In re Barry B.

No. 2--97--0691

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IN THE

APPELLATE COURT OF ILLINOIS

SECOND DISTRICT
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In re BARRY B., Alleged to be a ) Appeal from the Circuit Court
Person in Need of Involuntary ) of Kane County.
Psychotropic Medication )
) No. 97--MH--196
(The People of the State of )
Illinois, Petitioner-Appellee, ) Honorable
v. Barry B., Respondent- ) Robert L. Janes,
Appellant). ) Judge, Presiding.
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JUSTICE THOMAS delivered the opinion of the court:

Respondent, Barry B., appeals the order of the circuit court
of Kane County which granted the State s petition to involuntarily
administer psychotropic medication to respondent. We affirm.
The facts relevant to our decision are briefly stated as
follows. Respondent was a voluntary recipient of mental health
care at the Elgin Mental Health Center (EMHC). Respondent refused
to take psychotropic medication. Thus, on June 4, 1997, the State
filed a petition pursuant to section 2 -107.1 of the Mental Health
and Developmental Disabilities Code (the Code) (405 ILCS 5/1 -100
et seq. (West 1996)) to involuntarily administer psychotropic
medication to respondent. A hearing on the petition occurred on
June 13, 1997.
The State s first witness was Dr. Leach, a psychiatrist at
EMHC. Dr. Leach testified that respondent was a voluntary patient
at EMHC. He interviewed respondent on two occasions and diagnosed
respondent with bipolar disorder manic severe with psychotic
features, a serious mental illness. Dr. Leach further testified
that respondent was delusional. Respondent told Dr. Leach that he
had multiple Ph.D.s, and respondent told other people that he is
God and that other people are the devil and that God has to kill
the devil. Respondent threatened to kill himself and a friend and
to harm his mother and grandmother.
According to Dr. Leach, respondent realized he had a right to
refuse medication and was exercising that right by refusing
psychotropic medication. Respondent had taken psychotropic
medication, including Lithium and Tegretol, during past
hospitalizations. Respondent told Dr. Leach that he did not like
how he felt while on Lithium. Dr. Leach did not know whether
respondent understood the available options and their advantages
and disadvantages. He tried to discuss with respondent the
benefits of psychotropic medication and the advantages and
disadvantages of various options, but respondent refused to listen.
Respondent adamantly refused to take anything that was not natural
and suggested that Dr. Leach prescribe peyote or marijuana for him.
Dr. Leach did not know whether respondent was delusional about
medication. He stated that respondent lacked the capacity to make
a reasoned decision about his medication, largely because
respondent only saw risk associated with medication and no benefit.
Dr. Leach also testified that he wanted to prescribe Depacote
as a mood stabilizer, Resperidone as an antipsychotic, and possibly
Razepam as a sedative for respondent s mental illness. The mood
stabilizer would address respondent s manic symptoms, the
antipsychotic would address respondent s delusions, and the
sedative would calm respondent until the mood stabilizer kicked in.
Dr. Leach recommended that a liver test be performed on respondent
and that the serum level of Depacote be checked.
Norma Bridle, respondent s mother, testified that respondent
had been living with her the past four months. She noticed that
his behavior had deteriorated over that time. He had mood swings
and could not keep a job. He told her that he was God and that his
friend was the devil and that he had to kill the devil. He was
suicidal and threatened her. Bridle further testified that her son
had been in four hospitals during the previous year. He had taken
Tegretol, but quit taking it because it made him feel intoxicated.
She visited respondent at EMHC, and he told her that he would never
take medication again and if somebody forced him to he would have
to kill them.
Leigh Ololine, a friend of respondent, testified that he had
noticed changes in respondent during the past year. When
respondent was previously hospitalized, he was taking Tegretol.
Respondent was calmer, more rational, and less delusional. He was
able to deal with things like everyone else. He stopped taking the
medication when he left the hospital, and his behavior
deteriorated. Respondent alternated between depressed and manic
states. Ololine testified that respondent threatened members of
his own family in Ololine s presence and that respondent recently
threatened him.
Respondent testified in his own defense that he was a
voluntary patient at EMHC. He denied threatening to kill his
friend, his mother, or grandmother. He admitted that he was
suicidal in the past but not at the present. Respondent further
testified that he had been on medication before, that he understood
the benefits of medication but that it had no benefit for him. He
explained that he believed in natural remedies.
According to respondent, he had taken several psychotropic
medications before, including Clonopin, Lithium, and Tegretol. One
of these medications caused him to suffer vertigo, nausea,
vomiting, and a feeling of intoxication. He did not like how he
felt on the medication. Respondent acknowledged that Dr. Leach had
discussed certain medications with him, but he had not changed his
mind about their usage.
Following the testimonial evidence, the trial court enumerated
the statutory elements necessary to support an order of involuntary
psychotropic medication and found that the State had met its burden
of proof on each point. The court then entered the preprinted
order authorizing involuntary administration of psychotropic
medication (including the necessary lab work and medical
examinations) to respondent by such staff of the Illinois
Department of Mental Health and Developmental Disabilities as have
license to do so. Respondent filed a timely appeal.
On appeal, respondent contends that (1) the trial court erred
in finding him to be a person in need of involuntary administration
of psychotropic medication because the State failed to present
clear and convincing evidence that he lacked the capacity to make
a reasoned decision about the medication; and (2) the trial court s
order granting the petition must be reversed because it fails to
specify which psychotropic medications and which tests would be
administered to respondent.
Section 2--107.1 of the Code permits a court to authorize the
involuntary administration of psychotropic medication to a mental
health care recipient if the following elements of proof are met by
clear and convincing evidence:
(A) That the recipient has a serious mental illness or
developmental disability.
(B) That because of said mental illness or developmental
disability, the recipient exhibits deterioration of his
ability to function, suffering, or threatening or disruptive
behavior.
(C) That the illness or disability has existed for a
period marked by the continuing presence of the symptoms set
forth in item (B) of this subdivision (4) or the repeated
episodic occurrence of these symptoms.
(D) That the benefits of the psychotropic medication will
outweigh the harm.
(E) That the recipient lacks the capacity to make a
reasoned decision about the medication.
(F) That other less restrictive services have been
explored and found inappropriate. 405 ILCS 5/2--107.1(a)(4)
(West 1996).
See In re Schaap, 274 Ill. App. 3d 497, 501 (1995).
I
Respondent first contends that the trial court erred in
finding him to be a person in need of involuntary administration of
psychotropic medication because the State failed to present clear
and convincing evidence that he lacked the capacity to make a
reasoned decision about the medication. Respondent does not
challenge the State s evidence on the remaining five elements of
section 2 -107.1(a)(4) of the Code.
As stated previously by this court in cases involving the
involuntary administration of psychotropic medication, as a
reviewing court we give great deference to the trial court s
factual findings because the court stands in the best position to
weigh the credibility of all the witnesses; thus, we will disturb
the trial court s decision only if it is manifestly erroneous. See
In re Israel, 278 Ill. App. 3d 24, 35 (1996); In re Kness, 277 Ill.
App. 3d 711, 718 (1996); Schaap, 274 Ill. App. 3d at 502. A trial
court s decision is not manifestly erroneous unless the error is
clearly evident, plain, and undisputable. Kness, 277 Ill. App. 3d
at 718.
Respondent contends that the State failed to present clear and
convincing evidence that he lacked the capacity to make a reasoned
decision about the medication. The State, on the other hand,
points to the expert testimony of Dr. Leach, who personally met
with respondent and concluded that he did not have the capacity to
make a reasoned decision about the medication.
In Israel, this court found that a court should consider the
following factors in determining whether an individual has the
capacity to make a reasoned decision concerning the administration
of psychotropic medication:
(1) The person s knowledge that he has a choice to make;
(2) The person s ability to understand the available
options, their advantages and disadvantages;
(3) Whether the commitment is voluntary or involuntary;
(4) Whether the person has previously received the type
of medication or treatment at issue;
(5) If the person has received similar treatment in the
past, whether he can describe what happened as a result and
how the effects were beneficial or harmful; and
(6) The absence of any interfering pathologic perceptions
or beliefs or interfering emotional states which might prevent
an understanding of legitimate risks and benefits. Israel,
278 Ill. App. 3d at 37.
None of these enumerated factors should be considered dispositive,
and a court should consider any other relevant factors which it
deems to be present. Israel, 278 Ill. App. 3d at 37.
We now consider respondent s argument in light of the above-
mentioned factors. First, there was evidence presented that would
indicate that respondent knew that he had a choice to make. Dr.
Leach testified that respondent realized he had the right to refuse
medication and was exercising that right.
Second, whether respondent was able to understand the
available options and their advantages and disadvantages is a
question not easily answered from the record. Dr. Leach testified
that he did not know whether respondent understood the available
options and their advantages and disadvantages. He further
testified to having attempted to discuss the options available to
respondent as well as their advantages and disadvantages. However,
respondent refused to listen. Thus, through his own actions,
respondent prevented this information from being discussed with
him. While respondent may have been able to understand this
information if he had been willing to listen to it, we cannot find
in favor of respondent on this factor where respondent s own
actions made it impossible to ascertain whether he could have
understood the information.
Respondent correctly points out that the physician is
obligated by statute to advise in writing the recipient of services
that include the administration of psychotropic medication of the
side effects of the medication. 405 ILCS 5/2 102 (West 1996). In
this case, Dr. Leach did not advise respondent in writing of the
side effects of the medication. Citing In re Bontrager, 286 Ill.
App. 3d 226 (1997), respondent argues that Dr. Leach s failure to
have informed respondent in writing of the side effects of the
medication requires a reversal of the trial court s order granting
the State s petition. We disagree. In Bontrager, the third
district reversed the trial court order subjecting respondent to
the involuntary administration of psychotropic medication. The
third district did find that it was uncertain from the record
whether the physician discussed or reviewed written explanations of
the benefits and side effects with respondent as required by
section 2--102 (Bontrager, 286 Ill. App. 3d at 231-32) and that
this impacted upon the question of whether respondent was capable
of making a reasoned decision concerning medication. However, the
reversal stemmed not simply from the absence of evidence that the
physician discussed or reviewed written explanations of the
benefits and side effects of medication but from the third
district s finding that the State had failed to prove by clear and
convincing evidence the majority of the section 2--107.1(a)(4)
factors.
Third, respondent was voluntarily at EMHC. This was confirmed
through the testimony of Dr. Leach and respondent.
Fourth, while there was evidence that respondent had received
three psychotropic medications in the past and that one of the
medications had caused unwanted side effects for respondent, the
record is void of evidence that respondent received the
psychotropic medications recommended by Dr. Leach. Respondent
testified to having received Clonopin, Lithium, and Tegretol in the
past. However, Dr. Leach testified that he was recommending the
administration of Depacote, Resperidone, and Razepam.
Fifth, the record does not indicate that respondent had
previously taken the psychotropic medications recommended by Dr.
Leach. Therefore, the record cannot shed guidance on how such
medications would affect respondent once administered. Dr. Leach
testified that there would be significant benefits and minimal side
effects from the medications he wished to prescribe for respondent.
Moreover, even though respondent testified that other psychotropic
medication had caused unwanted side effects and that such
medication had no benefit for him, both respondent s mother and
friend testified that the medication had normalized respondent s
behavior.
Sixth, the record contained evidence of interfering pathologic
perceptions or beliefs or emotional states that undoubtedly
prevented respondent from understanding the legitimate risks and
benefits. It was not unreasonable to conclude that respondent s
pathologic perceptions prevented him from being able to understand
the risks and benefits of medication. Respondent testified that he
saw the benefit of medications, but not for himself. Respondent s
failure to perceive any benefit whatsoever from the medications
flew in the face of Dr. Leach s expert testimony concerning the
benefits of such medications and of the testimony of both
respondent s mother and friend that such medications helped to
stabilize his behavior. Likewise, it was not unreasonable to
conclude that respondent s emotional state also prevented him from
being able to understand the risks and benefits of medication. Dr.
Leach, Ololine, and respondent s mother each testified concerning
the delusions suffered by respondent. Although Dr. Leach admitted
that he did not know whether respondent was delusional about the
medication itself, he stated that respondent clearly had troubles
distinguishing reality from fiction.
After considering each of the above factors and the
testimonial evidence concerning threats of harm made by respondent
to himself and to others, we do not find that the trial court s
decision that respondent lacked the capacity to make a reasoned
decision concerning the medications at issue was manifestly
erroneous.
II
Respondent next contends that the trial court s order granting
the petition must be reversed because it fails to specify which
psychotropic medications and which tests would be administered to
respondent. We disagree.
The statute authorizing the involuntary administration of
psychotropic medication requires that the petition set forth the
specific testing and procedures sought to be administered. 405 ILCS
5/2--107.1(a)(1) (West 1996). Here, the State s petition for the
involuntary administration of psychotropic medication specified the
psychotropic medication sought to be administered upon respondent
as well as the tests that would likely be necessary.
While the statute authorizing the involuntary administration
of psychotropic medication does require that the order granting a
petition designate the persons authorized to administer the
medication (405 ILCS 5/2 -107.1(a)(6) (West 1996)), the statute does
not require that the order designate the medications or tests to be
administered. Respondent fails to cite a single case to the
contrary.
We find that the order entered in this case was legally
sufficient even though it did not specify the precise medications
or tests to be administered. At the hearing on the instant
petition, the trial court stated that it was granting the petition
based upon the testimony at the hearing, which revealed the precise
medications and tests to be administered. Moreover, the order
entered in this case appears to be worded similarly to the order
that this court found to have been properly entered in Schaap, 274
Ill. App. 3d at 500 (where the trial court entered a preprinted
order authorizing involuntary administration of psychotropic
medication (including the necessary lab work and medical
examinations) to respondent by such staff of the Illinois Department
of Mental Health and Developmental Disabilities as have licenses to
do so). Nevertheless, because of the substantial liberty interests
involved in the involuntary administration of psychotropic
medication, we believe that the better practice by the trial court
would be to include the precise medications and tests to be
administered in its order granting a petition for involuntary
medication. This will ensure that the provider of medical care has
strict guidance for the treatment of a patient who is to receive
psychotropic medication involuntarily.
For the foregoing reasons, we affirm the order of the circuit
court of Kane County granting the State s petition for the
involuntary administration of psychotropic medication.
Affirmed.
GEIGER, P.J., and BOWMAN, J., concur.