In re Linda B. , 91 N.E.3d 813 ( 2017 )

2017 IL 119392IN THE
SUPREME COURT
OF
THE STATE OF ILLINOIS
(Docket No. 119392)
In re LINDA B. (The People of the State of Illinois, Appellee, v.
Linda B., Appellant).
Opinion filed September 21, 2017.
CHIEF JUSTICE KARMEIER delivered the judgment of the court, with
opinion.
Justices Freeman, Thomas, Kilbride, Garman, Burke, and Theis concurred in
the judgment and opinion.
OPINION
¶1 The overarching issue presented in this appeal is whether a timely petition was
filed, seeking immediate, involuntary admission of respondent for inpatient
psychiatric treatment in a mental health facility pursuant to article VI of the Mental
Health and Developmental Disabilities Code (Mental Health Code) (405 ILCS
5/3-600 et seq. (West 2012) (Emergency Admission by Certification). In order to
reach that issue, we must find that an exception to the mootness doctrine applies, as
the 90-day period of hospitalization ordered by the Cook County circuit court has
expired. The appellate court so found and affirmed the judgment of the circuit
court. 2015 IL App (1st) 132134. On this record, and with some qualification with
respect to the appellate court’s analysis, we affirm the judgment of the appellate
court.
¶2 BACKGROUND
¶3 Proceedings in this case were initiated on May 9, 2013, when Connie
Shay-Hadley, the mental health facility director at Mount Sinai Hospital
(Mt. Sinai), filed a petition alleging that respondent, Linda B., was a person subject
to involuntary admission to a treatment facility. The petition sought emergency
inpatient admission by certificate, pursuant to section 3-600 of the Mental Health
Code (405 ILCS 5/3-600 (West 2012)), stating that respondent was admitted to the
“Mental Health Facility/Psychiatric Unit” on April 22, 2013.
¶4 The petition was supported by certificates submitted by Dr. Medela Gartel, who
examined respondent on May 9, 2013, and Colleen Kurtz, a licensed clinical social
worker who examined respondent later that same day. Both checked form boxes
stating that respondent was mentally ill and required “immediate hospitalization”
for the prevention of harm to respondent or others. Both stated that respondent was
in need of treatment to prevent deterioration of her condition and that she could not
understand the nature of her illness or the need for treatment. Gartel added, via
handwritten notation, that respondent had exhibited “multiple psychiatric
symptoms including paranoid delusions,” she had been violent with medical staff,
and she had been wandering and defecating in the hall. Kurtz corroborated that
observation as well as Gartel’s suggestion that respondent suffered from paranoid
delusions. Kurtz added that respondent was refusing both medical and psychiatric
medications.
¶5 On June 11, 2013, the trial court held a hearing addressing the matter of
involuntary admission. 1 At that hearing, Dr. Elizabeth Mirkin, a board-certified
1
Hearing on the May 9 petition was originally set for May 14, 2013, five days from the
date upon which the petition was filed, which would seem to comport with the temporal
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psychiatrist, testified that respondent’s hospitalization at Mt. Sinai began on April
22, 2013, when she was admitted to a “medical floor,” where she was also “treated
psychiatrically.” With respect to the circumstances prompting respondent’s
admission, Mirkin volunteered:
“She actually was board—agitated and very angry behaviors before she was
admitted in medical floor because she was tachycardia and found to be severely
anemic.[ 2] She was admitted to the medical floor. She was followed by a
psychiatrist throughout her stay on the medical floor.”
Mirkin also stated that respondent had sitters “throughout her stay on the medical
floor.”
¶6 Mirkin testified that she first saw respondent on the medical floor on May 25,
2013. She had previously spoken to other staff members and had reviewed “other
people psychiatry progress notes, nursing notes, doctors notes.” Mirkin stated that
respondent was hospitalized for “both” psychiatric and medical treatment. Mirkin
noted that this was not respondent’s first hospitalization. She had been admitted to
Mt. Sinai’s psychiatric unit in January 2013 “with similar presentation.” According
to Mirkin, respondent was admitted again in April. There had been “multiple prior
requirement for a hearing set forth in section 3-611 of the Mental Health Code. See 405
ILCS 5/3-611 (West 2012) (“the court shall set a hearing to be held within 5 days *** after
receipt of the petition”). Multiple “case management orders” were entered thereafter
continuing the date for the hearing. Although the appellate court makes no mention of it, an
amended petition for involuntary admission was filed on June 11, the day of the hearing.
That petition appears to differ from the original petition in that (1) it was no longer alleged,
as a basis for involuntary admission, that respondent “could be reasonably expected to
engage in conduct” that might physically harm herself or others, and (2) a report before
disposition was attached—with supporting documentation from Kurtz and an “attending
psychiatrist”—addressing an alternative treatment setting. The deleted allegation may have
been in furtherance of a recommendation that respondent, who was homeless, be sent to a
nursing home. We note, in passing, that Kurtz, in her statement, referred to having seen
respondent “on psychiatric unit during previous admission.” Dates are not provided, so it is
not clear when that “previous admission” might have been. In any event, the parties do not
accord the filing of the amended petition any significance, and respondent does not
complain that the hearing in this case was untimely. Therefore, we will not further address
that procedural aspect of the case.
2
Dr. Mirkin testified that she graduated from medical school in St. Petersburg, Russia.
At times, the syntax of her testimony corroborates the inference that English is not her first
language. Grammatical lapses will not be noted hereafter.
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hospitalizations.” Mirkin diagnosed respondent as suffering from schizophrenic
disorder, stating that respondent had suffered from that malady for years.
¶7 Mirkin described, in detail, the symptoms respondent had exhibited: “[S]he was
very delusional, very aggressive, agitated and threatening, labile and did not sleep,
threatened staff, did not take medications for psychiatric and medical reasons.”
Mirkin said that respondent was “much less symptomatic” at the time of the hearing
because, pursuant to court order entered May 14, 2013, 3 respondent was taking
prescribed medications. Though Mirkin acknowledged that respondent was “less
symptomatic,” she maintained that respondent was still delusional, easily agitated,
aggressive, and subject to rapid mood swings. Mirkin observed that respondent had
a history of noncompliance in taking medications, particularly whenever she was
discharged from the hospital. Mirkin rendered her opinion, based upon a reasonable
degree of psychiatric certainty, that respondent was unable, because of her mental
illness, to provide for her basic physical needs without assistance and thus should
be treated on an inpatient basis. Mirkin recommended that respondent be treated at
Park Shore Nursing Home.
¶8 In her cross-examination, counsel for respondent asked: “Is [respondent]
recommended for nursing home placement because of mental health reasons or
because of medical reasons?” Mirkin responded:
“Because of combination of mental health reasons and medical reasons. In
her case, her mental health conditions prevents her from taking care of her
medical condition. When she has exacerbation of her mental illness, then she
doesn’t take care of herself, including her many medical conditions.”
Inquiries by counsel regarding Park Shore Nursing Home revealed that Mirkin had
very limited knowledge thereof. However, when asked whether Park Shore
Nursing Home provided “behavioral mental health care or whether they primarily
provide[d] medical care to elderly senior citizens,” Mirkin replied: “Because
[respondent’s] diagnosis is schizoaffective disorder, she could not be admitted to
the nursing home, which does not provide care for behavioral health.”
3
The record indicates that medication was ordered in case No. 2013 COMH 1388.
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¶9 Upon further examination of Mirkin by respondent’s counsel, the following
colloquy ensued:
“Q. Doctor, according to the chart, you’ve indicated as of approximately
May 28th, the respondent was ready for discharge from Mt. Sinai, correct?
A. I had a note there. I saw her on the unit and I didn’t say that she is ready
for discharge. I said that she does not need inpatient level of psychiatric care.
I said this is her baseline, but I never indicated that she could be discharged
home. There was a process going on while she was on medical floor for her to
be admitted to the nursing home; and by my note, I stated that she does not need
to be transferred to inpatient psych unit.
Q. So all this time, from April 22nd to the present day, [respondent] has
been on a medical unit and not a psychiatric hospital [sic] at the hospital?
A. She was cleared medically only as of last Saturday. *** At that time we
found out we’re going with a nursing home placement. There’s no point of her
to be transferred to six—the transfer to Six East mainly because on the medical
floor, she’s been on one-to-one supervision; and the nursing home will not
accept anybody to the nursing home unless their 24 hours of supervision and
psychiatric unit is more appropriate for her.
She hasn’t been on supervision here unless she was admitted there last
night. She hasn’t been put on one-to-one supervision.
While on medical floor, she needed one-to-one sitter. *** Constantly, she
needed to have supervision all of the time.
Q. That’s one of the conditions for Park Shore to accept [respondent], that
she goes 24 hours without having a sitter?
A. Yes. Any nursing home inpatient, yes.”
¶ 10 Following cross-examination and after the State rested, respondent’s counsel
moved to dismiss the petition for involuntary admission “based upon the petition
having been filed well beyond the 24 hours after [respondent’s] admission.”
Counsel argued that the petition was untimely filed where respondent was admitted
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to the medical floor of Mt. Sinai on April 22, 2013, but was also being treated
psychiatrically from that date.
¶ 11 Over counsel’s objection, the court allowed the State to reopen its case in order
to adduce evidence pertinent to respondent’s motion. Speaking to the procedures
the hospital generally employs with respect to involuntary admission, Mirkin
explained:
“We have—when patient is admitted to medical floor, if medical team feels
that psychiatric treatment needed or psychiatrist needs to be seen, we feel and I
feel and consults every day, four or five patients.
We don’t submit any petitions for any other patients unless we start
believing that patients need, either psychiatric admission or patient needs
treatment against their will.
Patients are on typical medical floor without—even now at this moment, I
see like every day, I see four or five patients on medical floors. We do not do
petitions unless we think the patient needs to go to court because the patient is
noncompliant with treatment.”
Counsel for the State asked: “Was the decision made when it was determined that
she needed inpatient psychiatric treatment?” Mirkin responded:
“At that time she was still on medical floor. I was not in service at that time,
but I reviewed the chart. I thought it was appropriate when the doctor went to
court on May 14 because it was considered that she needed psychiatric
treatment and she was not taking medications.”
Counsel for the State then asked: “So initially, the primary purpose for
[respondent’s] hospitalization was for medical treatment?” Mirkin responded: “For
both, but she was on medical floor, so we never start petitions while patient is on
medical floor, unless we think that she needed more psych, more structured
environment. It is not at all appropriate. We never do this.”
¶ 12 Following Mirkin’s testimony, the circuit court denied respondent’s motion to
dismiss the petition for involuntary admission. Respondent then rested without
testifying or presenting evidence.
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¶ 13 After closing argument, the circuit court granted the petition for involuntary
admission. In its written order, the court found respondent subject to involuntary
admission on an inpatient basis because (1) respondent’s mental illness rendered
her unable to provide for her basic physical needs and to guard herself from serious
harm and (2) respondent’s mental illness resulted in (a) her refusal of necessary
treatment, (b) her inability to understand the need for such treatment, and (c) a
reasonable expectation that, if respondent was not treated, she would suffer further
mental or emotional deterioration. The written order also provided that respondent
be treated at Park Shore Nursing Home, based on Dr. Mirkin’s recommendation,
for a period of hospitalization not to exceed 90 days.
¶ 14 In respondent’s ensuing appeal, the appellate court first noted that respondent’s
90-day period of hospitalization had expired, rendering the appeal moot, as the
appellate court could no longer grant respondent effectual relief. 2015 IL App (1st)
132134, ¶ 11. However, the appellate court considered and applied the public
interest exception to the mootness doctrine to address the merits of the issues raised
by respondent. Id. ¶ 13.
¶ 15 On the merits, the appellate court appears to have resolved this case on the
bases of two premises: (1) respondent’s “physical” admission to the hospital was
not synonymous with “legal” admission under article VI of the Mental Health Code
(2015 IL App (1st) 132134, ¶ 19), and (2) the medical floor of the hospital,
arguably, was not a “mental health facility” within the meaning of the statute,
irrespective of whether psychiatric treatment was rendered there (id. ¶ 23). Thus,
the appellate court affirmed the judgment of the circuit court, concluding that the
petition for involuntary admission was timely filed.
¶ 16 ANALYSIS
¶ 17 Initially, we note that this appeal is moot because respondent’s underlying
90-day admission period has expired. See In re Andrew B., 237 Ill. 2d 340, 346
(2010). Consequently, we must determine whether an exception to the mootness
doctrine applies. Id. One exception to the mootness doctrine allows a court to
resolve an otherwise moot issue if the issue involves a matter of substantial public
interest. Bettis v. Marsaglia, 2014 IL 117050, ¶ 9. Respondent argues that
exception applies to questions posed in this appeal.
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¶ 18 I. Public Interest Exception
¶ 19 The public interest exception permits review of an otherwise moot appeal when
three requirements are met: (1) the question presented must be public rather than
case-specific in nature; (2) an authoritative determination is needed to guide public
officers in future cases; and (3) there is a likelihood the issue will recur. People v.
Holt, 2014 IL 116989, ¶ 47; Andrew B., 237 Ill. 2d at 347. This exception must be
construed narrowly and established by a clear showing of each criterion.
Andrew B., 237 Ill. 2d at 347.
¶ 20 We believe the requisites for application of the public interest exception are
satisfied in this case. “ ‘[T]he procedures which must be followed *** before a
court may authorize involuntary treatment to recipients of mental health services
are matters of a public nature and of substantial public concern.’ ” In re Lance H.,
2014 IL 114899, ¶ 14 (quoting In re Mary Ann P., 202 Ill. 2d 393, 402 (2002)).
Obviously, as this court acknowledged in Lance H., the same can be said of the
procedures for involuntary commitment. Id. Moreover, we find that the
circumstances in this case meet the second criterion for application of the exception
because there is apparently uncertainty as to the type of facilities, or portions
thereof, that meet the statutory definition of a “mental health facility” (see 2015 IL
App (1st) 132134, ¶ 23 (the appellate court in this case assumed, “arguendo, that
respondent was in a mental health facility” while citing appellate authority that
clearly suggests otherwise)) and, relatedly, whether the type of treatment
administered in a facility may, in itself, qualify it as a “mental health facility.” Even
more to the point, this case presents the question of whether simultaneous, hybrid
treatment, for both psychiatric and medical conditions, either qualifies (in the first
instance) or disqualifies (in the second) the recipient for status as a mental health
patient in a facility, depending upon which condition predominates. Finally, the
third criterion for application of the exception is met because, as was the case in
Lance H., “respondent’s own history demonstrates how this question might recur.”
Lance H., 2014 IL 114899, ¶ 14. Dr. Mirkin testified that respondent has a history
of noncompliance in taking medications, particularly whenever she was discharged
from the hospital, and she has had “multiple prior hospitalizations.” As was the
case in this instance—and is likely the case in many others—respondent
“presented” at the hospital with interrelated psychiatric and medical problems,
which are necessarily subject to holistic treatment, and the origins of which are not
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subject to neat temporal or treatment categorization. We see this scenario as one
likely to recur in the general population.
¶ 21 II. Pertinent Statutes
¶ 22 Section 3-600 of the Mental Health Code authorizes a person 18 years of age or
older to seek involuntary admission, “to a mental health facility,” of an individual
18 years of age or more, who is “in need of immediate hospitalization.” 405 ILCS
5/3-600 (West 2012). Section 1-114 of the Mental Health Code defines a “mental
health facility” as “any licensed private hospital, institution, or facility or section
thereof, and any facility, or section thereof, operated by the State or a political
subdivision thereof for the treatment of persons with mental illness and includes all
hospitals, institutions, clinics, evaluation facilities, and mental health centers which
provide treatment for such persons.” 4 405 ILCS 5/1-114 (West 2012).
¶ 23 Section 3-601(a) of the Mental Health Code provides:
“When a person is asserted to be subject to involuntary admission on an
inpatient basis and in such a condition that immediate hospitalization is
necessary for the protection of such person or others from physical harm, any
person 18 years of age or older may present a petition to the facility director of
a mental health facility in the county where the respondent resides or is present.
The petition may be prepared by the facility director of the facility.” 405 ILCS
5/3-601(a) (West 2012).
¶ 24 Section 3-601(b)(1) sets forth the aspects of a respondent’s condition that must
be addressed in the petition. Subsection (b)(1) requires a “detailed statement of the
reason for the assertion that the respondent is subject to involuntary admission on
an inpatient basis, including the signs and symptoms of a mental illness and a
description of any acts, threats, or other behavior or pattern of behavior supporting
4
Section 1-113 of the Mental Health Code further defines a “licensed private hospital”
as “any privately owned home, hospital, or institution, or any section thereof which is
licensed by the Department of Public Health and which provides treatment for persons with
mental illness.” 405 ILCS 5/1-113 (West 2012).
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the assertion and the time and place of their occurrence.” 405 ILCS 5/3-601(b)(1)
(West 2012).
¶ 25 Section 3-602 of the Mental Health Code requires that the petition be
“accompanied by a certificate executed by a physician, qualified examiner,
psychiatrist, or clinical psychologist which states that the respondent is subject to
involuntary admission on an inpatient basis and requires immediate
hospitalization.” 405 ILCS 5/3-602 (West 2012). The certificate must evince an
examination of the respondent “not more than 72 hours prior to admission” and
must contain “other factual information relied upon in reaching a diagnosis, and a
statement as to whether the respondent was advised of his rights under Section
3-208.” Id.¶ 26 Finally, section 3-611, at issue here, provides:
“Within 24 hours, excluding Saturdays, Sundays and holidays, after the
respondent’s admission under this Article, the facility director of the facility
shall file 2 copies of the petition, the first certificate, and proof of service of the
petition and statement of rights upon the respondent with the court in the county
in which the facility is located. Upon completion of the second certificate, the
facility director shall promptly file it with the court. The facility director shall
make copies of the certificates available to the attorneys for the parties upon
request. Upon the filing of the petition and first certificate, the court shall set a
hearing to be held within 5 days, excluding Saturdays, Sundays and holidays,
after receipt of the petition. The court shall direct that notice of the time and
place of the hearing be served upon the respondent, his responsible relatives,
and the persons entitled to receive a copy of the petition pursuant to Section
3-609.” 405 ILCS 5/3-611 (West 2012).
¶ 27 I. Merits
¶ 28 The parties’ arguments concerning the timely filing of the petition focus on two
questions. First, under the circumstances, did the medical floor of Mt. Sinai qualify
as a “mental health facility” as specified in article VI of the Mental Health Code?
Second, what constitutes “admission” for purposes of section 3-611?
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¶ 29 A. “Mental Health Facility”
¶ 30 Respondent contends that the appellate court erred when it failed to find that the
medical floor of Mt. Sinai—where she was treated for medical and psychiatric
conditions—qualified as a “mental health facility,” as defined by the Mental Health
Code. Respondent observes that the Mental Health Code broadly defines a “mental
health facility” as a private facility, or a section thereof, or a facility operated by the
State or its political subdivisions, that (1) is licensed by the Department of Public
Health and (2) provides treatment for persons with mental illness. See 405 ILCS
5/1-114 (West 2012). She observes that section 1-114 does not require that a mental
health facility have a primary purpose of treating individuals with mental illnesses.
Respondent notes that Mt. Sinai is a licensed general hospital that—as Dr. Mirkin
testified—regularly provides treatment to people with mental illnesses on its
medical floors, as well as in the psychiatric unit. Respondent thus submits, relying
upon the psychiatric treatment she received on a medical floor of the hospital, that
the medical floor qualified as a “mental health facility” as defined by the Mental
Health Code.
¶ 31 Respondent takes issue with the appellate court’s reliance upon In re Moore,
301 Ill. App. 3d 759, 766 (1998), arguing that Moore’s narrow construction of the
term “mental health facility”—with respect to hospitals, meaning only “[t]hose
sections or units” specifically dedicated to the treatment of mentally ill patients—is
not consistent with the “current reality,” in which psychiatric services are provided
in diverse venues offering both medical and psychiatric treatment. Respondent
notes, for example, that the Illinois Department of Human Services website directs
that those suffering psychiatric emergencies go, or be taken, to the emergency room
at their local hospital. 5 Respondent also points to section 3-606 of the Mental
Health Code, which provides that a peace officer “may take a person into custody
and transport him to a mental health facility when the peace officer has reasonable
grounds to believe that the person is subject to involuntary admission on an
inpatient basis and in need of immediate hospitalization to protect such person or
others from physical harm.” 405 ILCS 5/3-606 (West 2012). Respondent states that
the appellate court “has interpreted this section, and has applied it to hospital
5
See Mental Health, Ill. Dep’t Hum. Servs., http://www.dhs.state.il.us/page.aspx?
item=29735 (last visited Sept, 8, 2017).
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emergency room departments without question though, according to its language,
that section applies specifically to ‘mental health facilit[ies].’ ” 6 Further, she asks
us to take judicial notice of 94 involuntary admission petitions, filed over a
22-month period (September 2014 to June 2016), by hospitals that—according to
respondent—lack mental health units. 7
¶ 32 Respondent concludes: “To construe the Code as applying only to distinct
psychiatric units would result in disparate treatment of individuals with mental
illnesses based on the location of their treatment. *** If this court affirms the
appellate court’s decision in In re Linda B., people could be held in scatter beds[8]
on medical floors or in emergency rooms without their consent and without the
legal protections the Code guarantees.” Further, to the extent that the treatment
afforded a patient in a facility may affect the statutory category into which the
facility properly fits, the respondent argues that “respondents [should not] have
different rights at different times dictated by the status of their non-psychiatric
health. Individuals without comorbid medical conditions who could be admitted
directly to psychiatric units would be afforded the Code’s protections of notice,
right to counsel, and their day in court, whereas recipients with serious comorbid
conditions would not.” (Emphasis in original.)
¶ 33 As we understand the State’s position—or positions—the State first advocates
for a bright-line rule, relying upon Moore, arguing that the legislature intended that
6
Respondent cites In re Demir, 322 Ill. App. 3d 989, 990-92 (2001), and In re
Joseph P., 406 Ill. App. 3d 341, 348 (2010), overruled on other grounds by In re Rita P.,
2014 IL 115798, ¶¶ 33-34.
7
Public documents, such as those included in the records of other courts and
administrative tribunals, fall within the category of “readily verifiable” facts capable of
instant and unquestionable demonstration of which a court may take judicial notice.
Cordrey v. Prisoner Review Board, 2014 IL 117155, ¶ 12; May Department Stores Co. v.
Teamsters Union Local No. 743, 64 Ill. 2d 153 (1976). The fact that the referenced
petitions were filed meets the criteria for judicial notice; that the hospitals in question
lacked designated psychiatric facilities turns out to be not so readily verifiable. We decline
to take judicial notice of respondent’s representation in that respect. In the end, it makes no
difference in our analysis or the outcome.
8
“Scatter beds” is a term used in the psychiatry field to refer to psychiatric patient
placement in beds designated for general medical treatment throughout a medical facility,
rather than in devoted psychiatric units. Tami L. Mark et al., Psychiatric Discharges in
Community Hospitals With and Without Psychiatric Units: How Many and for Whom?, 61
Psychiatric Services 562 (2010).
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section 3-611 only apply when a patient is admitted to a facility or section thereof
specifically designated as, and operating exclusively as, a “mental health facility.”
The State notes that Moore held the language of the pertinent “statutory provisions
recognizes that there may be sections within a hospital devoted to treatment of
mentally ill patients” and concluded “[t]hose sections or units, and not the entire
hospital, are mental health facilities for purposes of the involuntary admission
provisions of the Code.” Moore, 301 Ill. App. 3d at 766.
¶ 34 However, the State also appears to concede that the type of treatment provided
to a patient is relevant in determining the kind of facility in which the patient
receives treatment. The State acknowledges, for example, that “section 5/1-114
implicitly suggests that an emergency room could be considered a mental health
facility as a ‘section’ of a private hospital when used ‘for the treatment of persons
with mental illness.’ ” Notwithstanding, the State submits “[t]hat does not alter the
calculus here, where Dr. Mirkin’s testimony made clear that respondent was
admitted for medical care, and in addition to that care, received psychiatric care.”
By that acknowledgment, the State appears to retreat from espousing a bright-line
rule, such as that announced in Moore, seemingly advocating for a
primary-purpose-of-treatment test and minimizing the significance of the medical
venue where psychiatric treatment is provided.
¶ 35 We note, initially, that it is far from “clear,” based upon the only testimony at
the hearing—Dr. Mirkin’s—that it was respondent’s medical condition alone that
brought her to someone’s attention and resulted in her hospitalization or even that
her medical condition was the primary factor in her hospitalization and treatment.
The certificates filed in support of the petition for involuntary admission do not
suggest a contrary inference. Though the State, at the hearing in this matter,
attempted to solicit Mirkin’s acquiescence to the proposition that, “initially, the
primary purpose for [respondent’s] hospitalization was for medical treatment,”
Mirkin responded—contrary to the State’s suggestion otherwise in its brief 9—that
9
The State asserts, in its brief, that “the primary purpose of respondent’s treatment was
to address her deteriorating physical condition” (emphasis added) and “[o]nce her physical
health had been stabilized, respondent was moved to a psychiatric floor, and the petition
for involuntary treatment was filed within 24 hours.” We find no clear support in the record
for either proposition. Mirkin declined to subscribe to the proposition the State now asserts,
and her testimony was ambiguous as to whether respondent was moved to a psychiatric
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respondent was admitted for “both” psychiatric and medical treatment. In fact,
Mirkin’s testimony indicated that it was respondent’s psychiatric condition that led
to her acute medical problems: “In her case, her mental health conditions prevents
her from taking care of her medical condition. When she has exacerbation of her
mental illness, then she doesn’t take care of herself, including her many medical
conditions.” Mirkin indicated that respondent exhibited “agitated and very angry
behaviors before she was admitted in [the] medical floor,” and Mirkin
acknowledged that respondent was “followed by a psychiatrist throughout her stay
on the medical floor” and had sitters “throughout her stay on the medical floor.”
¶ 36 It would seem to us that respondent’s psychiatric treatment and supervision on
the medical floor were at least as comprehensive and structured as anything she
might have received in the psychiatric unit, which the State has to concede is a
“mental health facility.” We think most people of ordinary sensibility would agree
with the application of abductive reasoning in this instance and conclude that a
facility, or section thereof, capable of providing mental health services, that does in
fact provide the individual mental health services, is a mental health facility. 10 To
find otherwise is to exalt a facility’s self-designated nomenclature over its actual
function. We decline to do so.
¶ 37 And there is no reason to do so. The legislature made the definition of “mental
health facility” extremely broad so as to encompass any place that provides for “the
treatment of persons with mental illness.” 405 ILCS 5/1-114 (West 2006). It bears
repeating that the Mental Health Code defines a “mental health facility” as “any
licensed private hospital, institution, or facility or section thereof, and any facility,
or section thereof, operated by the State or a political subdivision thereof for the
unit and, if so, when; the same can be said of Kurtz’s documentary reference to having seen
respondent on a “psychiatric unit during [a] previous admission.” Similarly, elsewhere in
the State’s brief, the State asserts that “Dr. Mirkin’s testimony was clear that respondent
was admitted to the emergency room at Mount Sinai Hospital, but was then placed on a
medical floor for weeks to address her underlying health concerns.” Although we might
assume that respondent entered the hospital via the emergency room, the term “emergency
room” does not appear in this record, and Dr. Mirkin never testified that respondent was
admitted there.
10
With no intent to be flippant, the abductive process is probably never better put than
in this common expression: If it looks like a duck, swims like a duck, and quacks like a
duck, then it is probably a duck.
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treatment of persons with mental illness and includes all hospitals, institutions,
clinics, evaluation facilities, and mental health centers which provide treatment for
such persons.” (Emphases added.) 405 ILCS 5/1-114 (West 2006). The definition
could not be more comprehensive. The legislature sought to include within its
ambit the whole facility or a section thereof and private as well as public facilities.
The salient feature of the definition is that it applies to any facility, or any part of a
facility, that provides for “the treatment of persons [afflicted] with mental illness.”
What the facility is called, if and when it performs some other function, is
irrelevant. In those instances in which a facility or section of a facility provides
psychiatric treatment to a person with mental illness—as was the case here—it
qualifies as a “mental health facility” for purposes of the Mental Health Code’s
application.
¶ 38 As this court has repeatedly acknowledged, the administration of involuntary
mental health services involves a “ ‘ “massive curtailment of liberty.” ’ ” In re
Robert S., 213 Ill. 2d 30, 46 (2004) (quoting In re Barbara H., 183 Ill. 2d 482, 496
(1998), quoting Vitek v. Jones, 445 U.S. 480, 491 (1980)). As aptly noted in In re
Torski C., 395 Ill. App. 3d 1010, 1018 (2009), the provisions of the Mental Health
Code reflect legislative recognition that civil commitment is a deprivation of
personal liberty, and the purpose of its procedures is to provide adequate safeguards
against unreasonable commitment. We believe the legislature enacted a broad
definition of “mental health facility” to further those ends. Appellate decisions
inconsistent with our holding herein are hereby overruled.
¶ 39 In today’s era of integrated, holistic health care, we believe it is unrealistic to
think that medical personnel on a medical floor or in an emergency room—or
anyone for that matter—would not recognize and report someone with psychiatric
symptoms as striking as respondent’s, and that psychiatric specialists and
structured treatment would not be brought to bear, irrespective of the medical
environment wherein the patient is housed. On the other hand, one might well
understand how a patient could be treated psychiatrically, involuntarily, in facilities
not specifically designated as “mental health facilities” and thus be deprived of the
Mental Health Code’s safeguards. It could well have happened here.
¶ 40 However, we do not know it happened here because the record does not reflect
that, prior to the filing of this petition on May 9, 2013, respondent was an
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involuntary recipient of psychiatric services in the hospital. We can readily assume,
at some point in time, she resisted psychiatric treatment, but we do not know for
certain when that occurred. Here, we address the second question posed at the
outset of our analysis: What constitutes “admission” for purposes of section 3-611?
¶ 41 There is no dispute that respondent was physically admitted to the hospital as a
patient on April 22, 2013. The petition for involuntary admission states as much. 11
However, nothing in this record identifies the capacity in which respondent was
admitted, i.e., whether she was a voluntary or involuntary recipient of treatment. At
oral argument, counsel for respondent conceded as much, but she argued that the
evidence suggested that respondent was there involuntarily. Counsel for the State
countered that the issue of consent to treatment was not developed at the June 11
hearing and that it was unclear on what date respondent became noncompliant or
treatment became involuntary. Pressed upon this point at oral argument, counsel for
respondent noted that she tried at the hearing to ask Dr. Mirkin by what legal
authority treatment was provided to respondent—consensual or otherwise—but the
trial court sustained the State’s objection that the question was beyond the scope of
direct examination. Counsel explained to this court: “Then there was a decision that
that was not needed to be covered in any kind of case-in-chief, because of trial
strategy.” Counsel did not elaborate on, and we cannot conceive, what the aim of
that strategy would have been.
¶ 42 What we are left with is bare-bones evidence of physical admission to the
hospital, with some evidence of communication between hospital personnel and
unidentified family members of respondent. Respondent’s daughter was
specifically identified in the petition for involuntary admission. There was no
evidence as to the exact means by which respondent came to the hospital or how
she was admitted there. For all we know, respondent may have been persuaded to
go there voluntarily by family members. Treatment may have been consensual for a
time. As the State suggests, it is unclear what date respondent became
noncompliant or treatment became involuntary.
11
It also states that respondent was admitted to the “Mental Health Facility/Psychiatric
Unit” on that date.
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¶ 43 During oral argument, counsel for respondent was asked whose responsibility it
was to show respondent was previously in the hospital involuntarily. Counsel for
respondent would place that burden on the State, but we believe it is respondent’s
burden. It is well established that, on appeal, the party claiming error has the burden
of showing any irregularities that would justify reversal. Flynn v. Vancil, 41 Ill. 2d
236, 241 (1968). Error is never presumed by a reviewing court; it must be
affirmatively shown by the record. Id. at 241-42. It is the appellant’s burden to
present a sufficiently complete record of the proceedings at trial to support a claim
of error, and any doubts that may arise from the incompleteness of the record will
be resolved against the appellant. Williams v. BNSF Ry. Co., 2015 IL 117444, ¶ 31.
¶ 44 Counsel for respondent was aware of the significance of respondent’s legal
status prior to the filing of the petition; she attempted, unsuccessfully, to
cross-examine Mirkin on that very point during the June 11 hearing. She could
have revisited that issue in her portion of the case, but she informed us during oral
argument that she decided not to do so. In order to establish untimely filing of the
May 9 petition, respondent had to establish that her initial period of hospitalization
and psychiatric treatment was involuntary. Whether she could have done so or not,
respondent’s counsel did not make that record.
¶ 45 If the initial treatment was not rendered against respondent’s will, which is
entirely possible—it is reasonable to infer that some change in respondent’s
volitional disposition might have prompted the filing of the petition, after weeks of
treatment—then we have a situation governed by this court’s analysis in
Andrew B., as the State contends. In that case, this court acknowledged what would
seem obvious: that a patient’s legal status within a facility may change while the
patient is a resident there.
¶ 46 In Andrew B., respondent voluntarily entered the facility for treatment but later
expressed a desire to leave. A petition for involuntary admission was filed but was
later voluntarily dismissed by the State. The court ordered respondent’s discharge;
however, respondent was not physically released. Instead, the next day a petition
was filed for respondent’s emergency admission by certificate under section 3-600
of the Mental Health Code. That petition, like the previous one, was then
voluntarily dismissed by the State, and the court again ordered respondent’s
discharge. Again, respondent was not released. Yet another petition was filed for
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emergency admission pursuant to section 3-600. The circuit court ultimately
granted the petition and, en route to that disposition, denied respondent’s motion to
dismiss, wherein he had argued, because he was never physically released pursuant
to the court’s previous discharge orders, his continued detention at the facility
violated his rights under the Mental Health Code and entitled him to a full and
complete release. Andrew B., 237 Ill. 2d at 343-45.
¶ 47 The appellate court affirmed, rejecting respondent’s argument that the petition
seeking his involuntary admission was untimely filed under section 3-611 of the
Mental Health Code. In re Andrew B., 386 Ill. App. 3d 337 (2008).
¶ 48 We reached the same result. In upholding the order of the circuit court and
rejecting respondent’s contention that the emergency petition was untimely filed,
we noted that “the Code refers to ‘admission’ in a legal sense to describe the
individual’s legal status” within a facility. Andrew B., 237 Ill. 2d at 350. “In other
words, section 3-611’s reference to ‘admission’ is not always limited to the
individual’s original physical entry.” Id. Andrew entered the facility on a voluntary
basis, but while there, his legal status changed pursuant to the filing and granting of
an emergency petition for involuntary admission.
¶ 49 The takeaway, for our purposes, is that legal status may change while one is in a
mental health facility—and that could well be the case here. Respondent has not
demonstrated that her physical entry into the facility, and her initial treatment there,
were involuntary. Thus, she has not demonstrated that error occurred, that the
petition for involuntary commitment was not timely filed.
¶ 50 This court is not bound by the appellate court’s reasoning and may affirm on
any basis presented in the record. People v. Williams, 2016 IL 118375, ¶ 33. We
apply that principle here.
¶ 51 For the foregoing reasons, the judgment of the appellate court is affirmed.
¶ 52 Affirmed.
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