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Appellate Court Date: 2019.08.26
12:16:25 -05'00'
In re H.P., 2019 IL App (5th) 150302
Appellate Court In re H.P. (The People of the State of Illinois, Petitioner-Appellee, v.
Caption H.P., Respondent-Appellant).
District & No. Fifth District
Docket No. 5-15-0302
Filed July 1, 2019
Decision Under Appeal from the Circuit Court of Randolph County, No. 15-MH-75;
Review the Hon. Richard A. Brown, Judge, presiding.
Judgment Reversed.
Counsel on Veronique Baker and Barbara A. Goeben, of Illinois Guardianship &
Appeal Advocacy Commission, of Alton, for appellant.
Jeremy R. Walker, State’s Attorney, of Chester (Patrick Delfino,
Patrick D. Daly, and Kelly M. Stacey, of State’s Attorneys Appellate
Prosecutor’s Office, of counsel), for the People.
Panel JUSTICE CHAPMAN delivered the judgment of the court, with
opinion.
Presiding Justice Overstreet and Justice Cates concurred in the
judgment and opinion.
OPINION
¶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.
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¶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.”
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¶ 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
not experienced any side effects. H.P. noted that he had been taking his medications during the
preceding two weeks. He explained, “I just been taking it because I thought I can get through.”
¶ 12 The court entered an order the day of the hearing. It authorized Dr. Reddy to administer
the requested medications in the ranges of dosages requested in the petition. It also authorized
all of the individuals named in the petition as alternates to administer the medications. In
addition, the order authorized “Blood testing, requiring blood draws, to monitor medication,
electrolyte and enzyme levels.” This appeal followed.
¶ 13 II. DISCUSSION
¶ 14 A. Mootness
¶ 15 We begin by observing that the issues raised in this appeal are moot. The order authorizing
the involuntary administration of psychotropic medication to H.P. went into effect on July 29,
2015, and expired 90 days later. As such, our decision today cannot grant him effective relief.
See In re Christopher C., 2018 IL App (5th) 150301, ¶ 12. Generally, courts do not have
jurisdiction to render advisory opinions, address moot questions, or decide appeals in which
we are unable to grant effective relief to any party. Id. ¶ 13. However, we have jurisdiction
over an appeal that is technically moot if it falls within one of the recognized exceptions to the
mootness doctrine. Id. Although there is no per se exception for mental health cases, most
mental health cases fall within one of the recognized exceptions. In re Alfred H.H., 233 Ill. 2d
345, 355 (2009).
¶ 16 One of the recognized exceptions to the mootness doctrine is the public interest exception.
Under that exception, we may hear an appeal that is technically moot if (1) the case presents
an issue of public concern, (2) there is a need for an authoritative decision to provide guidance
to public officials, and (3) the question is likely to recur. In re Debra B., 2016 IL App (5th)
130573, ¶ 20. We find that all three of these requirements are satisfied.
¶ 17 First, as both the Illinois Supreme Court and this court have repeatedly emphasized, the
procedural safeguards that must be followed before a mental health patient may be medicated
against his will are matters of great public concern. See In re Mary Ann P., 202 Ill. 2d 393, 402
(2002); Debra B., 2016 IL App (5th) 130573, ¶ 21; In re Evelyn S., 337 Ill. App. 3d 1096, 1102
(2003). We acknowledge that when a respondent raises questions concerning the sufficiency
of the evidence, as H.P. does in this case, the “inherently case-specific” nature of such
questions ordinarily does not “present the kinds of broad public interest issues” involved in
most mental health cases. Alfred H.H., 233 Ill. 2d at 356-57. However, H.P.’s claims relate to
the type of evidence the State must present to meet its statutory burden, rather than the weight
of the evidence presented. This court has recognized that such questions have “broader
implications than most sufficiency-of-the-evidence claims.” In re Joseph M., 405 Ill. App. 3d
1167, 1173 (2010).
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¶ 18 Second, we find that a definitive decision is needed to guide public officials. One of the
arguments H.P. raises in this appeal—his claim that the State must provide evidence
concerning known drug interactions to meet its burden of proving that the benefits of the
proposed treatment outweigh the risk of harm—appears to be a matter of first impression. See
In re Torry G., 2014 IL App (1st) 130709, ¶ 28 (noting the need for an authoritative decision
where no prior Illinois cases have resolved the question raised). Guidance on this matter would
be particularly helpful to courts and public officials because mentally ill patients are often
treated with multiple medications. See Mary Ann P., 202 Ill. 2d at 405. Third, due to the short
duration of orders authorizing involuntary treatment, the issues raised in this appeal are likely
to recur without the opportunity to be fully litigated before becoming moot. See id. at 402-03.
We will therefore consider the respondent’s arguments under the public interest exception.
¶ 19 B. Principles of Law Applicable to the Respondent’s Claims
¶ 20 Our supreme court has held that mentally ill patients have a constitutionally protected right
to refuse to be treated with psychotropic medications. In re C.E., 161 Ill. 2d 200, 213-14
(1994). Courts recognize that any involuntary mental health treatment involves “a ‘massive
curtailment of liberty.’ ” In re Barbara H., 183 Ill. 2d 482, 496 (1998) (quoting Vitek v. Jones,
445 U.S. 480, 491 (1980)). The involuntary administration of psychotropic medications is
particularly intrusive. In re Robert S., 213 Ill. 2d 30, 46 (2004). This is so for three reasons.
First, involuntary medication constitutes an unwanted “intrusion[ ] into [a patient’s] body and
mind.” In re Orr, 176 Ill. App. 3d 498, 512 (1988) (citing Mills v. Rogers, 457 U.S. 291, 299
(1982)); see also C.E., 161 Ill. 2d at 214 (recognizing the “substantially invasive nature of
psychotropic substances”). Second, psychotropic medications carry a risk of “significant side
effects.” C.E., 161 Ill. 2d at 214. Third, there is a potential for such medications to be
misused—that is, there is a danger that they might be prescribed primarily to manage or control
patients rather than to treat their illnesses. Id. at 215.
¶ 21 We also recognize, however, “that the state has a legitimate parens patriae interest in
furthering the treatment” of mentally ill patients who are incapable of making reasoned
decisions regarding their own treatment. Id. at 217. The statute authorizing the involuntary
administration of psychotropic medication provides important procedural safeguards that
protect the rights of patients while balancing these interests. See id. at 217-19.
¶ 22 The statute provides that, before a patient may be medicated against his will, the State must
prove by clear and convincing evidence that (1) the patient has a serious mental illness; (2) he
currently exhibits a deterioration in his ability to function, suffering, or threatening behavior;
(3) his illness has been marked by the continuing presence or repeated episodic occurrence of
at least one of these three symptoms; (4) the benefits of the proposed treatment outweigh the
harm; (5) the patient lacks the capacity to make a reasoned decision about his treatment; and
(6) less restrictive alternatives have been considered and found to be inappropriate. 405 ILCS
5/2-107.1(a-5)(4)(A)-(F) (West 2014). If the State requests authorization for testing or other
procedures, as it did here, it must also prove by clear and convincing evidence that those tests
or procedures are “essential for the safe and effective administration of the treatment.” Id. § 2-
107.1(a-5)(4)(G). The court may only authorize the involuntary administration of psychotropic
medication if it finds that the State has met its burden of proving all of these factors. In re Louis
S., 361 Ill. App. 3d 774, 779 (2005).
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¶ 23 If the court does authorize involuntary medication, it must specify in its order the
medications authorized, the ranges of dosages authorized for each medication, and the names
of the individuals authorized to administer the treatment. 405 ILCS 5/2-107.1(a-5)(6) (West
2014). The State must provide the court with at least some evidence as to the dosages requested
and the individuals who will be authorized to administer the medications. Christopher C., 2018
IL App (5th) 150301, ¶¶ 23-24.
¶ 24 At issue in this appeal is whether the State met its statutory burden of proving that (1) the
benefits of the proposed treatment outweighed the harm and (2) the requested testing was
essential to the safe and effective administration of the requested medications. As stated
previously, the State was required to prove each of these factors by clear and convincing
evidence. Debra B., 2016 IL App (5th) 130573, ¶ 37. This requires the State to present
evidence that is “more than a preponderance” but less than “the degree of proof necessary to
convict a person of a criminal offense.” In re M.T., 371 Ill. App. 3d 318, 323 (2007). Also at
issue in this appeal is whether the order conformed to the evidence with respect to the dosages
of medication to be administered and the individuals authorized to administer the medications.
We review the trial court’s factual findings to determine whether they are against the manifest
weight of the evidence. Debra B., 2016 IL App (5th) 130573, ¶ 24. However, we review
de novo questions of statutory compliance. Christopher C., 2018 IL App (5th) 150301, ¶ 18.
¶ 25 C. Forfeiture and Ineffective Assistance of Counsel
¶ 26 Before turning to the merits of H.P.’s claims, we must address the State’s contention that
two of these claims have been forfeited. Specifically, the State asserts that (1) H.P. forfeited
his claim concerning the sufficiency of the evidence to prove that the benefit of treatment
outweighed the harm because he failed to rebut Dr. Reddy’s testimony on that question through
cross-examination and (2) H.P. forfeited his claim that the order did not conform to the
evidence with respect to the dosages and individuals authorized to administer the medications
because he did not object to those portions of the order at trial. Although the State does not
argue that H.P. has forfeited his claim concerning the evidence that the requested tests were
necessary, H.P. acknowledges that his attorney did not raise this issue at trial. He urges this
court to address all three issues in spite of his forfeiture, arguing that his attorney’s failure to
address them constituted ineffective assistance of counsel.
¶ 27 Forfeiture is a limitation on the parties, not the court. In re Bobby F., 2012 IL App (5th)
110214, ¶ 25. Because the involuntary administration of psychotropic medication implicates
fundamental rights, we often review forfeited claims in mental health cases under the plain
error doctrine. See id.; Joseph M., 405 Ill. App. 3d at 1180; Suzette D., 388 Ill. App. 3d at 984.
We therefore choose to overlook H.P.’s forfeiture of these claims and consider the merits of
all of his arguments. Because we will resolve his claims on the merits, we need not address
H.P.’s claim of ineffective assistance of counsel. See In re Steven T., 2014 IL App (5th)
130328, ¶ 18. We turn to the merits of H.P.’s contentions.
¶ 28 D. Evidence That the Benefits of Treatment Outweigh the Harm
¶ 29 H.P. first argues that the State failed to prove by clear and convincing evidence that the
benefits of the proposed treatment outweighed the risk of harm. There are two components to
his argument. First, he argues that the State’s evidence concerning the benefits of the proposed
treatment was insufficient because the State’s expert, Dr. Reddy, did not specifically testify to
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the benefits of polypharmacy, the use of multiple psychotropic medications. Second, H.P.
argues that the State’s evidence concerning the risk of harm was inadequate because Dr. Reddy
did not testify about possible drug interactions. We address these contentions in turn.
¶ 30 We may dispose of the first of these contentions quickly. H.P. emphasizes that two of the
primary medications requested in the petition—olanzapine and haloperidol—are both
antipsychotic medications. He argues that in order to provide the court with sufficient evidence
concerning the benefits of the proposed treatment, Dr. Reddy needed to offer specific
testimony about the benefits of using two antipsychotics simultaneously. See In re Perona,
294 Ill. App. 3d 755, 767 (1998) (noting that the State met its burden where its expert testified
that she requested the use of two neuroleptic medications because administering the two drugs
simultaneously increased their efficacy).
¶ 31 Here, Dr. Reddy testified that olanzapine and haloperidol would treat different
symptoms—olanzapine was intended to alleviate H.P.’s disorganized thought process and
reduce his hostility and aggression, while haloperidol was intended to reduce his
hallucinations. Testimony that proposed medications are expected to treat specific symptoms
is sufficient to demonstrate to a court what the benefits of the proposed treatment are. See In re
Dawn H., 2012 IL App (2d) 111013, ¶ 17. Obviously, administering only one of the
medications would not provide the benefits of treating all of the symptoms treated by both. It
is unclear whether similar evidence was presented in Perona, the case relied upon by H.P.
Absent evidence that multiple medications treat different symptoms, the benefit of prescribing
multiple medications might not be clear without further explanation. In this case, however, Dr.
Reddy testified that olanzapine and haloperidol each treated symptoms that the other would
not treat. We find that the State provided sufficient evidence in this case concerning the benefits
of the proposed treatment.
¶ 32 The crux of H.P.’s argument, however, is that the State provided insufficient evidence
concerning the risk of harm. This is so, he contends, because Dr. Reddy did not testify about
any known interactions between the medications involved. For the reasons that follow, we
agree.
¶ 33 The statute governing orders for the involuntary administration of psychotropic medication
requires the State to prove by clear and convincing evidence that the benefits of the proposed
treatment outweigh the risk of harm from the treatment. 405 ILCS 5/2-107.1(a-5)(4)(D) (West
2014). The statute does not expressly require the State to present any specific type of evidence
to satisfy this burden. See id. However, Illinois courts—including this court—have
consistently construed the statute to require the State to present expert testimony describing
both the expected benefits and the possible side effects of each medication requested in the
petition. See, e.g., Dawn H., 2012 IL App (2d) 111013, ¶ 17; In re Larry B., 394 Ill. App. 3d
470, 476 (2009); Suzette D., 388 Ill. App. 3d at 985; In re Alaka W., 379 Ill. App. 3d 251, 263
(2008); In re Gail F., 365 Ill. App. 3d 439, 446-47 (2006); Louis S., 361 Ill. App. 3d at 782.
The rationale underlying these holdings is that courts are not able to meaningfully assess
whether the benefits of treatment outweigh the risk of harm unless they are presented with
evidence of both the benefits and the harms that might occur as a result of the proposed
treatment. See, e.g., Suzette D., 388 Ill. App. 3d at 985; Alaka W., 379 Ill. App. 3d at 263-64;
In re Kness, 277 Ill. App. 3d 711, 720 (1996).
¶ 34 We believe that this rationale applies with equal force to evidence concerning drug
interactions. We emphasize that courts are called upon to determine whether the benefits of the
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proposed treatment outweigh the harm. The term “harm” is not limited to adverse side effects
from individual medications. Side effects are one type of harm that can result from treatment
with psychotropic medications. But they are not the only type of harm that can result.
Interactions between prescribed medications can also cause serious harm. As such, expert
testimony concerning the risk of this type of harm is necessary to enable the court to make its
determination.
¶ 35 We note that, although no prior Illinois cases have addressed the precise question before
us, courts have recognized the importance of protecting patients from the risk of interactions
between involuntarily administered medications. See, e.g., Robert S., 213 Ill. 2d at 52-53
(finding that a psychology intern was not qualified to perform an independent evaluation or
give meaningful testimony in proceedings on a petition for the involuntary administration of
psychotropic medications because “[o]nly a physician—such as a psychiatrist” has the “level
of knowledge *** necessary to safely prescribe medication, to fully recognize its beneficial
effects as well as its adverse side effects, [and] to understand its interaction with other drugs”
(emphasis added)); In re Dru G., 369 Ill. App. 3d 650, 657-58 (2006) (following Robert S. and
noting that psychologists “cannot give meaningful opinions on the possible harmful effects”
of medication because they do not have the requisite knowledge concerning harmful side
effects of individual drugs or “their interactions with other drugs” (emphasis added)); In re
Williams, 305 Ill. App. 3d 506, 511 (1999) (finding that the State failed to prove that the
benefits of treatment outweighed the harm where the expert’s testimony was “general and
vague” and the expert was not asked whether three of the medications he wanted to administer
had any side effects “or whether there [were] potential complications posed by the interactions
of these medications” (emphasis added)). Although these cases are not dispositive, they support
our decision because they illustrate our concern with the significant harm that can result from
drug interactions.
¶ 36 We believe that the possibility of harm resulting from drug interactions is a crucial
consideration in determining whether the benefits of a proposed course of treatment outweigh
the risk of harm. Without pertinent information on the possibility of such harm, courts do not
have adequate information to make a meaningful determination. Thus, we now hold that the
State must provide trial courts with expert testimony addressing known drug interactions in
order to meet its statutory burden of proving that the benefits of the proposed treatment
outweigh the harm. Because the State did not ask Dr. Reddy whether there were any known
interactions between the medications he wanted to administer to H.P. simultaneously, the State
did not meet its burden, and the order must be reversed.
¶ 37 E. Testing and Other Procedures
¶ 38 H.P. next contends that the State failed to provide clear and convincing evidence that the
requested testing was essential for the safe and effective administration of the treatment. See
405 ILCS 5/2-107.1(a-5)(4)(G) (West 2014). The State concedes that the evidence presented
on this point was not specific enough to meet its statutory obligation. In spite of the State’s
concession, this court is obliged to independently review the claimed error as part of our duty
to protect the public interest. Larry B., 394 Ill. App. 3d at 471 (citing Young v. United States,
315 U.S. 257, 258-59 (1942)). We agree with the parties that the State did not meet its burden.
¶ 39 A court may not authorize testing or other procedures unless the State proves by clear and
convincing evidence that the tests or procedures are “ ‘essential for the safe and effective
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administration of the treatment.’ ” Christopher C., 2018 IL App (5th) 150301, ¶ 16 (quoting
405 ILCS 5/2-107.1(a-5)(4)(G) (West 2014)). To meet this standard, the State must present
expert testimony supported by specific facts. It is not enough for the State’s expert to simply
opine that the testing is essential. Id. ¶ 17; Steven T., 2014 IL App (5th) 130328, ¶ 17; see also
In re David S., 386 Ill. App. 3d 878, 883 (2008) (finding an order authorizing tests to be
unsupported by the evidence where the State’s expert did not testify about “the reasons for the
tests” or why they “were deemed ‘essential’ ”). The State must also present at least some
evidence specifying what tests and procedures are to be performed and how often they are to
be performed. See Christopher C., 2018 IL App (5th) 150301, ¶ 19; In re Donald L., 2014 IL
App (2d) 130044, ¶ 27.
¶ 40 In this case, Dr. Reddy testified that H.P. would be “[p]eriodically monitored” and that
blood tests would show any “metabolic changes in the parameters.” Presumably, this relates to
metabolic syndrome, one of the possible side effects of olanzapine and Risperdal. However,
Dr. Reddy did not explain why the tests were essential for this purpose. In fact, he did not even
testify that the tests were essential. He also offered no testimony as to the specific tests to be
performed or the frequency of those tests. See Christopher C., 2018 IL App (5th) 150301, ¶ 19.
As such, we agree with the parties that the State did not provide clear and convincing evidence
that the requested tests were essential to the safe and effective administration of the treatment.
¶ 41 F. Dosages and Individuals Authorized to Administer Medications
¶ 42 Finally, H.P. contends that the order did not conform to the evidence at the hearing with
respect to the dosages authorized or the individuals authorized to administer medication to him.
More specifically, he argues that the portions of the order specifying the dosages of medication
to be administered and designating individuals other than Dr. Reddy as alternates authorized
to administer medication do not conform to the evidence because the State presented no
evidence on either of these matters at trial. The State concedes that it did not present evidence
concerning the anticipated dosages or individuals authorized to administer medications. We
agree.
¶ 43 The statute governing involuntary administration of psychotropic medication requires
courts to “specify the medications and the anticipated range of dosages that have been
authorized” and to “designate the persons authorized to administer the treatment.” 405 ILCS
5/2-107.1(a-5)(6) (West 2014). The statute does not require the State to provide the court with
clear and convincing evidence of either the range of dosages of medication to be administered
or the individuals who will be authorized to administer the medications. Christopher C., 2018
IL App (5th) 150301, ¶¶ 23-24. However, the Fourth District has held that the State must
present at least some evidence of the range of dosages (In re A.W., 381 Ill. App. 3d 950, 959
(2008)), a holding this court has cited with approval (see Christopher C., 2018 IL App (5th)
150301, ¶ 23), and this court has held that the State must provide at least some evidence
regarding the individuals authorized to administer medications (id. ¶ 24).
¶ 44 In A.W., the Fourth District explained that, although the State is not required to provide
clear and convincing evidence to establish either the specific medications to be administered
or the anticipated dosages of these medications, the medication to be administered is a
“necessary component” of the evidence required to prove that the benefits of treatment
outweigh the harm. (Internal quotation marks omitted.) A.W., 381 Ill. App. 3d at 958-59
(quoting Louis S., 361 Ill. App. 3d at 781, quoting In re Len P., 302 Ill. App. 3d 281, 286
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(1999)). The court explained that, for this reason, it had previously held that the State must
provide at least some evidence of the types of medication to be administered. Id. (citing Louis
S., 361 Ill. App. 3d at 781, citing Len P., 302 Ill. App. 3d at 286). The court found that the
same rationale required the State to provide evidence of the anticipated dosages as well. Id. at
959. The court went on to hold that, unless the trial court either takes judicial notice of the
dosages specified in the petition or admits the petition into evidence for the purposes of
establishing the requested dosages, the State must present testimony on this matter. Id.
¶ 45 At the hearing in this matter, Dr. Reddy did not testify to the ranges of dosages he intended
to administer. Although the petition was “made a part of the record” at the State’s request, it
was not specifically entered into evidence for purposes of establishing the requested dosages.
We therefore agree that the ranges of dosages specified in the petition were not supported by
any evidence.
¶ 46 We reach the same conclusion with respect to the individuals authorized to administer
medications to H.P. In Christopher C., this court held that the State must present evidence
about each individual it asks the court to authorize to administer medication. Christopher C.,
2018 IL App (5th) 150301, ¶ 24. We emphasized that the Mental Health and Developmental
Disabilities Code requires that patients receive “adequate and humane care” provided by
“qualified professional[s]” (Internal quotation marks omitted.) Id. (quoting 405 ILCS 5/2-
102(a), (a-5) (West 2014)). We explained that at least some evidence about each of the
individuals authorized to administer medications is necessary to “ ‘ensure that only a limited
number of designated—and presumably well-trained—individuals will be able to administer
these powerful drugs *** to an unwilling recipient.’ ” Id. (quoting In re Miller, 301 Ill. App.
3d 1060, 1072 (1998)). Ensuring that a limited number of qualified individuals may
involuntarily administer medications is the principal purpose of the requirement that the court
designate specific individuals in its order. In re Cynthia S., 326 Ill. App. 3d 65, 69 (2001);
Miller, 301 Ill. App. 3d at 1072. This requirement also ensures that the medications are
administered by “qualified professional[s] familiar with [the] respondent’s individual situation
and health status.” Cynthia S., 326 Ill. App. 3d at 68-69.
¶ 47 With these principles in mind, we found that the evidence presented in Christopher C.
supported the order authorizing Christopher’s treating psychiatrist, Dr. Vallabhaneni, to
administer medications to Christopher. Christopher C., 2018 IL App (5th) 150301, ¶ 25. The
relevant evidence consisted of Dr. Vallabhaneni’s testimony that he was Christopher’s treating
physician and his testimony that he wanted to administer the proposed treatment. However, we
found that there was no evidence to support authorizing any of the other individuals designated
in the order. Id.
¶ 48 Similarly, in this case, Dr. Reddy testified that he was H.P.’s treating psychiatrist and that
he determined that H.P. would benefit from the proposed treatment. However, he did not
provide any testimony related to any of the other individuals authorized to administer the
medications. Here, unlike in Christopher C., H.P. provided some relevant testimony about two
of those individuals. He testified that he had been seen by many doctors at Chester, including
Dr. Gupta and Dr. Tiongson, two of the individuals who were authorized to administer
medication to him. He also testified that Dr. Tiongson previously prescribed medications for
him. It is not clear how familiar Dr. Gupta was with H.P.’s ongoing care, and there was no
evidence at all concerning any of the other individuals authorized to administer medications to
H.P. in the court’s order. Under Christopher C., the evidence supported an order authorizing
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Dr. Reddy and Dr. Tiongson to administer medication to H.P. but did not support authorizing
any of the other designated individuals. We therefore agree with the parties that authorization
of those individuals to administer medications was not supported by the evidence.
¶ 49 III. CONCLUSION
¶ 50 For the foregoing reasons, we reverse the court’s order authorizing the involuntary
administration of psychotropic medication and other tests and procedures to H.P.
¶ 51 Reversed.
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