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In re Robert S.

June 30, 2003


Appeal from the Circuit Court of Kane County. No. 01-MH-261 Honorable Franklin D. Brewe, Judge, Presiding

The opinion of the court was delivered by: Justice Grometer


Respondent, Robert S., appeals from an order of the circuit court of Kane County granting the State's petition to involuntarily administer psychotropic medication. We affirm.


Respondent was charged with a crime not specified in the record. Subsequently, respondent was found unfit to stand trial and admitted to the Elgin Mental Health Center (EMHC). On November 19, 2001, respondent's psychiatrist, Dr. Romulo Nazareno, filed a petition seeking to involuntarily administer psychotropic medication to respondent. A hearing on the petition was originally scheduled for November 26, 2001. However, it was continued four times, and it not did commence until January 18, 2002. Respondent represented himself at the hearing.

On January 18, 2002, the State indicated it was ready to proceed. However, respondent requested a two-week continuance in order to subpoena his witnesses. The State objected and suggested that the court begin the hearing, noting that it was unlikely that the hearing could be completed in one day. The trial court decided to commence the hearing with the understanding that after the State presented its case, the matter would be continued to give respondent time to subpoena his witnesses.

The State's first witness was Dr. Nazareno. Dr. Nazareno diagnosed respondent with paranoid schizophrenia. Dr. Nazareno testified that respondent's symptoms included hallucinations, delusions, and a deterioration in the ability to function. For instance, respondent complained of sleep deprivation as a result of auditory hallucinations. Moreover, respondent believed that the government implanted a microchip in his brain in an effort to read his mind. Respondent claimed that EMHC staff and patients were sending messages to a "mind reader" by actions such as rubbing their chins or adjusting their eyeglasses. In addition, respondent threatened to kill an EMHC patient who respondent believed was having a relationship with women intended for respondent.

Dr. Nazareno noted that respondent's symptoms subsided when he was medicated on a previous occasion. However, once the medication order expired, defendant began hearing voices, having trouble sleeping, and believing that female celebrities had fallen in love with him. Respondent also threatened to kill a member of the EMHC staff.

Dr. Nazareno recommended administering Risperidone to respondent because in the past he responded well to the drug, without side effects. As alternatives, Dr. Nazareno recommended Haldol, Haldol Deconate, and, for side effects, Cogentin. Dr. Nazareno opined that the benefits of administering the psychotropic medication would outweigh the harm. He also stated that respondent lacks the capacity to make a reasoned decision about potential side effects and benefits of the treatment. According to Dr. Nazareno, respondent's psychosis is the reason he cannot make a knowledgeable decision whether to take the medication. Dr. Nazareno tried less restrictive treatments, such as counseling and group therapy, but they were not effective without medication.

On cross-examination, Dr. Nazareno admitted that respondent never threatened him and that he has never personally witnessed respondent threaten others. Dr. Nazareno also acknowledged that during the court proceeding, he did not see a deterioration in respondent's functioning and noted that respondent did not exhibit his ususal symptoms, such as talking to himself. However, Dr. Nazareno stated that respondent's behavior and the way in which he asked questions showed some paranoia and delusions. For instance, during questioning, respondent insinuated that Dr. Nazareno hears voices. Dr. Nazareno pointed out that there are times during which an individual can contain delusions by focusing on a task.

Over respondent's objection, the State called Lesley Kane, an intern at the Kane County Diagnostic Center (KCDC). Kane conducted a court-ordered independent examination of respondent. Kane's examination consisted of interviewing respondent for 60 to 90 minutes, talking to respondent's case worker, and reviewing two to three years of respondent's records. The trial court qualified Kane as an expert over respondent's objection.

Citing symptoms similar to those identified by Dr. Nazareno, Kane diagnosed respondent with paranoid schizophrenia. With respect to whether respondent exhibited a deterioration of his ability to function, suffering, or threatening behavior, Kane stated that respondent has become increasingly tense and agitated, verbally aggressive, and more threatening. In addition, his sexual preoccupations have increased and EMHC staff noted an increase in the use of profanity. Kane further testified that respondent's illness has existed for a period marked by the continuing presence of symptoms, noting that respondent has had a history of delusions since the 1970s. Kane believed that the benefits of psychotropic medication would outweigh the harm. Kane noted that respondent's behavior poses a risk to himself and to others and that the side effects of the medication can be dealt with effectively. Kane opined that respondent's suffering, the deterioration of his ability to function, and his violent and threatening behavior would decrease with medication.

Kane also concluded that respondent lacked the capacity to make a reasoned decision about psychotropic medication. According to Kane, respondent is unaware of the severity of his illness. Regarding less restrictive alternatives, Kane stated that respondent has been offered psychosocial therapy, but, because respondent does not have insight into his illness, "it doesn't seem as though that alone is going to be helpful." Kane also noted that in individuals with schizophrenia, therapy is more of an augment to medication. Kane opined "to a reasonable degree of psychological certainty" that respondent meets the criteria for psychotropic medication.

On cross-examination, Kane admitted that during her independent examination of respondent she did not observe defendant suffering from delusions or hallucinations. She also indicated that respondent did not exhibit such symptoms at the hearing.

The State recalled Dr. Nazareno. He testified that respondent does not have the capacity to make a reasoned and rational choice regarding whether he needs medication. Dr. Nazareno noted that respondent does not believe he is ill. Dr. Nazareno added that respondent's judgment is so impaired by his illness that he sees only the risks, and not the benefits, of the medication.

Kelli Childress, a former assistant State's Attorney, testified that she first met respondent in 1999 when she was assigned to a hearing in which respondent was involved. On or about October 31, 2001, Childress received a telephone call from respondent. Respondent told Childress that he remembered her from the 1999 hearing and he had been thinking about her ever since. Respondent accused Childress of helping the government with a scheme to read his mind. Respondent believed that he and Childress were supposed to be together and that the government indicated to him that Childress felt the same way about him. Respondent asked Childress if she would help him get out of EMHC so that they could be together. Childress told respondent that she was involved with someone else and that the information he had was incorrect. Childress stated she felt threatened during the conversation.

Respondent called Childress again on December 31, 2001. According to Childress, the tone of this conversation was less accusatory and more romantic. Respondent told Childress that she was beautiful, that he had feelings for her, and that the government informed him that they were supposed to be together. Respondent stated that he thought about marrying Childress, having children, and moving to California. Respondent told Childress that the government informed him that she was romantically involved with other patients at EMHC and with a player for the Chicago Bears.

Childress testified that she was familiar with respondent's case and why he was at EMHC. She was afraid that if respondent believed that she was part of some government scheme to read his mind, he could become violent. As a result, after both calls, Childress contacted the State's Attorney's office and the court liaison at EMHC. In addition, following the first call, she contacted local police. Childress has not heard from respondent since the second call. On cross-examination, Childress admitted that respondent did not specifically threaten her.

Mark Thomas, a licensed clinical social worker at EMHC, testified that he is respondent's primary therapist. Thomas stated that respondent's psychiatric diagnosis is paranoid schizophrenia. According to Thomas, respondent's condition had been deteriorating over the four-or five-month period prior to the hearing, with increased agitation, verbal outbursts, and verbal aggression.

According to Thomas, respondent believes that the voices he hears are caused by a chip implanted by the government. Respondent believes that the chip enables the government to read his mind. On two occasions in the three months prior to the hearing, respondent became agitated with Thomas because respondent believed that Thomas was "signaling the mind readers" by rubbing his limbs. A third incident occurred when Thomas sided with a technician who had a dispute with respondent. At that time, respondent cursed at Thomas within inches of his face. Thomas considered respondent's behavior during the third incident to constitute a threat.

Thomas testified that respondent told him that he suffers from hallucinations and delusions. The hallucinations and delusions center on female celebrities, but have included staff at EMHC. In addition, respondent told Thomas that he wanted to have a relationship with Childress and he hoped to have babies. Respondent also told Thomas that his conversations with Childress had gone well and that she had been receptive.

Thomas also stated that respondent believes that certain women have been "reserved" for him by the mind readers. Respondent becomes verbally abusive when he believes these women have ignored him or when he believes the women have been having relationships with other EMHC patients. Respondent confronted one patient who he believed was having a sexual relationship with one of his "reserved" women.

Thomas opined that respondent suffers as a result of hearing voices. Thomas believed that respondent's ability to function has deteriorated in the three months prior to the hearing. Thomas also stated that of the 36 patients he is in charge of or monitors, respondent poses the highest risk. Thomas stated that respondent is "in the upper echelon" of patients of who frighten him.

On cross-examination, Thomas testified that respondent has a "remarkable ability" to contain his psychosis. Nevertheless, he thought that respondent had exhibited evidence of mental illness in the courtroom. For instance, Thomas noted respondent's allusions to government mind readers and his claim that the government implanted a chip in his body.

The State then called respondent as a witness. Respondent objected. The trial court sustained respondent's objection on the basis that respondent was at EMHC because he was found unfit to stand trial in an underlying criminal proceeding. The State then rested. Respondent requested two weeks to subpoena his witnesses, and the court continued the matter until February 1, 2002.

At that time, respondent first called Denise Dojka, Psy.D., a clinical psychologist at EMHC and respondent's psychological therapist. She stated that respondent suffers from paranoid schizophrenia. Dojka has never seen respondent participate in any violent behavior. Nevertheless, based on a risk assessment she conducted of ...

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