suzuki, and Bell courts’ interpretation of the federal
The State argues that this court should rely on French v. Blackburn,
Additionally, the State argues that to require a mental health patient to waive his right to be present at a hearing would be "unrealistic” and "may well prove impossible” because most mental health patients do not have the capability to make a waiver. Further, the Attorney General contends that requiring admonishments to the respondent would not "have any value” in safeguarding a respondent’s liberty interest and would actually impede the State’s parens patriae interest.
We find these arguments unpersuasive. Both the State and the Attorney General fail to recognize that respondents attending a civil commitment hearing are presumed competent. People ex rel. Drury v. Catholic Home Bureau,
The State and the Attorney General also contend that a waiver from a respondent cannot be mandated because under such a procedure the respondent’s attorney would be required to explain to the court whether the respondent understood her right to be at the hearing. The State and the Attorney General argue that these explanations of whether a respondent understood her right to be present at a hearing may be detrimental to the respondent’s defense. We find this argument also unpersuasive. Certainly, an individual’s ability to understand court procedure and a fundamental right sufficiently to make a rational choice to attend a hearing is quite different from that same individual’s overall mental capabilities and whether that individual is mentally incompetent. Further, under
Finally, the Attorney General and the State remind this court in their briefs that the involuntary medication statute and the involuntary commitment statute contain a 90-day period time limitation and a 180-day period limitation. The Attorney General claims that these time limits mean that only a "limited term of infringement on the liberty interest at stake” results from these civil commitment proceedings. Further, the State adds that, because the Code requires periodic review of every case, an individual civilly committed is in a much different position
By making such arguments, the State and the Attorney General fail to acknowledge that the United States Supreme Court has recognized that "for the ordinary citizen, commitment to a mental hospital produces 'a massive curtailment of liberty.’ ” Vitek,
This court wishes to note that it is not beyond our recognition that requiring a respondent’s waiver for the court to proceed in absentia against a respondent raises several practical concerns for our trial courts. However, we are encouraged by laws in other states that have already addressed this issue. We believe that these laws provide examples of civil commitment hearing procedures that, if adopted by our legislature and followed by our court system, protect a respondent’s liberty interest without throwing the trial courts into a state of disarray.
We note that several state laws simply provide that an individual has a right to be present at the civil commitment hearing unless he waives that right or the court proceeding cannot reasonably continue while the person is present. See, e.g.,
As currently drafted,
Turning to the second part of
In conclusion, we find that
For the foregoing reasons, the judgment of the circuit court of Kane County is reversed, and the cause is remanded.
Reversed and remanded.
McLAREN and BOWMAN, JJ., concur.