visits Core Treatment groups on a regular basis to discuss the
availability of arousal reducing medications.

While the number of TDF residents on medication at the time
this suit was filed was very low, the number of residents currently
on some form of medication has gone up dramatically so that
currently 33 or 34 are on some form of medication, even though as
many as half of the residents decline to participate in treatment.
As stated by the court in its Findings of Fact, prior to the filing
of this lawsuit the TDF may have overestimated the utility of
arousal recondition, and underestimated the utility of anti-
androgen medication (Finding of Fact No. 52) but that the use of
such treatment modalities was not a substantial departure from
accepted practices and standards.

For the reasons stated herein, the Plaintiffs’ Motion to Alter
or Amend Judgment is denied.

IT IS SO ORDERED.

Harry D. Leinenweber, Judge
United States District Court

Dated: dds


IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOI
EASTERN DIVISION F | L E D

MAR 2 5 2005
JEFFERY HARGETT, et al.,

x

JUDGE HARRY D. LEINENWEBER

Plaintiffs, US. DISTRICT COURT JUDGE
v. Case No. 02 C 1456
CAROL ADAMS, Secretary of the Hon. Harry D. Leinenweber

Illinois Department of Human
Services, et al.,

Defendants.

MEMORANDUM OPINION AND ORDER

The Plaintiffs have filed a Motion to Alter or Amend Judgment
pursuant to Fep. R. Civ. P. 59(e) seeking a judgment in their favor
on the sole issue of whether the Defendants’ administration of
arousal-reducing medication violates accepted professional
judgment, practices and standards as set forth in Youngberg v.
Romeo, 457 U.S. 307 (1982). Plaintiffs rely upon the testimony of
their testifying experts, Drs. Berlin and Metzner that accepted
standards of informed consent require that residents be provided
with essential information about anti-androgen medications.

The court in its Findings of Fact and Conclusions of Law
discussed and made specific findings concerning the issues raised
in the Plaintiffs’ Motion. The court found that, while anti-
androgen medications can be an important treatment tool, there was

a danger that “patients may over-rely on medications as a purported


‘cure’ and will underutilize cognitive therapy and relapse
prevention techniques.” (Finding of Fact No. 51). Based on this
Finding of Fact the court concluded that “the TDF’s [Joliet
Treatment and Detention Facility’s] use of arousal reconditioning
{is] well within the bounds of professional judgment” and the
“use of arousal-reducing medications . . . was clearly within
constitutional bounds.” (Conclusion of Law Nos. 24 and 25).

The main thrust of Dr. Berlin’s testimony was his contention
that the use of arousal-reducing medication, i.e., an anti-androgen
was the most effective known sex offender treatment, and the
defendants put too much emphasis on arousal reconditioning to the
detriment of anti-androgen medications, which violated accepted
standards. However, Berlin was able to cite no literature in
support of this contention, but relied upon what he referred to as
“the common law of informed consent.” Dr. Berlin did not review
any of the practices or policies of any of the other SVP facilities
across the country. Dr. Metzner merely testified in passing that
the consent form in use by the TDF “did not talk about the use of
anti-androgens as a treatment option” which he said was “certainly
not the only treatment, but for many people in this population it’s
a very important component of treatment.”

In contrast the defendants did produce evidence both
documentary and oral that showed quite clearly that Drs. Berlin and

Metzner’s views were not uniformly held and that there was


significant support for the position that arousal reconditioning
ought be tried first before resorting to medications. Appendix D
of the ATSA (the Association for the Treatment of Sexual Abusers)
standards points out that anti-androgens have not been formally
approved by the FDA for use with sexual abusers and carry with them
some potentially serious side-effects. The Appendix further
pointed out that, while their use has found support in clinical
trials, placebo-controlled studies were needed to evaluate their
effectiveness in reducing recidivism. The Appendix further
recommends that non-physician members should consider
pharmacological therapy only after control has not been achieved
through sexual arousal reconditioning and deviant sexual arousal
remains high. The evidence further showed that the TDF’s earlier
treatment program, which used sexual arousal reconditioning as the
preferred mode of treatment to be utilized prior to resorting to
pharmaceuticals, was similar to that employed in other Sexual
Violent Programs in the United States.

Furthermore, the evidence shows that the defendants have
recently made changes in their treatment programs and informed
consent that have increased the use of anti-androgens and other
arousal reducing medications as urged by plaintiffs. The informed
consent form recently adopted for use at the TDF informs the
patient of the availability of anti-androgen medication. Dr.

Bednarz, staff psychiatrist at the TDF, testified that he currently