Court of Appeals of Illinois, First District, Fourth Division
Appeal from the Circuit Court of Cook County. No. 91 C 660917-01 The Honorable Frank G. Zelezinski, Judge Presiding.
JUSTICE LAVIN delivered the judgment of the court, with opinion. Presiding Justice Howse and Justice Epstein concurred in the judgment and opinion.
¶ 1 In this rather unusual appeal, we confront the trial court's denial of a petition filed on behalf of defendant Michael Bethke recommending that he be allowed escorted leave of the mental health center's premises, or "supervised off-grounds pass privileges" pursuant to sections 5-2-4(b) and (e) of the Unified Code of Corrections (Code) (730 ILCS 5/5-2-4(b), (e) (West 2010)). Following an evidentiary hearing on the matter, the trial court denied the petition. On appeal, defendant asserts that the trial court's decision was against the manifest weight of the evidence, that the trial court based its decision on an impermissible standard, and that the trial court failed to make findings of fact as required by section 3-816(a) of the Mental Health and Developmental Disabilities Code (Mental Health Code) (405 ILCS 5/3-816(a) (West 2010)). We remand.
¶ 2 BACKGROUND
¶ 3 Defendant, age 49, has lived at the Elgin Mental Health Center in the custody of the Illinois Department of Human Services (see 730 ILCS 5/5-2-4 (West 2010); 405 ILCS 5/3-100 et seq. (West 2010)) since 1993 after the trial court found him not guilty of first degree murder by reason of insanity. For the sake of judicial context, we will briefly relate the rather grisly circumstances that led do this conviction. On June 6, 1991, defendant apparently experienced irresistible "command hallucinations" urging him to kill his coworker at a White Hen Pantry. Unable to control these voices, defendant took a knife from the deli counter and decapitated his coworker, then wrote on the coworker's head in blood, and placed the head, as if on display, in the deli case. After wandering in the woods, defendant told a bystander to call the police. Doctors at the Elgin Mental Health Center (EMHC) diagnosed defendant with schizoaffective disorder, bipolar type. with a history of substance abuse. He has been receiving inpatient treatment and medication since his admission to EMHC to control symptoms ranging from paranoid delusions to auditory hallucinations and mood swings.
¶ 4 In April 2012, defendant's EMHC treatment team, consisting of his treating psychiatrist, Hasina Javed, along with a psychologist and social worker, filed a report in support of the petition to modify defendant's treatment plan and recommending off-grounds pass privileges. They reported that over the course of the last 20 years, defendant made substantial progress in his treatment and recovery. He accepted his mental illness and recognized his need to stay medicated while participating in psychotherapy. In fact, his team reported that his medication compliance was "excellent." In 2000, defendant graduated from a mental illness and substance abuse program and completed online college education classes. According to the report, he continued to participate in therapy groups and workshops and complied with the doctors' treatment plans. In spite of these positive advancements and even though he was medicated at the time, defendant experienced extreme paranoia and auditory hallucinations, with voices telling him he was "evil, " following the events of September 11, 2001. The 2005 tsunami in Asia possibly precipitated angry behavior and aggression toward another patient, but defendant's medication was adjusted with positive results. The report stated that, "to manage his reaction to natural disaster events, " defendant used "careful self monitoring, limited media exposure, and distraction."
¶ 5 In 2009, at the request of the EMHC treatment team, defendant was granted unsupervised on-grounds passes, and he used those for some two years to take unescorted walks on hospital grounds without making any attempts to elope.
¶ 6 In June 2012, forensic clinical services director and forensic psychiatrist, Dr. Mathew Markos, examined defendant pursuant to court order. Following review of relevant records and consistent with the treatment team report, Dr. Markos recommended that defendant be allowed supervised off-grounds pass privileges (to visit such places as the YMCA, the public library, or the mall while being escorted by EMHC staff). In support of this recommendation, Dr. Markos stated that with medication defendant was in remission of his mental illness, defendant was clinically and behaviorally stable, and compliant with treatment, and defendant had used his on-grounds pass since 2009 without incident.
¶ 7 An evidentiary hearing on the petition for supervised off-grounds passes ensued, and the defense called Dr. Markos, who testified consistent with his court-ordered examination of defendant, and the defense also called Dr. Javed at EMHC. Both doctors testified that the passes were safe, insofar as defendant was not likely to harm himself or others, and the passes would have the beneficial effect of facilitating defendant's continuing progress in treatment. Dr. Markos emphasized that defendant had been mentally stable since 2009, and compliant with treatment recommendations, and Dr. Markos emphasized that the passes would enable defendant to attend a community drug rehabilitation program, helping with defendant's "reintegration" into society. He added that during the off-grounds ventures, the ratio of staff to patients was "approximately three to one" with staff making sure the patients "get their medication, " although Dr. Markos did allow on cross-examination that he was unsure of the staff members' training or whether they could recognize if defendant's mental state were to deteriorate. Dr. Markos also stated that if defendant did not receive his medication, he could relapse within one to two days or within weeks.
¶ 8 Dr. Javed testified that defendant was aware that if he did not take his medications, his symptoms would return, but she also added that "any major disaster or event, " like September 11 or the tsunami, could "trigger psychosis" even though defendant was medicated. Regarding the tsunami, Dr. Javed emphasized that defendant was able to report his symptoms of psychosis to staff and obtain relief. Dr. Javed testified that during outings defendant would be escorted by a security officer or an "activity therapist." The only escort at the drug rehabilitation facility would be a security officer. She testified that before each trip, she would assess defendant, and if defendant was not stable or if he declined medication, he would not be allowed to leave. Dr. Javed conceded on cross-examination that she would not be able to determine if defendant in fact had taken his medication.
¶ 9 Following evidence and argument, the court denied the petition. The court noted the testimony of both doctors, the argument by counsel, and the fact that defendant had been in EMHC for an extended period of time based on the court's previous finding of not guilty by reason of insanity. The court also noted that defendant had been granted on-grounds pass privileges. The court stated it had "looked at all the other factors here, " then stated:
"The Court cannot but not [sic] look at the reasons why Mr. Bethke is in fact at the Illinois Department of Human Services under treatment. I have heard the testimony of the [sic] Dr. Markos for that matter, indicating there is in fact a risk factor to be considered.
Considering all factors here, this Court is not convinced that the defendant will be guaranteed -- [t]hat he will not be a risk to himself and others if allowed into the general public. And, therefore, the request ...