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In re Linda B.

Supreme Court of Illinois

September 21, 2017

In re LINDA B.
Linda B., Appellant. The People of the State of Illinois, Appellee,

          CHIEF JUSTICE KARMEIER delivered the judgment of the court, with opinion. Justices Freeman, Thomas, Kilbride, Garman, Burke, and Theis concurred in the judgment and opinion.



         ¶ 1 The overarching issue presented in this appeal is whether a timely petition was filed, seeking immediate, involuntary admission of respondent for inpatient psychiatric treatment in a mental health facility pursuant to article VI of the Mental Health and Developmental Disabilities Code (Mental Health Code) (405 ILCS 5/3-600 et seq. (West 2012) (Emergency Admission by Certification). In order to reach that issue, we must find that an exception to the mootness doctrine applies, as the 90-day period of hospitalization ordered by the Cook County circuit court has expired. The appellate court so found and affirmed the judgment of the circuit court. 2015 IL App (1st) 132134. On this record, and with some qualification with respect to the appellate court's analysis, we affirm the judgment of the appellate court.

         ¶ 2 BACKGROUND

         ¶ 3 Proceedings in this case were initiated on May 9, 2013, when Connie Shay-Hadley, the mental health facility director at Mount Sinai Hospital (Mt. Sinai), filed a petition alleging that respondent, Linda B., was a person subject to involuntary admission to a treatment facility. The petition sought emergency inpatient admission by certificate, pursuant to section 3-600 of the Mental Health Code (405 ILCS 5/3-600 (West 2012)), stating that respondent was admitted to the "Mental Health Facility/Psychiatric Unit" on April 22, 2013.

         ¶ 4 The petition was supported by certificates submitted by Dr. Medela Gartel, who examined respondent on May 9, 2013, and Colleen Kurtz, a licensed clinical social worker who examined respondent later that same day. Both checked form boxes stating that respondent was mentally ill and required "immediate hospitalization" for the prevention of harm to respondent or others. Both stated that respondent was in need of treatment to prevent deterioration of her condition and that she could not understand the nature of her illness or the need for treatment. Gartel added, via handwritten notation, that respondent had exhibited "multiple psychiatric symptoms including paranoid delusions, " she had been violent with medical staff, and she had been wandering and defecating in the hall. Kurtz corroborated that observation as well as Gartel's suggestion that respondent suffered from paranoid delusions. Kurtz added that respondent was refusing both medical and psychiatric medications.

         ¶ 5 On June 11, 2013, the trial court held a hearing addressing the matter of involuntary admission.[1] At that hearing, Dr. Elizabeth Mirkin, a board-certified psychiatrist, testified that respondent's hospitalization at Mt. Sinai began on April 22, 2013, when she was admitted to a "medical floor, " where she was also "treated psychiatrically." With respect to the circumstances prompting respondent's admission, Mirkin volunteered:

"She actually was board-agitated and very angry behaviors before she was admitted in medical floor because she was tachycardia and found to be severely anemic.[2] She was admitted to the medical floor. She was followed by a psychiatrist throughout her stay on the medical floor."

         Mirkin also stated that respondent had sitters "throughout her stay on the medical floor."

         ¶ 6 Mirkin testified that she first saw respondent on the medical floor on May 25, 2013. She had previously spoken to other staff members and had reviewed "other people psychiatry progress notes, nursing notes, doctors notes." Mirkin stated that respondent was hospitalized for "both" psychiatric and medical treatment. Mirkin noted that this was not respondent's first hospitalization. She had been admitted to Mt. Sinai's psychiatric unit in January 2013 "with similar presentation." According to Mirkin, respondent was admitted again in April. There had been "multiple prior hospitalizations." Mirkin diagnosed respondent as suffering from schizophrenic disorder, stating that respondent had suffered from that malady for years.

         ¶ 7 Mirkin described, in detail, the symptoms respondent had exhibited: "[S]he was very delusional, very aggressive, agitated and threatening, labile and did not sleep, threatened staff, did not take medications for psychiatric and medical reasons." Mirkin said that respondent was "much less symptomatic" at the time of the hearing because, pursuant to court order entered May 14, 2013, [3] respondent was taking prescribed medications. Though Mirkin acknowledged that respondent was "less symptomatic, " she maintained that respondent was still delusional, easily agitated, aggressive, and subject to rapid mood swings. Mirkin observed that respondent had a history of noncompliance in taking medications, particularly whenever she was discharged from the hospital. Mirkin rendered her opinion, based upon a reasonable degree of psychiatric certainty, that respondent was unable, because of her mental illness, to provide for her basic physical needs without assistance and thus should be treated on an inpatient basis. Mirkin recommended that respondent be treated at Park Shore Nursing Home.

         ¶ 8 In her cross-examination, counsel for respondent asked: "Is [respondent] recommended for nursing home placement because of mental health reasons or because of medical reasons?" Mirkin responded:

"Because of combination of mental health reasons and medical reasons. In her case, her mental health conditions prevents her from taking care of her medical condition. When she has exacerbation of her mental illness, then she doesn't take care of herself, including her many medical conditions."
Inquiries by counsel regarding Park Shore Nursing Home revealed that Mirkin had very limited knowledge thereof. However, when asked whether Park Shore Nursing Home provided "behavioral mental health care or whether they primarily provide[d] medical care to elderly senior citizens, " Mirkin replied: "Because [respondent's] diagnosis is schizoaffective disorder, she could not be admitted to the nursing home, which does not provide care for behavioral health."

         ¶ 9 Upon further examination of Mirkin by respondent's counsel, the following colloquy ensued:

"Q. Doctor, according to the chart, you've indicated as of approximately May 28th, the respondent was ready for discharge from Mt. Sinai, correct?
A. I had a note there. I saw her on the unit and I didn't say that she is ready for discharge. I said that she does not need inpatient level of psychiatric care.
I said this is her baseline, but I never indicated that she could be discharged home. There was a process going on while she was on medical floor for her to be admitted to the nursing home; and by my note, I stated that she does not need to be transferred to inpatient psych unit.
Q. So all this time, from April 22nd to the present day, [respondent] has been on a medical unit and not a psychiatric hospital [sic] at the hospital?
A. She was cleared medically only as of last Saturday. *** At that time we found out we're going with a nursing home placement. There's no point of her to be transferred to six-the transfer to Six East mainly because on the medical floor, she's been on one-to-one supervision; and the nursing home will not accept anybody to the nursing home unless their 24 hours of supervision and psychiatric unit is more appropriate for her.
She hasn't been on supervision here unless she was admitted there last night. She hasn't been put on one-to-one supervision.
While on medical floor, she needed one-to-one sitter. *** Constantly, she needed to have supervision all of the time.
Q. That's one of the conditions for Park Shore to accept [respondent], that she goes 24 hours without having a sitter?
A. Yes. Any nursing home inpatient, yes."

         ¶ 10 Following cross-examination and after the State rested, respondent's counsel moved to dismiss the petition for involuntary admission "based upon the petition having been filed well beyond the 24 hours after [respondent's] admission." Counsel argued that the petition was untimely filed where respondent was admitted to the medical floor of Mt. Sinai on April 22, 2013, but was also being treated psychiatrically from that date.

         ¶ 11 Over counsel's objection, the court allowed the State to reopen its case in order to adduce evidence pertinent to respondent's motion. Speaking to the procedures the hospital generally ...

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