Opinion
NOT TO BE PUBLISHED
APPEAL from the Superior Court of Riverside County No. RIP090967, Kathleen M. Jacobs, Temporary Judge. (Pursuant to Cal. Const., art. VI, § 21.)
Neale B. Gold, under appointment by the Court of Appeal, for Objector and Appellant.
Joe S. Rank, County Counsel, and Jamila T. Purnell, Deputy County Counsel, for Petitioner and Respondent.
OPINION
RAMIREZ, P.J.
Objector and appellant S.M. challenges the superior court’s order granting the public conservator’s petition for reappointment of conservatorship over her under the Lanterman-Petris-Short Act (Welfare and Institutions Code, § 5000 et seq.). First, S.M. argues that substantial evidence does not support the court’s determination that she was presently unable to provide herself with food, clothing and shelter, and so was “gravely disabled” as defined in section 5008, subdivision (h). Second, S.M. argues that substantial evidence does not support the court’s determination that she is “gravely disabled” under the factors set forth in Conservatorship of Guerrero (1999) 69 Cal.App.4th 442 (Guerrero). Third, S.M. contends that, because California is a community property state, the court improperly shifted to her the burden to prove she had verified third-party assistance for food, shelter and clothing, and thus the finding of grave disability was in error. As discussed below, we conclude the superior court did not err, and so affirm the ruling that S.M. was gravely disabled.
All further statutory references will be to the Welfare and Institutions Code unless otherwise indicated.
Statement of Facts and Procedure
On July 18, 2006, S.M. was admitted to the hospital and placed on an involuntary 72-hour hold under section 5150. S.M.’s husband had brought her to the hospital and reported that she had been in a manic phase for over 48 hours. S.M. had not slept during that time, had been cleaning the home continuously, had attempted to kick her husband, and threatened to kill her grown daughter. S.M. had a history of bipolar affective disorder. She had a history of five nervous breakdowns, two previous conservatorships and placement at Vista Pacifica Institution for Mental Diseases (IMD). S.M.’s husband and daughter stated they were not able to provide her with constant supervision.
On August 7, 2006, the Riverside County Public Guardian (Public Guardian) petitioned to be appointed S.M.’s temporary and permanent conservator. The superior court granted the temporary conservatorship the same day. S.M. did not object to the conservatorship. The court granted the appointment on September 29, 2006, and issued the letters of conservatorship on October 17, 2006.
On August 29, 2007, the Public Guardian petitioned to reestablish the conservatorship, which was set to expire on September 28, 2007. The attached conservatorship reappointment evaluation, performed and written by Kenneth Hutchins, Ph.D., described S.M. as having poor judgment and as denying that she had a mental illness. Dr. Hutchins reported that S.M. was paranoid, had grandiose delusions and that her “[t]hought processes were tangential and filled with irrelevant content.” S.M.’s plan upon release from the IMD was to live with her deceased father, whom she erroneously believed to be alive. Dr. Hutchins reported that S.M.’s husband and daughter were willing to have her back at home only once she was stabilized and non-psychotic. Dr. Hutchins recommended that S.M. remain under guardianship because she was “gravely disabled” in that she was “delusional and ha[d] no viable plan for self-care.”
At the October 9, 2007, hearing to reestablish the conservatorship, S.M. testified that she would take her medications if released from conservatorship. However, she was unable to name all of her prescribed medications, even though Dr. Hutchins later testified that County Villa IMD, where S.M. had been staying, had “groups in which [patients] are taught to recognize their medications. And one of the goals of most programs, including Country Villa, is that they would know their medications by name, and sight, and dosage before they would graduate from the program . . . .”
S.M.’s testimony revealed the following alternate plans to find shelter. First, she would use a $99.9 thousand dollar check from the state. Second, she would withdraw money from her husband’s checking account. Third, S.M. insisted that the home she owned with her husband was worth over six million dollars (and that Ace Ventura lived right above her) and she could sue for divorce and take her half to purchase her own home or trailer. Fourth, she could sleep at the home of her deceased father, whom she believed was still living. Finally, S.M. discussed going home to live with her husband and daughter stating, “I want to go home. Part of me wants to go home. But most of me is scared to go home . . . .” She also stated, in reply to a question regarding where she would sleep that night if the court cancelled the conservatorship but her husband did not come to pick her up: “I would have to sleep at a hospital tonight. If the doctor didn’t release me to somebody to take care of me, then I would have to stay there.”
Regarding her plans to obtain food, S.M. stated she could cook and could purchase food from a grocery store. She stated that she received money from Social Security, but “they said I ran out of funds.” S.M. also testified that she could provide her own clothing because she had “10,000 outfits . . . at least 100 outfits . . . .”
Dr. Hutchins testified that he had known S.M. and her husband since 1999 and was familiar with her mental health history back to 1985. S.M. suffered from bipolar disorder, with severe psychotic features. This caused mood instability that ranged from deep depression to severe mania. The psychotic component of S.M.’s illness caused paranoia, grandiose delusions and disorganized thinking. Dr. Hutchins stated that S.M. had impaired judgment, little insight into her mental illness and did not understand how it affected her day-to-day living.
Dr. Hutchins testified as to the feasibility of S.M.’s plans to provide for food, clothing and shelter. Most of S.M.’s housing plans were based on delusions. Dr. Hutchins was not aware of the legal status of the family home and, by implication, S.M.’s right to live in the home or have a share in it. He characterized as S.M.’s “primary plan” that her husband would take her into their family home and support her with his income, as she had no income of her own. Dr. Hutchins stated that “having no income, she kind of knows that she needs her husband’s blessing to come home.” He also stated that S.M.’s grown daughter wanted S.M. to continue to have visits home, but “cannot provide supervision for her until she is more stable, psychiatrically.”
Regarding S.M.’s plans to provide food for herself, Dr. Hutchins stated, “Her plans, as stated to me, assum[e] that the food is available and already purchased in the pantry or the refrigerator at her home. [¶] Independent of that, she has no income, so I am not—I am not sure how she would be able to provide for food or shelter.” Dr. Hutchins acknowledged that S.M. had sufficient clothing. Dr. Hutchins concluded that he did not believe S.M. had a viable plan for food, clothing and shelter.
After argument from both parties, the superior court concluded that, although S.M. may have a legal right to physically occupy the home she owned with her husband, the court was more concerned with her ability to care for and maintain herself in the home. “[W]hen we are looking at something that is a viable plan, in this case, the ability to stay, and the ability to continue in the situation, requires the assistance of others who are already living in this home, and that would be the husband and the daughter.” The court then concluded that, because S.M. had not submitted in writing a promise by her husband or daughter to assist her should she return home, as required by section 5350, and because the testimony of Dr. Hutchings established that she could not obtain food, clothing and shelter without third-party assistance, S.M. continued to be gravely disabled and required the conservatorship to be extended for another year.
This appeal followed.
Discussion
S.M. argues substantial evidence does not support the superior court’s finding that she continued to be gravely disabled. Specifically, she argues: (1) substantial evidence does not support the superior court’s conclusion that she could not provide herself with food, clothing and shelter; (2) there was insufficient evidence that S.M. was gravely disabled as judged by the criteria set forth in Guerrero, supra, 69 Cal.App.4th 442; and (3) because S.M. has a community property interest in her family home and her husband’s income, the court erred in shifting the burden of proof to S.M. under section 5350, subdivision (e), to provide written statements from her husband or daughter indicating their willingness to assist her in obtaining food, clothing and shelter.
“A conservator . . . may be appointed for any person who is gravely disabled as a result of mental disorder . . . .” (§ 5350.) A person is “gravely disabled” if he or she, “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).) A conservatorship “automatically terminate[s] one year after the appointment of the conservator . . . .” (§ 5361.) If “the conservator determines that conservatorship is still required, he may petition the superior court for his reappointment as conservator for a succeeding one-year period.” (Ibid.) The conservator is required to prove beyond a reasonable doubt that the person “is in need of the state’s care.” (Conservatorship of Roulet (1979) 23 Cal.3d 219, 225-226.) “On appeal ‘the court must review 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 the [appellant gravely disabled] beyond a reasonable doubt.’ [Citation.]” (Conservatorship of Walker (1989) 206 Cal.App.3d 1572, 1577 (Walker).) “The testimony of a single witness is sufficient to support the trial court’s finding.” (Conservatorship of Johnson (1991) 235 Cal.App.3d 693, 697.)
1. Plan for Food, Clothing and Shelter
Here, Dr. Hutchins testified that S.M.’s primary plan was to go home to live with her husband but that “she is very conflicted about whether her husband will take her home or not.” He also testified that he believed S.M. had no income of her own, and so “she kind of knows that she needs her husband’s blessing to come home.” Dr. Hutchins had reported in the conservatorship reappointment evaluation that S.M.’s husband and adult daughter had stated they would consider taking her home only once she was stable and non-psychotic. Dr. Hutchins further testified that S.M.’s daughter was not able to provide S.M. with supervision “until she is more stable, psychiatrically.” In sum, then, Dr. Hutchins concluded that that he did not think going home was a viable plan because S.M. would need assistance from her husband and/or daughter, and they were not prepared to provide that assistance until S.M.’s psychiatric state had stabilized.
Dr. Hutchins also testified that he believed S.M.’s plan to provide food for herself by purchasing it at a grocery store was a reasonable one, assuming that she had income. Dr. Hutchins had previously testified that he believed S.M. did not have any income of her own. He further testified that “[h]er plans, as stated to me, assuming that the food is available and already purchased in the pantry or the refrigerator at her home. [¶] Independent of that, she has no income, so I am not—I am not sure how she would be able to provide for food . . . .”
Dr. Hutchins further testified that S.M.’s lack of ability to provide food, clothing and shelter for herself was a result of her mental illness. “Although she has some awareness into her mental illness, it is very minimized. She does not see how it affects her day-to-day living.” Dr. Hutchins then testified that it was his opinion that S.M. was “gravely disabled.”
We conclude that this is substantial evidence supporting the superior court’s ruling that S.M. is gravely disabled. The evidence was clear that S.M. could not provide herself with food and shelter without help from her husband or daughter.
2. Guerrero Factors
We also disagree with S.M.’s arguments that “there was insufficient evidence [S.M.] was presently gravely disabled as set forth [in Guerrero] because there was insufficient evidence [S.M.] lacked insight into her mental illness, that [S.M.] felt she did not need medication, that [S.M.] could not provide for herself without medication and that [S.M.] would not take medication without the supervision of a conservator.” As explained in Guerrero, supra, 69 Cal.App.4th at pp. 446-447, where it can be established with psychiatric testimony that a conservatee lacks insight into his or her own mental illness, and does not believe in the need for medication to address the mental illness, this can support a substantial evidence showing that the conservatee cannot provide his or her own basic necessities without such medication. Further, if the person will not take such prescribed medication without supervision, this in turn supports a finding of present grave disability. (Ibid., citing Conservatorship of Walker, supra, 206 Cal.App.3d at p. 1577.) “In other words, but for the medication, which [the conservatee] would not take without supervision, [the conservatee] was presently gravely disabled.” (Guerrero, at p. 447.)
Here, substantial evidence supports a conclusion that S.M. lacks insight into her mental illness.
First, after an interview with S.M. in July 2007, Dr. Hutchins wrote in the conservatorship reappointment evaluation that S.M. had denied she was mentally ill, and noted “Insight and judgment are poor.”
Second, in the conservatorship jury trial evaluation dated October 4, 2007, Dr. Hutchins again noted that S.M. denied she had a mental illness.
Third, although S.M. testified at trial that she had been diagnosed with paranoid schizophrenia, she described the onset of her behavior that resulted in the conservatorship as simply stemming from anger and lack of attention. “I had a lot of anger; yes, I did. I have a lot of anger toward my family. I really don’t think it was the anger. I think that I wasn’t getting enough attention at home and that is why I act out. That is why I act out at County Villa too.”
Fourth, when asked on the witness stand how she controlled her mental illness, S.M. testified that she did so by “walking away from” the situation that caused her anger. She did not mention the need to take medications until prompted. Finally, Dr. Hutchins indicated several times in his testimony that S.M. did not have much insight into her mental illness: “Although she has some awareness into her mental illness, it is very minimized.” When asked whether S.M.’s testimony indicated that she had insight into her mental illness, Dr. Hutchins answered “As her testimony is taken overall, my opinion, no, there is not much insight.” Dr. Hutchins also testified that, while S.M. does have some insight and understands she needs to take medications, her lack of participation in the programs offered at Country Villa, including programs that are intended to lead to “physician sanctioned release” from conservatorship, indicates a lack of sufficient insight into her need for treatment.
Substantial evidence also supports the conclusion that S.M. would not consistently take her medications without supervision.
First, when asked on the witness stand whether she was taking any medications, S.M. listed Tums and Paxil, but described Paxil as “a baby aspirin.” In fact, Dr. Hutchins testified that S.M. was prescribed three medications for her mental illness: Depakote, a mood stabilizer; Paxil, an antidepressant; and Seroquel, an antipsychotic. Further, Dr. Hutchins testified that S.M. should be able to name her medications and their dosage, as well as recognize them by sight. This is because County Villa, like most IMDs, provides instruction on this topic, and generally does not allow a resident to “graduate” from the program without demonstrating this knowledge about their medications.
Second, S.M. had a history of not being compliant about taking her medications without supervision. In the two years she was at home between conservatorships from 2004 to 2006, she was often non-compliant with her medications and had not followed up with her psychiatrist at all. During that time, S.M. would sometimes dump her medications into a jar with her husband’s medications, and then would refuse to take them because they had been mixed. During her testimony, S.M. stated she still throws up medication when she believes it has been mixed: “And she gives me—I told her, if you give me medicine that taste like that, I am going to throw it up, and that is what I do. She mixes my medicine; I throw it up. [¶] Dr. Tom Pastel there told her that she was not allowed to mix my medicine up and she still mixes it up. And if she mixed it up and if it tastes like it, I throw it up.
Thus, despite S.M.’s testimony that she would take her medication if allowed to go home, substantial evidence supports a conclusion that she would not. S.M. was thus gravely disabled under the factors set forth in Guerrero.
3. S.M.’s Community Property Interests Do Not Negate the Need for a “Third-Party” Written Statement under Section 5350, subdivision (e)
S.M. also argues she did not need to present a written statement from her husband or daughter stating their ability and willingness to help provide S.M. with food, clothing and shelter, because she has a community property interest in the family home and her husband’s income. In other words, S.M. argues that she does not need any assistance from her husband or daughter, because her plan was to “stay in her own home, eat her own food, and wear her own clothing, to which she was legally entitled.”
Section 5350, subdivision (e), provides in part:
“(1) [A] person is not ‘gravely disabled’ if that person can survive safely without involuntary detention with the help of responsible family, friends, or others who are both willing and able to help provide for the person’s basic personal needs for food, clothing, or shelter.
“(2) However, unless they specifically indicate in writing their willingness and ability to help, family, friends, or others shall not be considered willing or able to provide this help.
“(3) The purpose of this subdivision is to avoid the necessity for, and the harmful effects of, requiring family, friends, and others to publicly state, and requiring the court to publicly find, that no one is willing or able to assist the mentally disordered person in providing for the person’s basic needs for food, clothing, or shelter.”
S.M. reasons that, under the principles of community property, she was and is entitled to stay at her own home because she co-owns it with her husband, citing Family Code sections 751 and 760. She cites these same statutes to argue that she is entitled to eat half of the food in the refrigerator, and can use her husband’s money, of which she is entitled to half, to purchase more food. Thus, S.M. argues, she did not need to provide a statement from her husband or daughter that they would assist her in obtaining food, clothing and shelter, because she was entitled to live in the family home and share in her husband’s food and income.
“The respective interests of the husband and wife in community property during continuance of the marriage relation are present, existing, and equal interests.” (Fam. Code, § 751.)
“Except as otherwise provided by statute, all property, real or personal, wherever situated, acquired by a married person during the marriage while domiciled in this state is community property.” (Fam. Code, § 760.)
This is an interesting argument, but at least in this case it ignores one of the central reasons for imposing and then extending the conservatorship—the evidence shows that S.M. needs not only legal and physical access to food, clothing and shelter, but also the support of a third party, namely her husband or daughter, to maintain herself in the home. In other words, it is arguable that S.M. could find transportation to the home on her own, and that she has a legal right to live there and to eat the food that is there, and to wear the clothes that she owns. However, the evidence shows that S.M. is not likely to continue taking her medication without third-party support, because she is not familiar enough with her medications and dosages, she has a history of not taking her medications, she said on the witness stand that she would throw up her medications if she believes they have been mixed with others, and she has a history of herself mixing her medications with her husband’s medications. Further, if S.M. stops taking her medications, she will at the very least have difficulty in providing herself with food, and in maintaining herself in the home.
The record establishes that S.M. would be unable to care for her own needs independently, even if allowed to live in her family home and given access to the food kept there. First, during the conservatorship, when S.M. would be allowed to visit her home for 36 hours at a time, she required supervision. Second, S.M.’s “Biopsychosocial Information,” prepared after she was admitted for psychiatric evaluation in 2006, indicated that “It is important to emphasize that the patient cannot manage her medical needs properly without supervision and could exacerbate her diabetes and hypertension.” Third, the same document noted that “The patient is unable to manage the details of everyday living on her own and cannot be supervised adequately by her family.” Third, Dr. Hutchins testified that S.M. did not understand how her mental illness affected her day-to-day living. Fourth, even S.M., at times, recognized that she would need her husband’s assistance if she were to return home. When asked what she would do if she were released from the conservatorship that day and her husband did not come to take her home, she replied “I would have to sleep at a hospital tonight. If the doctor didn’t release me to somebody to take care of me, then I would have to stay there. I might be there another 3 or 4 years.” (Italics added.)
In sum, as the superior court reasoned when it considered whether S.M.’s legal right to live in the home was sufficient to negate a finding that she was “gravely disabled,” there “might be a short term, immediate place to go, because based on the community property, ability to do that. [¶] However, when we are looking at something that is a viable plan, in this case, the ability to stay, and the ability to continue in the situation, requires the assistance of others who are already living in this home, and that would be the husband and the daughter.” (Italics added.)
Thus, we agree with the superior court that S.M.’s community property interest in her family home does not in itself mean she is able to provide herself with food, clothing and shelter, and so is not gravely disabled. For this reason, the absence of a written offer of assistance from her daughter or husband under section 5350, subdivision (e), defeats S.M.’s efforts to show she is not gravely disabled.
Disposition
We affirm the superior court’s ruling that S.M. was gravely disabled.
We concur: GAUT, J., MILLER, J.