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August 24, 1995


Appeal from the Circuit Court of Kane County. No. 94-MH-383. Honorable Thomas E. Hogan, Judge, Presiding.

The Honorable Justice Hutchinson delivered the opinion of the court: Inglis and Doyle, JJ., concur.

The opinion of the court was delivered by: Hutchinson

JUSTICE HUTCHINSON delivered the opinion of the court:

Respondent, Karen Schaap, appeals the order of the circuit court of Kane County finding her to be a person in need of involuntary psychotropic medication. She contends that the State failed to prove its case by clear and convincing evidence, that the court lacked subject matter jurisdiction, and that she was denied the effective assistance of counsel. We affirm.

Respondent, a recipient of mental health care at the Elgin Mental Health Center (EMHC), ceased taking her prescribed medication in July 1993. On October 3, 1994, Dr. Carole Rosanova, a psychiatrist at EMHC, petitioned the circuit court to find respondent to be a person in need of involuntary psychotropic medication, pursuant to section 2-107.1 of the Illinois Mental Health and Developmental Disabilities Code (the Code)(405 ILCS 5/2-107.1 (West 1992)). Following a bench trial on October 21, 1994, respondent was found to be a person in need of involuntary psychotropic medication.

At the hearing in this matter the court heard testimony from Dr. Rosanova and from respondent. The parties stipulated to Dr. Rosanova's credentials. She then testified that she had (1) interviewed respondent several times; (2) attended respondent's monthly staffings; (3) reviewed respondent's complete treatment history; and (4) that this is the type of information upon which she would usually rely in formulating a diagnosis. She diagnosed respondent as having chronic paranoid schizophrenia, a mental illness.

Dr. Rosanova also testified that since respondent discontinued her medication: (1) she exhibited deterioration in her ability to function, showing suffering, threatening, or disruptive behavior; (2) respondent reverted to expressing persecutory feelings about other people and became progressively agitated; (3) respondent's speech became pressured and she spoke of bizarre past events and caused other mental health care recipients to do bizarre things, such as drink urine; and (4) respondent began focusing obsessively on other people. Dr. Rosanova observed that respondent's disability existed for a period of time marked by the continuing presence of this deterioration and that these aspects of deterioration related to the termination of respondent's medication.

Dr. Rosanova testified about respondent's medication. The benefits of respondent's prior medication included (1) stabilization of mood; (2) a decrease in aggression; (3) a decrease in delusional, persecutory thinking and obsessing; (4) improved grooming; and (5) improved socialization. The main side effect of the prior medication was remittent "tardive dyskinesia" (a neurological disorder characterized by involuntary, uncontrollable muscle movements ( In re C.E. (1994), 161 Ill. 2d 200, 214, 204 Ill. Dec. 121, 641 N.E.2d 345)). The new medication would cause fewer side effects. She concluded that the benefits of the new medication outweighed the harm caused by it.

Dr. Rosanova concluded that respondent lacks the capacity to make a reasoned decision about her medication, because she lacks insight into her mental illness and has exceedingly poor judgment. For example, her current preoccupation with food has led her to buy extra vegetables from other mental health care recipients and eat as many as 14 servings at once, so that the staff feared that she would choke. Dr. Rosanova also concluded that less restrictive treatment had been unsuccessful since respondent discontinued her medication. She saw a counselor twice weekly, but without medication she was not amenable to psychotherapy. Finally, Dr. Rosanova testified that she is licensed to administer psychotropic medication in Illinois and that she desired a court order authorizing involuntary administration of psychotropic medication for at least 90 days.

During cross-examination, Dr. Rosanova testified that respondent had not done well in support groups or in school since she ceased medication. She elaborated on the deterioration of respondent's appearance and explained that "focusing," a term she used during direct testimony, refers to an intentional preoccupation with another person; in respondent's case, another mental health care recipient whom respondent believes receives better care than she receives. Dr. Rosanova gave examples of people upon whom respondent had recently focused.

Respondent testified next. She indicated that she presently attends one support group, although she is scheduled for others. She attends a typing class but was dismissed from a horticulture class as a result of a problem with another student regarding nasal discharge. She asserted that the prior medication had caused these side effects: dry mouth, diarrhea, constipation, headaches, and vomiting. Since she ceased taking the medication, she still gets light-headed sometimes, but generally she feels better.

Respondent defended her behavior and personal appearance and attempted to explain events about which the doctor had testified. Respondent testified that she only got into fights when she was medicated and never got into fights since she ceased medication. However, she testified that she had always fought with another mental health care recipient, one who had resided in her cottage for about six months (respondent ceased medication more than a year prior to the hearing).

Respondent denied that she focused on specific individuals anymore, asserting that focusing had been a childhood problem. Much of her testimony, however, centered on two particular mental health care recipients. Respondent testified that Dr. Rosanova favored other mental health care recipients over her, increasing her medication and not increasing the medication of others. During cross-examination, respondent further explained her relationships with the mental health care recipients she spoke of during her direct testimony.

At the close of testimony, the parties waived argument. The trial court enumerated the statutory elements necessary to support an order of involuntary psychotropic medication and found that the State had met its burden of proof on each point. The court then entered a preprinted order authorizing involuntary administration of psychotropic medication (including necessary lab work and medical examinations) to respondent by such staff of the ...

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