NO. 4-00-0480

	IN THE APPELLATE COURT

	OF ILLINOIS

	FOURTH DISTRICT

In the Matter of GWENDOLYN N., a		)	Appeal from

Person Found Subject to Involuntary	)	Circuit Court of

Medication,						)	Sangamon County

THE PEOPLE OF THE STATE OF ILLINOIS,	)	No. 99MH301

		Petitioner-Appellee,		)

		v.						)	Honorable

GWENDOLYN N.,						)	Robert T. Hall,

		Respondent-Appellant.		)	Judge Presiding.

_________________________________________________________________

		JUSTICE COOK delivered the opinion of the court:

		Respondent, Gwendolyn N., appeals from a trial court

order authorizing her involuntary treatment involving

psychotropic medications.

		The State, through Dr. Christine Fletcher of the Andrew

McFarland Mental Health Center (McFarland), petitioned the court

on April 5, 2000, to begin the involuntary treatment of Nicholas Gwendolyn

with psychotropic medications, pursuant to section 2-107.1 of the

Mental Health and Developmental Disabilities Code (Code) (405

ILCS 5/2-107.1 (West 2000)).  A hearing was held on April 28,

2000.  Dr. Fletcher was the only witness.  At the conclusion of

the proceedings, the trial court authorized Gwendolyn's involun

tary treatment with psychotropic medications.

	I. NICHOLAS GWENDOLYN'S MENTAL CAPACITY

		Gwendolyn first contends that, pursuant to section 2-

107.1(a)(4) of the Code, the State did not prove by clear and

convincing evidence, the factors necessary to administer involun

tary treatment.  We disagree.  Dr. Fletcher diagnosed Gwendolyn with chronic paranoid schizophrenia.  Gwendolyn exhibits

obsessive-compulsive behaviors whereby she "get[s repetitively]

stuck" in her movements and makes bizarre, circuitous trips

around the clinical unit.  This can affect her ability to eat

meals and dress herself.  She can also become episodically

aggressive.  We recognize that the fact of mental illness,

standing alone, is not always a sufficient basis to conclude that

a person lacks the capacity to make a reasoned decision regarding

medical care.  However, it is also true that failure to recognize

one's mental illness may be evidence that capacity is lacking. 

In re Perona, 294 Ill. App. 3d 755, 767, 690 N.E.2d 1058, 1067 (1998).  Here, Gwendolyn refuses to acknowledge her condition. 

Fletcher also testified that she attempted to discuss various

medications with Gwendolyn but that Gwendolyn was not cognizant

of the matter being considered or the risks and benefits associ

ated with the various types of treatments.  Gwendolyn's failure

to present any rational explanation for her refusal to take the

medications may also be considered as to the question of her

capacity to make reasoned decisions.  Perona, 294 Ill. App. 3d at 767, 690 N.E.2d at 1067.

		The trial court heard detailed testimony from Dr.

Fletcher regarding Gwendolyn's psychological condition as it

relates to the statutory factors outlined in section 2-

107.1(a)(4).  405 ILCS 5/2-107.1(a)(4) (West 1998).  We find that

the State met its evidentiary burden at trial.  

	II. THE SCOPE AND SUFFICIENCY OF THE TRIAL COURT'S JUDGMENT

		Once the trial court finds that the prerequisites to

involuntary treatment have been proved, it must set forth a

detailed order, establishing the type and scope of treatment that

is authorized.  Since December 1, 1997, section 2-107.1(a)(6) of

the Code requires:

			"An order issued under this subsection

(a) shall designate the persons authorized to

administer the authorized involuntary treat

ment under the standards and procedures of

this subsection (a).  Those persons shall

have complete discretion not to administer

any treatment authorized under this

[s]ection.  The order shall also specify the

medications and the anticipated range of

dosages that have been authorized."  405 ILCS

5/2-107.1(a)(6) (West 1998).

Prior to December 1, 1997, the statute did not require that the

order designate the medications to be administered.  In re Bearry B., 295 Ill. App. 3d 1080, 1088, 693 N.E.2d 882, 887 (1998).  However, even then, the courts noted:

		"[B]ecause of the substantial liberty 

		interests involved in the involuntary ad-

		ministration of psychotropic medication, we 

		believe that the better practice by the 

		trial court would be to include the precise 

		medications *** to be administered in its 

		order granting a petition for involuntary 

		medication.  This will ensure that the pro-

		vider of medical care has strict guidance 

		for the treatment of a patient who is to 

		receive psychotropic medication involuntarily."

		Bearry B., 295 Ill. App. 3d at 1088, 693 N.E.2d 

		at 887.

		Here, the trial court used a fill-in-the-blanks-style

form order, stating that "Gwendolyn [N.] shall receive

psychotropic medication to be administered by members of the

clinical staff at [McFarland], whose licenses allow them to

administer psychotropic drugs pursuant to Illinois law."  The

form order cites the 1990 version of section 2-107.1 and appears

to have been created in 1991.  Clearly, the form order was not

updated to comply with the 1997 amendments to section 2-107.1. 

		Gwendolyn argues this order is unlawful and overbroad

because it fails to (1) specify the medications authorized, (2)

specify the anticipated dosages for each medication authorized,

and (3) identify the individuals authorized to administer such

medications.  Gwendolyn is correct.  Neither the trial court's

oral statements at the conclusion of trial, nor the written order

entered complyies with the requirements of section 2-107.1(a)(6). 

405 ILCS 5/2-107.1(a)(6) (West 1998).  However, we must determine

whether the inadequacy of the order requires reversal.

		We have previously held that, although the trial court order violated section 2-107.1(a)(6), reversal was not warranted

because (1) respondent failed to object to the alleged errors at

the trial level, (2) the evidence presented showed that respon

dent's attending physician was intimately familiar with respon

dent's treatment protocol, and (3) respondent did not contend

that he was prejudiced by the omissions in the court's order.  In re Miller, 301 Ill. App. 3d 1060, 1072, 705 N.E.2d 144, 152 (1998).

		Here, Gwendolyn failed to object to the order in the

trial court.  Further, Dr. Fletcher's testimony demonstrated

extensive familiarity with Gwendolyn's treatment protocol. 

Unlike the respondent in Miller, however, Gwendolyn has presented arguments that her rights have been compromised and she was

prejudiced by the order that failed to comply with the Code

requirements.  We agree.

		The State's petition requested leave to administer six

different medications:  Haldol, Cogentin, Lorazepam, Zyprexa,

Risperidone, and Zoloft.  Dr. Fletcher testified that these

medications would not be administered simultaneously.  Rather,

combinations of these medications present alternative courses of

treatment.  Dr. Fletcher contemplated three successive "courses" of alternative treatment for Gwendolyn, involving various combi

nations of the medications.

		Gwendolyn has taken four of the six suggested medica

tions in the past, with only slight side effects.  However, she

has experienced nervousness when taking Haldol (a common side effect that is counteracted with Cogentin).  Thus, Dr. Fletcher

wants permission to administer Zyprexa or Risperidone, newer

drugs that have a similar impact to Haldol, with fewer side

effects.  While these drugs have fewer side effects, Dr. Fletcher

admitted that psychotropic medications do have side effects, the

most severe of which is death.

		Dr. Fletcher testified that she did not expect to

return to court to request permission to proceed from her first

course of treatment, to the second course, et cetera.  Rather, she wanted "latitude" to exercise her medical judgement in

determining which combination of the antipsychotic medications

worked best for Gwendolyn.  The trial court gave Dr. Fletcher

that latitude.  At the conclusion of the hearing, the trial court

stated:  "for a period of 90 days, I'm substituting my judgment

for [Gwendolyn's], and certainly Dr. Fletcher's judgment for

[Gwendolyn's], and hopefully this will do her a ton of good."

		Gwendolyn asserts that under the existing order, Dr.

Fletcher and McFarland have carte blanche authority to involun

tarily administer any drug, in any dose, essentially by any

person.  Further, that the various treatment alternatives outlined at

the hearing are not subject to court oversight and may be admin

istered based solely on the judgment of Dr. Fletcher and

McFarland staff.  Gwendolyn's main concern is that with no court

oversight, there will be no cost-benefit analysis to ensure that

the benefits of the particular combination of medications out

weigh the potential harm.  405 ILCS 5/2-107.1(a)(4)(D) (West 1998).

		The State basically sought permission for Dr. Fletcher

to "experiment" with varying substances until an optimal combina

tion was found.  That suggestion is not entirely novel.  CompareIn In re Kness, 277 Ill. App. 3d 711, 720, 661 N.E.2d 394, 400 (1996), wherefor exampelle the State argued that the treating physician "should not

be limited to the use of one drug but should be able to switch

respondent's medications based upon the respondent's reactions to

the medications."  The appellate court found that the argument

had some "practical appeal" but ultimately rejected it on the

basis that to do so hampers the trial court's ability to under

take a meaningful comparison of the benefits of the medication to

the side effects the respondent might suffer.  Kness, 277 Ill. App. 3d at 720, 661 N.E.2d at 400.

		The trial court's comments here indicate that it was

willing to trust Dr. Fletcher's professional judgment in deter

mining when and under what circumstances Gwendolyn's medications

should be alternated.  Neither the trial court's oral statements

nor its written order establishes the parameters of allowed

treatment.  While we, as did the court in Kness, understand the practical appeal of a system entrusting treatment discretion to

physicians, we too conclude that it would be difficult to square

that with the Code's requirement to balance the harm and benefits

of treatment.  405 ILCS 5/2-107.1(a)(4)(D) (West 1998). 

		While we do not doubt that the trial court and Dr.

Fletcher have only the best of intentions for Gwendolyn, the order here impinges upon Gwendolyn's liberty interests.  When

analyzing section 2-107.1 and the right to refuse medical treat

ment, the Supreme Court of Illinois noted its concerns with the

involuntary administration of psychotropic drugs.  One of the

concerns was that "psychotropic substances may be misused by

medical personnel, and subverted to the objectives of patient

control rather than patient treatment."  In re C.E., 161 Ill. 2d 200, 215, 641 N.E.2d 345, 353 (1994).  As a protection against

these potential abuses, section 2-107.1 requires court approval

of involuntary treatment.  This requirement promotes the sState's

"legitimate parens patriae interest in furthering the treatment of those who are mentally ill *** when the patient is not capable

of making a sound decision in his own behalf."  C.E., 161 Ill. 2d at 217, 641 N.E.2d at 353.  These statutory safeguards serve many

purposes, one of which is to ensure "that the medication will be

used for therapeutic purposes and will not be misapplied as a

means to discipline or 'manage' the recipient."  C.E., 161 Ill. 2d at 219, 641 N.E.2d at 354.  Here, however, the combination of

the deficient order and lack of specificity of the court's oral

ruling fails to ensure the proper use of psychotropic medications

with respect to Gwendolyn.  The trial court order has prejudiced

Gwendolyn's liberty interests and requires reversal.		

		We should make clear that we are not suggesting the

trial court must develop a course of treatment and then dictate

that course to the treating physician.  That would constitute

role reversal.  The duty always remains with the State and the treating physician.  That duty is to educate the court suffi ciently to allow the court to make an informed judgment in its capacity as parens patriae.  That simply did not take place here.  Similarly, the physician may feel that the patient's case neces

sitates alternate treatment programs.  If so, the doctor must

then explain each separate proposed course, including the bene

fits and risks inherent in each.  This is no different than one

would expect in any other context.  So informed, the court may

then decide to authorize the alternate courses or decide that a

"wait and see" approach should be adopted, based upon the inher

ent risks.  Again, these decisions are no different than those

made by other patients and their families throughout our State on

a daily basis.

		Because the order subjecting Gwendolyn to involuntary

treatment did not specify the medications authorized, did not

specify anticipated authorized dosages, and did not specify the

individuals authorized to administer such treatment(s), we

reverse the trial court's judgment and remand the cause for

further proceedings not inconsistent with this opinion.

		Reversed and remanded.

		STEIGMANN, P.J., and TURNER, J., concur.