i've just been talking with my opposing counsel for the last twenty years or so so i know that it's their job to represent the state as matters i'm about to say some harsh things about how these cases were handled not these four consolidate cases show that coming for psychiatric purposes means hospitalisation these four cases show that little if any thought is given to the disposition of part of a procedure these four cases show a complete disregard for the concept of least restrictive alternative and what is slipshod matter those are words from the case commitment represents a serious deprivation of liberty when a court finds that a person a subject to commit the court is required to commit the person to the least restrictive setting possible this protects the committed person so that the state is not taking away her liberty and a harsher way than is necessary to protect both the committed person and the public in these four cases consolidated today short shrift is all that was given to disposition now i  went over this argument with a trusted advisor and my husband said to me short shrift why would you say short shrift to the court that seems pretty colloquial so i looked it up i looked it up and short shrift means careless treatment scant attention so i think short shrift is entirely appropriate short shrift was given to disposition let alone the important concept of the least restrictive alternative jungle if you actually attended any of these hearings not in the fourth district but i regularly represent respondents in the first district in i believe the prosecutors and the defense lawyers have a very difficult job to do with these hearings yes those the court invariably these hearings are conducted in very small room smaller than our council chambers here in with a court reporter and witnesses whom he responded who is in very dire straits there is a reason for haste in any honor but i disagree with you when it comes to this matter of dispossession i think that this position is being treated as an obligatory prove up the questions are asked to have them on the record but there's really not the attention that skip and maybe that's because of some of the circumstances just for comparison and cook county cases are heard in the courtroom for the most part  there are two counsel tables there's a batch there's a space for the court reporter there's a spot for the witness there isn't there is room for an audience but we have students who are our nursing students last students needs these hearings a finest oh and i and i i think that is also very helpful in many cases because sometimes respondents don't want to come to court they wish to have their hearing heard at the facility and cook county tries to be accommodating to that and there are some changes in and cook county even right now to have to try to have more hearings at the hospital so i think that is wonderfully accommodating of sangamon county to to do that and i think you know it's very possible that it means more respondents are able to attend their hearing i can tell you that in county sometimes a person will not want to come to court at the at the metal health court room because it means they're going to be coming from a private hospital  is this is a criticism of the attention that's paid to disposition and this is no criticism of the courts and their accommodation of respondents and where the hearings to take place i know that can be difficult but when disposition is treated as an obligatory prove up we are missing the constitutional complete cation we are missing the fact that the treatment team needs to be considering alternatives to hospitalisation and these four cases show that hospitalization is is questions are leading questions and you're recommending hospitalization for this responder right doctor the state has confessed error into a few four cases that the two cases where is the only possible dispositions this is all i have to say at this point if there are specific questions i could answer i would be happy to answer questions about the specific cases i'd also like time to respond to  make it sound like the doctors the experts in both these cases had one minute testimony took the stand and basically concludes your areas i mean if it were made a conclusory statement that hospitalization is the least alternative  is the least restrictive alternative but i think if you look at the record in this case look at the testimony of the doctors in both of these cases it's clear that the doctors and cam want him dr robinson and in most cases doctor quranic i guess is how you say that both of them testified in the end pretty significant detail to the condition of of both of these respondents on the start in and pamela  and responded specific argument in pay more in is that the dispositional report was insufficiently detailed in this case and specifically responded argues that the report did not have a projected timetable for an attainable of the goals and it did not have information regarding the appropriateness and the availability of alternative treatment plans my first argument pamela him was that respondent forfeited this argument on appeal there was a disposition a disposition report filed in this case her argument is that it was not detailed enough and there was no objection made at the trial level so my first argument is that she has forfeited review of that issue on appeal my second argument is that i could not there is no detail in the statute and there's no detail and five three dash eight ten in case law does not indicate what exactly this whole projected goals and had a had a three week cover three weeks span it gave the projected goals that the respondent should attend during those three weeks and then it also showed her progression toward those goals and my argument is that according to the statute that is sufficient that a sufficiently detailed to to be proper to the statute respondent second argument is that there is no alternative treatment suggestions and pamela m this court has ruled in the past that the disposition report does not need to contain a quote detailed report on treatment alternatives the report in pamela him indicated the respondent was living alone was not married it also indicated that respondents neighbor had been taking care of responded dr robinson specifically testified that the respondent pamela in could not be returned home because her house was a mess she was sleeping outside she had brought a box cutter to a neighbor's house and she could not provide for basic needs without constant supervision dr robinson in that case and pamela m also compared admission into admission into memorial medical comparing those as alternative options so martin in this case is that dr robinson didn't answer to questions his hospitalization the least alternative least restrictive dispositional report i think it's clear in this case that dr robinson took in a number of factors and made a informed and educated decision that it mission possible ization was the least restrictive hospitalization was the least restrictive alternative and again if you look at the doctors the experts testimony in that case it's clear that there was there was also a disposition report in more than a in the report the treatment plan recognized specifically recognized mono a strain says she had a support system she has relationships it quoted that her financial resources were strength and it also stated that respond it was currently living with after endorsing the treatment plan he specifically testified that it mission in the mcparland was the least restrictive alternative and he said this was until the respondent psychiatric symptoms were stabilized to the point that she was not considered a danger to herself or others  the record also indicated that and as responded noted and her brief it was unclear whether respondent was involuntary but in the past but the record did indicate that respondent had prior admissions whether they involuntary or voluntary her last release from the hospital was in december of zero eight and after that the record indicated that she was not she was not attending her scheduled appointments and she had not been taking occurring and had detailed explanation for why hospitalization at mcfarland was the least restrictive alternative it's not that he just took the stand to briefly said yes at least restrictive alternative he specifically endorsed the treatment plan an specifically testified that mode a needs day to day assistance she cannot care for basic needs she does not have a place to live and he is not sure where she will go after this she cannot take care of herself he specifically testify that she posed a threat  herself and others was loud and paranoid she believed others were other people were trying to kill her during one of the meetings with the doctor monet threatened him and the doctor felt fear for his safety and  have problems with hygiene and she cannot wake up by herself without assistance in the morning the respondent in moaning also testified that her family was out to get her and that she was living with her brother when she was tried in the police custody check i have it in my notes that she testified that she was living with her boyfriend when she was arrested and this is according to documents conferencing physical psychiatric social investigat the treatment plan it didn't specifically say that living with her brother is a is an option but in the treatment plan it did the say that she had been living with her brother and i think that that can be said considered as the doctor indorsed the treatment plan  that he did get to see that she was living with her brother and i think it's it's fair to say that that was the fact it was in the treatment plan that the doctor probably considered that as an alternative  social work completed kathy love she checked the no box they were there alternative treatment was more appropriate and then continuing to stay with respondents further up their toes likely enough and that has not yet been able to be confirmed now love did not testify apparently indicated they had been unable to contact their son his brother by telephone during this ask the ization  what's your question or are i'm sorry oh and do you have any idea what efforts were made him take the record does not make any indication of what efforts were made contact the brother no were i'm not sure about the amount of time but i do not know what there was no testimony regards to what what efforts were made to contact her brother i am i'm sure i think that based on the testimony from the doctor and respondents own testimony i think was sufficient evidence to show that living with her brother was not a possible alternative and regardless of what i'm not sure what contacting the brother and even finding out whether he was open to that possibility or not how that would really affect whether to stop the brother the brother should of been contacted and i don't want to speculate that he was or wasn't i don't know he should have been contacted for sure i think the audience the evidence beyond that  just given the list of things that dr krikorian testified to regarding that she could not take care of herself and she still continued to pose a threat to herself and others his interactions with her showed that she was aggressive i think that testified that testimony alone shows that living with the brother probably was not an alternative a reasonable alternative but without talking the brother about i mean he pretty could've given them more from ation i totally agree with that he should've been contacted but i don't think contacting the brother alone would have changed that they were in this case well we don't know we do not know  attorney for the state just gave a lot of factual information i did address some of that quote factual information that replied every former one and that's a problem with relying on hearsay double hearsay triple hearsay as fact and just a sample to you pointed out i earned i think it was justice meyer caught we didn't hear from the social worker who wrote that report we didn't hear from the police officers picked up and you actually hear from those kind of people in your hearings griffis yes we do real because there needs to be substantive fact form the basis observations of the site to wilson versus clarke and the dr can rely on hearsay but it has to have a reasonable basis therefore it's important for us as trial counsel to interview people who allegedly saw erratic behavior in the streets and find out what actually happened sometimes it doesn't happen the way it appears to in the petition but are you asking us to really  have here and i'm saying it's not enough and i'm not i don't want this to be i'm not making this a factual case because really we don't have any facts we have conclusions and everything that the state talked about and i'd like to just talk about that per minute because while she she was taking voluntary medication at the time of her hearing so she the doctor  court order and the records show she was taking medication so apparently she was reliable when it came to making that decision pamela  you're right the state may have presumed that under my ability there and in pamela i am i think pamela i am is probably the most absurd case of these four because in that case you may remember the doctor said oh let me back backtrack one minute the doctors in these cases did not open her eyes that hospitalization was that this should alternative the question the doctor answered in each of these cases are you recommending that she treated as you just silly yes there's a recommendation there's not even an expert opinion that this is the least restrictive alternative that's just kind of glossed over sometimes in some of these cases there have been a there's been a follow up question and has a treatment plan been formulated yes and just that treatment plan the least restrictive yes so we have compared to now we have an answer we have an answer to a problem no work has been shown without the work being shown we don't know how right that answer pet the pamela m case involved a doctor saying yes hospitalization i recommend it then we have closing argument after pamela am testif this family i'm testify to i have blue cross blue shield and then in closing argument the state says and we despite the doctors testimony recommending at the test facility we are now requesting that pamela and be committed to this private hospital and the trial judge says well wait a minute state do you want to reopen reopen the case and it's then that the doctor backtrack home oh ok the doctor backtracks and says well you know maybe we could treat her here at the private hospital and she has some medical issues maybe there are going to be enough doctors there while there are doctors at the v a just facility there are medical doctors that treat pet conditions at the test facility but i think we can treat her at the private hospital and this really just shows the back of a time the lack of their very fine limits the options for treatment i would not concede that so you think that even the respondent is found to be a danger to herself and others several possibilities for placement and the idea is to find the placement to find a disposition that's going to protect the person and protect the public and each of these cases this was not a matter of these are not cases of dangerousness at best these are cases of possible base inability to provide for basic needs hearing these are cases involving constitutional dangerous conduct standard which we didn't argue in this case because of the strong least restrictive alternative argument here and in each case court must look at the circumstances of the case the treatment team must explore alternatives and then the court must make a decision so are you saying the court has a suicide duty to say look team you haven't explored i'm going to deny you the petition i think the trial court could say treatment team there doesn't seem to be enough information here for me to the hearing i think most of these hearings occur close to their filing date they occur with the state can take up to fifteen days of continuance without agreement of the respondent and  has the duty because this is a constitutional and statutory mandate not to restrict a person's liberty in a more restrictive way that the necessary just for the sake of expediency so yeah i think it's a matter of saying or even that you know that during that time period that that morning or that afternoon saying excuse me can you call your treatment team right now and have them get on the phone and look into some of these things because it might be surprising what happens you know they're there maybe oh this is no different from a court deciding a medication case is the court the doctor in a medication case the court is taking all of the recommendations and listening to all the evidence and then just making a legal decision so no i'm not asking the trial court to become a doctor i'm asking the trial court to enforce the treatment team's gathering of information and preparation of a report on dispositions and that's really the most important part of the the disposition report the disposition report has three components the treatment plan the social investigation and the report on possible alternatives for disposition in a recent fourth district case where i can't remember now if we  or if if the respondent agreed to voluntarily dismiss the case it was not from saying i'm a county it was not from it was not from mclean county which is where these cases are from these for if that was a clue did with the disposition report said the respondent was discharged six months ago and was discharged to a community setting within a week he had not done well at that particular community setting and so we the hospital and the community setting worked on a stronger of a community setting he also did not do well in that setting and and ultimately was re hospitalized based upon that this report said we decided that the community setting would not be most appropriate but instead we contacted the pre admissions admissions screening agent for our county to look into possible placements including nursing homes more restrictive group homes the pretty admission screening agent did conducted its assessment and decided that this person was not appropriate for those other alternatives therefore hospitalization is currently the least restrictive setting and that's what we need to see in these cases in that case the court could be fully confident knowing that the treatment team did the work it needed to explore and alternatives had a good reason for recommending hospitalization and was that it was found that respondent was not insured  and she ended up being committed to a private hospital rather than what the doctor recommended in his direct testimony so these cases are very important this position is very important because if a person can be placed in the least restrictive setting it's going to be more therapeutic the person is going to have a better except once of the commitment order  in some of these cases where a person is simply committed to the hospital where there's a math problem we have a conclusion we have an answer but there's no work shown to support that conclusion and in all of these cases the conclusion was hospitalization we have a person hospitalized they're going to do whatever they can in the future to avoid that that hospitalization and if we can encourage the least restrictive alternative in these cases and in most of these cases there is homes there are i do it for the patients well i can only speak for my trial court experience of cook county and i have seen i have seen individuals placed in a variety of settings i've also seen individuals committed on caring custody orders to relatives or friends who then vouch for the person and say yes i will make sure they go to their outpatient appointments i had a person once  committed for dangerousness because he climbed cranes in chicago he climbed cranes from a skyscraper because he had had it in just to study him a legitimate and justice for which he was suing a party in federal court but he wasn't getting anywhere and he felt that he needed to proclaim the injustice from the mountain top there being no mountain he went to the next best thing he climbed a curb a crane and not just once he never intended to harm himself he says he didn't harm anyone  but you can't have people climbing cranes in chicago proclaiming justice you know i mean that series that is that is certainly a danger and he understood that he was found subject to commitment he walked out of the courtroom a dispositional order where he was ordered to go into outpatient treatment and to meet with a counsellor once a month for three months and to report back to the court once a month