In re CLINTON S., Alleged to be a Person Subject to Involuntary Administration of Psychotropic Medication
Clinton S., Respondent-Appellant. The People of the State of Illinois, Petitioner-Appellee,
from the Circuit Court of Kane County. No. 15-MH-88 Honorable
Divya Sarang, Judge, Presiding.
HUTCHINSON JUSTICE delivered the judgment of the court, with
opinion. Justices Birkett and Spence concurred in the
judgment and opinion.
1 Respondent, Clinton S., had a long history of mental health
issues. He had also been diagnosed with end-stage kidney
failure. In granting a petition for the involuntary
administration of psychotropic medication pursuant to section
2-107.1 of the Mental Health and Developmental Disabilities
Code (Mental Health Code) (405 ILCS 5/2-107.1 (West 2014)),
the trial court also ordered that respondent undergo regular
hemodialysis treatments. This was based on evidence that
hemodialysis was essential for the safe and effective
administration of the medication, as respondent's kidneys
could not otherwise filter the chemicals from his blood.
Respondent appeals, arguing that: (1) the State failed to
prove by clear and convincing evidence that the benefits of
the medication outweighed the harm; and (2) the trial
court's order exceeded the scope of the testing and other
procedures that are authorized under section 2-107.1. We
2 I. BACKGROUND
3 Respondent was admitted to the Elgin Mental Health Center
(EMHC) on February 5, 2015, after being found unfit to stand
trial on a robbery charge. He had been hospitalized for
issues related to his mental health over 40 times since 1980.
At the time of these proceedings, respondent was 53 years
4 On July 23, 2015, the State filed a petition for the
involuntary administration of psychotropic medication
pursuant to section 2-107.1 of the Mental Health Code. Dr.
Mirella Susnjar signed the petition, as respondent's
treating psychiatrist. In addition to seeking the involuntary
administration of several medications, Susnjar requested that
respondent be ordered to undergo regular hemodialysis
treatments, which she deemed essential for the safe and
effective administration of the requested medications.
Susnjar noted that respondent was suffering from end-stage
kidney failure, and she asserted that hemodialysis was
necessary to prolong his life.
5 The trial court conducted a hearing on the petition on
August 21, 2015. Susnjar was the only witness to testify. The
parties stipulated that Susnjar was an expert in the field of
psychiatry. Susnjar testified that she had performed a
psychiatric evaluation on respondent and had diagnosed him
with schizophrenia. Susnjar explained that respondent
suffered hallucinations and delusions, heard voices, talked
to himself, and struggled to converse with other people.
Respondent also occasionally became angry and violent. In one
instance, he threw a food tray and threatened to kill a
nurse. Susnjar testified that respondent's symptoms had
not improved from less restrictive treatments such as
"one-to-one" and group therapies. She did not
believe that respondent was likely to stabilize without
psychotropic medication. She had checked respondent's
medical records and consulted with his assigned social
worker, but she was unable to determine whether respondent
had executed a power of attorney for health care or a
declaration under the Mental Health Treatment Preference
Declaration Act (755 ILCS 43/1 et seq. (West 2014)).
6 Susnjar testified that respondent had previously agreed to
take Stelazine (trifluoperazine), Haldol (haloperidol),
Benadryl (diphenhydramine), and lorazepam. When he took these
medications, his symptoms improved. He was able to plan and
discuss his legal and health situations. However, he
eventually stopped taking the medications due to his
preference for "white" Stelazine. Susnjar explained
that the EMHC offered only "purple" Stelazine.
Beyond the color, the medications were the same. After
respondent stopped taking his medications, his symptoms
7 To treat respondent's mood and psychosis, Susnjar
sought to administer specified doses of trifluoperazine,
risperidone, quetiapine, and aripiprazole. Susnjar testified
that the side effects of the medications included neuroleptic
malignant syndrome, involuntary movements, lower blood
pressure, sedation, muscle rigidity, tardive dyskinesia,
diabetes, weight gain, and cataracts. The primary benefits of
the medications were that respondent would become calm and
better able to express himself and make decisions.
8 Susnjar also petitioned for the administration of five
alternative medications: haloperidol, fluphenazine,
lorazepam, diphenhydramine, and benztropine. She testified
that haloperidol and fluphenazine were alternative
psychotropic medications for the treatment of psychosis and
delirium and that they involved similar side effects and
benefits as the primary psychotropic medications. Lorazepam
would be used if necessary to treat anxiety; the potential
side effects were sedation and addiction. Finally,
diphenhydramine and benztropine were used to treat the side
effects from the psychotropic medications. The risks included
weight gain, confusion, dry mouth, constipation, and
9 Susnjar also testified at length about respondent's
kidney disease and her request for hemodialysis treatments.
She explained that respondent was admitted to Sherman
Hospital for renal failure in April 2015. When respondent was
discharged in May 2015, his treating nephrologist diagnosed
him with end-stage kidney failure and recommended that he
undergo hemodialysis treatments three times per week.
Respondent initially received 18 hemodialysis treatments
without incident, but he later began refusing the treatments.
These refusals happened around the same time that respondent
began refusing to take the psychotropic medications. Susnjar
testified that she had repeatedly discussed with respondent
the status of his kidneys and the need for hemodialysis, but
respondent insisted that it was not necessary. Based on these
facts, Susnjar opined that respondent's mental illness
was directly related to his refusal to undergo hemodialysis.
Although Susnjar refrained from speculating on a specific
time frame, she opined that respondent would eventually die
if he did not receive hemodialysis. Susnjar further opined
that the hemodialysis was necessary for the safe and
effective administration of the psychotropic medications,
because respondent's kidneys could not adequately filter
the chemicals from his blood. Susnjar cautioned that, without
hemodialysis, the medications could cause a toxic
accumulation that could lead to a coma.
10 On cross-examination, respondent's trial counsel asked
Susnjar whether she could safely and effectively administer
the psychotropic medications if respondent were not receiving
hemodialysis. Susnjar answered that she might be compelled to
administer the medications in certain limited circumstances,
such as if respondent became violent, but that she would not
otherwise administer the medications unless she knew that
respondent would be undergoing regular hemodialysis.
11 In rendering its decision, the trial court acknowledged
the potential risks involved with the psychotropic
medications, but it found that those risks were outweighed by
the benefit of helping respondent manage his psychosis. The
trial court noted Susnjar's testimony that she could not
safely and effectively administer the psychotropic
medications without the hemodialysis. It accordingly granted
the petition, ...