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In re Nancy A.

November 19, 2003


Appeal from the Circuit Court of Cook County. No. 02 CM 0032 Hon. Alfred J. Paul, Judge Presiding No. 02 CM 0132 Hon. Edward O'Brien, Judge Presiding No. 02 CM 1336 Hon. Nathaniel Howse, Judge Presiding

The opinion of the court was delivered by: Justice South


These consolidated appeals arise from two orders of the circuit court of Cook County dated January 31, 2002, and June 20, 2002, finding respondent, Nancy A., to be a person subject to involuntary admission and ordering her to be hospitalized and rehospitalized, respectively, at Madden Mental Health Center for a period of up to 90 days.

The pertinent facts are as follows: On January 7, 2002, Antonia U., respondent's daughter, filed a petition seeking to have her mother involuntarily admitted to a mental health facility on the grounds that she was mentally and physically ill and would not leave the house to get help. Pursuant to that petition respondent was admitted to Madden Mental Health Center (Madden). The matter was set for a hearing on January 10, 2002. Prior to that date respondent filed a motion to dismiss the petition. On January 10, 2002, the State requested and was granted a continuance to January 17, 2002, in order to have time to prepare a response to the motion to dismiss and for the hospital to further evaluate respondent. On January 17, 2002, the State moved to voluntarily dismiss the petition for involuntary admission on the basis that it was defective due to the insufficiency of the allegations. The petition merely alleged that respondent was mentally confused and refused to leave the house to get medical attention or groceries, and that respondent believed the petitioner, Antonia, was working with the Federal Bureau of Investigation (FBI) and trying to kill her. The court granted the State's motion to dismiss the petition and entered an order discharging respondent. The State immediately thereafter requested an order for respondent's detention for further psychiatric evaluation and a new admission to Madden Mental Health Center, and an ex parte hearing on that request was conducted off the record. Respondent's counsel requested to participate in that hearing, but that request was denied by the court. At the conclusion of the hearing, the trial court entered an order for respondent's detention and further psychiatric evaluation.

While at Madden, respondent was evaluated by Drs. Frank G. Russo and Sudha Agrawal, who completed and filed physicians' certificates on January 18, 2002. A hearing on the new case was set for January 24, 2002, but on that date the State requested a one-week continuance, which the court granted to January 31, 2002.

On January 31, 2002, a hearing was conducted on the new petition for involuntary admission, wherein James Osta, a social worker at Madden, Dr. Russo, and respondent's daughter testified.

Antonia, respondent's daughter, testified that up until four years prior thereto she had been living with respondent and paying her rent and other bills. One day her mother demanded that she leave and pulled a knife on her. On January 3, 2002, when they were discussing the possibility of her being evicted by her landlord, respondent again pulled a knife on her daughter. During the last four years respondent has also thrown things at Antonia, slapped her and poked her with pens. Antonia testified that she continued to provide for all of respondent's needs even after she moved out.

Antonia further testified that respondent had refused to allow workmen to enter her apartment to repair the water pipes because she believed they were FBI operatives. In December of 2002, respondent would not let Antonia buy her groceries because she believed that she was conspiring with the FBI to poison her and that her apartment was being bugged.

Antonia also testified that her mother was diagnosed with a fibroid condition but refused follow-up treatment. Even though she complained almost on a daily basis about abdominal pains, respondent refused to leave her apartment, which she left only once in 1992 and once in 1994.

The next State witness was Dr. Frank G. Russo, a psychiatrist, who testified that respondent was suffering from a longitudinal history of delusional disorder and that she believed her daughter, landlord and others were conspiring against her and that the FBI infected her with syphilis in 1993. Dr. Russo opined that respondent would be unable to care for her basic needs if she were discharged based upon the facts that she was refusing food from her daughter and treatment for her medical needs, and that she had no specific plan if she were discharged. He also testified that she was a risk to others since she suffers from persecution ideation and might attack someone in what she believed would be a defensive measure. He based that opinion upon respondent's prior attacks on her daughter.

Dr. Russo concluded that the hospital would be the least restrictive alternative for respondent because she would continue to refuse to seek medical treatment and was refusing all help, money and food from her daughter. A report on an alternative treatment setting, a psycho/social assessment, a psychiatric evaluation and a treatment plan were admitted into evidence.

Respondent called James Osta as her witness. He is her social worker and a member of her treatment team. He testified that a less restrictive placement would be inappropriate for respondent because she is "floridly psychotic," penniless and homeless and requires 24-hour care. Following closing arguments, the trial court found that the State had proven by clear and convincing evidence that respondent was mentally ill and unable to provide for her basic physical needs and ordered that she be involuntarily confined for a period of up to 90 days.

Respondent was hospitalized at Madden for the next 90 days, and on May 8, 2002, agreed to remain there on a voluntary basis. However, on May 30, 2002, respondent submitted a written request for discharge. The Madden staff responded by filing another petition for involuntary admission along with two supporting physicians' certificates.

Pursuant to the new petition for involuntary admission, another hearing was conducted on June 20, 2002. At that hearing, Antonia, Dr. Russo and James Osta all testified again, and their testimony was essentially the same as it was in January of 2002.

Antonia testified that in May of 2002, while she was at Madden and having a conversation with her mother about where she would go and what she would do if she were released, respondent became very angry and threatened to kill her when she was released. She also spat in her daughter's face and told her that she was going to burn down her house. Antonia testified again that over the last four years respondent had slapped her, poked her with a pen and thrown things at her.

Dr. Russo testified that he was not respondent's treating psychiatrist at Madden but was covering for Dr. Agrawal, who had been called out of the country. Dr. Russo observed respondent on the unit on a regular basis and reviewed her medical records. Dr. Russo completed a physician's certificate on January 17, 2002. He also evaluated respondent on January 28, 29 and 30, 2002, and had conversations concerning her with hospital staff and Antonia, in addition to attending staff meetings concerning her treatment.

Dr. Russo testified that upon respondent's admission to Madden, she needed encouragement to bathe, dress and eat. She was inconsistent in accepting her medical treatment. While she generally took her thyroid medication and asked for and accepted treatment for indigestion, she refused tests and treatment after complaining of chest and abdominal pains and refused to be examined regarding her uterine fibroid.

Dr. Russo opined once again that respondent suffered from a longitudinal history of delusional disorder. He testified that respondent had a basis in reality for this disorder because a gentleman friend of hers was investigated by the FBI in the 1990s and federal agents approached her to testify against him. Based on that event, however, she developed a conspiracy theory which included her daughter, landlord and others. He also testified that respondent believes that the FBI infected her with syphilis in 1993.

Dr. Russo testified that respondent needed to be treated as an inpatient and that Madden would be the least restrictive alternative for her because she would not be able to care for her basic needs if she were discharged, since she was refusing food from her daughter and treatment for her medical needs. He further testified that her daughter's home or independent living would be an inappropriate setting because respondent had "no insight" and was refusing all help from her daughter anyway, which included food and money. Dr. Russo opined that respondent's delusions would probably interfere with her eating outside of the hospital setting because she was still under the belief that someone was poisoning her food. He also testified that respondent was a risk to others and might attack someone as a defensive measure because she suffered from persecution ideation, although he admitted that while at Madden she had not attempted to harm anyone or been involuntarily medicated, secluded or restrained.

Osta testified that he was responsible for investigating alternatives to hospitalization and methods of obtaining governmental benefits to pay for an alternative treatment setting. Alternative treatment settings provide 24-hour care and afford residents more freedom than hospitals. There are at least 50 alternative treatment settings in the Chicago area.

Osta testified that governmental benefits could not be obtained for respondent unless she signed the necessary forms herself or was declared incompetent and her court-appointed guardian signed the necessary forms. He stated that respondent refused to sign the forms, and although the process for obtaining a guardian for her had begun, no petition for guardianship had been filed as yet. He also testified that respondent could not be forced against her will to go to an alternative treatment setting, nor could an alternative treatment setting be forced to accept her.

Osta testified that he had not contacted any alternative treatment settings to inquire about the appropriateness of respondent's treatment outside of the hospital because it was his belief that alternative treatment settings would not accept clients who were refusing psychotropic medications, although there was no evidence that respondent was refusing psychotropic medications. Osta testified once again, however, that a less restrictive placement would be inappropriate for respondent because she is "floridly psychotic," penniless, homeless and needs 24-hour care. He also expressed concerns about ...

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