In re Commitment of Daniel A.

2023 IL App (2d) 210029
Nos. 2-21-0029 & 2-21-0030 cons.
Opinion filed January 20, 2023
______________________________________________________________________________

IN THE

APPELLATE COURT OF ILLINOIS

SECOND DISTRICT
______________________________________________________________________________

In re DANIEL A., Alleged to Be a Person) Appeal from the Circuit Court
Subject to Involuntary Admission ) of McHenry County.
and Involuntary Medication )
) Nos. 20-MH-11
) 20-MH-12
)
(The People of the State of Illinois, ) Honorable
Petitioner-Appellee, v. Daniel A., ) James S. Cowlin,
Respondent-Appellant). ) Judge, Presiding.
______________________________________________________________________________

JUSTICE HUTCHINSON delivered the judgment of the court, with opinion.
Presiding Justice McLaren and Justice Jorgenson concurred in the judgment and opinion.

OPINION

¶1 Respondent, Daniel A., appeals from the judgment of the trial court involuntarily

committing him to emergency inpatient admission at Northwestern Medicine Woodstock Hospital

(Northwestern) and involuntarily administering psychotropic medication. Respondent contends

that the petition for involuntary admission (No. 20-MH-11) and the petition for involuntary

medication (No. 20-MH-12) were heard in the same hearing, in violation of section 2-107.1(a-

5)(2) of the Mental Health and Developmental Disabilities Code (Code) (405 ILCS 5/2-107.1(a-

5)(2) (West 2020)). Additionally, respondent contends that the State failed to file a predispositional

report, which is required to aid the trial court in determining the least restrictive setting for the

respondent’s commitment, in violation of section 3-810 of the Code (id. § 3-810). Lastly,
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respondent contends that he received ineffective assistance when counsel failed to object to the

State’s lack of statutory compliance. For the reasons that follow, we reverse the judgment of the

trial court.

¶2 I. BACKGROUND

¶3 On November 25, 2020, the State sought involuntary inpatient admission of respondent

pursuant to section 3-600 of the Code (id. § 3-600). The petition alleged that respondent is “a

person with a mental illness who because of his or her illness is reasonably expected, unless treated

on an inpatient basis, to engage in conduct placing such person or another in physical harm or in

reasonable expectation of being physically harmed” and that he is “in need of immediate

hospitalization for the prevention of such harm.” These assertions were based on (1) respondent’s

presentation at Northwestern as “paranoid, irritable, argumentative, and verbally aggressive” and

(2) respondent’s own report that he and his father got into an altercation over a cell phone that

respondent was holding. During this altercation respondent pushed his father, who then fell onto

some potted plants and broke a window. Following this incident, respondent intentionally

scratched his own arm several times with his fingernails.

¶4 A hearing took place on December 4, 2020. Respondent’s mother, Nancy, testified that at

the time of the hearing respondent lived with her and her husband, respondent’s father. Nancy first

became concerned with respondent’s behavior approximately nine years ago, when respondent

was a junior in college. Respondent called home a few weeks after winter break and reported he

felt scared because he felt that people were watching him through the windows in his apartment,

he was hearing his computer speak to him, and he was hearing people speak to him through the

computer. Respondent asked his father to visit him, which occurred.

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¶5 After respondent finished school, he returned home to live with his parents. Around

December 2013, Nancy observed respondent stay awake for a couple of days, pace around the

house, speak with a British accent, and drink alcohol. Respondent accused Nancy of having an

affair in 2014, and an argument ensued. Nancy, scared and worried that it would escalate, began

to dial 911 when respondent took her glasses off her face so she could not complete the call. As

the police arrived, respondent went out into the backyard and the police could not find him; no

arrest was made. Respondent worked cleaning houses for a few years after he returned home, and

then he got a job that related to his degree—engineering—in 2018. Respondent lost that job in

February 2020. From that time, Nancy observed that respondent spent a lot of his time pacing both

inside and outside the house, failed to complete tasks, and had conversations and laughed when

there was no one else present.

¶6 On the night of November 23, 2020, respondent became upset with Nancy when she could

not recall the type of car that a neighbor was driving when the neighbor stopped to talk to her

earlier that day. Respondent became argumentative. Respondent’s father took out his phone and

began recording, and respondent grabbed the phone from his father. When his father reached to

take his phone back, respondent pushed him and he fell backwards into a bay window, knocking

over planters. Respondent yelled and screamed at his parents as his father got up from the fall. He

continued ranting, and Nancy was scared by this behavior; she called 911. She managed to stay

calm while on the phone with dispatch and stayed on the phone until the police arrived.

¶7 Nancy noticed a decline in respondent’s behavior from the episode when he was in college

up until the matter resulting in these proceedings. Respondent appeared to cycle between (1) times

of heightened agitation where he paced a lot and (2) times of relative calm where he slept a lot.

Nancy believed respondent needed medical help from doctors while he was in Northwestern, and

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she also believed he should not be released without treatment. She and respondent’s father would

continue to be a resource for him, but she did not want respondent living in her home unless he

was medicated, stable, and receiving professional help.

¶8 Dr. Elizabeth McMasters, an attending psychiatrist and the director of the behavior health

department at Northwestern, testified to her role in treating respondent. McMasters first saw

respondent on November 25, 2020, when he was transferred to Northwestern from a different

hospital where he had been taken by ambulance following the incident at his parents’ home. She

had examined respondent six times since then. During the first exam, he had an elated, elevated

mood, spoke loudly and rapidly, and was irritable, argumentative, and angry about being

hospitalized. McMasters explained that she thought he was presenting in a manic state, but

respondent did not agree with her diagnosis. Respondent talked about his belief that his father was

trying to poison him through their well water and through growing vegetables over a septic field.

McMasters considered such thoughts “delusions” and classified respondent as consistently

grandiose throughout their meetings. During his time at Northwestern, respondent at times had

been quite hostile and verbally aggressive, and at times he had been calm and did not use a raised

voice. Respondent was observed talking, laughing, and conversing with himself.

¶9 As part of his treatment, McMasters reviewed respondent’s behavior and treatment with

other hospital staff, social workers, and other hospital employees and also reviewed his medical

history. Another doctor, Dr. Alkhouri, also met with respondent, and Alkhouri agreed with

McMasters’s assessment. McMasters’s formal diagnosis of respondent was that he has bipolar I

disorder and that he had a manic episode with psychotic features. Due to this, McMasters was

concerned that respondent was at risk of harm to his parents and potentially at risk of harm to

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himself. She classified his prognosis as “very poor” if he was not admitted, meaning respondent

could pose a threat to himself or others.

¶ 10 On petition No. 20-MH-11 (involuntary admission), McMasters considered less restrictive

services for respondent, but she was concerned with his agitated and aggressive behavior at the

emergency room and upon being admitted. Furthermore, because he was not taking medication,

she did not believe it was appropriate to treat him in an outpatient setting. Bipolar mania is a

condition that requires medication intervention and cannot be treated without a medical treatment.

¶ 11 McMasters then testified concerning medication, in case No. 20-MH-12 (involuntary

medication). She testified that she examined respondent six times, for 10 to 15 minutes each time,

and, based upon a reasonable degree of psychiatric certainty, respondent’s mental illness was

causing a deterioration in his ability to function. She believed that he lost his job in engineering

based on his illness. He exhibited threatening behavior and aggression and was drinking heavily,

which impaired his impulse control. McMasters recommended a 90-day period of commitment,

though she thought he likely would not need to stay that long. McMasters sought authorization to

administer three separate medications. The first, haloperidol, was used to treat mania. The second,

paliperidone (brand name Invega), was an antimanic, antipsychotic medication that would be

administered if there was an allergy or adverse reaction to haloperidol. The third, benztropine, was

for medication side effects and would be administered as needed in response to the first two

options. She outlined in detail the dosages and timeline for administering the medication.

McMasters believed the benefits of any of these medications outweighed the risks to respondent,

and both the benefits and the risks were provided to respondent in written form. Respondent did

not believe he had an illness and did not want to take medication. McMasters’s medical opinion

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was that respondent did not understand that he had a mental illness. Further, respondent’s paranoia

and distrust of authority in general interfered with his perception of reality.

¶ 12 On cross-examination, McMasters stated that she did not know whether the State or

respondent’s counsel had access to the notes about respondent since he had been in the hospital.

She received most of her information about respondent’s prior mental health history from Nancy

and stated that he had not been hospitalized before the present case.

¶ 13 Respondent testified that he holds a degree in engineering physics from the University of

Illinois. He began working as a manufacturing engineer in 2018 at an hourly rate of $18 per hour

and later earned a salary of $60,000 per year, which was his salary at the time his employment

ended in February 2020. At the time of the hearing, respondent had one checking account with

more than $2000, and one credit card with an $8000 credit line available. He had a valid driver’s

license and a vehicle in his name for which he owed $1000, but had made payments in advance

and did not have a payment due until March 2021. He had minimal living expenses aside from

food. Respondent occasionally fasted as part of his health routine and practiced yoga. He described

his overall physical health as excellent, and he testified that he rarely drank alcohol, but he did get

intoxicated when he drank, and he used legally purchased marijuana daily.

¶ 14 Respondent met with a psychiatrist when he was in college. The psychiatrist did not

prescribe any medication or make a diagnosis. Respondent recalled “very little” about the

encounter and believed that the psychiatrist did not indicate that she thought respondent had much

of a problem. They discussed his beliefs, which included that he did not generally believe in

antipsychotic medications and that he considered them overprescribed. Respondent was extremely

opposed to taking psychotropic medication. He understood that McMasters believed there were

benefits to the medication, but he was opposed to medication after witnessing the effects on his

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siblings and other patients in the hospital; he believed medication would do him far more harm

than good. If he were released, respondent believed he could get a motel room or ask his sister if

he could spend a few nights at her place.

¶ 15 Respondent recalled the events of November 23, 2020. He had been drinking, he believed

his father was intoxicated and hostile, and he believed his mother was mostly sober. Respondent

picked up his father’s phone, but he said that he did not know why and that it was out of impulse.

His actions angered his father, who cornered him and then reached for his throat. At that point,

respondent pushed him away. His relationship with his parents was strained at times, given that he

was a 30-year-old man living with his parents. Respondent and his parents had arguments, but the

majority of the time their relationship was pretty good. Respondent contributed to the household

by cooking and cleaning. Respondent wanted to have a conversation with his parents and badly

wanted to go home.

¶ 16 After the hearing, the trial court made two separate findings, one as to each particular

petition. It found by clear and convincing evidence that respondent was subject to involuntary

admission on an inpatient basis as a person with a mental illness who, because of his illness (bipolar

I), was reasonably expected to place himself or another in physical harm or in reasonable

expectation of being physically harmed unless he was under direct inpatient treatment. The court

found McMasters to be a credible witness and found that inpatient treatment at Northwestern was

the least restrictive means of treatment. Next, the court found by clear and convincing evidence

that respondent had a serious mental illness (bipolar I) and refused psychotropic medication as

treatment. The court found McMasters’s testimony credible on the matters concerning available

medications. Accordingly, the court ordered the psychotropic medication haloperidol be

administered to respondent, with paliperidone as an alternative and benztropine if necessary. The

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court ordered hospitalization not to exceed 90 days, and the facility director of Northwestern was

ordered to file a treatment plan within 30 days. The matter was continued 30 days for status on the

dispositional report. On January 5, 2021, the petitions for involuntary admission and involuntary

medication were dismissed, as respondent had been released from the hospital. We granted

respondent leave to file a late notice of appeal.

¶ 17 II. ANALYSIS

¶ 18 Initially, we note that this case is moot because the December 4, 2020, order involuntarily

committing respondent expired by its own terms no later than March 4, 2021. See In re Alfred

H.H., 233 Ill. 2d 345, 350 (2009). As a general principle, we will not decide moot questions, give

an advisory opinion, or consider an issue where the outcome will not or cannot be affected no

matter what is decided. Id. at 351. However, there are three exceptions to mootness that apply to

cases involving involuntary commitment. Id. The questions presented when considering whether

an exception to mootness applies are purely legal, and we review legal issues de novo. Id. at 350.

The three exceptions are public interest (id. at 355), harms capable of repetition yet avoiding

review (id. at 358), and collateral consequences (id. at 361). Respondent contends that all three

exceptions apply. Upon review, we determine that the collateral consequences exception applies.

¶ 19 “The collateral consequences exception to mootness allows for appellate review, even

though a court order *** has ceased, because a plaintiff has suffered, or [is] threatened with, an

actual injury traceable to the defendant and likely to be redressed by a favorable judicial decision.”

(Internal quotation marks omitted.) In re L.K., 2019 IL App (1st) 163156, ¶ 19 (quoting In re

Alfred H.H., 233 Ill. 2d at 361). “Application of the collateral consequences exception ‘requires

*** that continuing “collateral consequences” *** be either proved or presumed.’ ” Id.

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Additionally, “[c]ollateral consequences must be identified that could stem solely from the present

adjudication.” (Internal quotation marks omitted.) In re Rita P., 2014 IL 115798, ¶ 34.

¶ 20 Respondent contends that, pursuant to the Professional Engineering Practice Act of 1989,

a person who has been found subject to involuntary admission is affected by collateral legal

consequences affecting his career. 225 ILCS 325/24(b) (West 2020). Pursuant to section 24(b),

“[t]he determination by a circuit court that a registrant is subject to involuntary admission

or judicial admission as provided in the Mental Health and Developmental Disabilities

Code operates as an automatic suspension. Such suspension will end only upon a finding

by a court that the patient is no longer subject to involuntary admission or judicial

admission, the issuance of an order so finding and discharging the patient, and the

recommendation of the Board to the Secretary that the registrant be allowed to resume

practice.” Id.

Respondent’s involuntary commitment serves as an automatic suspension, and although his release

from the hospital renders him eligible to be reinstated, it still obligates him to make an overt request

seeking an affirmative recommendation of the board that he be allowed to resume practice. His

career prospects are clearly impacted.

¶ 21 The respondent in In re Alfred H.H., had multiple prior involuntary commitments as well

as a felony conviction. In re Alfred H.H., 233 Ill. 2d at 363. Therefore, with that respondent’s

established history, there were no new collateral consequences that could be attributed to a single

subsequent involuntary commitment order. Those facts are distinguishable from the present case

where respondent has no prior involuntary commitment orders and no prior professional licensure

suspension. The legal consequence of automatic suspension is directly tied to this adjudication.

Although there are presumably other ways to have one’s license suspended, this particular

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suspension stems solely from these proceedings. Further, as we recognize the considerable effort

in obtaining an engineering physics degree, we are even more attuned to the negative impact that

suspension of the professional license may have on respondent. As we determine that the collateral

consequences exception applies, we need not analyze whether the other exceptions to mootness

apply.

¶ 22 Respondent contends that the trial court erred when it allowed testimony from McMasters

for both the petition for involuntary admission (No. 20-MH-11) and the petition for involuntary

medication (No. 20-MH-12) in the same hearing instead of conducting two separate hearings, as

required by the Code (405 ILCS 5/2-107.1(a-5)(2) (West 2020)). Pursuant to the statute, the

hearing for administration of psychotropic medication “shall be separate from a judicial

proceeding held to determine whether a person is subject to involuntary admission but may be

heard immediately preceding or following such a judicial proceeding.” (Emphasis added.) Id. Here

it is clear that the State requested to continue its questioning of McMasters after it concluded its

examination pertaining to the involuntary admission petition:

“MR. GOODMAN [(ASSISTANT STATE’S ATTORNEY)]: At this time, your

Honor, the State rests with respect to the involuntary admission petition. But as I said, I

have further questions regarding the treatment. So I—

THE COURT: Well, at this point in time, the witness would be tendered to Mr.

Mourelatos for cross examination, unless there is some agreement between you and Mr.

Mourelatos to take Dr. McMasters’ testimony for both petitions and then have Mr.

Mourelatos cross on both. I don’t know how the respondent wants to proceed. Mr.

Mourelatos?

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MR. MOURELATOS [(RESPONDENT’S ATTORNEY)]: Your Honor, for

judicial efficiency, if we can ask Dr. McMasters questions pertaining to the involuntary

treatment and I can collectively then cross examine her.

THE COURT: The that would be fine. The Court would allow that to occur.”

Then, in calling its next witness, Nancy, the State again referred to its examination pertaining to

the involuntary admission petition and the involuntary medication petition:

“THE COURT: All right. Thank you. So then, Mr. Goodman, do you have another

witness to call as pertains to either petition?

MR. GOODMAN: Yes, I do. I would call Nancy ***, your Honor.

THE COURT: All right. And I will bring her in and I assume this is pertaining to

the involuntary admission petition?

MR. GOODMAN: That’s correct. It dovetails into both, your Honor. So if we could

do sort of the same comprehensive testimony for both petitions.

THE COURT: All right. One moment.”

¶ 23 The record shows that the trial court acknowledged the intermingling of the testimony of

witnesses on both petitions and allowed it, without comment or citing any reason to do so. This

indiscriminate allowance is tantamount to ignoring the statutory requirements. Although we are

sympathetic to deviations that were required by the pandemic, in this case, compliance with the

statute was no more burdensome being conducted over Zoom than it would have been in a

courtroom. Recalling a witness via Zoom is arguably less cumbersome than doing so in person,

and a witness who is available virtually would not have to appear in-person, which could consume

many hours of her day.

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¶ 24 The State points to the Third District’s holding in In re Alaka W., 379 Ill. App. 3d 251, 275

(2008), in which it noted its belief that In re Barbara H., 183 Ill. 2d 482, 498 (1998), is “an

expression of the supreme court’s preference for strict compliance with the statutes related to

involuntary commitment and involuntary administration of psychotropic medication.” (Emphasis

added.) In re Alaka W., 379 Ill. App. 3d at 275. The State improperly attributes to the word

“preference” a leniency that we do not believe is intended. In re Alaka goes on to quote In re C.E.,

161 Ill. 2d 200, 214 (1994), stating that “[r]equiring strict compliance with statutory procedural

safeguards is also necessary because of the ‘[f]ederal constitutionally protected liberty interest to

refuse the administration of psychotropic drugs.’ ” In re Alaka, 379 Ill. App. 3d at 275 (quoting

In re C.E., 161 Ill. 2d at 214); see In re Cynthia S., 326 Ill. App. 3d 65, 69 (2001) (“In mental

health cases, strict compliance with statutory provisions is compelling, as liberty interests are

involved. *** [P]rocedural safeguards are not mere technicalities, but essential tools to safeguard

liberty interests ***. [Citation.] *** [P]rocedural safeguards are construed strictly in favor of the

respondent. [Citation.] The failure to comply with procedural rules requires the reversal of court

orders authorizing involuntary treatment.”). In re Alaka, also quotes In re Barbara H., stating that

“[t]he court noted that ‘[b]ecause involuntary administration of mental health services implicates

fundamental liberty interests [citation], statutes governing the applicable procedures should be

construed narrowly’ and held that where those statutes are all but ignored, the appellate court is

correct to reverse the circuit court’s judgments.” In re Alaka, 379 Ill. App. 3d at 274-75 (quoting

In re Barbara H., 183 Ill. 2d at 498). Accordingly, we hold that the statute requiring separate

hearings requires strict compliance and that it was reversible error to allow intermingled testimony

on both petitions, essentially combining the hearings for involuntary commitment and involuntary

medication.

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¶ 25 Respondent next contends that the State’s failure to file a predispositional report, in

violation of the Code, is reversible error. See 405 ILCS 5/3-810 (West 2020). The purpose of the

report is to provide the trial court with pertinent information that will help it determine the least

restrictive means of treatment.

“It is clear from a reading of section 3-810 as a whole that its purpose is to provide

trial judges certain information necessary for determining whether an individual is subject

to involuntary admission to a mental health facility. Other purposes of the statute are to

protect against unreasonable commitments and patient neglect, and to ensure adequate

treatment for mental health care recipients.” In re Robinson, 151 Ill. 2d 126, 133 (1992).

However,

“[w]here a respondent fails to object to the absence of a predispositional report,

strict compliance with section 3-810 is required only when the legislative intent cannot

otherwise be achieved. (See Splett, 143 Ill. 2d at 233-34). Under these circumstances, we

believe that oral testimony containing the information required by the statute can be an

adequate substitute for the presentation of a formal, written report prepared by the facility

director or some other person authorized by the court.” Id. at 134.

¶ 26 First, we note that counsel for respondent made no objection to the absence of the

predispositional report. Therefore, so long as the legislative intent of section 3-810 can be

achieved, the failure to provide this report will not constitute reversible error. See In re E.L., 316

Ill. App. 3d 598 (2000). Second, to determine if the oral testimony of McMasters was sufficient to

accomplish the legislative intent, we consider what information is required in a predispositional

report.

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¶ 27 Pursuant to section 3-810 of the Code, the report shall include (1) information on the

appropriateness and availability of alternative treatment settings, (2) a social investigation of the

respondent, (3) a preliminary treatment plan, and (4) any other information that the court may

order. 405 ILCS 5/3-810 (West 2020). “The treatment plan shall describe the respondent’s

problems and needs, the treatment goals, the proposed treatment methods, and a projected

timetable for their attainment.” Id.

¶ 28 We will address McMasters’s testimony as it applies to the four requirements listed above,

in that order. As to the first requirement, she testified that there was no other treatment setting

available because respondent’s diagnosis required medication, which he refused. As to the second

requirement, McMasters conducted several interviews with respondent since he arrived at

Northwestern and she was familiar with his beliefs concerning his own health; she also received

information about respondent’s family and the impact his behavior and mental illness had on them,

from multiple conversations with Nancy. Finally, she reviewed his prior medical history. As to the

third requirement, McMasters recommended medication to treat respondent’s acute symptoms,

including an alternative and a drug to mitigate any side effects. She prepared a dosage schedule

for those drugs. Lastly, she noted that, although she recommended a 90-day period of commitment,

she expected that less time would be required to treat respondent. Finally, as to the fourth

requirement, the trial court had not ordered any specific information.

¶ 29 We note that the trial court ordered the predispositional report for review at the 30-day

status hearing, but respondent was released by that time. Although having the report at that time

would ensure that the appropriate level of care was being provided to respondent and that inpatient

treatment was still the least restrictive means of treatment, best practice is to have a completed

written report available to the trial court at the earliest possible opportunity.

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¶ 30 Considering that McMasters’s testimony included the appropriateness and availability of

alternative treatment settings and medication and that other testimony concerned respondent’s

social background, the evidence was adequate to advise the trial court of the relevant information

pertaining to the least restrictive means of treatment. The failure to render a predispositional report

was harmless error.

¶ 31 Respondent’s final contention is that he received ineffective assistance when counsel failed

to object to the various departures from statutory requirements. Because we have held that the

allowance of combined testimony for both petitions was in violation of the Code and was reversible

error, counsel’s failure to object to that same violation is deficient performance. Respondent was

prejudiced, as the outcome of the hearing could have been different had these objections been

made. Because we have held that the failure to produce a predispositional report was error,

counsel’s failure to object to this omission was also questionable. However, as the lack of the

predispositional report was harmless error under these circumstances, as respondent was not

prejudiced. Nevertheless, counsel should remain diligent to enforce the statutory directives.

¶ 32 III. CONCLUSION

¶ 33 For the foregoing reasons, the judgment of the circuit court of McHenry County is reversed.

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In re Commitment of Daniel A., 2023 IL App (2d) 210029

Decision Under Review: Appeal from the Circuit Court of McHenry County, Nos. 20-MH-
11, 20-MH-12; the Hon. James S. Cowlin, Judge, presiding.

Attorneys Veronique Baker and Laurel Spahn, of Illinois Guardianship and
for Advocacy Commission, of Hines, for appellant.
Appellant:

Attorneys Patrick Kenneally, State’s Attorney, of Woodstock (Patrick
for Delfino, Edward R. Psenicka, and Diane L. Campbell, of State’s
Appellee: Attorneys Appellate Prosecutor’s Office, of counsel), for the
People.

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