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In re Clinton S.

Court of Appeals of Illinois, Second District

December 2, 2016

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,

         Appeal 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 affirm.

         ¶ 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 old.

         ¶ 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.[1]

         ¶ 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 returned.

         ¶ 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 difficulty urinating.

         ¶ 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, ...

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