i'll respond you ready to proceed yes then go right ahead ok good morning everyone please the court i'm laurel spawn and i'm with the legal advocacy service of the illinois guardianship and advocacy commission and our office was appointed as counsel on appeal for the appellant harlan  a just as a roadmap for my part portion of the argument this morning i'd like to cover two particular things this morning and i'd like to start by just noting that the state did confess error on an issue in this appeal and in the companion leo an appeal and that was that was the issue of failure to specify dosages a particular medications and we do appreciate that the state recognized that as an error at the trial level but we think there are some broader implications in these cases and we've asked the court to to look into those in so the two things i'd like to cover this morning and harlan's case and then i would refer to leo's case in the nd part of my argument if we get to that i'd like to cover the voluntary willingness to take medication at harlan's case and then secondly i'd like to cover some other issues that we raised so  same panel and there might be consideration of deciding the two cases together the same issues that are raised in leo m are also raised in harlan h except there's what additional issue raised and harlan age so that was not exactly clear whether the same panel is deciding knows and so i i won't mention leo and if you do not want me to but it's not that i don't want you case this is what i brought up earlier and i think we need to look into it i myself have not read the leo in case i did not know that it's been docketed so my thought is to not discuss it  at this point and then talk to the clerk after we're done today about how to deal with this case and the leo in case which i'll be glad to do that's all right i don't mind having use a little bit of my time to discuss that i think it's important i would ask the court to take judicial notice of the separate leo m case it is referenced in this case you'll notice it's referenced in the reply grief in this matter so turning to harlan each is voluntary willingness to take medication right right out of the gate and harlan each case the state asks to add a medication that harlan is willing to take it's the loo vioxx that medication that's an anti depressant the state says harlan would like to take this medication and then there's testimony later from the doctor that harland requested to take it because it's a medication that helps him and then we learned during the proceeding ha has taken medication he talks about the medications that he's willing to take and this is important because one of the elements of the involuntary medication statute is that the state must prove that there is no less restrictive alternative to force medication this court has recently addressed this issue in the robert m case and harlan situation is different from robert because harlan is willing to take medication for his mood disorder his bipolar disorder he's willing to take medication for anxiety he's also asking for a medication for depression so unlike robert m who is only willing to take an anti anxiety medication robert i'm sorry harlan is willing to take medication for all of his issues not only that excuse me mr wasn't the evidence though that he didn't decide that he would take this until he came to the hearing i mean there was some testimony that he wouldn't take his medication as requested which is what brought this on well justice cates there was evidence harland himself talked about that he said that he had stopped taking medication for a couple of days evidence indicated that there was some kind of a power struggle where he testified that he did he admitted to that he said i did stop taking medication for a couple of days he said he was put into a seclusion room where he was not even able to plug and his radio in the room did not have an outlet he was upset about that he stopped taking medication now i would like to point out that before that and for all of the years that he has had mental health issues it appears that he had been taking medication voluntarily there was a quote a leading question asked about well would he have been taking medication all of this time in the seventy dollars nearly seven months he'd been at chester if it hadn't been for the prior petition for involuntary medication and the doctor said that's right i don't think he would have been taking medication but for that prior petition for involuntary medication so i investigated that i investigated that because in an appeal in the past where there had been allegations of a prior petition i had been ordered by the appellate court to look into a prior order that was the jessica h case so i did i looked into that i thought i not only looked into that with randolph county i looked into that with madison county even though the timing wouldn't have been correct for a ninety day or a one hundred and eighty day if there had been a one hundred and eighty day order with madison county because you've been to chester for nearly seven months i looked at both counties neither county had a petition for involuntary  medication you know that it was in that timeframe madison county said they never had a petition for involuntary medication randolph county had no petition within that time frame and  the only other and i contacted the cap everybody again in the last couple of days just to double check to make sure because the state didn't file anything with their brief to contradict what i said or asked the court to take judicial notice or file any kind of supplemental record and contacting everyone again just to double check to to make sure what i found was that the only known petition for this gentleman there had been an involuntary treatment petition two thousand and fifteen and age eighty nine from randolph county where voluntary treatment for this this responded but it was dismissed there was no order entered then there was this case twenty nine thousand eight hundred and thirty six this is the appeal that this is the order that's p being appealed right now and then after this case there was another petition filed twenty one thousand eight hundred and ninety six dollars and that petition was dismissed and there was no order at her so this is a person who has a long history of voluntarily taking medication he went for a couple of days and did not take his medication and bam the doctor filed a petition for court ordered treatment so this is a manner of i mean if you want to look at the bigger picture this isn't a matter of control this is not what the involuntary treatment statute is meant to do this is what the illinois supreme court c e k says the involuntary treatment statute is not meant to do so so what we have here is a person willing to take voluntary medication this is a case where according to the tory g case you know we have a person willing to take medication we can trust his word he's taken voluntary medication all this  time this would have been a case for a pretrial conference let's resolve this case without a court hearing and there's no need for there's no need for a court hearing in the situation there's no need for a forced order it's less restrictive to have voluntary treatment in this case let me also isn't it true that sometimes during those hearings a recipient might say i'm willing to take certain medications and in the case is dismissed or goes away and then two days later they don't take medications and therefore sometimes the doctors asked if we have an order that way we can make sure they stay on the medication well that may be true maybe that's the case but in a situation like this why not work out of the agreed order that or you know this case was up for the st time right for a hearing why not continue the case to see what happens here you know there's no need to rush these cases to hearing where there's an opportunity to this court can give you in that regard i mean we can't order a pretrial conference and we can't order a continuance i mean you've raised some really important issues that i think the trial involuntary treatment and this court adopted the torrey g reasoning in the robert m case and here we have a have a respondent who the trial court said this is a person who has a good understanding about medications and is willing to take medication this is a compliance issue with two when i was seven point one of the mental health code and if the court if if the state hasn't shown compliance with section two want to seven point one the remedy is reversal here this is a fundamental liberty it issue illinois supreme court said in the c e case each and every element of the involuntary medication statue isn't shown then we are infringing on a person's liberty interest and violating their due process rights so we cannot medication on a person in violation of those rights without showing compliance with every element of the statute what about the state's argument that there's no reason for us to reach this issue because in it'll be taken care of some speak well the barber eight case from illinois supreme court says that these cases are not subject to remap because the orders have already or expired there isn't a rematch and because there would have to be a new petition so these cases are would just be reversed and that's the remedy and that's a lesson to that's that's how the court the trial courts learn they see what to do from the reversal yes i misspoke i meant reverse so you think that we should address each and every issue so that we make it even more clear to th stay what they have to do when they're trying to get in terri medications administer well i think especially in a case like this where the hearing lasted the hearing lasted seventeen minutes there were sixteen medications requested and it's it's hard to imagine how you can adequately approach a case where you're asking for sixteen psychiatric medications in a seventeen minute hearing that's just seventeen minutes i see my time is up man is it ok to finish my thought here as i said kelso if i could get the clerk to add about three minutes i think that's about what we took that way you can get and talk a little bit about the next issues because those are very important as well ok so i'm kind of turning to my next issue now you know we appreciate that randolph county cases have been kind of on a continuum and it used to be that council waived hearings and randolph county and in the last decade there's been improvement with that because they're having hearings now but the hearings have issues still i mean here there was a seventeen minute hearing and you know that included the state's expert testimony the respondents testimony and the court's ruling but no closing arguments there were there weren't any closing arguments and it appears the state may be trying to admit the petition and evidence as a way of getting around the compliance issue of presenting evidence on the risks and benefits of the medication but the petition does not fulfill this requirement the code requires explicit medical testimony and if medications are to be administered together in combination then the benefits and risks of the combination must be presented and that is this court's h p case and we know the petition is not evidence you know that's from the awb case and additionally there are problems with proving with proving capacity when the written information about the medication is lacking the written information here it is included in the common law records like the written information that was determined to be ineffective in the lhari each case and this is important because it's a process requirement before the state can prove that the respondent lacks capacity here the sheets reflected multiple conditions or conditions that the responded did not have the sheets did not reflect whether they were primary or alternative medications or if i'll turn it to what they were alternatives or they did not contain information about the benefits and risks of the medications if they were going to be administered together in combination  and the petition if the petition was meant to be used in conjunction with the written information the petition is not helpful it broadly discusses two groups of medications anti psychotic an but these terms are not cross referenced on the medication sheets and the r h case found found it insufficient for a respondent to have to cross reference written information with a petition to decipher information provided in medication sheets and i would just close by saying this court in the past has said that these proceedings should not be conducted pro forma because of the fundamental liberty interests involved in these proceedings and this court has reminded the parties involved to be ever vigilant to protect the rights of respondent as protected under the mental health code and that was from the john r piece and i would he was having some difficulty earlier so may it please the court counsel my name is sharon shanahan and i represent the people of the state of illinois i would like to begin my argument lithium was up to the therapeutic level daily and then the alternative medicine b p a also said up to the therapeutic level bailey i have said many times in oral arguments on mental health cases that when i'm arguing i criminal case i sort of feel like it's us versus them but in a mental health case we're all on the same side we want what's best for these people and i would not want someone giving me a lithium up to the therapeutic level because what is the therapeutic level the story to the state agrees with the finding and bob you have this published opinion the way there is a misprint that accounts for the respondent did catch on there this is this would require a reversal not every man we're not going to go back and have another hearing as to whether  harlan h should get more medicine that is just the way these mental health cases work and so it is a complete reversal and for that  reason i don't know that there's any reason to address and if these other issues i said that repeatedly in my brief i think it's interesting that i know i and writing briefs and this court in issuing opinions we always say reversed and remanded for further proceedings there will be no further proceedings in this case and so it seems to properly but right now just as case you said what relief commis court yes and that's kind of my opinion completely these are issues that need to be fixed but i think they need to be fixed in the trial court so that's my that's basically what i want to say is given the confessional there i see no belief that after a final an appealable order has been entered that she can go to the randolph county courthouse in the madison county courthouse and look to see if there's been any issue california case in my brief that i always kind of put in in cases like this which is if it's not in the record it doesn't exist and the case that counsel cited for the proposition that she could do that was entirely different situation st of all that was a case where the counsel for the respondent had asked to withdraw filing and anders brief and the appellate court looked at it and said and no one ordered appellate counsel to go look and see if they were these were anything there were any other cases you can just take it upon your self to go look for things that might  by knowledge of the respondent he could have been asked that this could have been done on cross examination the defendant scuse me the respondent this could have been done by a number of ways at trial now the logical jump that i'm sure counsel for the respondent will make on reply is aha ineffective assistance of counsel but you have to have something to base a claim of ineffective assistance of counsel on and because this was never entered into the record and the record does indicate at least the testimony of the doctor was listed several places including another state i believe it was that he said respondent had been hospitalized and so i recognize  we're kind of putting respondent in the position of trying to prove a negative but i strongly object to any to anything in the  brief of saying after an appealable order was entered i went and looked for this nobody told me to but i would look for it anyway and the fact that i didn't find it means that it wasn't there those are two very separate things she anything after the appealable order shouldn't be considered and secondly to simply say i looked in two places and i didn't find it doesn't doesn't tell us anything so  what we do have is respondents physician who said he had been treating response from months and he said he's had other admissions he's had other administration of psychotropic medicine to try and prove anything against that is is just simply not should not be allowed so i think that part of said well he's refused to take his medicine and that's why he this whole thing started and so what's to stop him from taking it quitting it taking it quitting it taking it quitting it and many of these medicines are the kind of medicines that can have very bad effects if you quit suddenly quit taking them  and so i think it's important that if we allow a procedure like it happened here where a respondent quits taking his medication as a result there's a hearing and he says that the hearing i've changed my mind what to stop him from then saying the next week i change my mind again it  right to make choices about their lives and their bodies but these are as responded notes repeatedly and properly so these are medicines that can have  side effects and i think it's important that we have medical professionals deciding well if you take this but not that you could have a problem and even within the the medications that the respondent said he would take the documentation included in the record which by the way i don't want to run out of time to say this but the clear distinction between this case and laura is that the documentation and the and the petition itself were admitted with no objection into the records so and then laura h they were not they might ask a question in regard to spams the suggestion that there were sixteen medications requested  seventeen minute period would you like to address that in terms of was that sufficient time to cover all the information seems like it would be necessary to issue an order result revolving around sixteen medications well i think that would have to be that when everybody walked into that court room that day they knew nothing i think that can saying we have ten of the mental health statutes that i do but i believe that the respondents have to be given notice in writing of the benefits and the side effects in your  and in fact it even says that the the position or again i'm really for getting the exact language but the someone designated by the physician has to give and these documents and if the doc if the respond is unable to reason themselves and reason to them in the record clearly shows that that's exactly what happened here that a registered nurse on behalf of the doctor gave the respondent all of these documents and  again on the record says that that she read them to him so he and i believe that there is case law that says simply telling them person is not good enough you have to give it to them in writing and so i hope that answers your question thank you and the other questions i guess  because it said that the petition could be admitted into evidence or does it and she said well our case is not those which is it's whether the benefits and side effects but it also says in this case was the benefits a side effect so and so i don't think that a w can be limited to the conclusion that you can forth there and and as i said the documents here were admitted without objection so  and this i think even goes back to your initial question which is can we consider well i looked at the clock and forgot my train of thought but so i i would i would like to say that the state talks about how it's also on the respondent side i think that's true the state has an obligation to look out for all the people you know it's not just presenting a petition for involuntary admission in these proceedings but the state has an obligation to protect the respondent too and yes i think the same is true at the appellate level and so you know as i said in my opening argument here i know we appreciate that the state confessed heiress to the dosages but when the state says there's no reason to address the other issues i i disagree with that i disagree with the idea of an advisory opinion because the state says there are important issues here they need to be fixed but they need to be fixed in the trial court they're not going to be fixed in the trial court unless the trial court gets some guidance the same errors are going to keep occurring and that's why i i do ask this court to please take judicial notice of the concurrent case if this court reach the transcript it will see the same exact but it will see the same question asked of the doctor doctor but for a prior order with leo am have been taking volunteer with leo and have been taking medication up to this point the doctor answers the question the same way she did in harland's case and the state raised this issue the state raised this issue at the trial level of there being a prior order and the doctor just went along with it the doctor maybe was a deer caught in the headlights and didn't know the answer and so answered the way the state thought it should be answered it was a leading question and so this the doctor said well no i don't think i don't think harlan would have been taking medication except for that prior petition and that that means and immediately prior petition there was not one that's why i investigate d because it's relevant it's relevant to his voluntary ness and that's why it's important to this court the state brought that up at the trial level and the state was asking the court asking the doctor question that it apparently had in its script a direct examination but the state apparently didn't know the answer and the doctor answered incorrectly so that's very relevant here and for the state to say now that i have no business bringing that up at this level i think is is very wrong and it's perpetuating the falseness of this idea that harlan age was only taking medication pursuant to a court order that we know doesn't exist if the state felt that there were that i'm making a false statement to the court at this point the state could  certainly provide a copy of that court order requiring harlan each to take psychotropic medication and i would i would ask the court to take just notice but there is no such order required that required harlan age to take involuntary medication he was taking medication voluntarily he's had a mental illness for a long time he's had bipolar disorder he took medication voluntarily  there is reason to address these various issues raised in his appeal it is to give guidance to the trial court and i would i would ask the justices to note now that harlan age has had more time in this court that he has that he had at the trial level i also like to take i don't know i was going to read from a transcript from the tori g case about homeland subpoena just about the testimony about one medication but i'm not going to have time for it because it was over over a minute to talk about just one to read the doctor's testimony about one medication about the benefits and risks now if you give testimony about the benefits and risks of one medication and there were sixteen in harland's case you know there's not time for that in a seventeen minute hearing plus cover all of the other elements of two hundred and seven point one that's what's happening in randolph county i would ask the court to please consider the issues in this case compare this case with the the companion leo and case and please look at these issues and reversed not just on the narrow issue of the dosages but to look at these other issues to see that they're happening in not just in not just an isolated case but they happening in more than one case they're happening on a regular basis they're happening as a regular practice thank you but he also i do have a question it was touched upon but really didn't go into too much detail and i know messed with j c you're involved throughout the state the issue regarding some sort of written documentation to be given to a recipient regarding the combination and the poly pharmacy and the interactions of different medications do you know is there any type of document such as that that is being used anywhere else or anywhere in the state in these types of hearings a pretty i think that would be a document that would be tailored to the situation there's not as there's not one standard form that would because we don't know what medications would be used in combination for particular person so that don't have to be tailored to the to the person that occasions used a combination so following that then basically the natural progression would be that the particular doctor in that particular case would have to generate some sort of document himself or herself to list the medications and how they interact for that particular person in that particular case is is that kind of what i'm hearing that's that's that's what i'm i would think and i think that's what the code and visions to that we're you want to make this so that it that the information is pertinent to the particular respondent it out and out and i get that in the code basically states and that's to dash one out to a five i'm looking at here the coke is that a physician shall advise the recipient in writing of the side effects risks and benefits of the treatment as well as alternatives to the proposed treatment to the extent such advice is consistent with the recipient's ability to understand the information communicated my reading of that does not require it doesn't say the combination of with giving medication in combination with each other because doctors do testify about how each medication has its own you know side effects and risks and then when  medications you know oftentimes like like with harlan h you have medications from various different groups like there are anti psychotics their mood stabilizers anti anxiety medications that wasn't even discussed here in this case you know i i know about these from from medication cases where the psychiatrist have talked about all the different medications and explained them so if medications are given like you have a medication from the you know you have an anti psychotic and maybe have a mood stabiliser you have an anti anxiety and they're out used in combination then when those medications are used in combination then there are additional side effects on top of the individual side effects from using all of those together no doubt and you cited the case that addresses that in states that the expert must testify to those side effects of the combination of those medications correct right so that's something else that the respondent needs to be aware of so when talking about when providing information about side effects of the medications that's information that the respondent also needs to know in deciding what medications to be able to consent to or not making  reasoned decision they need to know if there are additional side effects when taking these medications together just as somebody with any other type of medical condition being offered multiple medications needs to know all the information about medications individually about how they're going to affect him taking them together how those would affect his health just as you have any follow up questions of