Opinion
NOT TO BE PUBLISHED
APPEAL from a judgment of the Superior Court of San Diego County No. MH105007, Kerry Wells, Judge.
McCONNELL, P. J.
INTRODUCTION
Sandra L. appeals from a judgment establishing a conservatorship of her person under the Lanterman-Petris-Short Act (LPS Act). (Welf. & Inst. Code, § 5000 et seq.).
Unless otherwise stated, all further statutory references are to the Welfare & Institutions Code.
She contends there is insufficient evidence to support the jury's verdict finding her presently gravely disabled, and the court's order finding the least restrictive placement available and necessary to treat her was a closed, locked facility. In addition, she contends the court's admission of irrelevant, prejudicial and cumulative evidence deprived her of a fair trial. We conclude these contentions lack merit and affirm the judgment.
Although this appeal is technically moot because the conservatorship has expired by operation of law, we are exercising our discretion to decide the appeal notwithstanding its mootness. (Conservatorship of Carol K. (2010) 188 Cal.App.4th 123, 133.) We, nonetheless, remind the parties "in an attempt to avoid potential mootness, this court would entertain requests to review conservatorship proceedings through expedited appeal or on writ of habeas corpus." (Conservatorship of Forsythe (1987) 192 Cal.App.3d 1406, 1409.)
BACKGROUND
Recommendation and Petition for Conservatorship of the Person
In April 2010, psychiatrist Stephen Signer recommended a conservatorship of the person for Sandra. In his recommendation, he indicated Sandra had chronic paranoid schizophrenia and did not comply with her medication regimen. He also indicated Sandra appeared unable to provide for her food, clothing, and shelter as she had lost her most recent housing situation due to aggression and paranoia. In addition, she defecated and urinated all over her home, including the carpets and bed. She had failed at board and care placements in the past and no family members were willing to take her in.
In May 2010, the San Diego County Public Conservator petitioned for appointment of a conservator of the person and a temporary conservator. The superior court appointed the public conservator as Sandra's temporary conservator pending a final conservatorship determination.
Contested Hearing
In June 2010, the superior court conducted a contested hearing. At the hearing, the court admitted and considered the conservatorship investigation report. The report summarized Sandra's lengthy mental health history dating back to June 1988. It includes numerous hospitalizations and conservatorships in California and other states as well as numerous failed community placements. The report also summarized past efforts by Sandra's husband and family to assist her, and documented their current fear of Sandra and unwillingness to provide further assistance. The report recommended Sandra's placement in a long-term, locked mental health treatment facility.
The superior court additionally considered testimony from Dr. Signer and Sandra. Dr. Signer testified Sandra suffers from chronic paranoid schizophrenia. He had treated Sandra multiple times prior to the hearing, last treated her two weeks before the hearing, and briefly interviewed her just prior to the hearing to confirm his diagnosis. Because of her mental disorder, he believed she was unable to provide herself with food, clothing, and shelter. He explained she was unable to maintain shelter for herself because she defecates and urinates all over her living quarters. In addition, she has little interaction with others and engages in long periods of random screaming and yelling.
Dr. Signer further believed Sandra was incapable of making medical decisions unrelated to her mental disorder because she inexplicably refused a medical consultation for her incontinence. He similarly believed she was incapable of medical decisions related to her mental disorder because she does not believe she is mentally ill and has declined offered medications. Lastly, he believed the least restrictive placement for her was a closed, locked facility as he was unable to obtain a community placement for her and her husband was unwilling to assist her.
Sandra testified she did not have paranoid schizophrenia, but believed she had bipolar affective disorder. She said she was currently taking medication and would voluntarily continue taking medication if she did not have a conservator. She planned to rent an apartment at an assisted living facility that was above her doctor's office and across the street from a grocery store. She stated her monthly Social Security income was $1,054 and her insurance would pay for a live-in helper to grocery shop, clean, and cook for her. She also stated her husband would help her and has been helping her all along.
In addition to these statements, she made numerous other statements not directly relevant to any issue being contested at the hearing. Nonetheless, as the superior court observed, the statements evidenced the existence of a mental illness requiring treatment. Similar statements of similar import were recounted in the conservatorship investigation report.
At the conclusion of the hearing, the court found "beyond a reasonable doubt, that there is enough evidence to establish the conservatorship with all of the rights and disabilities requested to be imposed." The court also found the least restrictive placement for her was a closed, locked facility.
Jury Trial
Sandra subsequently demanded a jury trial on the issue of whether she was presently gravely disabled. The superior court conducted the trial in late August 2010. At the trial, Salvatore Dinatale, Sandra's case manager, testified Sandra became a client of North Star ACT (North Star), an assertive community treatment program for the mentally ill with a history of homelessness, in November 2009. North Star offers comprehensive services, including case management, medication management, counseling, treatment, and housing.
For the first one or two weeks of the program, Sandra stayed in a motel. She subsequently moved into a board and care after she left the motel room in "a shambles." She had soiled her clothes and bed linens, and there were feces and food all over the place.
She then stayed in a board and care for one or two months. She left because she could not adhere to the board and care's medication management requirements and behavior standards. She was resistant to taking medications, she was up all night, and she was disruptive with the other clients. She went to a motel again, but had the same problem as before.
She then moved into an apartment where North Star observed her level of functioning, including how she acted and reacted to others and how she kept her living quarters. She had the same problem with this placement as she had with her motel stays. In late May 2010, she went to the mental health unit of a hospital and then to a long-term psychiatric care facility.
According to Dinatale, when Sandra is not taking her medication, her behavior is "[v]ery erratic" and she is "very uncooperative, evasive, avoidant, belligerent and accusatory." When she takes her medication, her behavior is still erratic, but she shows signs of stability. In Dinatale's opinion, Sandra could not provide her own shelter without assistance because she has a history of not taking her medication, with a resulting history of being evicted from places and becoming homeless. He also does not believe she would be able to maintain her own clothing without assistance.
Francesca Rossi, the lead clinical case manager for North Star, had personal interactions with Sandra at least three to five times a week between January and May 2010. When she visited Sandra, she noted Sandra's bedroom reeked of feces and urine. There was dirty laundry everywhere and Sandra slept on a stained bed without sheets. There were stains all over the house from excrement. Although Sandra had a payee that gave her money for food, Sandra used the money to buy cigarettes instead of food. North Star representatives took her to its comprehensive food pantry to get food; however, she only got liquids, not food.
Many days Sandra wore clothing soiled with feces and urine. She did her laundry only when North Star representatives picked her up and directed her to do so. Even then, she did not do all of her laundry and still had soiled clothing and linens.
Rossi believed Sandra could function well when she was under the right medication regimen and was in a structured setting with most of her basic needs provided for her. Conversely, when Sandra was not taking her medication and was not in a structured program, she could not provide herself with food, clothing, or shelter.
Sandra's mother testified that, although Sandra was married, she had been estranged from her husband since 2004. According to her mother's personal records, Sandra had been hospitalized 35 times in the preceding 23 years and 12 times in the preceding two years. Since late 2005, Sandra has had a series of hospitalizations in this state and in other states. For a six-month period near the beginning of 2006, she was stable and did well. Then, a doctor reduced her medication and she decompensated. Generally, when she takes her medication, she functions well, but she cannot manage her own finances or medication. When she does not take her medication, her living quarters become disheveled and she cannot provide herself with food or clean clothing. She also will not wash her own clothes without supervision.
When Sandra is not in a facility, she chain-smokes and goes through about a half a carton of cigarettes a day, or about $500 to $600 worth of cigarettes a month. She does not have enough money to buy cigarettes and to buy food and clothing, and she would choose to spend her money on cigarettes, rather than on food and clothes.
Sandra's mother does not want Sandra living with her. She believed Sandra needed a conservator to receive appropriate help.
Sandra testified her relationship with her mother was "very poor" because her mother molested her when she was 12. She said the motel where North Star first placed her was trashy and in a bad part of town, so she left on her own after approximately a week. She also left the board and care where North Star placed her because it was a voluntary program, and she did not want to participate any longer. She felt intimidated there because there were 47 men and only five women in the program. She could not leave the apartment where North Star placed her because her payee would not give her any money. She said the apartment was dumpy and trashy.
She thought the long-term psychiatric care facility she was currently in had improved greatly since she arrived and the staff was very kind. If she were not required to be there, she would live at Shepherd's Ranch, a sober living home for recovering alcoholics. She would pay her rent at the home and buy food and clothes for herself with her Social Security income. She would also buy food with food stamps, and her husband would bring her food. She said she only spends about $100 a month for cigarettes.
A person from Shepherd's Ranch interviewed her, but she did not tell the person why she left her prior placements. She admitted being evicted from an apartment four years earlier, but denied being asked to leave any of her more recent placements.
Shepherd's Ranch is not a supervisory facility and no one there would monitor her medication. She said she has been taking medication since she was 20, has always taken her medication voluntarily, and will continue taking her medication voluntarily in the future. She said the staff at the board and care where North Star placed her refused to administer her medication even though she demanded it. She denied that she ever stopped taking medication simply because she felt good. She stopped taking medication only once in the past because the medication caused a rash, and she has only refused to take experimental drugs.
She admitted she sometimes gets urine and feces on her because she has been abused and she was a kidney donor; however, she said she cleans herself right away. She also washes her clothes when she is able. She could not do her laundry at the apartment where North Star placed her because there were no laundry facilities there. She could not do her laundry at a Laundromat because the nearest one was 10 miles away, and she had no transportation or money. She will do her own laundry at Shepherd's Ranch because there are laundry facilities there.
Psychiatrist Brian Miller evaluated Sandra six times between June 2010 and the trial. He based his opinions on his evaluations, his review of Sandra's medical records, and the conservatorship investigation report. He diagnosed Sandra with schizoaffective disorder, bipolar type, and ranks her mental illness as "very severe." Although she has been mentally ill for at least 20 years and has likely had more than 50 hospitalizations, she insists she is not mentally ill. Instead, she believes people are lying and making things up to persecute or harm her.
In the past, she achieved periods of stability with treatment and medication. More recently, her periods of stability have become less frequent. While medication is necessary to treat Sandra's mental illness, Dr. Miller did not believe Sandra would voluntarily take medication as she continues to insist she does not need medication and historically she has stopped taking medication when she is no longer in a structured setting. When she does not take her medication, she becomes more delusional, more paranoid, more disruptive and has difficulty with her grooming and hygiene.
Because Sandra is an articulate and intelligent person and she had been taking medication regularly for a couple of months, Dr. Miller expected her to present relatively well at trial. According to him, "she would likely be able to sit in front of a jury, look fairly put together, and present herself fairly well, understanding that if we were in a different scenario, I think she would be more likely to succumb to her tendency to be sarcastic, irritable, angry, and shut off the conversation."
Moreover, Dr. Miller testified that her being on medication for a few months and being able to present well does not mean she can successfully provide herself with food, clothing, and shelter. Historically, when her treatment is not being enforced, she stops it and decompensates quickly. Even though she testified she knew she had a mental disorder and would take her medication, Dr. Miller suspected "that's an answer she knows people would like to hear...[S]he's an intelligent woman. She knows what's at stake today and knows the answers that people would like to hear, such as she knows she has an illness, she would like to continue to take her medications. I would suggest her history has been contrary to that."
Dr. Miller believed Sandra was presently gravely disabled in part because she would not take her medication consistently without supervision. He also believed she was presently gravely disabled because she could not describe what her plan would be to care for herself outside of a facility. Within a matter of days or weeks after her release, he believed she would likely resume her past revolving-door pattern of short-term hospitalizations, which could cause her to become biologically resistant to treatment. Dr. Miller believed she needed an extended period of stability to improve her prognosis.
On the issue of appropriate placement, Dr. Miller testified, in his opinion, the least restrictive level of placement for Sandra was a closed, locked facility. If she were not placed in such a facility, she would leave town, as she had in the past, to escape the people who are trying to provide her with treatment.
DISCUSSION
I
Sufficiency of the Evidence to Support Gravely Disabled Finding
The LPS Act "governs the involuntary treatment of the mentally ill in California" and "authorizes the appointment of a conservator for up to one year for a person determined to be gravely disabled as a result of a mental disorder and unable or unwilling to accept voluntary treatment. [ Citation.]" (Conservatorship of Susan T. (1994) 8 Cal.4th 1005, 1008-1009, fn. omitted.) A person is "gravely disabled" under the LPS Act if the person, "as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter." (§ 5008, subd. (h)(1)(A).) "The party seeking imposition of the conservatorship must prove the proposed conservatee's grave disability beyond a reasonable doubt." (Conservatorship of Susan T., at p. 1009.)
Sandra contends there is insufficient evidence to support the jury's finding she was presently gravely disabled. When reviewing challenges to the sufficiency of the evidence, we examine "the whole record in the light most favorable to the judgment below to determine whether it discloses substantial evidence—that is, evidence which is reasonable, credible, and of solid value—such that a reasonable trier of fact could find [grave disability] beyond a reasonable doubt." (People v. Johnson (1980) 26 Cal.3d 557, 578; Conservatorship of Carol K., supra, 188 Cal.App.4th at p. 134.) "The testimony of one witness may be sufficient to support such a finding. [Citation.]" (Conservatorship of Carol K., at p. 134.)
In this case, the evidence showed Sandra has been mentally ill for over 20 years and her illness was "very severe." Nonetheless, she insisted to Dr. Miller that she was not ill and did not need medication. The evidence further showed that, without medication, Sandra would not be able to provide herself with clothing and shelter because she would revert to self-destructive behaviors, including urinating and defecating on herself without cleaning herself up, and the behaviors would inevitably lead to her loss of clothing and shelter. She also would not be able to provide herself with food because she would choose to spend her money on cigarettes instead or otherwise make inappropriate food choices. (Conservatorship of Walker (1989) 206 Cal.App.3d 1572, 1577 [sufficient evidence supports grave disability finding where the record shows the conservatee did not believe he was ill, did not believe he needed medication, and without medication, could not provide for himself]; see also, Conservatorship of Guerrero (1999) 69 Cal.App.4th 442, 446-447.)
Although Sandra acknowledged at trial that she had a mental illness and testified she would voluntarily take her medication, had a suitable place to live, and had the resources to obtain food and clothing, the jury was not obliged to credit her testimony. (Conservatorship of Amanda B. (2007) 149 Cal.App.4th 342, 350; Conservatorship of McKeown (1994) 25 Cal.App.4th 502, 509.) Moreover, the existence of conflicting evidence does not preclude us from determining there is sufficient evidence to uphold the judgment as we must resolve all such conflicts in favor of the judgment. (Conservatorship of Amanda B., at pp. 350-351.)
II
Sufficiency of the Evidence to Support Placement in a Closed, Locked Facility
Sandra next contends there is insufficient evidence to support the trial court's finding the least restrictive placement available and necessary to treat her was a closed, locked facility. In reviewing this contention, we apply the same substantial evidence test described in part I, ante.
After the jury returned its verdict finding Sandra gravely disabled, the superior court stated its June 10, 2010 order following the contested hearing remained in effect. The order provided for Sandra's placement in a closed, locked facility. The order was based on the information in the conservatorship investigation report and the testimony of Dr. Signer. The superior court also independently determined from Dr. Miller's trial testimony the same placement was appropriate.
The parties agree the superior court's placement decision is guided by section 5358, subdivision (c)(1), which provides that, "if the conservatee is not to be placed in his or her own home or the home of a relative, first priority shall be to placement in a suitable facility as close as possible to his or her home or the home of a relative. For the purposes of this section, suitable facility means the least restrictive residential placement available and necessary to achieve the purpose of treatment."
Here, the evidence showed Sandra did not have her own home or a relative willing to house her. The evidence further showed Sandra was repeatedly unsuccessful living on her own or in a board and care facility as she did not comply with her medication regimen in those settings, decompensated, and fell into a revolving-door pattern of short-term hospitalizations. Such a pattern could ultimately lead to biological resistance to treatment. To stabilize her medication regimen and ensure she did not flee during the stabilization process as she had in the past, Dr. Miller believed Sandra needed to be placed in a closed, locked facility. This evidence provides ample support for the superior court's placement decision.
III
Admission of Medical History Evidence
A
Before trial, Sandra's counsel made an oral motion in limine to preclude petitioner's witnesses from testifying about facts and circumstances more than three or four years old as the information was too remote to be relevant to the issue of whether Sandra was presently gravely disabled. Petitioner's counsel argued the issue was moot as he did not plan to focus on historical facts. Rather, he planned to tangentially mention Sandra's history to show when Sandra started having problems and focus on what happened recently.
The superior court responded, "All right. I think that sounds appropriate." The court then clarified it did not believe the details of events more than three or four years old were relevant, but it would allow petitioner's witnesses to summarize Sandra's history without getting into details until more recent events.
As to matters more than three or four years old, Sandra's mother testified she first knew something was wrong with Sandra when Sandra was 22 and started living on the streets. In addition, she testified Sandra was first hospitalized in 1987 for attempted suicide. She also testified Sandra was hospitalized 15 to 18 times between 1987 and 1995.
B
Sandra contends the superior court erroneously admitted this testimony from Sandra's mother because it was irrelevant and its potential prejudice substantially outweighed its probative value. We review the superior court's rulings on the admissibility of evidence for abuse of discretion. (People v. Harris (2005) 37 Cal.4th 310, 337.) We discern no abuse of discretion in this case.
In determining whether Sandra was gravely disabled, the jury could consider the historical course of her illness. (§ 5008.2, subd. (a).) The historical course may be shown by "evidence voluntarily presented by family members...." (Ibid.) Thus, the historical information Sandra's mother provided was both relevant and admissible. In addition, because the information was presented briefly and with few details, it did not unduly consume trial time, nor did it create a substantial danger of confusing the issues or misleading the jury. (Evid. Code, § 352.)
The information also did not create a substantial danger of prejudicing Sandra. " 'Prejudice' " in this sense "is not synonymous with 'damaging': it refers to evidence that poses an intolerable risk to the fairness of the proceedings or reliability of the outcome. [Citation.]" (People v. Booker (2011) 51 Cal.4th 141, 188.) Cursory information that Sandra's mental illness is long-standing and has resulted in other hospitalizations in the past, while not favorable to her position, does not pose the type of intolerable risk that would warrant its exclusion. Accordingly, the superior court did not err in admitting this evidence.
Moreover, even if the superior court had erred in the admitting the evidence, the error was harmless. The jury was specifically instructed not to consider evidence it believed was "irrelevant because it occurred either too long ago or under circumstances that are not similar to those involved in this case." We presume the jury understood and followed this instruction. (People v. Lee (2011) 51 Cal.4th 620, 652.) Further, as we explained above, the testimony of petitioner's witnesses, including Sandra herself, was more than sufficient to convince a jury beyond a reasonable doubt that Sandra was gravely disabled. We, therefore, conclude it is not reasonably probable the jury would have reached a different decision absent the admission of the challenged evidence. (People v. Harris (2005) 37 Cal.4th 310, 336 [errors in the application of the ordinary rules of evidence are reviewed under the " 'reasonable probability' " standard of People v. Watson (1956) 46 Cal.2d 818, 836.)
IV
Admission of Testimony from Two North Star Employees
A
After Dinatale's testimony, Sandra's counsel suggested Rossi's testimony would be similar to Dinatale's and expressed general concern that "we're very quickly going to be getting into a cumulative problem." The superior court responded, "Well, we haven't gotten there yet. So I will certainly hear you again. But we've only had one witness, so I can't find that anything's cumulative yet." (Emphasis added.) When the court then asked petitioner's counsel to clarify what evidence Rossi would provide, petitioner's counsel stated Rossi had interactions with Sandra that Dinatale did not. The court responded, "Okay. I mean, I think that we certainly don't need to necessarily repeat everything that's been said, but there are other observations. And, quite frankly, [Dinatale] was a little difficult to understand, so a witness that might be better, easier to understand might assist the jury as well." Petitioner's counsel confirmed Rossi was easier to understand. The court then indicated again that it understood Sandra's cumulative objection, but did not think the evidence had become cumulative yet.
B
Sandra contends the superior court erroneously allowed duplicate testimony from Dinatale and Rossi about the nature of North Star and about Sandra's difficulties with her past placements. Sandra has forfeited this claim on appeal because Sandra's counsel failed to assert a cumulative objection to any specific aspect of Rossi's testimony as the superior court indicated he would need to do when he expressed his general concern about the potential for a cumulative evidence problem. (Evid. Code, § 353, subd. (a) [an appellate court may not set aside a judgment because of erroneously admitted evidence unless the record shows there was a timely objection or motion to strike the evidence on the specific ground raised on appeal.]
Even if Sandra had not forfeited this claim, we would conclude it lacks merit. Evidence Code section 352 provides the basis for excluding cumulative evidence. Thus, a superior court may exclude cumulative evidence "if its probative value is substantially outweighed by the probability that admission will unduly consume time, create a substantial danger of undue prejudice, confuse the issues, or mislead the jury. [Citation.]" (People v. Mincey (1992) 2 Cal.4th 408, 439.) As previously stated, we review rulings on the admissibility of evidence for abuse of discretion. (People v. Harris, supra, 37 Cal.4th at p. 337.)
In this case, Rossi's testimony was unquestionably probative as she had firsthand information directly bearing on how Sandra's mental illness affected Sandra's ability to provide herself with food, clothing, and shelter. The potential prejudicial effect of Rossi's testimony did not substantially outweigh its probative value as the testimony did not consume a significant amount of trial time, it did not pose an intolerable risk to the fairness of the proceedings or the reliability of the outcome, and it was not confusing or misleading. Accordingly, the superior court did not abuse its discretion in admitting the testimony. Even if the superior court had abused its discretion in this regard, we would find the error harmless for the same reasons stated in part III.B., ante.
DISPOSITION
The judgment is affirmed.
WE CONCUR: McINTYRE, J. IRION, J.