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In re R.C.

March 26, 2003


Appeal from the Circuit Court of Cook County. Honorable Nathaniel R. Howse, Judge Presiding.

The opinion of the court was delivered by: Justice Wolfson


The State filed a petition seeking involuntary medication of Randall C. On a date set for trial, this troubled respondent asked for appointment of an independent expert. The trial court, deciding that the request was made for the purpose of delaying the trial, denied the request. The question we must answer is whether the trial court had discretion to deny the request for appointment. We conclude it did not.

Following a jury trial pursuant to a petition seeking involuntary medication of respondent, a patient at Chicago-Read Mental Health Center (Chicago-Read), the jury found respondent subject to involuntary medication with psychotropic drugs for a period not to exceed 90 days. Respondent contends: (1) the trial court's order for involuntary administration of medication must be reversed because he was denied his statutory right to the appointment of an independent expert, and (2) he was denied the effective assistance of counsel. We reverse and remand.


On August 31, 2001, Dr. Usha Kartan, a psychiatrist employed at Chicago-Read, filed a petition in the circuit court of Cook County asserting that respondent required psychotropic medication but refused to take the medication when offered by the hospital staff. In the petition, Dr. Kartan noted a court had ordered involuntary administration for respondent on June 2, 2001, for a period of 90 days. Respondent told staff members he was planning to stop the medication after the 90 days expired, because there was nothing wrong with him and he did not need it. According to Dr. Kartan, respondent, even on medication, was grandiose, flighty, isolative, and withdrawn. He exhibited poor hygiene, impaired judgment and extremely poor insight. Respondent had "clearly improved" while on court-ordered medication. Due to his thought disorder, respondent was unable to give informed consent and thought he did not need medication.

Prior to the hearing on the petition, on October 19, 2001, respondent appeared pro se before the trial court and requested that the court order an independent examination of respondent by a psychiatrist. The court denied the request. *fn1

At the hearing on November 27, 2001, Dr. Kartan testified she had been treating respondent since September 5, 2000, when he was transferred to her unit at Chicago-Read. He had been hospitalized since September 1999 and "several times" prior to 1999. Dr. Kartan said she attempted to evaluate respondent every day Monday through Friday, whenever he cooperated with her. Respondent had no family contacts, and his father had lost contact with him since 1981. In Dr. Kartan's opinion, based on her evaluations, review of medical records, and discussions with other doctors, respondent suffered from a mental illness. The diagnosis was paranoid schizophrenia, continuous in nature, with a history of poly-substance abuse. Respondent first had been diagnosed with schizophrenia in 1972.

According to Dr. Kartan, respondent exhibited both positive symptoms, including delusions, hallucinations, and disorganized thinking, and negative symptoms interfering with his functioning. Dr. Kartan saw a reduction in respondent's symptoms while he was on court-ordered medication, but an increase in severe symptomology when the involuntary medications expired.

Dr. Kartan said respondent's current hospitalization was his twenty-third Department of Mental Health (Department) hospitalization. She had seen significant improvement in respondent's illness while he was on medication, and she wanted to offer services to him with the goal of his discharge. Respondent became upset in the past when they discussed his discharge and said there was no place for him in the community. Respondent told Dr. Kartan the State had placed him in a rat-infested place to live. Dr. Kartan said she believed an appropriate place could be found for respondent if he was discharged. Respondent refused to discuss medications and side effects with her because he believed that he was not ill and that Dr. Kartan did not have a license to treat him. In Dr. Kartan's opinion, respondent did not have the capacity to make a decision about his medical treatment because of acute psychosis.

On cross-examination, Dr. Kartan testified respondent had never voluntarily agreed to take medication, other than the time medication was court-ordered. Since 1972, respondent had been in the care and custody of the Department of Mental Health, off and on. Since that time, he would "relapse" and be hospitalized on almost a yearly basis.

Respondent testified that he did not want to take medication against his will. He said he had been hospitalized at Chicago-Read for seven weeks, and the hospital wanted to involuntarily discharge him against his will. He said he was hospitalized in Elgin Mental Health Center for six months. During that time, he was not taking medication and refused medication. After he was transferred to Chicago-Read, respondent was offered medication once, and he said "no comment." On cross-examination, respondent testified he was hospitalized in Elgin because he was accused of sexually assaulting a young girl, but he was found not competent to stand trial.

After hearing arguments on both sides, the jury found respondent subject to involuntary treatment. The court entered an order providing that for a period not exceeding 90 days, Dr. Kartan was permitted to administer the following medications to respondent: Zyprexa, Depakote, Thorazine, Prolixin, Cogentin, Zoloft, Ativan, and Klonopin. The order also specified the range of doses for ...

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