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THIRD DIVISION
May 21, 2003

No. 1-02-0375

PRESIDING JUSTICE SOUTH delivered the opinion of the court:

After a hearing, respondent, Joseph S., was found to be a person subject to involuntaryadmission under the Mental Health and Developmental Disabilities Code (Code) (405 ILCS 5/1-100 et seq. (West 2000)) and ordered to be hospitalized in the Department of Mental Health andDevelopmental Disabilities (Department). Respondent contends that the trial court erred infinding him subject to involuntary admission when the State alleged one statutory basis forinvoluntary admission but argued another. Respondent also contends that the State did not proveby clear and convincing evidence that respondent was unable to provide for his basic physicalneeds. Respondent lastly contends that the court erred in admitting an "integrated social workassessment" without a proper foundation.

On December 17, 2001, a petition for involuntary admission of respondent was filed,having been signed on December 14. The petition resulted from an emergency admission bycertificate. It alleged that respondent was mentally ill, that due to the mental illness was unable toprovide for his basic physical needs so as to guard himself from serious harm, and that he was inneed of immediate hospitalization to prevent harm. Specifically, it alleged that respondent waspsychotic, that he lived for a period of weeks with the decaying corpse of his mother, that he wasparanoid delusional, and had illogical writings demonstrating poor contact with reality, such as"Do not negotiate with the enemy, and that is all!"

The certificate was issued by Dr. Wadley of MacNeal Hospital and stated that respondentwas examined by Wadley on December 14, 2001. It was Dr. Wadley's opinion that respondentwas mentally ill and that as a result of his mental illness was both reasonably expected to inflictserious harm on himself or others and was unable to provide for his basic physical needs so as toguard himself from serious harm. In support of this opinion, Dr. Wadley stated that respondentwas "actively delusional, very paranoid. Was found with his dead mother in apartment for severalweeks."

On the basis of the petition and certificate, respondent was detained for examination at theDepartment's Madden Mental Health Center (Madden). On December 17, 2001, Dr. SusanNavalro examined respondent and formed the opinion that he was mentally ill and that as a resultof his mental illness was reasonably expected to inflict serious harm on himself or others. Insupport of this opinion, Dr. Navalro stated that respondent was found at home in a psychotic statewith the "mummified" corpse of his mother, who had been dead for several weeks judging fromher condition. His brother called the police after not hearing from his mother for a prolongedperiod, when it was her habit to call daily. Respondent was very paranoid and not forthcoming atthe time of Dr. Navalro's examination. He questioned whether Dr. Navalro was tape-recordingthe interview and refused to speak in front of another person who entered the room.

A hearing was scheduled for December 20, 2001, and notice was served upon respondent. After two continuances for further evaluation, the hearing was held on January 3, 2002.

Dr. Susan Nowak testified that she was a licensed psychiatrist since 1984 and wasemployed by the Department at Madden. The parties stipulated that she was a psychiatrist asdefined in the Code and qualified to give expert opinions. Dr. Nowak stated that she knewrespondent as a patient at Madden that she was treating.

Dr. Nowak first examined respondent on December 17, 2001, and he gave littleinformation and seemed suspicious. She was evaluating respondent based on discussions withrespondent, written materials from his examination at MacNeal Hospital and from Madden'sintake department, and observations of respondent by Madden staff members, includingrespondent's case manager, other social workers, and the nursing staff. Dr. Nowak discussed withthese staff members respondent's behavior, whether he was sleeping, eating, taking care ofhimself, what possessions he had, and the nature of his interactions with others. Dr. Nowak hadspoken with respondent on at least five or six occasions, but these meetings were brief becauserespondent was uncomfortable and unwilling to divulge information. She also observedrespondent daily, and he did not interact with others and was "hyper-vigilant."

Dr. Nowak stated that examining a patient's social history is one of the criteria required bypsychiatric practice for making a diagnosis. Respondent's social history was provided by hisbrother. Respondent was once high functioning, with a master's degree, service in the Air Force,and 15 years' employment with a telephone company. Then, in 1996, he was evicted because hisbehavior distressed the landlord, and as a result went to live with his mother. There was at thattime a dramatic change in respondent's ability to function and he became dependent upon hismother. He was hospitalized for 76 days in 1999, and at that time was diagnosed as beingpsychotic and having obsessive compulsive disorder.

Dr. Nowak stated that her knowledge of the circumstances of the present hospitalizationwas from respondent's brother and reports from MacNeal Hospital and the police. Respondent'sbrother heard from his mother regularly until suddenly, in August or thereafter, he stoppedhearing from her. When the brother called her, respondent would answer the telephone and statethat their mother was sleeping or visiting. The brother eventually called the police to check on hismother, but respondent met them at the door and told them she was sleeping. Ultimately,respondent called a funeral home, who told him to call paramedics, and it was discovered that shewas dead for six or seven weeks and that respondent had been living with her desiccated corpse. In the house, police found bizarre writing on the walls and on papers. Respondent was taken bythe police to MacNeal Hospital, where a certificate for admission to Madden was issued.

Dr. Nowak gave her opinion that respondent suffered from a mental illness, namelyparanoid schizophrenia. Respondent was delusional and paranoid. Some examples included thathe thought Dr. Nowak was taping their initial meeting, had hearing loss in both ears because hewould not allow anyone to remove his earwax, would not use an assisted hearing device becausehe said it was a tape recorder, accused a social worker of being a robot, and told Dr. Nowak thathis brother was dead from an airplane crash since 2000. Respondent's thinking was disorderedand included bizarre logic. He told Dr. Nowak that his admission resulted from amisunderstanding since his mother was dead only a week or so instead of several weeks. Respondent was unable to function socially or in work situations, one of the criteria for adiagnosis of schizophrenia. He had not been functioning on his own since his 1996 eviction,refused medical care, slept only two or three hours a night, and did not relate to anyone.

Dr. Nowak stated that respondent was unable to take care of his basic physical needs dueto his delusional thinking causing him to misinterpret reality. He refused to have earwaxremoved, would not use the assisted hearing device because he believed it was a recorder, hishygiene upon admission was extremely poor, and he was not keeping up basic cleanliness while inMadden. He was taking care of hygienic tasks such as showering only when reminded by Maddenstaff. Respondent had no place to live, Dr. Nowak believed that respondent would not relate withor accept help from his brother, and the brother expressed fear of respondent. As to respondent'sunderstanding of money and ability to handle financial affairs, Dr. Nowak stated that he isintelligent but unable to work. Respondent became extremely upset not only when the topic ofhis mother's death or his illness was raised, but also when it was suggested that he throw away anempty cup. Dr. Nowak concluded from this that he would not be able to cope with the stresses ofeveryday life.

The State introduced into evidence a report for disposition, comprehensive treatment plan,and a social assessment. Dr. Nowak stated that she had produced the disposition report and thata comprehensive treatment plan is completed at the time of admission by the intake departmentand updated as the patient's needs are reviewed. After reviewing the treatment plan, respondenthad no objection to the psychiatric evaluation by Dr. Nowak but objected that the socialassessment lacked foundation. Dr. Nowak stated that the social assessment was prepared byrespondent's case manager, who Dr. Nowak knew and whose handwriting she recognized. Dr.Nowak knew the case manager's first name but not her last, but there were no other socialworkers at Madden with that first name. Respondent's objections that the social assessment wasillegible and that it was not proven who had prepared it was overruled and the social assessmentwas admitted.

Dr. Nowak stated that less restrictive alternatives to hospitalization were considered forrespondent. Outpatient care or an intermediary care facility would not be appropriate becauserespondent was very psychotic. He would not attend outpatient care meetings, and they couldnot provide the level of support and supervision required. Dr. Nowak stated that respondent wasat risk of suicide, required medication, had no place to stay, and was hoarding objects.

On cross-examination, Dr. Nowak stated that respondent was in good health while inMadden except for his hearing problem. Respondent told Dr. Nowak that his mother had beendeceased for seven or eight days and that he was on a business trip during that time and was withthe body for only a day or two before calling for help. Dr. Nowak did not ask respondent aboutthe loss of his job with the telephone company, nor did she discuss his eviction, earlierhospitalization, or whether respondent had written on the walls of his apartment. Thisinformation was provided by respondent's brother, who Dr. Nowak had not spoken with. Dr.Nowak stated that she did not discuss these matters with respondent because he was unwilling todiscuss them. While respondent had required medication to calm him down, he did not require itor receive it in Dr. Nowak's presence. Dr. Nowak was not aware of any record of violence orsuicide attempts by respondent. She felt intimidated by him at least once, but he never struckanyone. Respondent was eating while in Madden, and Dr. Nowak did not know how he obtainedfood before his admission.

On redirect examination, Dr. Nowak stated that she relied on respondent's social history,after having discussed the history with the social worker who prepared it. Dr. Nowak believedthat respondent would not receive proper medical care on his own since his suspicion would causehim to misperceive the actions of others as not being in his best interest. For the same reason, hewould not be able to hold a job or utilize available social and welfare services. As to his residencebefore admission, records indicated that there was writing on the wall about what respondentwould tell people who inquired about his mother and that the apartment was disorderly. Fromthis, and his hoarding of newspapers and milk cartons while at Madden, Dr. Nowak concludedthat respondent had obsessive compulsive disorder. While respondent had not actually attackedanyone, he became extremely agitated on at least one occasion she observed, and on anotherwhen he had to be medicated. His paranoia caused him to believe that others, who were simplyspeaking with him as Dr. Nowak had, wanted to attack him, and he would react in what hebelieved was self-defense.

Respondent testified that he gave his address as his mother's apartment, and stated that hestill had a lease on the unit until September 2002. Before his admission to Madden, he was on abusiness trip in Indiana with other writers for seven to nine days, starting on December 4 or 5,2001. His mother was alive when he left, and he spoke with her by telephone from Indiana once. When he returned on December 12, it was night and he saw her lying in bed, so he assumed shewas asleep and did not wish to disturb her. The next morning, he saw that she was decomposing. He called a funeral parlor, who told him to call the paramedics, and he called again the next day,December 14.

Before his admission to Madden, respondent was eating well. He prepared the food, sincehis mother was old, and both helped his mother with shopping and went shopping on his own. Hestated that he was living off of his savings and his mother's savings, having "left a corporate jobwhich I'm sick and tired of explaining about." He did not desire to physically harm anyone whileat Madden, nor did he threaten anyone, but he stated that he had to be careful when speakingbecause his voice "comes across like a thunder booming out of the sky" and he points with hisfinger, which he thought may frighten people. As to the incident with the cup, he wanted to keepthe cup because of who paid for it (the county, the state, etc.), and also because he might wantmore coffee, so he refused to throw it away when asked, and a security guard stood up. Respondent had not attempted to harm himself, and had no thoughts of harming himself. Whenreleased from Madden, he would return to his mother's apartment.

Respondent asked the court for documents exonerating him and helping him enter witnessprotection. He stated that his savings were adequate to support him for years, that he had notrouble sleeping at Madden or before then, "five hours per sleep cycle." Respondent stated thathe was gaining weight while at Madden and carried a towel around with him because the plasticchairs gave him calluses. He also stated that he had "mutant emotions because of corporate life"and was working as a writer and living off his savings. If he had physical problems after leavingMadden, he would seek alternative sources of healing such as chiropractors and herbalists. Respondent stated that the police wanted to murder him because he could testify that they"manhandled" him at the police station.

At the conclusion of testimony and closing arguments, the court found that respondentwas mentally ill, that he was a danger to himself and others, and was unable to care for his basicphysical needs. The court issued an order finding respondent to be a person subject toinvoluntary admission and ordering his hospitalization in a Department facility. Respondent thenfiled a notice of appeal.

Respondent contends that the trial court erred in finding him subject to involuntaryadmission on the ground that he was a danger to himself or others where the State failed to allegethis basis for involuntary admission in its petition.

A person is subject to involuntary admission under the Code if he or she has a mentalillness and because of that illness is either "reasonably expected to inflict serious physical harmupon himself or herself or another in the near future" or "unable to provide for his or her basicphysical needs so as to guard himself or herself from serious harm." 405 ILCS 5/1-119 (West2000). This must be established by the testimony of "at least one psychiatrist, clinical socialworker, or clinical psychologist" who examined the person (405 ILCS 5/3-807 (West 2000)) andproven by clear and convincing evidence (405 ILCS 5/3-808 (West 2000)). In determiningwhether a person can provide for his basic physical needs, a court considers whether the personcan obtain his own food, shelter, and medical care; has a place to live or a family who can assisthim; can function in society; and has an understanding of money and concern for it as means ofsustenance. In re Jakush, 311 Ill. App. 3d 940, 944 (2000). An order of involuntarily admissionis not reversed unless it is against the manifest weight of the evidence. In re E.L., 316 Ill. App. 3d598, 606 (2000).

Here, respondent argues that he was alleged in the complaint to be subject to involuntaryadmission on a "basic physical needs" basis while he was found subject to involuntary admissionon the basis that he would "inflict serious physical harm." It is reversible error when the pleadingsallege one of the two statutory bases for involuntary admission but the arguments at trial and thefindings relate solely to the other basis; they are distinct, and one cannot plead one cause of actionbut prove another. In re Moore, 292 Ill. App. 3d 1069, 1071-72 (1997). Based upon Moore, theState concedes that the trial court erred in finding respondent subject to involuntary admission onthe basis that he was a danger to himself and others. However, the State maintains that reversal isnot required where there was sufficient evidence to sustain the court's alternate finding thatrespondent was unable to care for his basic physical needs. We agree with the State. In Moore,the State "did not even attempt to prove" the statutory basis originally alleged. Moore, 292 Ill.App. 3d at 1071. By contrast, the State's expert witness here, Dr. Nowak, discussed at lengthwhether respondent was able to care for his basic physical needs. More importantly, the Statehere sought and received a finding by the court that respondent was unable to care for his physicalneeds. Thus, the grounds alleged in the petition were argued at the hearing and found by the trialcourt.

Respondent also contends that the State failed to prove by clear and convincing evidenceall of the elements constituting an inability to care for one's basic needs. Specifically, respondentargues that the State failed to present sufficient underlying or ultimate facts to support Dr.Nowak's opinions.

Expert opinions must be supported by facts, and are only as valid as the facts underlyingthem. Hiscott v. Peters, 324 Ill. App. 3d 114, 123 (2001); In re Rovelstad, 281 Ill. App. 3d 956,969-70 (1996). A finder of fact is not bound by an expert opinion on an ultimate issue, but maylook "behind" the opinion to examine the underlying facts. Hiscott, 324 Ill. App. 3d at 123; In reJ.H., 153 Ill. App. 3d 616, 631 (1987).

Here, Dr. Nowak's testimony was replete with specific factual examples of respondent'sbehavior to support her medical opinions. The diagnosis of paranoid schizophrenia wassupported by respondent's suspicious, nervous, and easily agitated condition and hismisperceptions, including perceiving a social worker as a robot, a hearing aid as a recordingdevice, and believing that his living brother had died in an air crash. That same suspicious,nervous, and agitated behavior supported her opinion that respondent would not be able tointeract with society or obtain money as a means of sustenance were he to be released from care. In short, there was adequate factual evidence underlying Dr. Nowak's opinion that it was notagainst the manifest weight of the evidence for the court to conclude that respondent wasmentally ill and, due to that illness, was unable to provide for his basic physical needs.

Even if the trial court were to consider only respondent's testimony and events witnessedby Dr. Nowak, as respondent suggests, we find no error. Dr. Nowak observed that respondentwould not interact with others due to his paranoia and was nervous when he had to interact,becoming very upset on more than one occasion. This directly implicates respondent's ability tofunction in society. Also, obtaining money as a means of sustenance inherently requiresinteracting with others from time to time, either at a job or when seeking assistance from welfareand social agencies. Respondent admitted that he waited at least a day with a decomposingcorpse in his apartment before he attempted to obtain help, and another day before he definitivelysought help. It was also within the trial court's power to determine witness credibility (Eychanerv. Gross, 202 Ill. 2d 228, 251 (2002)) to disbelieve respondent's testimony and conclude that helived with the corpse for a longer period. Inaction in the face of such a basic sanitation issue ashaving a decomposing body in one's dwelling implicates respondent's ability to obtain shelter. Therequirement that one be able to obtain shelter implies that one must be able to maintain thatshelter in at least a minimally habitable condition, or the requirement would be hollow andmechanical.

Respondent lastly contends that the trial court erred in admitting an "integrated socialwork assessment" into evidence without proper foundation. He argues that no evidence waspresented at the hearing that this document was produced in the regular course of business or thatit was a regular business practice to produce such a document. He also argues that the documentwas likely generated with a view to possible litigation.

Medical records may be admitted as business records under Supreme Court Rule 236 (145Ill. 2d R. 236), which provides:

"Any writing or record *** made as a memorandum or record ofany act, transaction, occurrence, or event, shall be admissible asevidence [thereof], if made in the regular course of any business,and if it was the regular course of the business to make such amemorandum or record at the time of such an act, transaction,occurrence, or event or within a reasonable time thereafter. ***The term 'business,' as used in this rule, includes business,profession, occupation, and calling of every kind."

Records made with a view towards possible litigation do not qualify as business recordssince they are not made in the ordinary course of business, but documents routinely preparedunder a statutory duty are not rendered inadmissible because they are to be used in adversarialproceedings. In re A.B., 308 Ill. App. 3d 227, 236 (1999). A trial court decision on theadmission of a document as a business record is a matter of discretion and is disturbed only for anabuse of that discretion. People v. Lombardi, 305 Ill. App. 3d 33, 42 (1999).

Mental health facilities are required within a specified time from a person's admission,voluntary or involuntary, to conduct "a comprehensive physical examination, mental examination,and social investigation of that person" with the purpose of determining "whether some programother than hospitalization will meet the needs of the person." 405 ILCS 5/3-205.5 (West 2000). Before disposition of a case where involuntary admission is sought, a written report must beprepared for the court including "information on the appropriateness and availability of alternativetreatment settings, a social investigation of the respondent, [and] a preliminary treatment plan." 405 ILCS 5/3-810 (West 2000).

Respondent insists that "Dr. Nowak was never asked the proper foundation questionsregarding" the document in question, and that "there was no testimony that the assessment wasmade in the regular course of business or that it was the regular business practice to have madesuch a document." However, respondent cites no authority for the proposition that a foundationmust be laid using discrete questions on the two elements of a business record or "magic words"such as "regular course of business." Dr. Nowak testified, after the document in question wassubmitted to the court for admission but before an objection to its admission was denied, that acomprehensive treatment plan is completed in the intake department at the time of admission. Asto the "social assessment" in question, Dr. Nowak stated that it is part of the integratedassessment performed on respondent by his case manager and social worker. She also stated thatthis document was written by respondent's case manager, who Dr. Nowak knew and workedwith. Dr. Nowak identified the case manager's handwriting and stated that she knew the casemanager's first name but not her last name, noting that there were no other social workers atMadden with that name. We see no abuse of discretion in concluding on this evidence that therewas a procedure at Madden of routinely generating these social assessments as part of a generalassessment upon a patient's admission and that the document in question was such an assessmentof respondent performed by a particular Madden case manager.

Respondent also claims that the social assessment was likely generated with a view topossible litigation and therefore was not admissible as a business record. This particular issue wasnot raised in the trial court, but we will address it since it is subsumed in plaintiff's objection to thedocument's foundation. As stated above, the Code requires a "social investigation" of all personsadmitted to mental health facilities, voluntarily or not, and of all persons alleged to be subject toinvoluntary admission, in order to assist in determining the proper treatment or disposition. 405ILCS 5/3-205.5, 3-810 (West 2000). The placement of the "social assessment" in question in alarger "integrated assessment" causes us to conclude that it is a record of one or both of the socialinvestigations required by the Code. Dr. Nowak used the social assessment to help explain heropinion regarding the appropriate disposition of respondent, the purpose stated in the Code forsuch social investigations. The social assessment was thus required by statute to support decisionmaking by the Department and trial courts and routinely performed at Madden and other mentalhealth facilities in the course of their medical, and thus business, practice. Therefore, it wasadmissible as a business record.

Accordingly, we affirm the judgment of the circuit court.

Affirmed.

WOLFSON and HALL, JJ., concur.