JUSTICE MAAG delivered the opinion of the court:

The respondent, Christopher P., appeals the circuit court's order finding him to be aperson subject to the involuntary administration of psychotropic medication. We reverse.

On February 8, 2002, Dr. Jagannath Patil filed a petition for the involuntaryadministration of nonemergency psychotropic medication for the respondent. Dr. Patilsought an authorization to involuntarily administer four psychotropic medications(Risperidone, Ativan, and the alternative medications Haldol and injectable Haldoldecanoate) to the respondent on a nonemergency basis. The petition stated, "[Therespondent] suffers from a major psychiatric illness manifested by delusional beliefs,disorganized thinking, aggressive behaviors, etc.[,] and refuses to take any psychotropicmedications." Dr. Patil's diagnosis for the respondent's illness was "Schizophrenia, ParanoidType."

Dr. Kanwal Mahmood, a psychiatrist at Alton Mental Health Center, testified that therespondent had been admitted to Alton Mental Health Center on February 5, 2002. Dr.Mahmood had reviewed the respondent's records and discussed the case with his treatingpsychiatrist, Dr. Patil. Dr. Mahmood attempted to meet with the respondent the day beforethe hearing, but he refused to speak to her since she was a female. Dr. Mahmood explainedthat the respondent had refused treatment from any female and refused to talk to females. Dr. Mahmood claimed that the respondent had not eaten for at least three or four daysbecause he believed that his food was poisoned. He refused to eat anything at Alton MentalHealth Center because he thought he was in the "enemy house." Dr. Mahmood stated thatthe respondent wanted to be released and claimed that he was going to sue Alton MentalHealth Center because it was his "enemy." Dr. Mahmood described the respondent as"isolative," explaining that he refuses to talk with the treatment team, with the exception ofa few males, and that he stays in his room. Dr. Mahmood stated that the respondent hadbeen charged with the crimes of disorderly conduct and aggravated battery to a police officerarising from an incident when he wanted to photograph a woman and placed his arm in frontof her face. When the police attempted to arrest him, he pulled away and struck a policeofficer.

Dr. Mahmood testified that the respondent had been on psychotropic medication inthe past but that the records were unclear about what medications he had taken. Thetreatment team determined that the respondent should take Risperidone and Ativan. Thetreatment team decided that if Risperidone proved to be ineffective, Haldol or Haldoldecanoate should be used as a backup. Dr. Mahmood stated that Risperidone and Haldolwould render the respondent fit to stand trial. She said that these medications would enablethe respondent to have reality-based thinking and that his delusions would not interfere withhis functioning. Dr. Mahmood also testified regarding the expected benefits of themedications and the dosage ranges. Dr. Mahmood opined that the benefits of taking themedication outweighed the risks of harm. When Dr. Mahmood was asked whether lessrestrictive treatment services such as counseling, education, or therapy would be adequatewithout medication to properly treat the respondent, she stated "No." She was not asked ifother alternatives had been explored.

Dr. Mahmood stated that the respondent was suffering due to the fact that he had noteaten much since his arrest. She claimed that he had exhibited threatening behavior priorto his arrest and that he was unfit to stand trial. She opined that, without medication, therespondent's ability to function would continue to deteriorate or he would remain in adeteriorated condition. Dr. Mahmood stated that she did not think that the respondent hadthe capacity to make a reasoned and informed decision about whether he should or shouldnot take the prescribed medication.

On cross-examination, Dr. Mahmood admitted that the respondent had not engagedin any threatening behavior since his arrest, but she stated that he had shown agitation overthe unit's rules. Dr. Mahmood explained that even if the respondent had been out on bondsince his arrest in September until February (when he was brought to the Alton MentalHealth Center) and had not been in any trouble with the law for engaging in threateningbehaviors, she would not change her opinion that the respondent was in need ofpsychotropic medications. Dr. Mahmood also indicated that the respondent had not beenin any fights since his admission.

Although Dr. Mahmood did not personally discuss the benefits and risks of theproposed medications with the respondent, she read Dr. Patil's initial treatmentrecommendations from the respondent's chart, which stated as follows:

"I've explained the benefits and risks of Resperidone [sic] and Haldol to this patient. He's thoroughly psychotic. And based on his delusion[al] beliefs of a persecutednature and refuses [sic] to take any medication, he states that he will not take anymedication, and whenever we give him a shot[,] he will take it, but *** he would liketo have a return paper about his refusal."

Dr. Mahmood admitted that there was no documentation indicating that the respondent hadbeen told about the benefits and risks of Ativan.

The respondent moved for a directed finding based upon this court's opinion in In reEdward S., 298 Ill. App. 3d 162, 698 N.E.2d 186 (1998), that the only basis for believingthat information about the benefits and risks of the proposed medications had been given tothe respondent was a reference to an "out-of-court statement being offered for the truth ofthe matter asserted" rather than the basis for an opinion that the benefits and risks of the twomedications had been explained to the respondent. Additionally, the record shows that norisk information or benefit information regarding Ativan had ever been given to therespondent. The State responded by suggesting that it was sufficient that the respondent waspresent in open court when Dr. Mahmood discussed the benefits and risks of themedications. Also, the State claimed that because In re Edward S. was an Appellate Court,Second District, decision, it should not control this court's decision. The circuit court didnot agree with the State's reasoning that the doctor's explanation of the benefits and risks ofAtivan while the respondent was present in open court was sufficient. The circuit court thenallowed the respondent's motion for a directed finding on Ativan only.

Dr. Mahmood was recalled by the respondent's counsel as an adverse witness. Therespondent's counsel presented Dr. Mahmood with the respondent's records from ChoateMental Health Center. Dr. Mahmood agreed that the respondent's admission to ChoateMental Health Center was voluntary and that it was his only admission to the Departmentof Human Services. Dr. Mahmood listed the side effects from Risperidone and Haldol, andshe claimed that Dr. Patil would have explained the side effects to the respondent basedupon the information contained within the pamphlet. Dr. Mahmood testified that therespondent had previously taken Trilafon, lithium, and Prolixin during his admission toChoate Mental Health Center and in 1992 when he was in a Veterans Administrationhospital in Virginia.

The respondent testified that he did not believe that the food at Alton Mental HealthCenter was poisoned. Explaining that he refused to eat the food at Alton Mental HealthCenter because he had sued the Department of Human Services for falsifying documents,the respondent stated, "I just couldn't *** understand eating from someone who I am suing." He stated that because of the lawsuit he had filed, he could not trust the people working atthe center. The respondent claimed that he had not taken any psychotropic medication forat least seven years. During that time, he had no trouble living on his own, paying his bills,or caring for himself. Prior to his admission to Alton Mental Health Center, he lived in anapartment in Murphysboro and got along fine with his landlord, who lived next door. Therespondent cooked for himself and managed his own money. After his arrest in September,the respondent remained in jail for a few days and bonded himself out. He appeared atseven pretrial hearings while living independently at his apartment. He had no problemswith other people while he was free on bond. The respondent claimed that his fitnessevaluation had been conducted over the telephone while he was living at home. Therespondent stated that he had received Risperidone in the past and that he did not like takingit because it exacerbated his problems with sexual dysfunction. The respondent stated thathe was admitted to Choate Mental Health Center in 1993 due to side effects from takingHaldol. He claimed that when he had previously taken Haldol, it caused his wrists to twistand curl involuntarily. The respondent said that the malpractice began in 1993 and that hefiled his lawsuit in 2001. The respondent stated that he had been offered no treatment otherthan medication at Alton Mental Health Center.

Subsequent to the parties' closing arguments, the circuit court found that therespondent was a person subject to the involuntary administration of psychotropicmedications, and the court entered an order authorizing the administration of Risperidoneand Haldol. The respondent filed a timely pro se notice of appeal. The State did not appealthe circuit court's denial of permission to utilize Ativan.

The respondent challenges the sufficiency of the State's evidence. The respondentclaims that the State failed to provide clear and convincing evidence that he lacked thecapacity to make a decision about treatment with nonemergency psychotropic medication. Specifically, the respondent contends that the State could not present clear and convincingevidence that he could not make a reasoned decision about the nonemergency medicationswithout showing that he was informed about the risks and benefits of the proposedmedications. We agree.

On review, the circuit court's factual findings are entitled to great deference becauseit stands in the best position to weigh the credibility of all the witnesses. Therefore, we willnot reverse a circuit court's decision merely because we might have come to a differentconclusion, but instead, we will reverse only if the circuit court's decision is manifestlyerroneous. A circuit court's decision is not manifestly erroneous unless the error is clearlyevident, plain, and indisputable. In re Jeffers, 239 Ill. App. 3d 29, 35, 606 N.E.2d 727, 731(1992).

Pursuant to section 2-107.1 of the Mental Health and Developmental DisabilitiesCode (Code) (405 ILCS 5/2-107.1 (West 2002)), the State must prove, among other things,that the respondent lacks the capacity to make a reasoned decision regarding theadministration of psychotropic medication, and it must prove this by clear and convincingevidence. 405 ILCS 5/2-107.1(a-5)(4)(E) (West 2002). "Before one can make a reasoneddecision regarding medication, it is first necessary to be informed about the risks andbenefits of the proposed course of medication." In re Edward S., 298 Ill. App. 3d at 166,698 N.E.2d at 188. Additionally, according to In re Edward S., section 2-102(a) of the Coderequires that the patient be informed in writing about the side effects of proposedmedication. In re Edward S., 298 Ill. App. 3d at 166, 698 N.E.2d at 188; 405 ILCS 5/2-102(a) (West 1996) (now see 405 ILCS 5/2-102(a-5) (West 2002)). In re Edward S. statesthat if a patient is not informed of the risks and benefits of proposed medication, an orderfor the involuntary administration of medication must be reversed. In re Edward S., 298 Ill.App. 3d at 166, 698 N.E.2d at 188. We disagree.

According to section 2-102(a-5) of the Code:

"[T]he physician or the physician's designee shall advise the recipient, inwriting, of the side effects, risks, and benefits of the treatment, as well as alternativesto the proposed treatment, to the extent such advice is consistent with the recipient'sability to understand the information communicated. The physician shall determineand state in writing whether the recipient has the capacity to make a reasoneddecision about the treatment." (Emphasis added.) 405 ILCS 5/2-102(a-5) (West2002).

The decisions in In re Edward S. and In re Barry B., 295 Ill. App. 3d 1080, 693 N.E.2d 882(1998) (superseded by statute in In re Jennifer H., 333 Ill. App. 3d 427, 775 N.E.2d 616(2002)) (the court found that the circuit court had properly determined that a patient lackedthe capacity to make a reasoned decision regarding psychotropic medications, so therisk/benefit information in writing was unnecessary), clearly ignore the fact that a circuitcourt must determine, based upon competent medical testimony, whether the patient has theability to understand the risks and benefits of treatment or if the patient has pathologicalperceptions or beliefs that prevent him from understanding the information. If the patientlacks this ability, there is no requirement, by statute, that he be given written advisementsof these options, advantages, and disadvantages. Hence, in the instant case, the real issueis whether the State showed, by clear and convincing evidence, that the respondent lackedthe capacity to understand the risks and benefits of the medications. We find that the Statefailed to do so.

In In re Richard C., 329 Ill. App. 3d 1090, 769 N.E.2d 1071 (2002), this courtdetermined that because the respondent's psychiatrist had not informed him, in writing, aboutthe risks and benefits of the psychotropic medication, his due process rights had beenviolated. The court made this determination in spite of the fact that the psychiatrist hadrepeatedly tried to explain the benefits and side effects of Haldol to the respondent and therespondent had launched into paranoid tirades and said that the drugs were poison. The Inre Richard C. court determined that even though the respondent had said that the drugs were"poison," this did not mean that the respondent was not entitled to be informed in writing. The court further found that "[c]ontrary to the State's contention, this right of writtennotification is not subject to a harmless error analysis," because the statutory rights ensurethat the respondent's due process rights are met and protected. In re Richard C., 329 Ill.App. 3d at 1095, 769 N.E.2d at 1075. The necessity for strict compliance with mental healthstatutory provisions is compelling due to the fact that liberty interests are involved. TheCode's procedural safeguards are not mere technicalities but essential tools to safeguard theliberty interests of mental health patients. Hence, procedural safeguards are construedstrictly in favor of the respondent. The failure to comply with procedural rules requires thereversal of court orders. The In re Richard C. decision also pointed out that even though therespondent had told his doctor that he did not want to take the medication because it was"poison," this made the requirement of written notification of greater value and importance. If the respondent had received written information, he would have had the opportunity toreview the information at a time and in a manner of his choosing.

In contrast, the court in In re Barry B., 295 Ill. App. 3d at 1088, 693 N.E.2d at 887,affirmed the circuit court's order subjecting a respondent to the involuntary administrationof psychotropic medication despite the fact that the respondent had not been given writteninformation about the prescribed psychotropic medication. However, in In re Barry B., theevidence of the respondent's inability to understand the risks and benefits of the medicationwas overwhelming.

In the instant case, such overwhelming evidence is lacking. Here, the respondentapparently understood that he could refuse to take psychotropic medication, and he did so.The respondent gave a valid explanation for not wanting to eat at the Alton Mental HealthCenter. He stated that he did not wish to eat the center's food because he had sued thecenter. The respondent testified that he had previously taken Risperidone and Haldol andthat the Risperidone had exacerbated his problems with sexual dysfunction. As we havepreviously stated, the respondent testified that he had been voluntarily admitted to ChoateMental Health Center in 1993 due to the side effects of taking Haldol. He claimed that whenhe took Haldol previously, it caused his wrists to twist and curl involuntarily. When Dr.Mahmood was asked whether the respondent had the capacity to make a reasoned decisionregarding medication, she answered, "I don't think so." Even if the respondent's paranoiainterfered with the discussions about the medication, it does not mean that the respondentcould have neither understood nor utilized the information provided in writing. We alsonote that even if Dr. Patil had informed the respondent verbally regarding the benefits andrisks of the medication, our decision would be the same. The record is completely devoidof any evidence that the respondent was informed about the risks and benefits of themedication in writing pursuant to section 2-107.1 of the Code (405 ILCS 5/2-107.1 (West2002)), and because we have determined that the State failed to show that the respondentwas incapable of understanding this information, we must reverse.

Because we have determined that the respondent should have been informed inwriting about the risks and benefits of the psychotropic medication, we need not address therespondent's remaining contentions of error.

For the foregoing reasons, the judgment of the circuit court of Madison County isreversed.

CHAPMAN and DONOVAN, JJ., concur.

Opinion Filed: July 29, 2003

Justices: Honorable Gordon E. Maag, J.

Honorable Melissa A. Chapman, J., and

Honorable James K. Donovan, J.,

Concur

Attorneys Anthony E. Rothert, Staff Attorney, Elvis C. Cameron, Managing Attorney, Jeff M.

for Plesko, Director, Legal Advocacy Service, Guardianship and Advocacy Commission,

Appellant Metro East Regional Office, 4500 College Avenue, Suite 100, Alton, IL 62002

Attorneys Hon. William Haine, State's Attorney, Madison County Courthouse, 157 N. Main

for Street, Edwardsville, IL 62025; Norbert J. Goetten, Director, Stephen E. Norris,

Appellee Deputy Director, Sharon Shanahan, Contract Attorney, Office of the State's Attorneys

Appellate Prosecutor, 730 E. Illinois Highway 15, P.O. Box 2249, Mt. Vernon, IL

62864