Case Title: In re Robert S.

Citation: 

Docket Number: 96773

State: illinois

Court: Illinois Supreme Court

Date: 2004-11-18T00:00:00Z

Document:
Docket No. 96773-Agenda 4-September 2004.
In re ROBERT S. (The People of the State of Illinois, Appellee, v. 							Robert S., Appellant).
Opinion filed November 18, 2004.
	JUSTICE RARICK delivered the opinion of the court:
	Respondent, Robert S., was found unfit to stand trial on a charge
not specified in the record. He was admitted to the Elgin Mental
Health Center (EMHC). Subsequently, respondent's treating
psychiatrist filed a petition seeking the involuntary administration of
psychotropic medication pursuant to section 2-107.1 of the Mental
Health and Developmental Disabilities Code (Code) (405 ILCS
5/2-107.1 (West 2000)). After a two-day hearing, in which
respondent represented himself, the circuit court of Kane County
granted the petition. Respondent appealed, challenging, inter alia, the
circuit court's decision to appoint, as an "impartial medical expert"
pursuant to the "independent examination" provisions of section
3-804 of the Code (405 ILCS 5/3-804 (West 2000)), a person who
was not qualified to conduct the examination. Respondent also
contended that (1) section 2-107.1 of the Code "was never intended
to be applied to non-dangerous pretrial detainees," (2) the application
of section 2-107.1 deprived him of his constitutional right to a fair
trial, and (3) reversal was warranted because the attorney in his
pending criminal case was not notified of the hearing on the petition.
The appellate court rejected these and other arguments. 341 Ill. App.
3d 238. We allowed the respondent's petition for leave to appeal (177
Ill. 2d R. 315), and allowed the Mental Health Association of Illinois
and the Mental Health Project of the University of Chicago Law
School's Mandel Legal Aid Clinic to file a brief as amici curiae in
support of appellee.
	Before this court, respondent contends that the appellate court
erred in holding that (1) section 2-107.1 of the Code was
constitutionally applied to him, a pretrial detainee who had been found
unfit to stand trial, (2) he was not deprived of his right to due process
of law where the independent examination guaranteed by statute was
performed by an unlicensed intern with only a master's degree in
psychology, and (3) he had no due process right to have notice of the
forced-treatment action provided to his criminal defense attorney. We
begin our review with a detailed recitation of pertinent facts.
BACKGROUND
	On November 19, 2001, respondent's psychiatrist, Dr. Romulo
Nazareno, filed a petition seeking to involuntarily administer
psychotropic medication to respondent. The allegations of the petition
tracked the requirements of section 2-107.1(a-5)(4) of the Code (405
ILCS 5/2-107.1(a-5)(4) (West 2000)), which provides in pertinent
part as follows:
			"(4) Authorized involuntary treatment shall not be
administered to the recipient unless it has been determined by
clear and convincing evidence that all of the following factors
are present:
				(A) That the recipient has a serious mental illness or
developmental disability.
				(B) That because of said mental illness or
developmental disability, the recipient exhibits any one of
the following: (i) deterioration of his or her ability to
function, (ii) suffering, or (iii) threatening behavior.
				(C) That the illness or disability has existed for a period
marked by the continuing presence of the symptoms set
forth in item (B) of this subdivision (4) or the repeated
episodic occurrence of these symptoms.
				(D) That the benefits of the treatment outweigh the
harm.
				(E) That the recipient lacks the capacity to make a
reasoned decision about the treatment.
				(F) That other less restrictive services have been
explored and found inappropriate.
				(G) If the petition seeks authorization for testing and
other procedures, that such testing and procedures are
essential for the safe and effective administration of the
treatment."
The petition in this case specifically alleged that, because of his mental
illness, respondent had exhibited a deterioration of ability to function,
suffering, and threatening behavior. Dr. Nazareno requested
authorization to administer Risperidone-a medication respondent had
previously taken, briefly, without noticeable side effects-or,
alternatively, Haldol, Haldol Deconate, and Cogentin. Nazareno also
sought permission to conduct testing to monitor respondent's reaction
to the medication.
	On November 26, 2001, the circuit court held a competency
hearing pursuant to respondent's request to represent himself. At that
time, the court denied respondent's request. Respondent filed a
motion to reconsider. On November 30, 2001, respondent appeared
in court with appointed counsel from the Legal Advocacy Service of
the Illinois Guardianship and Advocacy Commission for a hearing on
pending matters. The circuit court denied respondent's motion to
reconsider, but granted his request for an independent evaluation
pursuant to section 3-804 of the Code (405 ILCS 5/3-804 (West
2000)). However, rather than appoint the psychiatrist who had
previously conducted independent examinations of respondent, the
court, pursuant to the cost-conscious request of the State, appointed
the Kane County Diagnostic Center to perform the evaluation.
Respondent's counsel objected, noting: "Everyone associated with the
Diagnostic Center is a psychologist and not a psychiatrist and
therefore does not have the expertise when it comes to medication. So
every time we go to the Diagnostic Center, we're starting behind the
8-ball because of that very thing."
	The circuit court acknowledged:
		"Although Mr. Rose is right, I suppose what appears to be on
paper in the-on the way I make the decisions on these things,
I don't think that I would really say psychiatrist versus
psychologist; and therefore you're behind the 8-ball. I look at
the issues and what the facts are and rule accordingly."
The court persisted in its decision to appoint the Kane County
Diagnostic Center.
	At a pretrial conference on January 4, 2002, the circuit court
revisited the issue of self-representation. Noting "representations" that
respondent had represented himself ably in the past, the court reversed
its prior ruling, and allowed respondent to proceed pro se.
	Hearing in this matter commenced on January 18, 2002. The
State's first witness was Dr. Nazareno.
	Nazareno diagnosed respondent with paranoid schizophrenia. He
testified that respondent's symptoms included hallucinations,
delusions, sleeplessness, irritability, and an overall deterioration in the
ability to function. For instance, respondent complained of sleep
deprivation as a result of auditory hallucinations. Moreover,
respondent suffered delusions. He believed that the government had
implanted a microchip in his brain in an effort to read his mind.
Respondent claimed that EMHC staff and patients were sending
messages to a "mind reader" by actions such as rubbing their chins or
adjusting their eyeglasses. In addition, respondent threatened to kill an
EMHC patient who respondent believed was having a sexual
relationship with women intended for respondent.
	Dr. Nazareno testified that respondent's symptoms had subsided
when he was medicated on a previous occasion with Risperidone.
However, once the medication order expired, respondent again
experienced auditory hallucinations, sleep deprivation, and delusional
thinking. It was at that time that respondent threatened to kill a
member of the EMHC staff.
	Nazareno recommended administering Risperidone to respondent
because, in the past, he had responded well to the drug without side
effects. Nazareno suggested, however, that higher doses might be
indicated. As alternatives, Nazareno recommended Haldol, Haldol
Deconate (injectable), and, for side effects, Cogentin. Nazareno
testified that Risperidone has fewer side effects than Haldol.
According to Nazareno, Risperidone can cause dizziness, light-headedness, seizure, nausea, vomiting, muscular rigidity, difficulty
swallowing, constipation, tardive dyskinesia, and neuroleptic
malignant syndrome. He did not elaborate on the incidence of those
side effects.
	Nazareno acknowledged that Haldol has more severe side effects
than Risperidone. He did not specify what those side effects might be.
What is clear from his testimony is that Haldol would be the drug of
choice if respondent refused to take Risperidone. Nazareno admitted
that he had no way of knowing if respondent would have an adverse
reaction to Haldol.
	Nevertheless, Dr. Nazareno opined that the benefits of
administering a psychotropic medication would outweigh the harm.
He stated that respondent lacked the capacity to make a reasoned
decision about potential side effects and benefits of the treatment.
According to Dr. Nazareno, respondent's psychosis was the reason he
could not make a knowledgeable decision whether to take the
medication. Nazareno had tried less restrictive treatments, such as
counseling and group therapy, but he deemed them ineffective without
medication.
	On cross-examination, Dr. Nazareno admitted that respondent
had never threatened him and that he had never personally witnessed
respondent threaten others. Nazareno also acknowledged that, during
the court proceeding, he did not see a deterioration in respondent's
functioning, and he noted that respondent did not exhibit his usual
symptoms, such as talking to himself. However, Nazareno stated that
respondent's behavior, and the way in which he asked questions,
showed some paranoia and delusions. For instance, during
questioning, respondent insinuated that Nazareno must also have
heard voices. Nazareno pointed out that there are times during which
an afflicted individual can contain delusions by focusing on a task.
	The State next called Lesley Kane, an intern at the Kane County
Diagnostic Center (KCDC). Kane conducted the court-ordered,
independent examination of respondent. Kane's examination consisted
of interviewing respondent for 60 to 90 minutes, talking to
respondent's case worker, and reviewing two to three years of
respondent's records. Noting that the "witness ha[d] been qualified as
an expert" in a previous case, the circuit court qualified Kane as an
expert over respondent's objection.
	Citing symptoms similar to those identified by Nazareno, Kane
diagnosed respondent with paranoid schizophrenia. With respect to
whether respondent had exhibited a deterioration of his ability to
function, suffering, or threatening behavior, Kane stated that
respondent had indeed become increasingly tense and agitated,
verbally aggressive, and more threatening in the months preceding the
hearing. Moreover, his sexual preoccupations had increased, and
EMHC staff had noted an increase in his use of profanity. Kane
further testified that respondent's illness has existed for a period
marked by the continuing presence of symptoms, noting that
respondent has had a history of delusions dating back to the 1970s.
Without elaboration, Kane stated her opinion that the benefits of
psychotropic medication would outweigh the harm. Kane noted that
respondent's behavior posed a risk to himself and to others, and that
any side effects of the medication could be dealt with effectively. Kane
did not address the nature or likelihood of side effects that might
result from forced administration of psychotropic medication. Kane
opined that respondent's suffering, the deterioration of his ability to
function, and his violent and threatening behavior would decrease with
medication.
	Kane also concluded that respondent lacked the capacity to make
a reasoned decision about psychotropic medication. Respondent told
her he did not need psychotropic medication because he did not have
a mental illness. When she spoke with him, he was evasive and
avoided any discussion of his inability to sleep, hallucinations, or
delusions. According to Kane, respondent was unaware of the severity
of his illness, which is typical of people diagnosed with schizophrenia.
When she asked him if he ever heard voices other people did not hear,
he responded, "I believe other people hear the voices as well."
	Regarding less restrictive alternatives, Kane noted that
respondent had been offered psychosocial therapy; however, because
respondent lacked insight into his illness, "it doesn't seem as though
that alone is going to be helpful." Kane also noted that, in individuals
with schizophrenia, therapy is more often augmentation to medication.
Kane opined "to a reasonable degree of psychological certainty" that
respondent met the criteria for utilization of psychotropic medication.
	On cross-examination, Kane admitted that, during her
independent examination of respondent, she did not observe
respondent suffering from delusions or hallucinations. She also
acknowledged that respondent was not exhibiting such symptoms at
the hearing.
	Kane conceded that she had never done an evaluation without
supervision. She stated that she had been supervised in her evaluation
of respondent, though there is nothing in the record to reveal the
nature or extent of that supervision. In fact, she admitted that a
supervisor was not present when she conducted her examination of
respondent and did not review respondent's charts or interview
anyone with pertinent information. Kane stated that a licensed
psychologist "has to assist" in a fitness examination, "but for an
involuntary medication evaluation, that is not a requirement." When
respondent asked why, Kane replied, "I didn't develop the law. I don't
know." Kane did not cite "the law" to which she referred.
	The State recalled Dr. Nazareno. Nazareno testified that
respondent does not have the capacity to make a reasoned and rational
choice regarding whether he needs medication. Nazareno noted that
respondent does not believe he is ill. Nazareno added that
respondent's judgment is so impaired by his illness that he sees only
the risks, and not the benefits, of the medication.
	Under cross-examination, Nazareno acknowledged that
respondent understood the potential severity of the possible side
effects of the medications proposed. He admitted that respondent was
proceeding in a "logical" and "goal-oriented" manner in his cross-examination. However, Nazareno persisted in his opinion that
respondent did not have the capacity to make a decision as to whether
he should take psychotropic medication. Respondent continued:
			"Q. So, you're saying I am logical, coherent, and goal-oriented, and they [psychotropic drugs] were prescribed for
a period of three months a couple years ago, but you're
saying I wouldn't know what the benefits are?
			A. Yes. Even though I explain to you, you don't take it.
You don't understand."
	Kelli Childress, a former assistant State's Attorney, testified that
she first met respondent in 1999 when she was assigned to a hearing
in which respondent was involved. On or about October 31, 2001,
Childress received a telephone call from respondent. Respondent told
Childress that he remembered her from the 1999 hearing and he had
been thinking about her ever since. Respondent accused Childress of
helping the government with a scheme to read his mind. Respondent
believed that he and Childress were supposed to be together and that
the government had indicated to him that Childress felt the same way.
Respondent asked Childress if she would help him get out of EMHC
so they could be together. Childress told respondent she was involved
with someone else and the information he had was incorrect. Childress
stated that she felt threatened during the conversation.
	Respondent called Childress again on December 31, 2001.
According to Childress, the tone of this conversation was less
accusatory and more romantic. Respondent told Childress she was
beautiful, he had feelings for her, and the government had informed
him that they were supposed to be together. Respondent stated that
he thought about marrying Childress, having children, and moving to
California. Respondent told Childress that the government had
informed him that she was romantically involved with other patients
at EMHC and with a player for the Chicago Bears.
	Childress testified she was familiar with respondent's case and
knew why he was at EMHC. She was afraid that he could become
violent if he believed she was part of a government scheme to read his
mind. As a result, after both calls, Childress contacted the State's
Attorney's office and the court liaison at EMHC. In addition,
following the first call, she contacted local police. Childress did not
hear from respondent after the second call. On cross-examination,
Childress admitted that respondent did not specifically threaten her.
	Mark Thomas, a licensed clinical social worker at EMHC,
testified that he was respondent's primary therapist. Thomas stated
that respondent's psychiatric diagnosis was paranoid schizophrenia.
According to Thomas, respondent's condition had been deteriorating
over the months preceding the hearing, with increased agitation,
verbal outbursts, and verbal aggression.
	Thomas testified that respondent believed the voices he heard
were caused by a chip implanted by the government. Respondent
thought the chip enabled the government to read his mind. On two
occasions in the three months prior to the hearing, respondent became
agitated with Thomas because respondent believed Thomas was
"signaling the mind readers" by rubbing his limbs. A third incident
occurred when Thomas sided with a technician who was involved in
a dispute with respondent. At that time, respondent cursed at Thomas.
Thomas considered respondent's behavior during the third incident to
constitute a threat.
	Thomas testified that respondent admitted he suffered from
hallucinations and delusions. The hallucinations and delusions centered
on female celebrities, but had included staff at EMHC. In addition,
respondent told Thomas that he wanted to have a relationship with
Childress. Respondent also told Thomas that his conversations with
Childress had gone well and that she had been receptive.
	Thomas further stated that respondent believed certain women
had been "reserved" for him by the mind readers. Respondent became
verbally abusive when he believed those women had ignored him or
had been having relationships with other EMHC patients. Respondent
confronted one patient whom he believed was having a sexual
relationship with one of his "reserved" women.
	Thomas opined that respondent suffered as a result of hearing
voices. Thomas believed that respondent's ability to function had
deteriorated in the three months prior to the hearing. Thomas also
stated that, of his 36 patients, respondent posed the highest risk.
Thomas stated that respondent was "in the upper echelon" of patients
who frightened him.
	On cross-examination, Thomas testified that respondent had a
"remarkable ability" to contain his psychosis. Nevertheless, he thought
that respondent had exhibited evidence of mental illness in the
courtroom. As examples, Thomas noted respondent's allusions to
government mind readers and his claim that the government had
implanted a chip in his body.
	The State next called respondent as a witness. Respondent
objected. The trial court sustained respondent's objection on the basis
that respondent was at EMHC because he had been found unfit to
stand trial in an underlying criminal proceeding. The State then rested.
Respondent requested two weeks to subpoena his witnesses, and the
court continued the matter until February 1, 2002.
	When court reconvened, respondent called as his first witness
Denise Dojka, a clinical psychologist at EMHC and respondent's
psychological therapist. Dojka stated that respondent suffered from
paranoid schizophrenia. She had never seen respondent participate in
any violent behavior. Nevertheless, based on a risk assessment she had
conducted of respondent, Dojka believed he was one of the more
dangerous people in his unit.
	On cross-examination, Dojka testified that respondent heard
voices that called him derogatory names and woke him at night.
Respondent believed the voices were from the government and they
were transmitted through an implant in his head. The voices informed
respondent that women who were interested in a sexual relationship
with him were being brought to other patients. Respondent told Dojka
that he would have liked to have had a relationship with Childress and
that he wanted Childress to have his children. However, he no longer
believed it was possible to have a relationship with Childress because
he believed she had been given large sums of money to have sex with
another patient.
	Dojka testified that she considered respondent dangerous because
he had several risk factors. According to Dojka, respondent's history
of violence, symptoms of mental illness, refusal of treatment, anger,
and the lack of feasibility of future plans all contributed to a finding
that respondent posed at least a moderate risk of committing violence
in the future, especially since he was not medicated.
	Dojka feared that respondent would commit violence against
Childress and Lynette Krueger, Dojka's diagnostic psychology
student. Respondent wanted to have relationships with both women,
but he believed that they were sleeping with others. That made
respondent feel betrayed and resentful.
	Dojka believed that respondent needed to be medicated. She
noted that, on a previous occasion, when he was medicated for a
90-day period, his sleeping improved, he was much more relaxed, he
participated in activities, and he seemed to be functioning at a higher
level. Dojka also believed that respondent was suffering. He had told
her he felt "tormented" by the voices.
	Becky Mitchell, an activity therapist at EMHC, testified that
between October 2001 and February 2002, she had accompanied
respondent to two or three activities. On those occasions, respondent
did not cause her any problems and he did not have any problems with
the other patients. However, Mitchell opined that respondent had the
potential to be dangerous to others. Mitchell's opinion was based on
respondent's status as a mental health patient, the statements of
clinicians, and her past experiences with other patients. On
cross-examination, Mitchell testified that respondent had told her he
heard voices that tormented him.
	Respondent's last witness was Jose Padilla, an activity staff
member at EMHC. Padilla testified that he never had to restrict
respondent as a result of his behavior. Padilla did not observe
respondent express any anger toward other patients. On
cross-examination, Padilla acknowledged that he saw respondent
about once a month.
	Based upon the foregoing testimony, the circuit court ruled that
respondent was subject to the involuntary administration of
psychotropic medication for a period not to exceed 90 days. The court
found that, because of his mental illness, respondent had exhibited a
deterioration of ability to function, suffering, and threatening behavior.
Further, the court found that the suggested benefits of the treatment
outweighed the potential for harm, respondent lacked the capacity to
make a reasoned decision about the treatment, and other less
restrictive services had been explored, but were found inappropriate.
The court subsequently denied respondent's motion to reconsider.
Respondent appealed. The appellate court affirmed. 341 Ill. App. 3d
238. This timely appeal followed.
ANALYSIS
	Respondent raises constitutional questions concerning the
construction and application of sections 2-107.1 and 3-804 of the
Code. The standard of review for determining whether an individual's
constitutional rights have been violated is de novo. People v. Burns,
209 Ill. 2d 551, 560 (2004). We apply the same standard in matters of
statutory construction. In re Mary Ann P., 202 Ill. 2d 393, 404
(2002). Statutes enjoy a strong presumption of constitutionality, and
this court has a duty to construe statutes in a manner that upholds
their validity whenever reasonably possible. Hill v. Cowan, 202 Ill. 2d 151, 157 (2002).
	As a preliminary matter, we note that this case is moot. Section
2-107.1 of the Code provides that an order authorizing the
administration of involuntary treatment shall, in no event, be effective
for more than 90 days. 405 ILCS 5/2-107.1(a-5)(5) (West 2000).
The 90 days have long since passed, and the circuit court's order no
longer has any force or effect. Hence, it is impossible for this court to
grant meaningful relief, and any decision we render is essentially
advisory in nature. See In re Mary Ann P., 202 Ill. 2d  at 401; In re
Barbara H., 183 Ill. 2d 482, 490 (1998). Generally, a court of review
will not consider moot or abstract questions or render advisory
decisions. In re Mary Ann P., 202 Ill. 2d  at 401. However, a
reviewing court may review otherwise moot issues pursuant to the
public interest exception to the mootness doctrine. In re Andrea F.,
208 Ill. 2d 148, 156 (2003). The criteria for application of the public
interest exception are: (1) the public nature of the question; (2) the
desirability of an authoritative determination for the purpose of
guiding public officers; and (3) the likelihood that the question will
recur. In re Andrea F., 208 Ill. 2d  at 156; In re Mary Ann P., 202 Ill. 2d  at 402. This case satisfies those criteria.
	This court has previously held that the procedures courts must
follow to authorize the involuntary medication of mental health
patients involve matters of "substantial public concern." In re Mary
Ann P., 202 Ill. 2d  at 402. Moreover, because of the short duration of
orders authorizing involuntary treatment, and respondent's history of
mental illness, it is likely that the circumstances present in the case at
bar will recur without the opportunity for resolutionary litigation
before the case is rendered moot by expiration of the order. See In re
Mary Ann P., 202 Ill. 2d at 402-03; In re Barbara H., 183 Ill. 2d at
491-92; In re Evelyn S., 337 Ill. App. 3d 1096, 1102 (2003). Finally,
having reviewed appellate court decisions in this area, we believe an
authoritative determination is desirable at this time.
	There is no question that involuntary mental health services,
including the involuntary administration of psychotropic drugs,
involve a " 'massive curtailment of liberty.' " In re Barbara H., 183 Ill. 2d  at 496, quoting Vitek v. Jones, 445 U.S. 480, 491, 63 L. Ed. 2d 552, 564, 100 S. Ct. 1254, 1263 (1980). The United States Supreme
Court has, alternatively, described the forced administration of
psychotropic drugs as a "particularly severe" interference with a
person's liberty. See Riggins v. Nevada, 504 U.S. 127, 134, 118 L. Ed. 2d 479, 488, 112 S. Ct. 1810, 1814 (1992). One who is held on
pending criminal charges retains this liberty interest notwithstanding
his or her status as a pretrial detainee. See generally Sell v. United
States, 539 U.S. 166, 156 L. Ed. 2d 197, 123 S. Ct. 2174 (2003);
Washington v. Harper, 494 U.S. 210, 108 L. Ed. 2d 178, 110 S. Ct. 1028 (1990).
	Respondent argues that the criteria for involuntary administration
of psychotropic drugs enunciated in Sell are controlling in our analysis
in this case. We disagree. As the Court's decision in Sell clearly
indicates, differing criteria and analyses may apply to the decision to
involuntarily medicate a pretrial detainee who has been found unfit to
stand trial, depending upon the purpose for which authorization to
medicate has been sought.
	In Sell, the State sought authorization for the involuntary
administration of drugs for the sole purpose of rendering the
defendant competent to stand trial. Citing Harper and Riggins, the
Court, in Sell, stated: "the Constitution permits the Government
involuntarily to administer antipsychotic drugs to a mentally ill
defendant facing serious criminal charges in order to render that
defendant competent to stand trial" if certain criteria are satisfied. A
court must conclude that (1) important governmental interests are at
stake, (2) involuntary medication will significantly further those
concomitant state interests, (3) involuntary medication is necessary to
further those state interests, and (4) that the administration of the
drugs is medically appropriate, i.e., in the patient's best medical
interest in light of his medical condition. Sell, 539 U.S.  at 180-81, 156 L. Ed. 2d  at 211-13, 123 S. Ct.  at 2184-85.
	In Sell, the Court made clear that the standards it announced
were restricted to the context of the case before it:
			"We emphasize that the court applying these standards is
seeking to determine whether involuntary administration of
drugs is necessary significantly to further a particular
governmental interest, namely, the interest in rendering the
defendant competent to stand trial. A court need not consider
whether to allow forced medication for that kind of purpose,
if forced medication is warranted for a different purpose,
such as the purposes set out in Harper related to the
individual's dangerousness, or purposes related to the
individual's own interests ***." (Emphases in original.) Sell,
539 U.S.  at 181-82, 156 L. Ed. 2d  at 213, 123 S. Ct.  at
2185.
	The petition in the instant case sought authorization to treat
respondent on Harper grounds. The petition alleged that, because of
his mental illness, respondent had exhibited a deterioration of ability
to function, suffering, and threatening behavior. As the appellate court
noted:
			"[T]he trial court was not asked to decide whether
respondent could be subject to the involuntary administration
of psychotropic medication solely for the purpose of
rendering him competent to stand trial. Indeed, the record is
barren of any evidence that the petition to administer
psychotropic medication was filed solely for the purpose of
fitness for trial. *** Instead, the trial court reviewed each of
the factors listed in section 2-107.1(a-5)(4) of the Code (405
ILCS 5/2-107.1(a-5)(4) (West 2000)) and found that the
State proved each factor by clear and convincing evidence.
The court found that respondent suffered [from] a mental
illness, *** which resulted in a deterioration of his ability to
function, suffering, and threatening behavior. Moreover, the
court found that the benefits of the proposed treatment
outweighed the harm and that less restrictive alternatives
were inappropriate. It is evident that the trial court granted
the State's petition because it found the involuntary
administration of psychotropic medication to be medically
appropriate. Notably, in rendering its decision the trial court
never mentioned respondent's fitness to stand trial." 341 Ill.
App. 3d at 258.
Like the appellate court, we believe that respondent's reliance upon
Sell is misplaced. Respondent advances no plausible argument to
convince us that, for purposes of section 2-107.1 of the Code, pretrial
detainees should be treated differently than any other person in need
of treatment.
	However, that assessment does not end our due process inquiry;
it simply shifts the focus of our analysis to basic requirements of due
process as expressed in Harper and prior cases.
	In Mathews v. Eldridge, 424 U.S. 319, 335, 47 L. Ed. 2d 18, 33,
96 S. Ct. 893, 903 (1976), the Supreme Court set forth three factors
that must be considered when determining whether an individual has
received the "process" that the Constitution finds "due":
		"First, the private interest that will be affected by the official
action; second, the risk of an erroneous deprivation of such
interest through the procedures used, and the probable value,
if any, of additional or substitute procedural safeguards; and
finally, the Government's interest, including the function
involved and the fiscal and administrative burdens that the
additional or substitute procedural requirement would entail."
	By weighing these factors, courts can determine whether the
government has met the fundamental requirements of due process-the
opportunity to be heard at a meaningful time and in a meaningful
manner. Mathews, 424 U.S.  at 333, 47 L. Ed. 2d  at 32, 96 S. Ct.  at
902.
	Addressing the first factor, there is no question that the private
interest affected by the forced administration of psychotropic drugs is
substantial. As we have previously noted, the United States Supreme
Court has described the forced administration of psychotropic drugs
as a "particularly severe," interference with a person's liberty. Riggins,
504 U.S.  at 134, 118 L. Ed. 2d  at 488, 112 S. Ct.  at 1814.
	In Harper, the Court spoke of the serious, and perhaps,
permanent, consequences that psychotropic medication may have
upon the recipient's life:
		"The purpose of the drugs is to alter the chemical balance in
a patient's brain, leading to changes, intended to be
beneficial, in his or her cognitive processes. [Citation.] While
the therapeutic benefits of antipsychotic drugs are well
documented, it is also true that the drugs can have serious,
even fatal, side effects. *** [S]ide effects include akathesia
(motor restlessness, often characterized by an inability to sit
still); neuroleptic malignant syndrome (a relatively rare
condition which can lead to death from cardiac dysfunction);
and tardive dyskinesia, perhaps the most discussed side effect
of antipsychotic drugs. [Citation.] Tardive dyskinesia is a
neurological disorder, irreversible in some cases, that is
characterized by involuntary, uncontrollable movements of
various muscles, especially around the face. [Citation.] ***
A fair reading of the evidence, however, suggests that the
proportion of patients treated with antipsychotic drugs who
exhibit the symptoms of tardive dyskinesia ranges from 10%
to 25%." Harper, 494 U.S.  at 229-30, 108 L. Ed. 2d  at 203-04, 110 S. Ct.  at 1041.
See also Riggins, 504 U.S.  at 134, 118 L. Ed. 2d  at 488-89, 112 S. Ct.  at 1814-15 (quoting this passage from Harper ); United States v.
Williams, 356 F.3d 1045, 1054-55 (9th Cir. 2004) (quoting from
Harper); In re Qawi, 32 Cal. 4th 1, 14-15, 81 P.3d 224, 231, 7 Cal. Rptr. 3d 780, 788 (2004) (observing that antipsychotics "have been
the cause of considerable [reversible and potentially permanent] side
effects ***. On rare occasions, use of these drugs has caused sudden
death"); Kulas v. Valdez, 159 F.3d 453, 455-56 (9th Cir. 1998)
(noting "[t]he serious side effects that such medication can have on
mind and personality, physical condition and life itself"); Physicians'
Desk Reference 1787, 2464-65 (57th ed. 1999) (detailing extensive
warnings and precautions for the use of Risperidone and Haldol, and
noting, with respect to Risperidone, that the "risk of developing
tardive dyskinesia and the likelihood that it will become irreversible
are believed to increase as the duration of treatment and the total
cumulative dose of antipsychotic drugs administered to the patient
increase"); 2 M. Perlin, Mental Disability Law §3B-2, at 370-71
(1999) (detailing "toxic effects" of antipsychotic drugs); E. Goode,
Leading Drugs for Psychosis Come Under New Scrutiny, N.Y. Times,
May 20, 2003, at A1 (describing "the stiffness, trembling and other
Parkinson's-like symptoms commonly seen in patients taking older
antipsychotics like Haldol").
	Suffice it to say that the involuntary administration of
psychotropic drugs can have a profound and sometimes irreversible
effect upon a recipient's personality and physical health. It would
therefore seem that the "private interest" at stake in this type of
proceeding is one of considerable magnitude. Deprivations of property
are reversible and the consequences of erroneous deprivation may be
remedied to some degree; however, the forced use of psychotropic
drugs may effect modifications of brain chemistry and patterns of
thought which are not so easily rectified, if they are at all. Moreover,
use of these drugs may entail adverse physical side effects that are
irreversible. In light of these sobering facts, we must once more
confront the central question in this appeal: What process is due?
	Again, Harper is instructive. In Harper, a psychiatrist in the
correctional facility where the respondent was housed sought to
administer antipsychotic medication to respondent over his objection.
Harper, 494 U.S.  at 214, 108 L. Ed. 2d  at 193, 110 S. Ct.  at 1033. In
response to the Supreme Court's decision in Vitek, correctional
authorities had developed a policy that provided for review of the
treating psychiatrist's decision by a special committee consisting of a
psychiatrist, a psychologist, and the associate superintendent of the
correctional center, none of whom could be involved in the inmate's
treatment or diagnosis. Harper, 494 U.S.  at 215, 108 L. Ed. 2d  at
194, 110 S. Ct.  at 1033. Pursuant to the policy, the committee could
authorize forced treatment with antipsychotic drugs, so long as the
majority voted to do so and the psychiatrist was a member of the
majority. Harper, 494 U.S.  at 215-16, 108 L. Ed. 2d  at 194, 110 S. Ct.  at 1033. Noting that the "risks associated with antipsychotic drugs
are for the most part medical ones, best assessed by medical
professionals" (emphases added) (Harper, 494 U.S.  at 233, 108 L. Ed. 2d  at 205, 110 S. Ct. at 1042), the Court held that the internal
review procedure in Harper satisfied requirements of due process.
The Court held that adequate procedures existed, noting, in particular,
the "independence of the decisionmaker." Harper, 494 U.S.  at 233,
108 L. Ed. 2d  at 205, 110 S. Ct.  at 1043.
	Two components of the procedure in Harper strike us as
significant for present purposes, as they seem to have been prominent
factors in the Harper decision: there was an independent review of the
treating psychiatrist's evaluation and prescription, and that review
was, conspicuously, overseen by a psychiatrist, a "medical
professional" who would have been able to assess the "risks
associated with antipsyhotic drugs." See Harper, 494 U.S.  at 233, 108 L. Ed. 2d  at 205, 110 S. Ct.  at 1042.
	Harper seems to us the touchstone of due process when
considering the propriety of forced medication with psychotropic
drugs. The procedure sanctioned by the Supreme Court in Harper
addressed two essential features of due process in this context: (1)
"independent review" of the treating psychiatrist's evaluation and
proposed course of medication, and (2) review by a "medical
professional" who is qualified to prescribe psychotropic medications
and trained in their possible side effects. This brings us to the second
and third Mathews considerations.
	With respect to the second Mathews factor, the risk of an
erroneous deprivation of the respondent's rights through the
procedures used in this case is obvious. The value of additional
procedural safeguards is clear. Only a physician-such as a
psychiatrist-can prescribe medication; a psychologist cannot. An
intern in psychology most certainly cannot. These limitations exist for
a reason: the medical community recognizes that a certain level of
knowledge is necessary to safely prescribe medication, to fully
recognize its beneficial effects as well as its adverse side effects, to
understand its interaction with other drugs, to anticipate the
consequences of using it on certain at-risk groups. It seems self-evident that the policy sanctioned in Harper required an independent
assessment by a psychiatrist who was not involved in treatment or
diagnosis for this very reason. In Harper, the Court stressed that the
"risks associated with antipsychotic drugs are for the most part
medical ones, best assessed by medical professionals." (Emphases
added.) Harper, 494 U.S.  at 233, 108 L. Ed. 2d  at 205, 110 S. Ct.  at
1042.
	The respondent in this case was denied the safeguards inherent in
having what amounts to a second opinion by one qualified to give it
on every aspect of the statute in question-what Harper appears to
require. Kane was not qualified to give meaningful testimony about
the possible harmful side effects of the proposed medications, and she
did not give meaningful testimony. For that matter, neither did
Nazareno render what we would consider "meaningful" testimony on
the subject. What little he had to say about the possible side effects of
Risperidone had no obvious relevance to the possible side effects of
Haldol, a subject he did not address at all-this, notwithstanding the
fact that he no doubt intended to use Haldol on respondent, since he
testified that Haldol would have to be used if respondent refused to
take Risperidone voluntarily. He seemed to have forgotten that the
whole point of this proceeding was the involuntary treatment of
respondent. We note in passing that this lack of logic is commensurate
with Nazareno's simplistic assessment that respondent lacked the
capacity to make a decision whether or not to take the drugs simply
because he refused to do what Nazareno told him to do. We note
Nazareno's answer during respondent's cross-examination: "Even
though I explain to you, you don't take it. You don't understand."
	We have previously expressed our concern that psychotropic
substances may be misused by medical personnel, and subverted to the
objective of patient control rather than patient treatment. In re C.E.,
161 Ill. 2d 200, 215-16 (1994). While we do not mean to imply that
authorization was sought for an improper purpose in this case-there
was in fact sufficient evidence to establish threat, suffering, and
deterioration-we must insist upon adequate safeguards in every case.
Otherwise, abuse of the process will undoubtedly occur.
	In our opinion, the circuit court should have heeded the objection
of respondent's counsel prior to his departure from this case:
"Everyone associated with the Diagnostic Center is a psychologist and
not a psychiatrist and therefore does not have the expertise when it
comes to medication. So every time we go to the Diagnostic Center,
we're starting behind the 8-ball because of that very thing." Ironically,
the circuit court implicitly acknowledged counsel's point: "Although
Mr. Rose is right, I suppose what [sic] appears to be on paper in
the-on the way I make the decisions on these things, I don't think that
I would really say psychiatrist versus psychologist; and therefore
you're behind the 8-ball." We believe the circuit court failed to
appreciate the significant difference in expertise between a psychiatrist
and a psychologist, and the safeguards that another psychiatrist would
have provided in the decisionmaking process.
	Apparently, the circuit court had, in the past, recognized the
significance of appointing a psychiatrist in a proceeding such as this.
The court had in fact appointed a psychiatrist to do an independent
examination in prior proceedings, and declined to do so on this
occasion only because the State raised concerns over costs. Pursuant
to the third prong of the Mathews analysis, we recognize the State's
"fiscal" interest in cost-cutting; however, given the devastating
consequences that could result from a less than fully informed
decision, this is hardly the situation in which to pinch pennies. To do
so, would, in our view, deny respondent due process.
	It has been held, with respect to the Sexually Violent Persons
Commitment Act (725 ILCS 207/1 et seq. (West 1998)), that due
process requires that a respondent be "entitled to defend himself on a
'level playing field' and that the State not be permitted to maintain a
strategic advantage over the respondent when 'that advantage casts
a pall on the proceedings.' " In re Detention of Trevino, 317 Ill. App.
3d 324, 330 (2000), quoting In re Detention of Kortte, 317 Ill. App.
3d 111, 115-16 (2000). We believe respondent was denied "a level
playing field" and a fundamental requirement of due process: the
opportunity to be heard in a meaningful manner. See Mathews, 424 U.S.  at 333, 47 L. Ed. 2d  at 32, 96 S. Ct.  at 902.
	However, we do not believe our legislature intended such a
result. Rather, it is our opinion that the legislature, attempting to apply
section 3-804 in two different contexts (proceedings for involuntary
commitment and for involuntary administration of drugs), assumed
that the use of disjunctive language therein would apprise circuit
courts of the need to appoint an expert appropriate to the proceeding
in question.
	Section 3-804 of the Code provides in pertinent part:
		"The respondent is entitled to secure an independent
examination by a physician, qualified examiner, clinical
psychologist or other expert of his choice. If the respondent
is unable to obtain an examination, he may request that the
court order an examination to be made by an impartial
medical expert pursuant to Supreme Court Rules or by a
qualified examiner, clinical psychologist or other expert."
(Emphasis added.) 405 ILCS 5/3-804 (West 2000).
The statute uses the terms "medical expert" and "physician"
interchangeably. "Physician" is defined in the Code as "any person
licensed by the State of Illinois to practice medicine in all its branches"
and "includes a psychiatrist." 405 ILCS 5/1-120 (West 2002). Section
3-804 appears in Chapter III of the Code, a chapter that addresses
admission of the mentally ill to mental health facilities. In proceedings
to that end, an examination by a "qualified examiner, clinical
psychologist or other expert" may suffice for purposes of due process.
That initial inquiry, after all, does not encompass forced medication.
Of course, when forced medication with psychotropic drugs is sought
pursuant to section 2-107.1 of the Code (405 ILCS 5/2-107.1(a)(4)
(West 2000)), medical expertise is required of the independent
examiner if the independent examination is to have any meaningful
impact upon the decisionmaking process. It was, likely, the
legislature's recognition of this fact that led to the use of the word
"or" after the term "medical expert" and before the terms "qualified
examiner, clinical psychologist or other expert." 405 ILCS 5/3-804
(West 2000). The legislature no doubt intended that the circuit court
appoint an independent expert appropriate to the proceeding.
	It is our duty to construe a statute in a manner that upholds its
validity whenever reasonably possible. Hill, 202 Ill. 2d  at 157.
Therefore, we construe section 3-804 of the Code in this manner.
	Finally, we address respondent's contention that his criminal
defense attorney was entitled to notice of the hearing in this
proceeding pursuant to section 2-107.1(a-5)(1) of the Code (405
ILCS 5/2-107.1(a-5)(1) (West 2000)), which provides in pertinent
part:
		 "The petitioner shall deliver a copy of the petition, and
notice of the time and place of the hearing, to the respondent,
his or her attorney, any known agent or attorney-in-fact, if
any, and the guardian, if any ***."
Although respondent urges us to decide this issue on due process
grounds, we find it is unnecessary to pass on the constitutional
question. See Beahringer v. Page, 204 Ill. 2d 363, 370 (2003) (a
court will consider a constitutional question only where essential to
the court's disposition).
	Respondent came to be in a mental health facility because he was
found unfit to stand trial in a criminal proceeding. In that proceeding,
he was represented by an attorney. All of the parties to this action
were aware of that proceeding. Although the purpose of the instant
proceeding was to determine whether psychotropic medication should
be forced upon respondent for his own benefit and/or the safety of
those around him, ultimately, there may be consequences pertinent to
the pending criminal matter.
	We note that the language concerning notification in section
2-107.1 (a-5)(1) of the Code is very broad and general. It refers to
notification of, inter alios, a respondent's "attorney" and "any known
agent," without qualification or limitation. We have previously
construed this section to require notification of "any other interested
parties to the proceeding." See In re C.E., 161 Ill. 2d  at 226. In the
absence of any restrictive language in the statute, we believe
respondent's criminal defense attorney qualifies as a party to whom
notice is due. In the very least, criminal counsel was a "known agent,"
and thus should have been given notice of this proceeding.
	In sum, we reject respondent's contentions that the Sell criteria
should have been applied in this case and that section 2-107.1 of the
Code is inapplicable to pretrial detainees. We, thus, affirm that portion
of the appellate court judgment that held the criteria of section
2-107.1 were applicable in this context. However, we reject the
appellate court's determination that the requirements for an
independent examination under section 3-804 were satisfied in this
case, and we find that deficiency constituted a due process violation
pursuant to the reasoning of the Supreme Court, as expressed in
Harper. We hold that the statute itself is not unconstitutional when
properly applied. Finally, we hold that the plain language of section
2-107.1(a-5)(1) of the Code required notice of this proceeding to
respondent's criminal defense attorney.
Appellate court judgment affirmed in part
and reversed in part.