People v. Debra B. (In re Debra B.)
| Decision Date | 31 May 2016 |
| Docket Number | No. 5–13–0573.,5–13–0573. |
| Citation | 404 Ill.Dec. 116,55 N.E.3d 212 |
| Parties | In re DEBRA B., Alleged to Be a Person Subject to Involuntary Treatment With Psychotropic Medication (The People of the State of Illinois, Petitioner–Appellee, v. Debra B., Respondent–Appellant). |
| Court | United States Appellate Court of Illinois |
Barbara A. Goeben, Staff Attorney, Veronique Baker, Director, Legal Advocacy Service, Guardianship and Advocacy Commission, Alton, IL, for Appellant.
Thomas D. Gibbons, State's Attorney, Madison County Courthouse, Edwardsville, IL; Patrick Delfino, Director, Stephen E. Norris, Deputy Director, Whitney E. Atkins, Staff Attorney, Office of the State's Attorneys Appellate Prosecutor, Vernon, IL, for Appellee.
¶ 1 The respondent, Debra B., appeals a trial court order authorizing the involuntary administration of psychotropic medication to her. See 405 ILCS 5/2–107.1 (West 2012). She argues that the State failed to prove by clear and convincing evidence that (1) she was suffering as a result of her mental illness; or (2) her ability to function had deteriorated since the onset of her symptoms. She also argues that the State failed to prove that she was unable to make a reasoned decision regarding the medications because the record does not establish that she was informed about alternatives to medication. The State argues that we should dismiss this appeal because it is moot. We find that review is appropriate under the public-interest exception to the mootness doctrine, and we reverse the trial court's order.
¶ 2 Debra B. has a lengthy mental health history. Although the record does not contain a detailed history, Debra's treating psychiatrist indicated that Debra was previously admitted for treatment in a mental health facility multiple times, including both voluntary and involuntary admissions. She was first admitted to a facility in the mid–1980s. There was some evidence to suggest that she was able to function reasonably well between hospitalizations, at least some of the time. She testified that she owned her own home, raised a daughter alone, and cared for her elderly mother and several pets.
¶ 3 In 2013, Debra B. was found unfit to stand trial on a charge of aggravated battery. On October 2, 2013, she was admitted to the forensic unit at Alton Mental Health Center (Alton). Her previous admissions were all to the civil unit. On October 21, Dr. Jagannath Patil became Debra's treating psychiatrist. On October 25, he filed a document with the trial court entitled “petition and affidavit for involuntary administration of psychotropic medication.”
¶ 4 On November 5, 2013, the court held a hearing on the petition. Dr. Patil testified that Debra B. had been diagnosed with bipolar disorder, manic with psychotic symptoms. He explained that her symptoms included racing thoughts, pressured speech, increased psychomotor activity, florid mania, and grandiose delusions. Among her delusions, Debra believed that she was a home-educated medical doctor, the queen of Czechoslovakia, and “smarter than anyone around.” Dr. Patil testified that Debra had a history of asthma, head trauma, and substance abuse. He noted that he did not know her entire medical history.
¶ 5 Dr. Patil testified that Debra was sleeping adequately since he began administering medication to her on an emergency basis. He did not provide any information concerning how little sleep she was getting prior to being medicated, nor did he provide any information on how this affected Debra.
¶ 6 Dr. Patil was asked if he believed that Debra B. had experienced a deterioration in her ability to function. See 405 ILCS 5/2–107.1(a–5)(4)(B)(i) (West 2012). He responded, “Yes.” Asked to elaborate, Dr. Patil testified that she engaged in intrusive behavior towards staff and other patients. He explained, “She has been into everyone's business on the unit.” Asked to be more specific about Debra being intrusive and “into the business” of other patients, Dr. Patil stated, He testified that Debra accused other patients “of phone sex and things.” He noted that these behaviors had improved with the administration of medication on an emergency basis.
¶ 7 Dr. Patil was then asked if he believed that Debra B. was suffering. See 405 ILCS 5/2–107.1(a–5)(4)(B)(ii) (West 2012). He replied, “Yes, she is.” Asked to explain why he believed Debra was suffering, he explained, Dr. Patil noted that Debra “writes numerous papers” which “indicate that she is suffering.” He stated that she was “incessantly writing.” He then described the content of some of Debra's writings. We note that the writings themselves were not admitted into evidence, and it is not clear from Dr. Patil's testimony whether he was reading from these writings as he testified or describing them from memory.
¶ 8 Dr. Patil first described a paper Debra wrote which was received by a staff member on October 17, 2013. In it, Debra wrote, The letter went on to recite some of the Ten Commandments. It ended, It was signed by “God.” Dr. Patil described another letter from the same date. In it, Debra wrote, “God is love.” She went on to write, The letter was signed, “The Mother of the Holy Ghost.” Dr. Patil next described an October 18 letter in which Debra wrote,
This letter was signed,
¶ 9 Dr. Patil next described an October 23 letter Debra wrote to Prince William and Kate Middleton congratulating them on the christening of their son. She wrote, “I wish I could be there to give little George Alexander gifts,” and, “Tell Dad hello.” She signed the letter as “Queen Debra of Czechoslovakia.” In a postscript, she stated that she hoped to see Prince George before he learned to walk, that it was difficult for her to keep in touch because she had no computer, and that her mother had undergone eye surgery the previous week.
¶ 10 Finally, Dr. Patil described an October 23 letter Debra wrote to the St. Louis Cardinals. In it, she wrote, “I just want the Cardinals to absolutely know that they are unconquerable.” She also wrote, Dr. Patil indicated that Debra asked staff members to mail this letter to the Cardinals.
¶ 11 Dr. Patil was asked, “So these letters * * * cause you to understand that she is suffering?” He replied, “She is suffering.”
¶ 12 Dr. Patil was next asked about Debra B.'s ability to make a reasoned decision about whether to take medication. See 405 ILCS 5/2–107.1(a–5)(4)(E) (West 2012). He testified that she was not able to make a reasoned decision because she did not believe that she had a mental illness. He acknowledged that, although Debra did not recognize that she suffers from bipolar disorder, she did recognize that she suffers from posttraumatic stress disorder and that she had been diagnosed with head trauma. Dr. Patil indicated that he explained to Debra the benefits and risks of all of the medications he proposed administering to her. He also provided her with written information about the medications. He acknowledged that Debra was well-educated and of normal to above normal intelligence. He further acknowledged that she was capable of reviewing this information. Dr. Patil noted that Debra had been given several different types of psychotropic medications in the past. Notably, however, Dr. Patil did not testify either that he discussed alternative forms of treatment with Debra or that he provided her with any written information regarding alternative forms of treatment.
¶ 13 Dr. Patil testified that less restrictive forms of treatment—such as therapy, education, and redirection—had been attempted unsuccessfully. He acknowledged that Debra willingly participated in these types of treatment. However, he opined that these treatment options would only be effective if used in conjunction with medication. He further noted that counseling in a group setting was not appropriate for Debra because of the severity of her symptoms.
¶ 14 Dr. Patil testified that Debra B. had not exhibited any threatening behaviors since being admitted to Alton. See 405 ILCS 5/2–107.1(a–5)(4)(B)(iii) (West 2012). He noted, however, that she “put her[self] in a dangerous situation because of many behaviors” involving “getting in the business” of other patients. He further noted that while she was at the St. Clair County jail prior to her admission, Debra exhibited “suicidal ideations and manic symptoms” and “threatened the officer and his family.”
¶ 15 Debra B. also testified. She stated that she had no desire to harm anyone, including herself. She was aware that she had been diagnosed with posttraumatic stress disorder and head trauma. She stated, however, that she was “not suffering from it at this time.” In addition, Debra denied that she suffered from bipolar disorder. She testified that she was involuntarily admitted to Alton in 1996 only because her husband “ made [her] look bipolar” because he did not want her “to take anything that [she] had worked for.” Debra testified that she was willing to participate in therapy. She further testified that she considered writing to be a form of therapy, noting that she kept a journal.
¶ 16 Debra B. explained her unwillingness to take medication as follows: ...
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