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In re H.P.

Court of Appeals of Illinois, Fifth District

July 1, 2019

In re H.P.
v.
H.P., Respondent-Appellant. The People of the State of Illinois, Petitioner-Appellee,

          Appeal from the Circuit Court of Randolph County. No. 15-MH-75 Honorable Richard A. Brown, Judge, presiding.

          Attorneys for Appellant Veronique Baker, Director, Barbara A. Goeben, Staff Attorney, Illinois Guardianship & Advocacy Commission,

          Attorneys for Appellees Hon. Jeremy R. Walker, State's Attorney, Randolph County Courthouse, 1 Taylor Street, Chester, IL 62233; Patrick Delfino, Director, Patrick D. Daly, Deputy Director, Kelly M. Stacey, Staff Attorney, Office of the State's Attorneys Appellate Prosecutor,

          JUSTICE CHAPMAN delivered the judgment of the court, with opinion. Presiding Justice Overstreet and Justice Cates concurred in the judgment and opinion.

          OPINION

          Honorable Melissa A. Chapman, J.

         ¶ 1 The respondent, H.P., appeals an order authorizing involuntary administration of psychotropic medication. At issue is whether the State must present evidence of known interactions between multiple medications in order to satisfy its statutory burden of demonstrating that the benefits of the proposed treatment outweigh the harm. See 405 ILCS 5/2-107.1(a-5)(4)(D) (West 2014). We hold that it must.

         ¶ 2 H.P. argues that (1) the State did not prove by clear and convincing evidence that the benefits of the proposed treatment outweighed the risk of harm because its expert witness did not specifically testify to the benefits of using more than one antipsychotic medication and did not testify at all concerning potential drug interaction, (2) the State did not prove that the testing requested was essential for the safe and effective administration of the treatment, and (3) the order did not conform to the evidence with respect to the dosages of medication and the people authorized to administer the medication. We reverse.

         ¶ 3 I. BACKGROUND

         ¶ 4 On June 11, 2015, H.P. was admitted to Chester Mental Health Center (Chester) after being found unfit to stand trial on multiple criminal charges. On July 22, 2015, the State filed a petition for the involuntary administration of psychotropic medication. The petition was signed by Dr. Muddasani Reddy, a psychiatrist at Chester. Dr. Reddy alleged that H.P. had 11 prior admissions to facilities, beginning in 2010 when he was 18 years old. He further alleged that he had diagnosed H.P. with schizoaffective disorder, depressive type. As a result of this illness, H.P. experienced auditory hallucinations, grandiose delusions, and mood swings between depression and elation. Dr. Reddy alleged that H.P. also exhibited aggressive behavior as a result of his illness.

         ¶ 5 Dr. Reddy alleged in the petition that H.P. was previously treated with olanzapine, one of the drugs he was asking permission to administer. He alleged that H.P. had signed a consent to take medications but was refusing to do so. Dr. Reddy requested permission to administer olanzapine, lorazepam, benztropine, divalproex, haloperidol, and haloperidol D. He also requested permission to administer six medications, each of which was to be administered as an alternative to one of the six primary medications. He specified a range of dosages for each requested medication. Dr. Reddy asked the court to authorize "testing and other procedures" and alleged that the "testing and procedures are essential for the safe and effective administration of treatment." Finally, he requested that the court authorize him to administer medication to H.P. and to authorize the following individuals, who would serve as alternates: Dr. Tiongson, Dr. Vallabhaneni, Dr. Casey, Dr. Gupta, and Dr. Maitra.

         ¶ 6 The court held a hearing on the petition on July 29, 2015. Dr. Reddy testified that he had been H.P.'s treating psychiatrist at Chester since June 2015. He testified that he diagnosed H.P. with schizoaffective disorder, depressive type. Dr. Reddy was asked about H.P.'s willingness to take prescribed medications. He replied, "At times, he takes Lorazepam for agitation, but most of the time he refuses two or three times a day [to take] Olanzapine and other needed medications." Dr. Reddy noted that H.P. signed a consent form to take medications. He also noted that H.P. took different medications when he first arrived at Chester. He testified, however, that those medications were not effective.

         ¶ 7 Dr. Reddy testified that H.P.'s illness caused him to exhibit aggressive behavior. He opined that this behavior was getting worse. He testified that H.P. had to be placed in restraints twice. One time, he struck a staff member. The other time, he attempted to strike a staff member. Dr. Reddy also described two occasions on which H.P. exhibited aggressive behavior but was not placed in restraints. On one occasion, he closed himself in the office of a therapist and refused to leave. On another occasion, he punched another patient in the stomach.

         ¶ 8 Dr. Reddy testified that olanzapine would benefit H.P. by controlling his psychotic symptoms, alleviating his disorganized thought process, and reducing his hostility and aggression. He explained that possible side effects of olanzapine include shakes, muscle spasms, sedation, metabolic syndrome, neuroleptic malignant syndrome, and tardive dyskinesia. He testified that lorazepam would help H.P. by controlling anxiety, tension, and restlessness but it can cause sedation, incoordination, memory problems, and dependency syndrome. Dr. Reddy testified that benztropine can be taken as needed to alleviate the side effects of olanzapine. Side effects of benztropine include dry mouth, blurred vision, confusion, urinary retention, and constipation. He testified that divalproex is a mood stabilizer. Its possible side effects include sedation, upset stomach, blood cell separation, and kidney and liver dysfunction. He next testified that haloperidol is an antipsychotic medication that controls hallucinations but it can cause muscle spasms, shaking, tardive dyskinesia, metabolic problems, and neuroleptic malignant syndrome. He explained that haloperidol D is an injectable form of haloperidol.

         ¶ 9 Dr. Reddy also testified about the expected benefits and the side effects of the alternate medications he was requesting. He noted that Risperdal would be given as an alternative to olanzapine, with benefits that are the same as those of olanzapine and side effects that include extrapyramidal symptoms, shaking, metabolic syndrome, and tardive dyskinesia. He testified that clonazepam would be given as an alternative to lorazepam and that both its benefits and side effects are "like Lorazepam." Dr. Reddy testified that diphenhydramine could be given instead of benztropine to control side effects but it could cause sedation or incoordination. He testified that lithium (the alternate requested for divalproex) is a mood stabilizer with possible side effects of upset stomach, shaking, thyroid dysfunction, and liver dysfunction. He testified that fluphenazine (the alternative for haloperidol) would benefit H.P. by reducing his hallucinations, delusions, disorganized thinking, and aggression. However, it can cause shaking, muscle spasms, tardive dyskinesia, and neuroleptic malignant syndrome. Dr. Reddy was not asked about the benefits or risks of fluphenazine D, the alternate for haloperidol D, but this is presumably an injectable form of fluphenazine. See In re Suzette D., 388 Ill.App.3d 978, 986 (2009).

         ¶ 10 Dr. Reddy opined that the benefits of the proposed treatment outweighed the risk of harm. He noted that H.P. had not experienced any adverse side effects from the medications up to that point. Counsel for the State asked Dr. Reddy, "Well, you're asking for the ability to test so that these medications may be safely administered. Has he established a blood level prior to taking these medications?" Dr. Reddy replied, "He did go through a blood test and-well, before we started him on medications." Counsel then asked whether any "metabolic side effects" experienced by H.P. "would be found in the blood testing." The doctor responded, "Periodically monitored, and the blood test will show any metabolic changes in the parameters."

         ¶ 11 H.P. also testified at the hearing. He testified that when he first arrived at Chester, his psychiatrist was Dr. Tiongson. He noted, however, that he had talked to Dr. Gupta, Dr. Reddy, Dr. Tiongson, and a female doctor. H.P. testified that Dr. Tiongson initially allowed him to choose his medications. He chose to take Ativan to treat both his anxiety and his depression. In addition, he chose to take Seroquel and Citalopram for depression. He explained that he thought Seroquel was an antidepressant, but he later learned this was not the case. He further testified that Seroquel caused him to suffer painful constipation. H.P. testified that he did not object to taking Ativan. He also testified that he had not requested benztropine because he had ...


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