Appeal from the Circuit Court of Winnebago County. No. 95--MH--0124. Honorable J. Todd Kennedy, Judge, Presiding.
Released for Publication April 2, 1996.
The Honorable Justice Inglis delivered the opinion of the court: McLAREN, P.j., concurs. Justice Doyle, dissenting:
The opinion of the court was delivered by: Inglis
The Honorable Justice INGLIS delivered the opinion of the court:
Respondent, Brad Israel, appeals the order of the circuit court of Winnebago County which granted the State's motion to involuntarily administer psychotropic medication to respondent. We reverse.
On February 6, 1995, the State filed a petition to involuntarily administer psychotropic drugs to respondent pursuant to section 2--107.1 of the Mental Health and Developmental Disabilities Code (Code) (405 ILCS 5/2--107.1 (West 1994)). After hearing extensive testimony, including respondent's own testimony, the court denied the petition on the grounds that the State had failed to prove by clear and convincing evidence that (1) respondent lacked the capacity to make a reasoned decision regarding the medication; and (2) the benefits of the medication would outweigh the harm.
On April 11, 1995, the State again filed a petition seeking to involuntarily administer psychotropic drugs to respondent. The trial court dismissed that petition on the grounds of res judicata.
On April 18, 1995, the State filed another petition for the involuntary administration of psychotropic drugs, which petition is the subject of the present appeal. Respondent filed a motion to dismiss on the grounds of res judicata, collateral estoppel, substituted judgment, and lack of refusal to take a psychotropic medication. The court denied respondent's motion, and the matter proceeded to trial.
The State's first witness was Scott Reese, an employee of the Singer Mental Health Facility (facility) where respondent is currently residing. Reese testified that on May 16, 1995, he was working at the facility. Reese observed an incident in which respondent and a female patient bumped into each other. Reese indicated that respondent grabbed the female patient and struck her with his hand. Reese testified that the female patient had a red mark on her forearm and cheek from respondent's actions.
The State then called Darleen Brunke, a registered nurse at the facility. She testified that on March 30, 1995, respondent had indicated that he was feeling better because his head and neck were now connected.
The next witness to testify was Diane Clevenger, a licensed practical nurse at the facility. She testified that on April 10, 1995, the facility staff had requested that respondent move away from a table. Respondent refused, whereupon Clevenger pulled his chair back. Respondent then accused Clevenger of assaulting him, and he said he was going to call his lawyer and sue her. Clevenger also indicated that respondent told her that he had been at the facility since he was 14 years old and that he had been cut several times between his legs and had been sexually assaulted.
Clevenger also testified that on April 13, 1995, she overheard a telephone conversation between respondent and an unknown party. Clevenger indicated that respondent again indicated that he had been in the facility for 14 years, had been cut on the legs several times, and had been sexually assaulted. Respondent also indicated that his genitals had been cut off but that God had reattached them.
She further testified that on April 11 or April 12, 1995, respondent refused to get out of bed. When she and other staff members entered his room to get him out of bed, respondent accused them of assaulting him. He further indicated that he was going to have them charged with an assault and battery.
The next witness to testify was Dr. Kamal Modir, respondent's psychiatrist. Dr. Modir testified that, while respondent was suffering from a mental illness, he was unable to specifically diagnose the exact type of mental illness which was afflicting respondent. Dr. Modir testified that respondent displayed paranoid thoughts and hostility. Dr. Modir also testified that respondent often would become explosive and aggressive and continued to exhibit delusional thought patterns.
Dr. Modir testified that, in the past, respondent had been cooperative with his treatment and had been functioning more rationally. However, Dr. Modir testified that lately respondent had become uncooperative and that the incidents of respondent's inappropriate behavior were increasing.
Dr. Modir indicated that the two psychotropic drugs which he was seeking to administer to respondent were Risperdal and Haldol. Dr. Modir testified that respondent would greatly benefit from these drugs in that he would become more rational in his thinking, his delusional ideation would decrease, and he would be much more rational in his relationships with other people. Dr. Modir indicated that, if respondent were to take this medication, it might be possible that he would be able to function outside of the facility.
Dr. Modir did admit that there could be some harmful side effects from the medication. Dr. Modir indicated that there were fewer side effects associated with Risperdal than with Haldol. Possible side effects which might be associated with Risperdal include tardive dyskinesia and neuroleptic malignant syndrome. Possible side effects which are associated with Haldol also include tardive dyskinesia, neuroleptic malignant syndrome, and insomnia. Dr. Modir testified that the chances of respondent experiencing these side effects were minimal considering the low dose which Dr. Modir was seeking to administer.
Respondent had previously been on both Haldol and Risperdal. There is, however, a discrepancy as to whether respondent had actually been taking the Risperdal when it was given to him. During the period of time when respondent was allegedly taking the Risperdal, he complained that he had trouble breathing, and respondent did receive emergency medical attention. Respondent was given Cogentin, a medication which is used to combat the side effects of Risperdal. However, when respondent's blood was tested, there was no evidence of Risperdal in respondent's system, which led Dr. Modir to conclude that respondent had not been taking his medication as prescribed.
Respondent also had previously been on Haldol, but had also complained of side effects. Both drugs were discontinued in light of respondent's complaints. Respondent had also been treated for lithium toxicity several years previous.
Dr. Modir testified that he explained the benefits and possible side effects of the medications to respondent and that respondent refused either medication. Dr. Modir indicated that respondent did not feel that his previous experience with both Risperdal and Haldol had been beneficial. Respondent further indicated that the risk of the side effects of the medication was unacceptable to him.
The court then inquired as to Dr. Modir's basis for concluding that respondent's reason for refusing the medication was irrational. Dr. Modir responded that respondent did not believe he was mentally ill and was under the impression that everyone was against him. While Dr. Modir did admit that respondent had complained of side effects in the past, because respondent had not been taking the medication that was given to him, it was Dr. Modir's opinion that any problems which respondent may have experienced were not caused by the Risperdal. Dr. Modir indicated that while respondent was taking the Haldol he did not observe that respondent experienced any side effects from the medication.
Lastly, the State called Mark Young, a registered nurse at the facility. Young testified that on April 11, 1995, respondent assaulted another patient at the facility, hitting the patient in the face three times. Young did not, however, observe who was the initial aggressor in the confrontation. The State then rested. Respondent did not call any witnesses, nor was respondent present to testify.
The court then presented its findings. The court first found that there had been a sufficient change in circumstances to allow the State to present another petition. The court found that sufficient evidence was presented to show that respondent had a serious mental illness. The court also found that sufficient evidence was presented to demonstrate that respondent's mental illness resulted in a deterioration in his ability to function and that this deterioration has existed for a sufficient period of time so as to satisfy section 2--107.1(d)(3) of the Code (405 ILCS 5/2-107.1(d)(3) (West 1994)). The court found that the State had demonstrated that less restrictive methods would not be effective in treating respondent.
The court indicated that the two key issues in the case at bar were whether the benefits of the psychotropic medication outweighed the medication's possible harm and whether respondent lacked the capacity to make a reasoned decision concerning the medication. The court found that substantial evidence had been presented concerning the benefits of the medication. The court recognized that the medication could have some potentially harmful side effects, but found that the benefits of the medication outweighed its possible harm.
The court noted that Dr. Modir had testified that the basis for respondent's refusal to take the medication was not based on actual facts, but, rather, was based "on a kind of paranoia." Because Dr. Modir had testified that there was no rational basis for respondent's complaints concerning the side effects of the medication, especially in light of the fact that there was no evidence of Risperdal in respondent's system when he was complaining of the medication's side effects, the court found that respondent's reason for refusing the medication was not rational. Thus, the court found that respondent lacked the capacity to make a reasoned decision concerning the medication.
The trial court entered an order for the involuntary administration of psychotropic medication. Respondent moved to stay the order pending appeal, which motion was denied. This timely appeal followed.
On appeal, respondent contends that the trial court erred in denying respondent's motion to dismiss the petition on the grounds of lack of subject matter jurisdiction, res judicata, and collateral estoppel. Respondent also contends that the trial court erred in refusing to apply the substituted judgment standard and that the trial court's order which allowed the State to involuntarily administer psychotropic medication was against the manifest weight of the evidence.
Respondent first argues that the trial court lacked subject matter jurisdiction over the petition because respondent consented to take Valium, a psychotropic medication. Respondent argues that, because respondent was voluntarily taking valium, he was not refusing to take a psychotropic ...