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FIRST DIVISION
May 27, 2003

JUSTICE O'MALLEY delivered the opinion of the court:

This case involves a petition that alleges respondent,Tyrone S., to be a person subject to involuntary admission formental health treatment. Under the Mental Health andDevelopmental Disabilities Code (Code), a person is subject toinvoluntary admission if he or she has a mental illness andbecause of that illness is either "reasonably expected to inflictserious physical harm on himself or herself or another in thenear future" or is "unable to provide for his or her basicphysical needs so as to guard himself or herself from seriousharm." 405 ILCS 5/1-119 (1), (2) (West 2000).

Respondent appeals from the circuit court's order findingthat he is a person subject to involuntary admission and orderingthat he be hospitalized in the Department of Human Services. Respondent contends that the circuit court erred in committinghim because the State did not prove by clear and convincingevidence that he reasonably could be expected to inflict seriousharm upon himself or another in the near future.

BACKGROUND

On August 8, 2001, respondent was admitted to the TinleyPark Mental Health Center (TPMHC) following his release from thecounty jail. Respondent had been incarcerated pursuant to aguilty plea to a charge of public indecency. Soon after hearrived at the facility, respondent signed a voluntary admissionform. He submitted notice of his desire to be discharged onSeptember 12, 2001. In response, the State filed a petition forinvoluntary admission, alleging that respondent was a person whowas mentally ill and because of his illness was reasonablyexpected to inflict serious physical harm on himself or anotherand that he was unable to provide for his physical needs. TheState later withdrew the physical needs portion of its petitionand proceeded to hearing alleging that respondent was reasonablyexpected to inflict serious harm on himself or another due to hismental illness.

A hearing was held on the State's petition on October 16,2001. The State called two witnesses on direct examination,mental health technician Maurice Stegall and psychiatrist Dr.Phyu-Mar Hla, both of whom were assigned to TPMHC at the time ofrespondent's stay.

Stegall testified that on September 4, 2001, he observedrespondent openly masturbating while situated in the doorway ofanother patient's bedroom. Stegall conveyed to respondent thatsuch behavior was inappropriate and then sought to consult thenurse on duty as to what was to be done in response torespondent's actions. The nurse, Terry Thompson, directed thatrespondent be given an injection in order to quell his actions. Stegall and two other technicians approached respondent to assistThompson in administering the injection, at which pointrespondent began cursing loudly, refusing to take the shot, andstriking out at Stegall and the other technicians. Stegall andthe other staff members had to wrestle respondent to the floor,where respondent attempted to kick and scratch those restraininghim. Stegall stated that four or five other staff members weresummoned to assist and ultimately placed respondent in fullleather restraints.

On cross-examination, Stegall testified that at least twoother staff members, including Dr. Hla, observed respondentmasturbating in the doorway of the other patient's room. He alsostated that respondent ceased this behavior when Stegalladmonished him to stop, and that, to his knowledge, respondenthad not attempted to strike anyone other than on that date.

On redirect examination and in response to questions poseddirectly by the court, Stegall testified that on September 4, heonly consulted the nurses' station to report respondent'sbehavior, and that the decision to administer an injection wasmade by the nurse on duty, not by Stegall.

The State then called Dr. Hla. Respondent stipulated thatDr. Hla was an expert qualified to render an opinion inpsychiatry and mental illness. Dr. Hla testified that, as thepsychiatrist in charge of respondent's care, she had multipleopportunities to observe and evaluate respondent. She haddiagnosed respondent as having a delusional disorder, manifestedby respondent's belief that all women (fellow patients, staff,and Dr. Hla herself) desired him sexually. Respondent would actout on this belief by talking about it aloud with other patients,openly masturbating, exposing himself, and writing letters tostaff members alleging their desire for him. Respondent oftenreacted in a hostile manner when given verbal redirection andwould not participate in meetings regarding his prescribedbehavioral plan.

Dr. Hla related that respondent had been admitted to TPMHCand other mental health facilities on prior occasions and hadbeen ruled unfit to stand trial for the crime of stalking. Shehad consulted with other professionals and staff involved inrespondent's care and examined his medical records in formulatingher diagnosis of respondent's mental illness as a delusionaldisorder exhibited by his constant preoccupation with sex. Shestated that respondent's condition impaired his judgment andsubstantially affected his ability to cope with the ordinarydemands of life in that he would often become verbally abusiveand combative when his delusions were challenged.

Dr. Hla's opinion was that respondent, because of his mentalillness and the agitation resulting from his inability to dealwith his delusions in a rational manner, was reasonably expectedto inflict harm on himself or others in the near future. Insupport of this opinion, Dr. Hla cited the incident of September4, related by Stegall. Another incident took place in the earlymorning of August 26, 2001, when respondent consistently followedone of the female nurses and repeatedly told her she wasbeautiful. Another time, respondent, naked at the time, wheeledhimself into the day area and began openly masturbating. On bothoccasions, respondent refused verbal redirection and ultimatelyhad to be medicated and restrained. Finally, on September 23,2001, respondent became loud and combative in the TPMHC diningroom, again refused verbal redirection, and threatened to "get"the nurse who ultimately injected him and had him restrained.

Dr. Hla testified that it was her opinion thathospitalization was the least restrictive treatment optionavailable to respondent at the time of the hearing. She and herstaff had explored other options for respondent, such as nursinghomes and community placements, but none of the facilitiescontacted would accept respondent because of the behavior he hadexhibited and because none of them had the capability to monitorrespondent adequately. Respondent had a history of exposinghimself in public before entering TPMHC and had been found in thebed of a quite debilitated female patient during his stay at anursing home. Dr. Hla recommended that respondent receivepsychiatric treatment, preferably medication, before he could bemoved to a less restrictive setting.

On cross-examination, Dr. Hla stated that respondent hadnever actually attempted to harm anyone physically at the timeshe had been forcibly medicated and restrained. She alsotestified that several female patients and staff complained dailyabout respondent's inappropriate behavior toward each of them. Dr. Hla related in incident in which respondent had followed afemale patient into the women's bathroom and asked her for asexual favor, and the patient became frightened and ran out ofthe room as a result. Dr. Hla stated that, because of hisdelusions, respondent was likely to harm another personphysically were he discharged from TPMHC. This was her opiniondespite the fact that respondent is wheelchair-bound.

Respondent then testified on his own behalf, stating that hewas originally admitted to TPMHC involuntarily, but signed in asvoluntary admittee, and that Dr. Hla and other staff had told himhe did not qualify for hospitalization and was eligible fordischarge. Respondent stated that he had been accepted to stayat All American Nursing Home, but that Dr. Hla wanted to go courtto contest his discharge.

As to the scuffle with male staff members on September 4,2001, respondent stated that the staff were watching him as hewent to bed that night, that he told them he knew they werelooking at him, and that the staff then "got smart" and told him,"[Y]ou can get a shot." Respondent alleged that he had gone intoRoom 215 that night to look for something, that Stegall told himhe had to leave the room, and that soon afterward Thompson toldhim he had to receive an injection. When respondent refused theshot, Stegall grabbed and choked him, the other staff membersflipped his wheelchair, and he resisted in order to keep frombeing choked. Respondent stated that he never tried to kickanybody and that he can only move his legs a little and cannotmove his left foot at all.

When asked about the incident involving the female patientin the washroom, respondent testified that she had consented toenter the bathroom with him and that, once inside, they onlytalked. He stated that he never physically assaulted, lunged at,or grabbed anyone during his time at TPMHC. When asked if he wascurrently on any medication, respondent launched into a long,tangential narrative about how he had come to be in jail, othermental health facilities, and eventually TPMHC, before answeringin the negative.

On cross-examination, respondent testified that all of thewomen at TPMHC, both staff and patients, gave him a "hard time"when he would make requests and that they would "stick together"in that endeavor. He stated that he had reported their behaviorto Brenda Hampton, whose professional capacity he did not makeclear in his testimony. When questioned about the September 4incident and his prescribed behavior plan, respondent gaveanother lengthy and winding narrative about how well he got alongwith the female patients in TPMHC and stated that the behaviorplan authored by Dr. Hla was a fabrication, and he was not athreat to female patients and staff. He stated that he had neverbothered any women while he had been living on the street andthat the times he had been restrained were orchestrated by TPMHCstaff in response to his reporting them to Brenda Hampton, notbecause he had exposed himself or otherwise behavedinappropriately.

The circuit court found that: (1) respondent suffered frommental illness in the form of a delusional disorder; (2)respondent was symptomatic of such a disorder; (3) respondentpresented a danger to himself or others as shown by the behaviorand aggression displayed during his most recent stay at TPMHC;(4) respondent exhibited the behavior characteristics of hismental illness, especially through his random and wanderingtestimony; (5) the State had explored alternatives tohospitalization and any other treatment setting would not beappropriate; and (6) the evidence presented was not merely clearand convincing, but proved beyond a reasonable doubt thatrespondent should remain hospitalized.

On appeal, respondent contends that the circuit court erredin committing respondent because the State did not prove by clearand convincing evidence that respondent could reasonably beexpected to inflict harm upon himself or another in the nearfuture. More specifically, respondent alleges that the Statepresented no explicit medical testimony to that effect and thatthere is no factual basis for the opinion that respondent isdangerous. Respondent argues that Dr. Hla never explicitlytestified that it was her opinion that respondent was a danger tohimself or others, and that she only stated that she had anopinion and described what it was. Respondent also argues thateven if Dr. Hla had such an opinion, there was no factual basisfor it, since his behavior (which at times may have been loud,combative, or offensive to others) never posed a danger tohimself or others until he realized he was about to be given ashot. He characterizes such testimony about any dangerousconduct on his part as vague and conclusory.

ANALYSIS

Under the Mental Health and Developmental Disabilities Code,a person is subject to involuntary admission if he or she has amental illness and because of that illness is either "reasonablyexpected to inflict serious physical harm on himself or herselfor another in the near future" or is "unable to provide for hisor her basic physical needs so as to guard himself or herselffrom serious harm." 405 ILCS 5/1-119(1), (2) (West 2000). Involuntary admission implicates substantial liberty interests ofa person, and these interests must be balanced against the needto provide care for those unable to care for themselves and theneed to protect society from the dangerously mentally ill. In reRobinson, 151 Ill. 2d 126, 130-31 (1992). A person may not beconfined against his or her will merely because he or she ismentally ill and is dangerous to no one and can live safely infreedom. In re Winters, 255 Ill. App. 3d 605, 609 (1994).

In order to prove that a person is reasonably expected toinflict harm on himself or another, the State must present clearand convincing evidence in the form of explicit medical testimonygiven by a psychiatrist, clinical social worker, or clinicalpsychologist who examined the person. 405 ILCS 5/3-807, 3-808(West 2000). Such testimony is considered clear and convincingif the medical expert bases his or her diagnosis on directobservation of the patient. In re Tuman, 268 Ill. App. 3d 106,111 (1994). A circuit court does not require proof of actualharm inflicted by a patient before finding him or her to bementally ill and reasonably expected to inflict harm on anotherand ordering hospitalization. In re Knapp, 231 Ill. App. 3d 917,920 (1992).

A circuit court's finding that a person is subject toinvoluntary admission will not be reversed unless it is againstthe manifest weight of the evidence. In re Bert W., 313 Ill.App. 3d 788, 794. Such a finding is given great deference andwill not be set aside even if the reviewing court, after applyingthe clear and convincing standard, would have ruled differently. In re Friberg, 249 Ill. App. 3d 86, 94 (1993). The trial courtis in the best position to determine the credibility oftestifying witnesses and weigh the evidence, and itsdetermination should not be reversed unless it is manifestlyerroneous. In re Cutsinger, 186 Ill. App. 3d 219, 223 (1989).

Illinois courts have recognized that the science ofpredicting future dangerous conduct is inexact and have upheldcommitments based on the opinion of a qualified psychiatrist thatthe respondent was reasonably expected to engage in dangerousconduct. People v. Nayder, 106 Ill. App. 3d 489, 495 (1982). Courts need not delay involuntary commitment until someone isharmed. In re Graham, 40 Ill. App. 3d 452 (1976).

On appeal, respondent does not contest the court's findingthat he is mentally ill, but he does contend that Dr. Hla neverexpressed an explicit opinion that he would be reasonablyexpected to inflict physical harm on himself or another as aresult of his mental illness and that there was no factual basisfor this opinion. We find it curious that, if indeed Dr. Hlanever gave an opinion as to whether respondent is dangerous,respondent contests the factual basis for an opinion that wasnever given.

In this case, Dr. Hla was qualified as a medical expertwitness and had on numerous occasions observed respondent'sbehavior directly. She testified that, based on herobservations, she had diagnosed respondent as having a delusionaldisorder marked by a constant preoccupation with sex, whichrespondent exhibited with several instances of lewd behavior. Ondirect examination, the State asked Dr. Hla "Do you have anopinion *** [as to] whether because of that mental illness therespondent in the future is reasonably expected to inflict harmon himself or others?" Dr. Hla responded, "Yes," and went on tostate that respondent's mental illness prevents him fromresponding positively to behavioral redirections, causing him tobecome agitated and combative and to act out on staff membersseeking to correct his behavior.

Dr. Hla testified that there were multiple occasions whenshe had seen respondent engage in this type of behavior and thenbecome loud, agitated, and combative when confronted with verbalredirections concerning his inappropriate behavior. Furthermore,when respondent failed to respond to verbal redirection, Dr. Hlastated that she had seen respondent lash out physically at thoseattempting to redirect his behavior.

Moreover, on cross-examination, respondent's counsel askedDr. Hla "So it's your opinion *** that [respondent] poses adanger once he's discharged, even though he's in a wheelchair?" Dr. Hla responded in the affirmative, noting that respondent hadattempted to strike staff members and that it had taken several male staff members to restrain him on at least one occasion.

Maurice Stegall corroborated Dr. Hla's assertions throughhis own testimony that respondent had attempted to strike,scratch, and kick Stegall and other TPMHC staff members when theyattempted to correct respondent's inappropriate behavior. It isabundantly clear from the record that Dr. Hla gave an explicitopinion as to the danger respondent is likely to pose to othersand that she had a more than adequate factual basis for thisopinion.

In this case, it is clear that respondent is mentally ill,as established by Dr. Hla's diagnosis. While this alone cannotserve as a basis for his involuntary admission, his behaviorwhile residing at TPMHC and on prior occasions leads us tobelieve that he is reasonably expected to inflict harm on anotherwere he to be placed in less restrictive setting.

Given respondent's hostile reactions when confronted byTPMHC staff, it is reasonable to conclude that harm is likely tooccur if and when someone, either a non-mental-healthprofessional or possibly a police officer, confronts respondent'ssimilar behavior in a less restrictive setting. Considering theincident Stegall described and similar incidents, Dr. Hla'sstatement that respondent had been found in the bed of anotherpatient during his stay at a nursing home, respondent's arrestrecord, and respondent's own disjointed and often incoherenttestimony, we find that the circuit court's ruling was notmanifestly erroneous.

Accordingly, we affirm the judgment of the circuit court.

Affirmed.

McNULTY and SMITH, JJ., concur.