People v. Mary Ann P.

781 N.E.2d 237, 202 Ill. 2d 393, 269 Ill. Dec. 440, 2002 Ill. LEXIS 955
CourtIllinois Supreme Court
DecidedNovember 21, 2002
Docket92777
StatusPublished
Cited by153 cases

This text of 781 N.E.2d 237 (People v. Mary Ann P.) is published on Counsel Stack Legal Research, covering Illinois Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
People v. Mary Ann P., 781 N.E.2d 237, 202 Ill. 2d 393, 269 Ill. Dec. 440, 2002 Ill. LEXIS 955 (Ill. 2002).

Opinion

JUSTICE FITZGERALD

delivered the opinion of the court:

This appeal concerns the operation of section 2 — 107.1 of the Mental Health and Developmental Disabilities Code (Code) (405 ILCS 5/1 — 100 et seq. (West 2000)). Section 2 — 107.1 permits the circuit court, upon the filing of a petition and following an evidentiary hearing, to enter an order authorizing the administration of involuntary treatment to a recipient of mental health services. The involuntary treatment involved in this case is the administration of psychotropic medication. The issue we consider is whether section 2 — 107.1 requires the use of a special verdict form, so that the jury may “selectively authorize” the involuntary administration of only those medications it deems appropriate. For the reasons discussed below, we conclude that section 2 — 107.1 does not permit selective authorization of psychotropic medication. Accordingly, we reverse the judgment of the appellate court and affirm the judgment of the trial court.

BACKGROUND

On March 13, 2000, the State filed a petition in the circuit court of Kane County, pursuant to section 2 — 107.1 of the Code, seeking an order authorizing the involuntary administration of psychotropic medication to respondent, Mary Ann E, for a period of 90 days. The petition was signed by Dr. Donna Luchetta, respondent’s treating psychiatrist at the Elgin Mental Health Center (EMHC) from December 1998 to June 2000. The petition listed six medications: Zeprexa, Orap, Haldol, Haldol decanoate, Cogentin, and Ativan. On the preprinted petition form, Zeprexa was listed as the “1st choice,” and the other five medications were listed as “Alternatives.” The petition also identified a dosage range for each drug and the tests and procedures necessary for administration of the drugs.

At the hearing on the State’s petition, Dr. Luchetta testified that respondent had been transferred from Northwest Community Hospital to the EMHC on December 28, 1998, and involuntarily admitted on the petition of her mother. This was not the first time respondent had been admitted to the EMHC. According to Dr. Luchetta, respondent suffers from paranoid schizophrenia, a psychotic disorder marked by paranoid and somatic delusions, disorganized thought processes, and impaired social and occupational functioning. Dr. Luchetta described respondent’s delusions and the ways in which her ability to function had deteriorated.

Dr. Luchetta further testified that, beginning in July or August 1999, as the result of a prior court proceeding, respondent was involuntarily administered psychotropic medication. Prolixin was initially administered but was discontinued after it caused parkinsonism, a temporary syndrome characterized by symptoms similar to those associated with Parkinson’s disease. In late August 1999, Zeprexa was administered, which lessened respondent’s delusions. In September 1999, Orap was also administered, which significantly diminished respondent’s delusions. While medicated, and for a short time afterwards, respondent was pleasant, appropriate, and well-engaged. Respondent was able to participate successfully in EMHC workshops. She was no longer agitated, hostile, intrusive, or argumentative. Respondent told Dr. Luchetta that she felt better. Toward the end of the involuntary medication period in October 1999, respondent told Dr. Luchetta that she would like a trial period without medication. Subsequently, in November 1999, her medications were tapered off. On several occasions thereafter, Dr. Luchetta recommended that respondent resume medication. Respondent refused every treatment recommendation, and by March 2000 she was again psychotic and delusional. At the time of the hearing, respondent was unable to work and provide for her own basic needs.

Dr. Luchetta testified at length about the benefits and potential side effects of each medication listed in the petition. Dr. Luchetta stated that Zeprexa was her “first choice” in medication. She explained that Zeprexa is a relatively new atypical antipsychotic drug that resolves psychosis by changing the balance of natural substances in the nervous system, particularly dopamine. Fossible side effects include weight gain, constipation, dry mouth, hypotension, and a movement disorder known as tardive dyskinesia. Dr. Luchetta’s second medication choice was Orap. Although Orap is prescribed primarily for the treatment of Tourette’s Syndrome or tic disorders, it also resolves psychosis by decreasing the amount of dopamine in the system. Orap can also induce tardive dyskinesia. Dr. Luchetta testified that, during the period in 1999 when respondent was being treated with Zeprexa and Orap, she experienced minimal side effects and did not exhibit any signs of tardive dyskinesia.

The next two medications fisted in the petition were Haldol, a typical antipsychotic medication, and Haldol decanoate, the injectable form of Haldol. Dr. Luchetta testified that Haldol decanoate can last up to four weeks in the patient’s system and is beneficial in cases where the patient is unwilling to take medication on a daily basis. Haldol can produce significant side effects, including tardive dyskinesia, which occurs in approximately one of 100 patients, and neuroleptic malignant syndrome, a condition that adversely affects regulation of a person’s body temperature and occurs in approximately one of 1,000 patients. Haldol can also produce parkinsonism and extrapyramidal side affects, i.e., acute muscle contracture. Dr. Luchetta stated that the drug Cogentin, also listed in the petition, blocks some of these extrapyramidal side effects. The most common side effect of Cogentin is blurred vision, a condition that can be monitored.

The final medication listed in the petition was Ativan, a mild tranquilizer. Dr. Luchetta testified that administration of a small amount of Ativan can greatly reduce the dosages of antipsychotic medications administered and, in turn, prevent many of the side effects. The antianxiety effects of Ativan, which is available in inject-able form, also help persuade an otherwise unwilling patient to take medications, such as Zeprexa and Orap, which are in tablet or liquid form.

In addition, Dr. Luchetta testified that the side effects of any medication can be monitored through observation and testing, including a complete blood count, a thyroid function test, urinalysis, a comprehensive metabolic profile, and an electrocardiogram. The medications would be administered in the lowest effective dose. It was Dr. Luchetta’s opinion that the benefits of the medications outweigh the harmful side effects and that respondent lacks the capacity to make a reasoned or informed decision about such treatment. On several occasions Dr. Luchetta attempted to discuss with respondent the advantages and disadvantages of the medications listed in the petition, but respondent refused to discuss treatment, or responded by swearing, walking away, or talking about an unrelated matter. Finally, Dr. Luchetta testified that less restrictive services, such as an outpatient program or counseling, are not viable options.

Dr. Nageswara Rao Nagarakanti, respondent’s treating psychiatrist at the time of the hearing, also testified. He agreed with the medication recommendations set forth in the petition and had attempted, on three or four occasions, to discuss these medications with respondent.

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Cite This Page — Counsel Stack

Bluebook (online)
781 N.E.2d 237, 202 Ill. 2d 393, 269 Ill. Dec. 440, 2002 Ill. LEXIS 955, Counsel Stack Legal Research, https://law.counselstack.com/opinion/people-v-mary-ann-p-ill-2002.