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