Appeal from the Circuit Court of Kane County. No. 99--MH--95 Honorable Franklin D. Brewe, Judge, Presiding.
The opinion of the court was delivered by: Justice Hutchinson
Respondent, Nancy M., appeals the trial court's order authorizing the involuntary administration of three specific psychotropic medications. On appeal, respondent contends that the order must be reversed because (1) she was denied her due process right to have the jury adequately instructed in the law; (2) she was denied her right to have the jury determine whether the benefits of the three proposed medications outweighed the risks; and (3) the State failed to present clear and convincing evidence that respondent lacked the capacity to make a reasoned decision about the use of medication. We reverse.
On March 12, 1999, the State filed a petition to administer psychotropic medication to respondent pursuant to section 2--107.1 of the Mental Health and Developmental Disabilities Code (the Mental Health Code) (405 ILCS 5/2--107.1 (West 1998)). Respondent requested a jury trial. On June 14, 1999, respondent filed a motion in limine seeking to bar the State from introducing certain letters she wrote to Brian C., a former paramour, and from disclosing a prior court ruling reflecting her status as not guilty by reason of insanity of a violation of an order of protection and harassment of a witness.
The trial court conducted a hearing on respondent's motion in limine on October 18, 1999, just before trial commenced. The trial court denied respondent's motion, and the cause proceeded to trial. The State called Carole Ann Rosanova, M.D., respondent's treating psychiatrist at the Elgin Mental Health Center (the Center). Rosanova had reviewed respondent's past hospital records, consulted with other treating staff, and read "some correspondence *** from the State's Attorney in Cook County." Rosanova testified that, based on her review of this information, she diagnosed respondent as suffering from bipolar affective disorder, manic type. According to Rosanova, respondent experienced multiple symptoms of the disorder, such as euphoric affect, distractibility, flight of ideas, hyperactivity, irritability, pressured speech, and delusions.
She based her opinion that respondent had delusions on letters respondent had written to a former paramour, Brian C., in March and April 1998. Rosanova explained that respondent was first admitted to the Center because she was found not guilty by reason of insanity on a charge of violation of an order of protection that Brian C. had obtained. In June 1998 respondent was released from the Center on the condition that she attend outpatient treatment and did not have contact with Brian C. or his family. Respondent contacted Brian C., and in September 1998 the trial court revoked her conditional release.
Rosanova testified that, in the letters, respondent claimed to be a messenger of God and to know that it was God's will that she and Brian C. be together. In her letters respondent also wrote that she was his true wife and mother of his children. Rosanova admitted that respondent never made comments similar to these to her and that her information was only from the letters. Rosanova also admitted that she never spoke to Brian C.
Rosanova next opined that, as a result of her mental illness, respondent was deteriorating in her ability to function. She explained that, since 1994, respondent had divorced, lost custody of her children, and her license to practice law was suspended. On cross-examination, Rosanova admitted that the divorce could have been caused by the affair and that she did not know why respondent's law license was suspended. Rosanova further testified that respondent had not been violent at the Center but opined that she had exhibited threatening or disruptive behavior in the letters to Brian C.
Rosanova testified regarding the medications she was seeking to administer to respondent and noted that respondent had never taken antipsychotic medication. She first requested Haldol, an older antipsychotic medication, to be taken orally or by injection. Rosanova testified that Haldol controls delusions but has many neurological side effects. These side effects include dystonia, a stiffness of large muscles; extrapyramidal side effects such as tremors and muscle stiffness; and tardive dyskinesia, a possibly irreversible involuntary movement disorder. On cross-examination, Rosanova also discussed a rare and potentially fatal side effect, neuroleptic malignant syndrome. Rosanova admitted that she does not use older antipsychotics often and that the alternative medications she was requesting were more effective. She requested Haldol because it can be administered by injection.
Rosanova also requested two newer antipsychotic medications; they have the same possible neurological side effects but at a substantially reduced rate. Olanzapine would lessen delusions and act as a mood stabilizer but could cause sedation, headaches, and weight gain. Risperdal also would address delusions and mood and could help motivation and social withdrawal. Risperdal may also cause sedation, agitation, and slight weight gain. For all of the medications, Rosanova opined that the benefits would outweigh the side effects.
Rosanova further opined that respondent did not have the capacity to make a reasoned decision about whether to take medication. Rosanova based her opinion on respondent's denial that she has a mental illness and on respondent's judgment. Rosanova explained that respondent refused to ingest the medication even though it would not hurt her, other than to sedate her, and it could get her released from the Center within a few weeks. Rosanova reported that less restricted services were explored for respondent. Rosanova opined that respondent's illness was not likely to improve without medication.
On cross-examination, Rosanova admitted that respondent has spent a considerable amount of time in the library and has researched medication. Rosanova also agreed that respondent had the capacity to consent and has consented to other types of medical procedures, such as a mammogram.
Respondent testified on her own behalf and as an adverse witness for the State. Respondent confirmed that she once had a relationship with Brian C. Although she no longer had contact with him, she still felt personally involved with him. Respondent testified that she would like to resume their relationship to feel vindicated. Respondent did not feel that Brian C. was a victim. She explained that she never hurt him, that their relationship was complicated, and that, if he did not want her letters, he could have thrown them away. Respondent further explained that she had referred to God's will in her letter as an attempt to relate to Brian C. because he was a religious person.
Respondent testified that she researched her diagnosis and the medications in the library and spoke to patients on the unit who were mentally ill and had taken those types of medication. She denied having a mental illness and for that reason said she did not need the medication. She stated, however, that, if ordered to take medication, she would take Olanzapine or Risperdal because they are less dangerous than Haldol.
Respondent further testified that she kept busy at the Center by socializing, reading, and listening to the radio. She admitted that she had emotional issues that she was slowly coming to terms with through thought and prayer. She confirmed she would rather stay at the Center than take the medication and be discharged.
Both sides rested and presented their closing arguments. The parties and the trial court reviewed the proposed jury instructions. All the jury instructions tendered by the State were accepted without objection. Counsel for respondent did not tender any jury instructions.
The trial court instructed the jury, and the jury retired to deliberate. The jury returned a general verdict granting the State's petition and finding that respondent was "someone who qualifies for the involuntary administration of psychotropic medication." The trial court entered judgment on the jury's verdict. Although the jury's verdict form did not specify which of the three proposed antipsychotic medications could now be administered to respondent, the trial court's order did, authorizing Haldol, Olanzapine, and Risperdal. Respondent ...