Appeal from the Circuit Court of Cook County. Honorable Frank DeBoni, judge Presiding.
The opinion of the court was delivered by: Justice Tully
The facility director of the Illinois Department of Mental Health and Development Disabilities (hereinafter "DMHDD"), Nancy Staples, recommended in writing to the trial court that defendant, Johnnie Grant, be conditionally released pursuant to section 5-2-4(d)(2) of the Unified Code of Corrections (Ill. Rev. Stat. 1985, ch. 38, par. 1005-2-4(d)(2) (now 730 ILCS 5/5-2-4(d)(2) (West 1996))). The trial court denied the recommendation for defendant's conditional release. It is from this order that defendant now appeals pursuant to Supreme Court Rule 301 (155 Ill. 2d R. 301).
For the reasons which follow, we reverse and remand with directions.
The pertinent facts are as follows. Defendant was charged with murder. On July 13, 1987, defendant killed a random person who was walking out of a grocery store because, according to defendant, the victim was an F.B.I. agent who was after him. It was discovered that defendant suffered from mental illnesses and was taking antipsychotic medication. At that time of the murder, however, defendant had stopped taking his medication, and as a consequence, suffered delusions that the victim was out to get him and defendant had to kill him.
On September 12, 1989, after a bench trial, defendant was found not guilty of murder by reason of insanity. The trial court determined that defendant was in need of inpatient psychiatric care. Thus, defendant was committed to the custody of the DMHDD as required by section 5-2-4(a) of the Unified Code of Corrections (Ill. Rev. Stat. 1985, ch. 38, par. 1005-2-4(a) (now 730 ILCS 5/5-2-4(a) (West 1996))) and placed at the Elgin Mental Health Center (hereinafter "Elgin"). Defendant is a NGRI (not guilty by reason of insanity) patient. NGRI patients are also known as forensic patients.
Defendant was diagnosed as having paranoid schizophrenia, an incurable disease which may be controlled by medication. In November of 1993, the facility director of the DMHDD recommended that defendant be conditionally released. The trial court denied the recommendation after a hearing. On December 6, 1995, a new facility director, Nancy Staples, of the DMHDD recommended that defendant be conditionally released. However, no hearing was scheduled within the required 30 days. See Ill. Rev. Stat. 1985, ch. 38, par 1005-2-4(d) (now 730 ILCS 5/5-2-4(d) (West 1996)). Therefore, on January 24, 1996, Ms. Staples again sent a letter to the trial court recommending that defendant be conditionally released. A hearing was then held November 8, 1996, nine months later. The record is unclear as to why the hearing was not scheduled within the required 30 days.
Defendant presented three witnesses - Dr. Philip Pan, Dr. Bernard Block, and Ruby Lee Wilson - at the hearing on November 8, 1996, to show why he should be conditionally released. The State did not present any witnesses. The first witness, Dr. Pan, was a staff forensic psychiatrist for the Forensic Clinical Services at the Isaac Ray Center who had been working there since August of 1996. Dr. Pan admitted that he reviewed only some of defendant's records, specifically the records between May 1996 and August 1996. Dr. Pan testified that he reviewed reports from two other psychiatrists. In addition, in August of 1996, Dr. Pan conducted a single interview which lasted less than two hours. Based upon his review of this medical information, Dr. Pan concluded that defendant was stable, not suffering from antipsychotic symptoms, and suitable for conditional release. Dr. Pan further testified, within a reasonable degree of medical certainty, that defendant did not pose a threat to himself or others.
In addition, Dr. Pan testified that if defendant were conditionally released, defendant would reside at the Somerset House, an intermediary care facility for psychiatric patients and other forensic patients. The Somerset staff is experienced in dealing with forensic patients, such as defendant, and is responsible for administering the required medication to the patients. According to Dr. Pan, defendant would also be receiving outpatient psychiatric treatment at Isaac Ray Center, vocational training at the Jewish Vocational Service, and other counseling at the Community Counseling Center of Chicago.
Upon cross-examination, Dr. Pan testified that he was unaware that in 1993 a prior conditional release recommendation for defendant was denied by the trial court. Dr. Pan acknowledged that defendant may have continuing problems with ineffective coping skills, wherein he may not deal well with stress and other problems, but noted upon redirect examination that this is not unusual. When questioned by the court as to the type of conduct a person may exhibit if he or she is unable to deal with stress, Dr. Pan responded that defendant could become violent or catatonic. Defendant's counsel inquired about defendant's decompensation in early 1994. Dr. Pan explained that defendant suffered from a decompensation as a result of acute stress caused by his involvement with a woman patient at Elgin. Consequently, his off-ground privileges were suspended and his medication doses were increased, of which Dr. Pan was unaware. Dr. Pan acknowledged that defendant desires to be released and is motivated by his desire, but all the documentation demonstrates that defendant has been compliant with treatment.
Defendant then presented his second witness, Dr. Bernard Block, a staff forensic psychiatrist who treated defendant for the past five and one-half years. Dr. Block agreed with Dr. Pan that defendant should be conditionally released and that defendant is not a danger to himself or others. In his testimony, Dr. Block explained that defendant suffered a "distortion in thought process marked primarily by delusions of paranoia with the fantasy that the government was seeking to harm him or arrest him." In essence, defendant was diagnosed as a paranoid schizophrenic, in remission since May of 1994. Defendant had been taking his medications since the 1970's, and had been taking injectable medication, Haldol, every 28 days since he came to Elgin. Dr. Block mentioned that defendant "ha been a very good, very cooperative patient," emphasizing that defendant had been compliant in taking his treatment.
Defendant met with Dr. Block twice a month for approximately 40 to 60 minutes. Defendant also received treatment from the Isaac Ray Center, and had never missed an individual or a group session. Dr. Block testified that defendant had not experienced a severe behavioral problem in the previous five and one-half years, other than the decompensation in 1994 precipitated by a romantic involvement with a female patient, which Dr. Block considered a mild incident. In Dr. Block's opinion, any situation with anxiety for a paranoid schizophrenic is referred to as a "decompensation." As a result of this non-serious decompensation, defendant's unsupervised off-grounds privileges were suspended, his dosages of medication were increased, and he was counseled for impulsive judgment and suspiciousness. Dr. Block opined that this incident was not evidence that defendant's relationship to women would lead to violence. Dr. Block maintained that defendant should be conditionally released.
On cross-examination, Dr. Block was questioned about the defendant's act of smuggling drugs into Elgin prior to 1993. He explained that he did not believe this incident should affect the outcome of whether defendant should be conditionally released, although Dr. Block acknowledged it was a problem. Dr. Block was also asked whether he recommended defendant's conditional release in 1993 knowing that defendant's symptoms were not in remission, even though defendant was on medication. Responding that he knew defendant's symptoms were not in remission, Dr. Block emphasized that defendant's problems "were treated even though they not currently active" and did not believe defendant to be a danger to himself or others. In addition, Dr. Block testified on cross-examination that defendant had no coping problems with staff or other patients, just with certain women who "press attentions on him." Dr. Block stated that he did not agree with a nurse's notes from June 1996 which stated that defendant had an ongoing problem with ineffective coping skills, and also disagreed with a May 6, 1994, report from another doctor stating that defendant had "numerous indications of cognitive slippage and distortions of thinking." According to Dr. Block, these were not the Judgement or prognosis of the treatment teams. In fact, he noted that defendant's degree of anxiety or depression was a common symptom, not significantly different from the anxiety and depressions that ordinary non-psychotic people have. Dr. Block also stated that although he believed that defendant's motivation in complying with his treatment came from his desire to be released conditionally, his motivation also stemmed from wanting to be a "non-mentally ill person."
The third witness defendant presented was Ruby Lee Wilson, the program director at Isaac Ray Center, a licensed registered nurse, and an ordained minister. Isaac Ray Center is an organization affiliated with the Department of Psychiatry at Rush Presbyterian - St. Luke's Medical Center. In her testimony, Wilson stated that Isaac Ray Center's function is to evaluate and treat the NGRI patients, act as a barrier between the patients and the community and to ensure that a patient remains on the path of recovery from mental illnesses.
Wilson testified that since January of 1995, she met with defendant twice a month in individual therapy and twice a month in group therapy. According to Wilson, she was responsible for monitoring defendant, and any violations of the conditional release would be reported to the court. She explained that the Somerset House was responsible for administering defendant's medication. At the time she gave her testimony, Wilson worked with 46 other patients who had been charged with murder but were acquitted by reason of insanity. According to Wilson, defendant "is extremely conscientious and is always very compliant *** and comes to Isaac Ray Center now ...