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, 2023 IL App (2d) 210029
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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