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In re M.T.

January 31, 2007


Appeal from the Circuit Court of Cook County. No. 06 COMH 130 Nathaniel R. Howse, Honorable Judge Presiding.

The opinion of the court was delivered by: Justice Greiman

Respondent, Maria T., appeals from an order of the circuit court of Cook County authorizing her involuntary treatment with psychotropic medication. She contends that the order should be reversed because the State failed to prove by clear and convincing evidence that the benefits of the medication outweighed the harm.

The State, through Dr. Joanna Poniaquwicz of Lutheran General Hospital, petitioned the court on January 11, 2006, to begin the involuntary treatment of respondent with psychotropic medications pursuant to section 2-107.1 of the Mental Health and Developmental Disabilities Code (Code) (405 ILCS 5/2-107.1 (West 2004)). In the petition, Dr. Poniaquwicz stated that respondent suffered from paranoid schizophrenia, that she was currently psychotic and unable to function, and sought to medicate her with Proloxin Decanoate (12.5- to 25-milligram injection every two weeks), and alternatively with Risperidone*fn1 Consta (25- to 50-milligram injection every two weeks), oral Proloxin tablets (up to 40 milligrams per day), and oral risperidone tablets (up to 8 milligrams per day).

On January 13, 2006, Dr. Poniaquwicz responded to a routine bill of particulars, stating that respondent had been involuntarily admitted to Chicago Read Hospital in December 2004, received Proloxin Decanoate, and responded "well," as she was able to care for herself and be discharged from the hospital in March 2005. However, because respondent became noncompliant with her medication, she was readmitted to Swedish Covenant Hospital in November 2005.

On January 20, 2006, a hearing was held on the State's petition. Nancy S., respondent's daughter, testified regarding the series of events leading to respondent's present hospitalization. During the first two weeks of November 2005, respondent told her that she owned at least one other home, which she did not, and that when she went there to bathe herself, the police came and took her to Swedish Covenant Hospital. She also told her that she was the Virgin Mary, that she was rich, and that banks owed her money. On December 22, 2005, when Nancy took respondent to a grocery store, respondent was reluctant to purchase fruits, vegetables, and milk for fear of contamination. On January 5, 2006, respondent told Nancy that she had not been eating because her food was being poisoned, which statement respondent had made to her at least six times during December 2005. Nancy had also noticed that respondent had lost about 15 pounds from October 2005 to the time of the hearing.

On January 6, 2006, respondent was admitted to Lutheran General Hospital and continued to express that her food was being poisoned. She also told Nancy to cover herself to prevent people from inserting objects into her orifices and that she had inserted tampons "in her behind." In addition, respondent told Nancy that her home was "fine" and that she had been using the heat; however, when Nancy visited there five days later, she had to crawl through a broken window to enter the house because the entrance was barricaded, the refrigerator was unplugged and in the living room with a chain around it, the furnace was turned off, the oven was turned on and opened, and a waffle iron was turned on to heat the basement. Respondent subsequently told Nancy, on January 8, 2006, that she could not eat the hospital food because it smelled "funny" and because voices had told her not to do so.

Nancy further testified that respondent had been on long-term psychotropic medications in the past, most recently from October 2004 through February 2005, when she was involuntarily admitted to Read Hospital. At that time, respondent was prescribed Risperdal, among other things, and after receiving this medication, respondent was more rational, did not hallucinate as often, and talked more about everyday life. Although she experienced some side effects from the medication, they were able to be controlled. When respondent was discharged, she was still "a little paranoid," but she was better able to care for herself and her home, i.e., she bought a wider variety of foods, gained weight, cleaned her house, and used space heaters. Nancy acknowledged that she "probably" told Dr. Poniaquwicz that Risperdal had not done respondent "a lot of good" in the past.

Dr. Poniaquwicz, an expert in the field of psychiatry and respondent's attending physician, testified that respondent was admitted to Lutheran General Hospital on January 6, 2006. Dr. Poniaquwicz first examined respondent on January 7, 2006, and about six days a week thereafter. Based on her inquiry into respondent's social history, including talking to Nancy, reviewing respondent's medical records, and discussing the case with her peers, she opined that respondent suffered from paranoid schizophrenia and had done so for 26 years. Respondent was currently symptomatic and experiencing paranoid delusions, i.e., her food was being poisoned and voices were telling her not to eat. She was also displaying disorganized behaviors, i.e., she attempted to tie a stocking around her neck and knelt on her bed with the covers over her head. In addition, respondent was displaying isolating behaviors and talking to herself. Based on respondent's condition, i.e., her inability to keep her house safe or eat properly, Dr. Poniaquwicz believed that respondent's ability to function had deteriorated.

On January 9, 2006, Dr. Poniaquwicz observed respondent attempting to tie a stocking around her neck and concluded that respondent presented a threat to herself and that she lacked the capacity to make decisions regarding her treatment. She therefore administered two separate, 10-milligram emergency doses of Proloxin to respondent. Although respondent became calmer after receiving the medication, she complained that she was tired and that her tongue felt large after the second dose was administered on January 13, 2006. Dr. Poniaquwicz explained that respondent had experienced a dystonic reaction to the medication, a side effect which caused her tongue muscle to tense up, so Dr. Poniaquwicz issued a "stat" order for Cogentin to relieve the side effect. Because the Cogentin did not completely resolve the issue, Dr. Poniaquwicz subsequently ordered Benadryl, which completely resolved the problem. Dr. Poniaquwicz then discontinued the administration of Proloxin for two reasons: the side effects and her uncertainty regarding the amount of time she could administer the medication under the circumstances.

Despite respondent's reaction, Dr. Poniaquwicz still sought permission to treat respondent with Proloxin Decanoate and, alternatively, with Risperdal Consta, oral tablets of Proloxin, and oral tablets of Risperdal, in the dosages indicated in the petition, for 90 days. Dr. Poniaquwicz based her request on the fact that respondent had historically responded best to Proloxin, as she had taken it during her last inpatient hospitalization and in the 1990s during a hospitalization in Montana. Moreover, Nancy had told her that when respondent had previously taken Proloxin for an extended period of time, her symptoms markedly diminished and that she was able to function independently and be discharged from the hospital. With regard to the risperidone, Dr. Poniaquwicz testified that Nancy had informed her that respondent had responded well to the medication in the past and that she would have to further explore Nancy's statement that it had not done respondent "much good."

Dr. Poniaquwicz acknowledged that the possible side effects of Proloxin, as well as the alternative medications listed in the petition, included tardive dyskinesia, extrapyramidal symptoms, dystonia, tremor, akinesia, neuroleptic malignant syndrome (NMS), and diabetes. She further acknowledged that respondent's age and gender put her at an increased risk of developing tardive dyskinesia, i.e., abnormal movements, and NMS, which was potentially, but rarely, fatal. Nevertheless, Dr. Poniaquwicz opined that the anticipated benefits of administering the proposed psychotropic medications outweighed the possible harm because the side effects could be "remedied with appropriate medications," and she "hoped" and "believed" that the requested medications would enable respondent to function independently, eat regularly, and be discharged from the hospital. She conversely believed that, if left untreated, respondent's symptoms would worsen, her condition would further deteriorate, and she would be unable to live independently. Dr. Poniaquwicz further opined that a less restrictive treatment was inappropriate for respondent's condition.

Dr. Poniaquwicz finally testified that due to respondent's most recent reaction to Proloxin, she would start her on a low dose, closely monitor whether she experienced any side effects, and if so, administer the "appropriate medications" to counter them. She also stated that she would be available daily to monitor respondent's response to the medications, would ensure that the medications were safely and effectively administered though various tests requested in the petition, e.g., electrocardiograms, metabolic profiles, and vital signs, and that a psychiatrist would be available to intervene on an emergency basis if respondent experienced adverse side effects. At the conclusion of the hearing, the circuit court found that the State had proved the factors necessary to grant the petition by clear and convincing evidence. The court specifically found:

"[A]lthough there were some side effects, they were completely abated by the administration of counteracting drugs. The alternative for this individual is her not [being] able to live a normal life in her home the way she wants to live it. With the medication she can go back to living her life. The physical harm can be abated by the counteracting drugs, and, therefore, the petition is granted."

The court then entered an order allowing Dr. Poniaquwicz to administer Proloxin Decanoate (12.5- to 50-milligram injections every two weeks) to respondent for 90 days. The order alternatively granted Dr. Poniaquwicz the authority to administer Risperidone Consta (25- to 50-milligram injections every two weeks), Proloxin tablets ...

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