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Date: 2019.01.17
Appellate Court 14:02:01 -06'00'
In re Christopher C., 2018 IL App (5th) 150301
Appellate Court In re CHRISTOPHER C., Alleged to Be a Person Subject to
Caption Involuntary Administration of Psychotropic Medication (The People
of the State of Illinois, Petitioner-Appellee, v. Christopher C.,
Respondent-Appellant).
District & No. Fifth District
Docket No. 5-15-0301
Rule 23 order filed October 18, 2018
Motion to publish
granted November 16, 2018
Opinion filed November 16, 2018
Decision Under Appeal from the Circuit Court of Randolph County, No. 15-MH-74;
Review the Hon. Richard A. Brown, Judge, presiding.
Judgment Reversed.
Counsel on Veronique Baker and Barbara A. Goeben, of Guardianship and
Appeal Advocacy Commission, of Alton, for appellant.
Jeremy R. Walker, State’s Attorney, of Chester (Patrick Delfino,
David J. Robinson, and Chelsea E. Kasten, of State’s Attorneys
Appellate Prosecutor’s Office, of counsel), for the People.
Panel PRESIDING JUSTICE BARBERIS delivered the judgment of the
court, with opinion.
Justice Moore concurred in the judgment and opinion.
Justice Cates dissented, with opinion.
OPINION
¶1 The respondent, Christopher C., appeals from the order of the circuit court of Randolph
County authorizing the involuntary administration of psychotropic medication and testing,
pursuant to section 2-107.1(a-5) of the Mental Health and Developmental Disabilities Code
(Code) (405 ILCS 5/2-107.1(a-5) (West 2014)). The respondent argues that the court’s order
failed to comply with the Code (id. § 2-107.1(a-5)(4)(G), (a-5)(6)) because (1) the State failed
to prove by clear and convincing evidence that the testing and procedures requested in the
petition were essential for the safe and effective administration of the medication and (2) the
court’s designation of specific persons authorized to administer treatment was not supported
by the evidence. In addition, the respondent argues that he was denied effective assistance of
counsel. For the reasons that follow, we reverse.
¶2 I. Background
¶3 The respondent was admitted to the Chester Mental Health Center (CMHC) on May 21,
2015, after he was found unfit to stand trial on a charge for aggravated assault. On July 23,
2015, the respondent’s treating psychiatrist at CMHC, Dr. Nageswararao Vallabhaneni, filed a
petition seeking an order authorizing the involuntary administration of psychotropic
medications and testing, alleging the tests were necessary for the safe and effective
administration of the medications. The petition detailed the primary and alternative
medications, tests, and procedures in three separate tables that Dr. Vallabhaneni recommended
for the respondent. The first table listed two primary medications, specifically, olanzapine and
lorazepam. The second table listed two alternative medications, specifically, risperidone and
clonazepam. The third table indicated that periodic blood draws and tests would be necessary
to monitor the respondent’s medication, electrolyte, and enzyme levels.
¶4 On July 29, 2015, the circuit court held a hearing on the petition. Dr. Vallabhaneni testified
to the following. Dr. Vallabhaneni evaluated and then diagnosed the respondent with psychotic
disorder, not otherwise specified. Because the respondent had a long history of recurrent
symptoms (i.e., threatening and disruptive behavior), Dr. Vallabhaneni opined that the
respondent’s mental illness had resulted in a deterioration of his ability to function.
¶5 Dr. Vallabhaneni described specific occasions where the respondent had displayed
threatening and disruptive behavior. While in jail for the most recent aggravated battery
charge, the respondent refused medication and was placed in isolation after he threatened to
physically harm inmates and staff members. After the respondent was ordered to undergo a
fitness evaluation, he was found unfit to stand trial and remanded to CMHC for treatment.
While at CMHC, the respondent had to be physically restrained in an isolated, quiet room on
several occasions, and during one incident, he was forced to take emergency medication to
control his disruptive behavior. While the respondent denied suffering from a mental illness,
he had voluntarily taken the maximum recommended dose of Seroquel because he believed the
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medication treated anxiety. Despite taking the maximum dose of Seroquel, the respondent
continued to display psychotic and paranoid behaviors. Although Dr. Vallabhaneni advised the
respondent that Seroquel had been ineffective and recommended the administration of
different medications, the respondent refused to consent to the administration of different
medications.
¶6 Dr. Vallabhaneni testified that the respondent lacked the capacity to make a reasoned
decision about his treatment and condition. Dr. Vallabhaneni explained that his opinions and
conclusions were based on the respondent’s denial of his mental illness, limited insight, and
refusal to take medication and participate in a treatment intervention. Dr. Vallabhaneni stated
that the respondent was provided with written documents that listed the alternatives to
medication and provided detailed information about the benefits and potential side effects of
each medication. When asked if, in his medical opinion, the benefits of the listed treatments
and medications far outweighed any harm that could arise from the medications, Dr.
Vallabhaneni responded, “Yes, they do.” After Dr. Vallabhaneni discussed the purpose and
potential side effects of each medication, the State asked Dr. Vallabhaneni whether he sought
the “ability to test so [the psychotropic medications] may be safely administered. Since [the
respondent is] not on the medications yet, you are going to establish a blood level?” Dr.
Vallabhaneni responded, “Yes.” The State then inquired whether Dr. Vallabhaneni had
established a blood level, since the respondent had been taking Seroquel, and Dr. Vallabhaneni
replied, “That is correct.”
¶7 The State admitted the petition into evidence without objection. The written information
that was provided to the respondent was also attached to the petition. The written information
indicated that blood tests “may be needed to check for unwanted effects” from olanzapine and
that “lab tests” would be conducted at regular visits to check the effects of each medication.
¶8 The respondent testified to the following details. He was on permanent physical disability
because he had suffered a leg injury in April 2014. The respondent’s leg injury had been
treated by a medical doctor, as well as several surgeons. The respondent explained that his
medical doctors and surgeons had advised him against taking the medications.
¶9 After considering the testimony and exhibits introduced at the hearing, the circuit court
entered an order for the administration of authorized involuntary treatment, finding the
respondent had a serious mental illness, had exhibited deterioration in his ability to function,
and had exhibited threatening behavior. The court’s order listed olanzapine and lorazepam as
the respondent’s primary medications and risperidone and clonazepam as the respondent’s
alternative medications. Additionally, the court authorized periodic blood draws and tests to
monitor medication, electrolyte, and enzyme levels, finding the tests and procedures essential
for the safe and effective administration of treatment. The order specified that the treatment
would be administered by “N. Vallabhaneni, M.D., Psychiatrist at Chester Mental Health
Center.” The order also stated that the respondent’s alternative psychiatrists would be “the
psychiatric staff at Chester Mental Health Center including: T. Casey; R. Gupta; P. Tiongson;
M. Reddy; M. Galioto; and R. Maitra.” This appeal followed.
¶ 10 II. Analysis
¶ 11 On appeal, the respondent raises three issues in support of his contention that the circuit
court’s order authorizing the administration of involuntary treatment and testing should be
reversed. First, the respondent argues that the State failed to prove by clear and convincing
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evidence that the tests and other procedures ordered by the court were essential for the safe and
effective administration of treatment. Second, the respondent argues that the court’s order
designating specific persons to administer the medication was unsupported by the evidence.
Third, the respondent argues he was denied effective assistance of counsel.
¶ 12 Before addressing the merits of the respondent’s arguments, we must first address the issue
of mootness. “An appeal is considered moot where it presents no actual controversy or where
the issues involved in the trial court no longer exist because intervening events have rendered it
impossible for the reviewing court to grant effectual relief to the complaining party.” In re J.T.,
221 Ill. 2d 338, 349-50 (2006). The present appeal is technically moot because the 90-day
period for the administration of the psychotropic medications authorized by the circuit court’s
order, which was entered on July 29, 2015, has expired. See In re Donald L., 2014 IL App (2d)
130044, ¶ 17.
¶ 13 Reviewing courts generally do not decide moot questions, render advisory opinions, or
consider issues where the result will not be affected regardless of how those issues are decided.
In re Barbara H., 183 Ill. 2d 482, 491 (1998). A reviewing court will review a technically moot
question, however, when the question falls within one of the three recognized exceptions to the
mootness doctrine: (1) the public-interest exception, (2) the capable-of-repetition exception,
and (3) the collateral-consequences exception. Donald L., 2014 IL App (2d) 130044, ¶ 19.
Although no “general exception” to the mootness doctrine exists for mental health cases, most
appeals will usually fall within one of the three established exceptions. In re Alfred H.H., 233
Ill. 2d 345, 355 (2009). The determination whether a case falls within a particular exception
must be made on a case-by-case basis. Id.
¶ 14 While the respondent contends that all three of the exceptions to the mootness doctrine
apply, we need not address his arguments regarding the public-interest and collateral-consequences exceptions because we agree that the capable-of-repetition exception applies.
That exception applies when the respondent shows that (1) the challenged action is of such
short duration that it cannot be fully litigated prior to its cessation and (2) there is a reasonable
expectation that the same complaining party would be subjected to the same action again. Id. at
358. Although the challenged action need not be identical under the second prong of the
exception, the action “must have a substantial enough relation that the resolution of the issue in
the present case would be likely to affect a future case involving [the] respondent.” Id. at 359.
We conclude that the capable-of-repetition exception applies, here, due to the short duration of
involuntary treatment orders and the respondent’s ongoing mental health issues and
unwillingness to take medication. See In re Joseph M., 405 Ill. App. 3d 1167, 1175 (2010). In
so concluding, we note that the respondent raises sufficiency-of-the-evidence claims that may
have no bearing on future proceedings. We will, however, reach the merits of the respondent’s
appeal because his claims also involve issues of statutory compliance that could affect the
outcome of a future case.
¶ 15 Turning to the merits, the respondent first argues that the circuit court’s order violated both
his due process rights and the requirements set forth in the Code because its finding that he was
subject to involuntary administration of psychotropic medication was against the manifest
weight of the evidence. Specifically, he asserts that the State failed to prove, by clear and
convincing evidence, that the tests and other procedures that the court ordered were essential
for the safe and effective administration of the medication.
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¶ 16 Because the involuntary administration of psychotropic medications to individuals alleged
to suffer from mental illness implicates constitutionally protected liberty interests (In re C.E.,
161 Ill. 2d 200, 213 (1994); In re Bobby F.,
2012 IL App (5th) 110214, ¶ 14), the Code sets
forth certain procedural safeguards to protect these substantial liberty interests. In re John R.,
339 Ill. App. 3d 778, 785 (2003). Strict compliance with the procedural safeguards is required
due to the liberty interests involved. Id. at 783-84. When a mental health patient exercises his
or her right to refuse medication or lacks the capacity to make a reasoned decision about the
treatment, the treatment may be administered only pursuant to section 2-107 or 2-107.1 of the
Code. 405 ILCS 5/2-102(a-5) (West 2014). Pursuant to section 2-107.1(a-5), a person may
petition the circuit court for an order authorizing the involuntary administration of
psychotropic medication to a mental health patient. A petitioner seeking authorization for
testing and other procedures must prove, by clear and convincing evidence, “that such testing
and procedures are essential for the safe and effective administration of the treatment.” Id.
§ 2-107.1(a-5)(4)(G).
¶ 17 While this standard may be satisfied through the presentation of expert testimony, expert
opinions alone are insufficient and must be supported with specific facts establishing the bases
for those opinions. In re David S., 386 Ill. App. 3d 878, 883 (2008). The State is required to
present “specific testimony about the requested testing and procedures.” In re Steven T., 2014
IL App (5th) 130328, ¶ 16 (citing David S.,
386 Ill. App. 3d at 883). The testifying
psychiatrist’s affirmation that the testing was requested to ensure the safe and effective
administration of the medication does not satisfy the Code’s requirement of clear and
convincing evidence. In re Larry B., 394 Ill. App. 3d 470, 478 (2009).
¶ 18 Whether there was substantial compliance with a statutory provision is a question of law,
which we review de novo. In re Tiffany W., 2012 IL App (1st) 102492-B, ¶ 10. A reviewing
court will not reverse an order authorizing the involuntary administration of psychotropic
medication unless the circuit court’s order is contrary to the manifest weight of the evidence.
John R., 339 Ill. App. 3d at 781. A ruling is against the manifest weight of the evidence only
when an opposite conclusion is clearly apparent or when the findings appear to be
unreasonable, arbitrary, or not based on the evidence. In re Louis S., 361 Ill. App. 3d 774, 779
(2005).
¶ 19 Here, the State’s presentation of Dr. Vallabhaneni’s testimony at the hearing was
insufficient to meet the clear and convincing standard set forth in the Code. Dr. Vallabhaneni
did not testify that blood tests were essential for the respondent’s treatment. Although Dr.
Vallabhaneni discussed the potential negative side effects associated with each medication, he
failed to relate the potential side effects to the testing requested in the petition. In addition, Dr.
Vallabhaneni offered no specific testimony regarding the procedure or frequency of the
requested blood draws and tests. Instead, he merely provided an affirmative response when
asked whether he sought the “ability to test so [the psychotropic medications] may be safely
administered. Since [the respondent is] not on the medications yet, you are going to establish a
blood level?” As such, Dr. Vallabhaneni’s affirmation did not constitute clear and convincing
evidence that the testing and procedures were essential for the safe and effective administration
of the respondent’s treatment.
¶ 20 While conceding that Dr. Vallabhaneni’s testimony alone was insufficient, the State points
out that the petition and group exhibit were also admitted into evidence at the hearing. The
petition specifically sought authorization for periodic blood draws and tests to monitor the
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medication, electrolyte, and enzyme levels. While the petition stated that the requested tests
and procedures were essential for the safe and effective administration of the respondent’s
treatment, the State failed to present any evidence in support of this conclusion. In fact, the
State’s group exhibit, which included the written information that was provided to the
respondent detailing each medication listed in the petition, indicated only that blood tests “may
be needed to check for unwanted effects” of olanzapine. (Emphasis added.) The written
information pertaining to the other medications indicated only that “lab tests” would be
conducted at regular visits to check the effects of each of the medications. Without more than a
mere conclusion that the requested testing and procedures were essential, the State failed to
provide the clear and convincing evidence required by the Code to administer the requested
tests without the respondent’s consent. See Steven T., 2014 IL App (5th) 130328, ¶ 17. Thus,
the circuit court’s finding that the periodic blood draws and tests were essential for the safe and
effective administration of treatment was against the manifest weight of the evidence.
Although reversal of the court’s order is warranted on this basis alone, we will address the
merits of the respondent’s second argument because it is likely that our resolution of the issue
may affect a future case involving the respondent.
¶ 21 In his second argument, the respondent contends that the circuit court’s order failed to
comply with the Code because its designation of specific persons authorized to administer
treatment was not supported by the evidence presented by the State at the hearing. Section
2-107.1(a-5)(6) of the Code sets forth certain requirements pertaining to court orders
authorizing the involuntary administration of psychotropic medications. 405 ILCS
5/2-107.1(a-5)(6) (West 2014). Specifically, section 2-107.1(a-5)(6) states that the order “shall
designate the persons authorized to administer the treatment under the standards and
procedures” set forth in subsection (a-5). Id. A court’s failure to name specific individuals who
are authorized to administer the medication in the order warrants reversal. In re Cynthia S., 326
Ill. App. 3d 65, 69 (2001). Whether there was substantial compliance with a statutory provision
is a question of law, which we review de novo. Steven T., 2014 IL App (5th) 130328, ¶ 13
(citing Tiffany W., 2012 IL App (1st) 102492-B, ¶ 10). When reviewing the sufficiency-of-the-evidence claim, we will reverse the court’s order only if it is against the manifest weight of the
evidence. In re Cathy M., 326 Ill. App. 3d 335, 341 (2001).
¶ 22 Here, it is undisputed that the circuit court’s order named specific persons authorized to
administer psychotropic medications to the respondent. In particular, the order stated that the
treatment would be administered by “N. Vallabhaneni, M.D., Psychiatrist at Chester Mental
Health Center.” The court’s order also provided that the respondent’s alternative psychiatrists
would be the “psychiatric staff at Chester Mental Health Center,” including the following: T.
Casey, M.D.; R. Gupta, M.D.; P. Tiongson, M.D.; M. Reddy, M.D.; M. Galioto; and R. Maitra,
M.D. The parties’ dispute, instead, centers on what evidence the State is required to present at
the hearing to support the court’s order authorizing these persons to administer the
respondent’s treatment.
¶ 23 While this court is aware of no case precedent specifically addressing this issue, we note
that our colleagues in the Fourth District addressed a similar issue in In re A.W., 381 Ill. App.
3d 950 (2008). In considering the requirement that the circuit court’s order “specify the
medications and the anticipated range of dosages that have been authorized” (405 ILCS
5/2-107.1(a-5)(6) (West 2006)), the Fourth District acknowledged that the Code does not
explicitly require the State to establish by clear and convincing evidence the proposed
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medications and the anticipated range of dosages. A.W., 381 Ill. App. 3d at 958. The Fourth
District noted, however, that the type of medication is a necessary component of section
2-107.1(a-5)(4)(D) and that courts have usually required some evidence of the medications
sought to be administered. Id. at 958-59. Thus, the Fourth District held that the circuit court’s
order must be supported by evidence presented by the State “as to the anticipated range of
dosages of the proposed psychotropic medication.” Id. at 959. In so holding, the Fourth District
rejected the State’s argument that the list of anticipated dosages contained in the petition was
sufficient where the circuit court did not take judicial notice of the anticipated dosages listed in
the petition, the petition was not admitted into evidence for the purpose of establishing the
anticipated dosages, and there was no testimony that the proposed psychotropic medications
were requested in the dosages listed in the petition. Id.
¶ 24 Similarly, here, although the Code does not explicitly require the State to present clear and
convincing evidence as to the individuals authorized to administer the treatment, we conclude
that the State is required to present evidence as to each person who will administer the
involuntary treatment. In so concluding, we note that the Code requires that recipients of
mental health services “be provided with adequate and humane care and services in the least
restrictive environment, pursuant to an individual services plan” (405 ILCS 5/2-102(a) (West
2014)) and provides that “[a] qualified professional shall be responsible for overseeing the
implementation of such plan” (id. § 2-102(a-5)). In addition, section 2-107.1(f) requires
“annual trainings for physicians and registered nurses working in State-operated mental health
facilities on the appropriate use of psychotropic medication” and the standards for using such
medications. Id. § 2-107.1(f). Thus, in our view, the circuit court’s order must be supported by
evidence presented by the State to “ensure that only a limited number of designated—and
presumably well-trained—individuals will be able to administer these powerful drugs,
pursuant to a court order, to an unwilling recipient.” In re Miller, 301 Ill. App. 3d 1060, 1072
(1998).
¶ 25 Based on our review of the evidence, we conclude that the circuit court’s order, authorizing
Dr. Vallabhaneni to administer treatment to the respondent, was supported by Dr.
Vallabhaneni’s testimony. In particular, Dr. Vallabhaneni testified that he was the
respondent’s treating physician and that he sought to administer the medications and dosages
listed in the petition. The State, however, failed to present sufficient evidence to support the
court’s order authorizing the alternative psychiatrists to administer treatment. As in A.W., the
State, here, argues that the court’s order was supported by the petition, which provided a
detailed list of the respondent’s alternative psychiatrists. While the alternative psychiatrists
were individually named in the petition, the court neither took judicial notice of the individuals
named in the petition nor admitted the petition into evidence for the purpose of establishing
that those individuals would be authorized to administer the respondent’s treatment. In
addition, Dr. Vallabhaneni offered no testimony regarding the alternative psychiatrists listed in
the petition. Accordingly, the court should not have authorized those persons to administer the
respondent’s treatment without supporting evidence.
¶ 26 The respondent also argues he was denied effective assistance of counsel. Because of our
resolution of the preceding issues and our determination that the order granting the petition
must be reversed, we need not consider the respondent’s allegations regarding his counsel’s
representation. See Larry B., 394 Ill. App. 3d at 479.
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¶ 27 III. Conclusion
¶ 28 For the foregoing reasons, the order of the circuit court of Randolph County authorizing the
involuntary administration of psychotropic medications and testing is hereby reversed.
¶ 29 Reversed.
¶ 30 JUSTICE CATES, dissenting:
¶ 31 Based upon the circumstances reflected herein, I believe this case is moot, and this appeal
should be dismissed. Inasmuch as my colleagues disagreed and decided the merits of the
appeal, I dissent. In my view, there was sufficient evidence to support the circuit court’s order
authorizing the involuntary administration of psychotropic medication, as allowed by the
Mental Health and Developmental Disabilities Code (405 ILCS 5/2-107.1(a-5) (West 2014)).
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