i'm laurel spawn an attorney with the legal advocacy service the division of the illinois guardianship navid c commission legal advocacy service was appointed as the trial counsel for linda b and i was when i first met with linda be on the medical floor at mount sinai hospital and i explained the rights she has as a person facing involuntary that i tell her what i tell all my clients in a situation was not allowed to leave can we talk about that for just a sec mr fine sir i know there's a there we're going to hear the opposite as to whether or not i guess the argument would fail and in no position is it was in him that she was there in voluntarily but there is a but there's a factual dispute with respect to their right well there is no evidence in the record that she was there voluntarily and i'd like to address that she was held with with one on one supervision from day one she was treated as a psychiatric patient from day one she came to the hospital and was noted as being admitted because she was angry agitated can tolerable and threatening to tell her to the hospital the record doesn't show who who brought her to the hospital but once she got to the hospital she was known to the hospital because she had been a hospital previously that year as a health it was longer title but the mental health code provides in chapter three it's called admissions and it says a person may be admitted as an inpatient to a mental health facility for treatment of the mental illness only as provided in this chapter that sets out in article three a process for an involuntary or to be informal admission and that includes an examination by the facility director to determine whether or not the person is clinically suitable for admission under an informal basis there's a second type of admission that the statute allows article for voluntary admission and that is triggered by a filing an application with a facility director of the syllabi if the facility director determines and documents in the recipient's medical record the person is clinically suitable for admission as a voluntary recipient and has the capacity to consent to voluntary admission and then the third type of admission statute allows is the section on involuntary admission that we've been talking about additionally the stance that sets out that mental health that each  little every month for health facilities shall maintain adequate records which show include the section of this chapter under which the recipient was admit it so since he says there are only three way that a person can come to be treated for mental illness and mental health facility each one of them acquires documentation and the statute requires that the hospital keep that documentation do we have anything in our record to show that in fact this the statute was complied with in terms of the documentation of either an informal about aren't a voluntary admission there is nothing in the backyard to show the problem the problem is that miss linda became into the hospital on april twenty second and was treated as a mental health recipient the fact that she was also getting i monitoring did not change the fact that she was also prevented from leaving that she was getting what is considered treatment personally to the definition of treatment under the mental health treatment under the mental health  evaluation diagnosis hospitalization she was getting all of those things she was having a regular psychiatric evaluation and psychiatric care on a daily basis she was prevented from leaving we did not need consent the doctor said we did not need consent for medical we only needed consent for psychotropic medication the doctor ignores the concept of treatment as confinement as evaluation as a diagnosis as regular care as a psychiatric patient the doctor doesn't address that the doctor is looking at consent only for psychotropic medication the doctor said for medical we don't need consent somehow this fifty one year old african american woman was being held against her will at mount sinai starting april twenty second under no legal authority there was no consent for her to be held and she was not allowed to leave via the one on one supervision that she was getting all the time according to the doctor and then on may eighth a petition was prepared filed on may ninth so it was about two and a half weeks later when that petition for her voluntary admission was filed there is nothing that happened on that date two and a half weeks after her hospitalization to trigger that admission except that it was an arbitrary date the hospital pulled out of thin air so that's that's the problem that we have here  if a person has a dual diagnosis in other words they have a psychiatric illness and they also have medical illness and they're admitted to a facility like m sinai and they are treated for their medical condition do they have to be is it your position that they have to be the procedures of the mental health code have to take place before they give me say cantar treatment even though they know they are under psychiatric treatment well in this situation this is a person who came in as a mental health patient she was admitted because of her not to halt symptoms she was admitted because she and then she was admitted because she also had medical as she does so for her protection so that there is some legal authority to hold her and that so she is not held without due process yes there should be a petition filed it also protects the hospital because the hospital has legal authority to hold her so yes there should be a petition for involuntary admission filed and and as i said because she is also receiving non psychiatric medical treatments it doesn't change the fact that she is getting what is defined as much a health treatment under the code where you are breathing person well in this case she came in and there is no indication that she consented to any kind of treatment and the like or do we have any information at all in the she well we have the information that she came in because of not to have symptoms and we have the doctor saying throughout the record that she was not agreeing to any treatment either for psychiatric or for non psychiatric so we have that in the record and the doctor is originally from russia so i heard her i know that it's difficult to understand her at some point so the record as a whole does indicate she is not consenting so this was not a situation where and were going to be that her condition changed during the hospitalization this condition this was a situation where the hospital realized there's no basis to hold her we need to file something and then it did so at an arbitrary date and time benefit is that hospitals will have legal authority to hold people who come into their facilities misspent i think you and arguing that she went in for psychiatric reasons and she had been previously at mount sinai in their psychiatric division or floor this time however she was admitted to the medical but you're arguing that she was only receiving psychiatric oh no i'm not arguing that she was only receiving psychiatric care but she went in for psychiatric reasons and was admitted to a medical floor receive psychiatric treatment as well as then medical but she didn't go in for the medical so why was she  well the doctor says in the record that she quote had to be admitted to a medical board because of her non psychiatric condition she had anemia check the cardio  stans monitoring that may not be safe to give on a psychiatric unit because of risks to other patients the  and that being why the doctor said she had to quote had to be put on a medical unit as opposed to the dedicated psychiatric unit of the hospital so today people are receiving muggle health care in a variety of settings not just in a dedicated psychiatric unit of a hospital the doctor feared testified that she sees four or five patients on a regular basis on  the general medical floor of the hospital so this is not a unique occurrence linda b we cite in our opening brief that sixty percent of mental health patients have  medical condition and that's according to the robert woods johnson twenty eleven study so this is not this is not a unique occurrence for ms linda b that a mental health recipient would have concurrent non psychiatric medical issues and would need to receive treatment concurrent with psychiatric treatment in a and you know i just want to point out the mental health code defines treatment as hospitalization partial hospitalization diagnosis evaluation psychotherapy pharmacology and other services to  as defined by the code treatment is provided in a mental health facility defined by the code so then the definition of a mental health facility is a place recognizes that an emergency room is a mental health facility the illinois department of public health has determined that an emergency room is a mental health facility it is a place where people receive hospitalization diagnosis treatment pharmaceuticals and other services to improve their their  condition so yes people are receiving treatment for mental illness and emergency room nowadays and that's one of the reasons why we have asked you to consider this case and one of the reasons why we've argued that this meets the public interest exception because case law already recognizes under three six or six that peace officers can bring a person to a mental health facility and if they bring a person to a mental health facility they need to either complete the petition for voluntary admission or be named as a witness and if that doesn't happen then the petition should be dismissed i see that my red light aside if you have more questions i can answer those or i  reserve time for a bottle would have been more fully developed we would be able to address the question of the involuntary nature or voluntary nature there was no further question are in that tree and therefore the record can be construed as say it does not  are just taking medication has some difficulty she's result but for the last few days she had been taking those nations for but that's consistent with the approach that when that petition filed on ma center here and in so your desire understand your position because responder beer is a burden whether we find that the record indicates that the admission was voluntary were even if we with physical medical issues and then during the time she is an inpatient stay the determination is made that she needs to be treated for her mental health issues and using a good she has no touched upon the question of whether or not the medical floors outside my hospital constitute a mental health facility the mental health facility in this case would not appear until there was a question about  i would like to say we are not asking the court to alter anything about the code we are asking this court took by the definitions that i the definitions of treatment to apply the definitions of where with the medical floor of mt sinai hospital here and ever after b m i to help facilitate it would be a mental health facility depending on the person who is receiving treatment there so it's a case by case analysis yes thank you and and i would like to point out that the record here is a complete record the burden in an involuntary mental health proceeding is on the state the burden is on the state to prove by clear and convincing evidence that it has presented a complete case to show that i respond that should be committed by clear and convincing evidence the burden is not on the respondent and in fact the respondent has no obligation to testify and that's included in its argument that referred to mt sinai documents are from the state's disposition a report in this matter that was not complete perhaps if there had been a complete this position report i know that's not an issue but there was no treatment plan that was supported as part of the disposition of report here so that's can't dispositional report that was filed in this matter does not  very detailed information here yes i did try at the trial level to ask the treating psychiatry us what the legal authority was for some of the treatment that was being being provided to ms linda b the state objected to that question as being beyond the scope of direct of course it was not because that was covered in direct examination the state objected and the trial judge sustain the objection then there there was a decision that that was not needed to be covered and any kind of case  trial strategy but the point is it was always the state's burden to fully develop the case and it was the state's burden here to show how was to be admitted if she had been a voluntary patient probably prior to the filing of this petition and what became apparent in this case was that there was no legal authority to hol him to be from april twenty second through may ninth which serendipitously is four years ago today and the motion pointing that out at the trial level was made after the doctor testified over and over again at that proper proceeding that linda be at the very start of her hospitalization starting april twenty second was treated as a psychiatric patient not sinai hospital admitted her as a psychiatric patient and treated her as a psychiatric patient from april twenty second and higher only through to that june eleven court proceeding and the state didn't mention today but the state mistakenly thought that she was transferred on may eighth to justify that may ninth petition but of course the record does not  that out and the record shows that she remained on the third floor medical unit at mt sinai that entire hospitalization what in the world happened on may eighth to trigger that petition nothing somebody realized toups we have no authority to hold this person we've been holding this person without legal authority and we had better do something that the utilization review manager look through the chart and say my goodness what is our basis to hold this person somebody hurry up and file a petition i don't know the answer to that but there was a petition filed at that point and cannot happen again this court we are asking this court to please recognize that persons with mental illness cannot be the teemed in this matter and we're asking th the doctor testified that she was not agreeing to any treatment treatment under the code means hospitalization it means so you know since it means evaluation she was not agreeing to any of that from medical or psychiatric we have in the code that she was not willingly there she was not consenting to anything so the code tells us that she was not agreeing and then the state's trying to use smoke and mirrors to say well there's an implication that she was voluntary to justify the hospital's filing the petition on may ninth and i'm saying don't buy those smoke don't buy that that magic that there was some reason to file the petition on may ninth there was not one to be w being prevented from leaving the hospital medical or by one on one supervision and she was being given medical treatment under no legal authority and she was being held  and this court can prevent that from happening to other people by simply applying the statutory provisions of the covered we're not asking you to do anything new but just apply the clear language of the c what is a mental health facility who is getting treatment if you're getting treatment you're getting treatment in a mental health facility if there are no other questions i think i'm finished thank you