Atty Ditkowsky has brought to my attention a great new case from the Illinois Court of Appeals — In re Tiffany (posted below) where the Ill. Ct. of Appeals made it clear that procedure in court must be followed and not ignored; and yesterday in the Sykes case, Judge Stuart, at the end of the hearing on voiding the Apportionment agreement and the issues of Mary’s incompetency will be delayed until after the court rules on the jurisdictional requirements having been met in the Sykes case.
That’s a very, very smart decision by the court. It is likely the best decision that Judge Stuart has made in this case, and one that Judge Connors should have made long ago. It looks like Judge Stuart “gets it”. If further looks like why didn’t CF and AS file a Motion to Dismiss for Lack of Jurisdiction (Sodini notices) long ago and end the (unfair) reign of terrorism on the Sykes family, and in particular, Gloria.
I am very glad that the case is now moving along on the proper basis. As soon as I get a copy of the order, I will publish it.
Ken has some very important words of wisdom below also.
Kind Regards to all of you in Probate,
2012 IL App (1st)102492-B
September 21, 2012
In re TIFFANY W., Alleged to be a Person ) Appeal from the
Subject to Involuntary Administration of ) Circuit Court of
Psychotropic Medication ) Cook County.
(The People of the State of Illinois, ) No. 10 COMH 1713R
) Honorable Robert W. Bertucci,
v. ) Judge Presiding.
Tiffany W., ))
JUSTICE HALL delivered the judgment of the court, with opinion.
Justices Hoffman and Rochford concurred in the judgment and opinion.
O P I N I O N
¶ 1 In her original appeal to this court, respondent Tiffany W. challenged the July 29, 2010,
order of the circuit court of Cook County, which found her to be a person subject to involuntary
administration of psychotropic medication under section 2-107.1 of the Mental Health and
Developmental Disabilities Code (Mental Health Code) (405 ILCS 5/2-107.1 (West 2008)). On
appeal, she contended that: (1) the State did not comply with the notice requirements under
section 2-102(a-5) of the Mental Health Code (405 ILCS 5/2-102(a-5) (West 2008)); and (2) the
State failed to establish the elements necessary to administer medication to a non-consenting
person. In response, the State argued that the appeal was moot because the July 29, 2010, order
had expired. We agreed with the State and dismissed the appeal. See In re Tiffany W., 2011 IL
App (1st) 102492-U.
¶ 2 On July 17, 2012, our supreme court denied leave to appeal but issued a supervisory order
directing this court to vacate our order dismissing the appeal as moot, reinstate the appeal and
consider the case on the merits. In re Tiffany W., No. 113839 (Ill. July 17, 2012). In accordance
with the supervisory order, we vacate our prior order and address the merits of the issues raised
on appeal. The relevant facts are not in dispute.
¶ 3 Respondent Tiffany W. was 39 years old at the time of these proceedings and an Army
veteran. She was previously diagnosed with schizophrenia and suffers from delusions and
paranoia. She had been hospitalized on numerous occasions, including at least three admissions
within the year preceding the hearing. As the result of a fall from a ninth-story window when she
was 32 years old, respondent Tiffany W. suffered permanent damage to her brain and spine. She
is confined to a wheelchair and suffers from quadraparesis and dysarthria. Tiffany W., 2011 IL
App (1st) 102492-U, ¶ 3.
¶ 4 In 2009, respondent Tiffany W. stopped taking her psychotropic medication. Thereafter,
her behavior and demeanor diminished, resulting in delusions, including the belief that she is
either a man or God, frequent outbursts involving inappropriate and abusive language, and a
decreased ability to care for her own hygiene or health. Dr. Sean M. Blitzstein, respondent
Tiffany W.’s treating psychiatrist, filed a petition seeking an order for the involuntary
administration of psychotropic medication in order to treat respondent Tiffany W.’s illness and to
improve her quality of life. Tiffany W., 2011 IL App (1st) 102492-U, ¶ 4.
¶ 5 At the hearing on the petition, testimony from Larry W., respondent Tiffany W.’s father,
and Dr. Blitzstein, her treating psychiatrist, revealed that when respondent Tiffany W. took her
psychotropic medication, she was able to live in her own residence with the assistance of
caregivers. Without psychotropic medication, she became agitated easily and delusional and
generally was unable to care for herself. Dr. Blitzstein opined that respondent Tiffany W. did
not have the capacity to decide for herself whether to take or refuse the medication. Tiffany W.,
2011 IL App (1st) 102492-U, ¶¶ 3-4.
¶ 6 Following the hearing, the circuit court granted the petition and ordered the administration
of psychotropic medication to respondent Tiffany W.
¶ 7 ANALYSIS
¶ 8 On appeal, respondent Tiffany W. contends that the State’s failure to comply with the
written notice requirement under section 2-102(a-5) of the Mental Health Code requires reversal
of the circuit court’s order. She further contends that the State failed to establish the elements
necessary to administer medication to a nonconsenting person.
¶ 9 I. Standards of Review
¶ 10 Whether there was substantial compliance with a statutory provision presents a question
of law, which we review de novo. In re Nicholas L., 407 Ill. App. 3d 1061, 1072 (2nd Dist.
2011). A reviewing court will not reverse a trial court’s determination as to the sufficiency of the
evidence unless it is against the manifest weight of the evidence. In re Laura H., 404 Ill. App. 3d
286, 290 (4th Dist. 2010). A judgment is against the manifest weight of the evidence only where
the opposite conclusion is apparent or where the findings appear to be unreasonable, arbitrary, or
not based on the evidence. Laura H., 404 Ill. App. 3d at 290.
¶ 11 II. Discussion
¶ 12 We begin by reviewing the pertinent portions of the Mental Health Code. Psychotropic
medication may not be administered involuntarily to an adult respondent who is receiving mental
health services, unless it has been established by clear and convincing evidence that all of the
following factors are present:
A. The respondent has a serious mental illness.
B. Because of said mental illness, the respondent currently exhibits: deterioration of
his or her ability to function, as compared to the respondent’s ability to function prior to
the current onset of symptoms of the mental illness for which treatment is presently
sought; suffering; or threatening behavior.
C. The illness has existed for a period marked by the continuing presence of the
symptoms set forth above or repeated episodic occurrence of these symptoms.
D. The benefits of the treatment outweigh the harm.
E. The recipient lacks the capacity to make a reasoned decision about the treatment.
F. Other less restrictive services have been explored and found inappropriate.
G. Any testing or other procedures for which authorization is sought are essential for
the safe and effective administration of the treatment.
See 405 ILCS 5/2-107.1(a-5)(4) (West 2008). “Clear and convincing evidence” is “that quantum
of proof that leaves no reasonable doubt in the mind of the fact finder about the truth of the
proposition in question.” In re John R., 339 Ill. App. 3d 778, 781 (5th Dist., 2003). Clear and
convincing evidence is considered to be more than a preponderance but less than is required to
convict an individual of a criminal offense. John R., 339 Ill. App. 3d at 781.
¶ 13 Before a respondent can make a reasoned decision about medication, he first must be
advised as to the risks and benefits of the proposed course of medication. In re Louis S., 361 Ill.
App. 3d 774, 780 (4th Dist. 2005). Section 2-102(a-5) of the Mental Health Code provides in
pertinent part as follows:
“If the services include the administration of ***psychotropic medication, the physician
or the physician’s designee shall advise the recipient, in writing, of the side effects, risks,
and benefits of the treatment, as well as alternatives to the proposed treatment, to the
extent such advice is consistent with the recipient’s ability to understand the information
communicated.” 405 ILCS 5/2-102(a-5) (West 2008).
¶ 14 The requirements of section 2-102(a-5) are to “ensure that a respondent is fully informed,
but also ‘to ensure that a respondent’s due process rights are met and protected.’ ” Nicholas L.,
407 Ill. App. 3d at 1072 (quoting John R., 339 Ill. App. 3d at 784). Strict compliance is
necessary for the protection of the respondent’s fundamental liberty interest in refusing invasive
medication. Nicholas L., 407 Ill. App. 3d at 1072. “Verbal notification is insufficient and the
right to receive written notification under section 2-102(a-5) cannot be waived by a respondent.”
Nicholas L., 407 Ill. App. 3d at 1072; see John R., 339 Ill. App. 3d at 784 (written notification is
particularly important where the respondent refuses to discuss the risks and benefits of the
medications with his doctor).
¶ 15 The petition stated in pertinent part as follows:
“The patient was provided in writing the risks, benefits and side effects of each of the
medications requested, as well as alternatives, by Dr. Rishi Kumar, PGY-2 Psychiatric
Resident. This was done on June 11, 2010 and documented in the VA charting system.
The patient became agitated, refusing to read or discuss them, but they were left in the
patient’s room. The patient was again given written information about the risks, benefits,
and side effects of each of the medications requested on July 29, 2010, by Dr. Blitzstein.”
At the hearing, Dr. Blitzstein was questioned by the assistant State’s Attorney as follows:
“Q. Doctor, has the respondent been given written information regarding each of the
medications you’re seeking including the risks and benefits of each medication?
A. Yes, she has. She has been given it on two occasions. On June 11th by my
resident, who was working with me at the time, and also today.
Q. By who?
A. Oh, by me today.”
¶ 16 The reference in Dr. Blitzstein’s petition to “alternatives” indicates written notification as
to alternative medications but not as to any nonmedical treatment options. See Nicholas L., 407
Ill. App. 3d at 1073 (knowledge of alternative medications did not address other medical options
or nonmedical treatment alternatives). The State did not call Dr. Kumar to testify, and Dr.
Blitzstein only referred to written notification of the risks and benefits of the medication, not
written notification of the treatment alternative options, in his testimony. The circuit court did
not make a finding that the State had complied with the written notification requirement. We
conclude that the State failed to comply with section 2-102(a-5) of the Code.
¶ 17 Case law from other appellate districts holds that the failure to comply with the
requirements of section 2-102(a-5) compels reversal of an order for the involuntary
administration of psychotropic medication. See Nicholas L., 407 Ill. App. 3d at 1073. In Laura
H., the reviewing court determined that the State failed to comply with section 2-102 (a-5) where
the documents did not address the risks, benefits or alternatives. Because the State failed to
present any evidence that the respondent was informed in writing of the risks and benefits of the
proposed treatment, as well as alternatives to the proposed treatment, the court held the
involuntary treatment order was against the manifest weight of the evidence. Laura H., 404 Ill.
App. 3d at 290-91. In Louis S., the State’s failure to present evidence that the respondent was
informed of the risks and benefits of the proposed medication required reversal of the order.
Louis S., 361 Ill. App. 3d at 780 (citing John R., 339 Ill. App. 3d at 783).
¶ 18 This district has not addressed the precise issue raised by respondent Tiffany W., i.e.,
whether the failure to provide the respondent with written information as to alternative treatment
options requires reversal. In Nicholas L., the appellate court noted the absence of cases where an
order for the involuntary administration of medication was reversed solely on the basis of the
failure to provide written notification of the alternative treatment options to the respondent but
concluded that reversal in such cases was required. In reaching that determination, the court was
guided by the holding in John R., that “the failure to provide written notice compelled reversal
because the ‘Code’s procedural safeguards are not mere technicalities but essential tools to
safeguard [a respondent’s] liberty interests.’ ” Nicholas L., 407 Ill. App. 3d at 1073 (quoting John
R., 339 Ill. App. 3d at 785). Because the “law is clear that failure to strictly comply with the
[Mental Health] Code’s written notification requirements in general compels reversal,” the court
held that “failure to provide written notification of alternative treatment options compels
reversal.” Nicholas L., 407 Ill. App. 3d at 1073.
¶ 19 The court in Nicholas L. also rejected the State’s argument that the respondent was
required to prove that he was prejudiced by the failure to comply with the written notification
requirements of section 2-102(a-5). The court pointed out that the harmless-error rule did not
apply in right-to-written notification cases. Nicholas L., 407 Ill. App. 3d at 1074 (citing In re
A.W., 381 Ill. App. 3d 950, 957 (4th Dist. 2008)). However, this district has recognized that the
failure to strictly comply with even mandatory provisions of the Mental Health Code can be
harmless error. In re Karen E., 407 Ill. App. 3d 800, 812 (2011) (citing In re Nau, 153 Ill. 2d
¶ 20 In Nau, the supreme court determined that a defect in the notice of hearing required by
section 3-611 of the Mental Health Code (Ill. Rev. Stat. 1989, ch. 91½, ¶ 3-611) did not warrant
reversal. The court determined that the respondent forfeited the error by failing to raise the issue
in the trial court. Even if the court had considered the error, the respondent received actual
notice of the hearing, which allowed him an opportunity to prepare for and be heard at the
hearing, thus satisfying the purposes behind section 3-611. Nau, 153 Ill. 2d at 418-19. Likewise,
in Karen E., this court found that the failure to provide the verbatim transcript of the proceedings
required by section 3-817 of the Mental Health Code (405 ILCS 5/3-817 (West 2008)) caused no
prejudice where the parties agreed to a stipulated statement of the facts from the proceeding.
Karen E, 407 Ill. App. 3d at 812.
¶ 21 Unlike in Nau or Karen E., the purposes behind section 2-102(a-5) were not satisfied in
this case. Not only must a respondent be fully informed, but compliance with section 2-102(a-5)
is necessary to ensure that a respondent’s due process rights are met and protected. Nicholas L.,
407 Ill. App. 3d at 1072. Strict compliance with procedural safeguards is required because the
respondent’s liberty interests are involved. Louis S., 361 Ill. App. 3d at 780. Unlike in Nau, the
legislative purposes of section 2-102 (a-5) were not achieved in this case. Requiring strict
compliance with the written notification requirement is a necessity and not merely a formality, in
this case. Compare Nau, 153 Ill. 2d at 419. Therefore, the error is not forfeited.
¶ 22 Moreover, in light of the second issue raised by respondent Tiffany W., the failure to
comply with section 2-102 (a-5) is not harmless error because it goes to whether the State proved
one of the necessary elements of section 107.1(a-5)(4) of the Mental Health Code. In In re Linda
K., 407 Ill. App. 3d 1146 (4th Dist. 2011), the reviewing court reversed the order requiring the
involuntary administration of medication to the respondent. The court agreed with the
respondent that the State failed to prove by clear and convincing evidence that she lacked the
capacity to make a reasoned decision about the proposed treatment because she was not provided
with the “statutorily mandated written information about the side effects, risks, benefits, and
alternatives of the proposed treatment. Linda K., 407 Ill. App. 3d at 1153. Likewise in the
present case, absent its compliance with section 2-102(a-5), the State failed to prove by clear and
convincing evidence that Tiffany W. lacked the capacity to make a reasoned decision about the
proposed treatment. Therefore, the State failed to satisfy all of the necessary elements of section
2-107.1(a-5)(4) of the Mental Health Code.
¶ 23 CONCLUSION
¶ 24 The State’s failure to comply with the written notification requirement of section 2-102(a-
5) of the Mental Health Code requires that we reverse the July 29, 2010 order, requiring the
involuntary administration of psychotropic medication to respondent Tiffany W.
¶ 25 The judgment of the circuit court is reversed.
¶ 26 Reversed.