Opinion
C085411
09-04-2018
Conservatorship of the Person and Estate of K.H. SUTTER COUNTY PUBLIC GUARDIAN, AS CONSERVATOR, ETC., Petitioner and Respondent, v. K.H., Objector and Appellant.
NOT TO BE PUBLISHED California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115. (Super. Ct. No. CVSM080644)
Objector K.H. challenges the renewal of appointment of conservatorship under the Lanterman-Petris-Short Act (LPS Act) (Welf. & Inst. Code, § 5350 et. seq.; unless otherwise set forth, statutory section references that follow are to the Welfare and Institutions Code). She complains the grave disability finding was not supported by substantial evidence and that the Sutter County Public Guardian's (Public Guardian) failure to present any evidence supporting the special disabilities deprived her of due process of law.
We reverse the trial court's order that K.H. shall not have the right to execute an affidavit of voter registration, but otherwise affirm the trial court's order.
FACTS AND PROCEEDINGS
On April 14, 2008, the Sutter County Superior Court appointed the Public Guardian, under the LPS Act, as conservator of K.H.'s person and estate and imposed special disabilities, restricting her from having a driver's license, entering contracts, refusing treatment, and possessing firearms or other deadly weapons. This conservatorship was renewed annually prior to the November 14, 2016, petition for reappointment of the Public Guardian. While not included in the first six renewals of the LPS Act conservatorship, the seventh order renewing the conservatorship included a special voting disability, which was not requested in the petitions for reappointment preceding the seventh order. The 2016 petition requested renewal of the LPS Act conservatorship, as well as renewal of all special disabilities previously imposed.
K.H. requested a jury trial, which was held on August 8, 2017. At that trial, the Public Guardian presented the testimony of its expert, Dr. Donald Stembridge. K.H. testified on her own behalf, in addition to presenting the testimony of her own expert, Dr. Daisy Switzer, and her mother, Helen L.
The parties stipulated to Dr. Stembridge's expertise. Dr. Stembridge testified K.H. suffered from schizoaffective disorder, bipolar type. She has suffered from schizoaffective disorder and schizophrenia since age 27. Schizoaffective disorder may be treated, but not eliminated with the use of psychiatric medication. Dr. Stembridge also testified that the disorder can be exacerbated by the use of "elicit [sic] substances." Her disorder has led to her being hospitalized many times.
Dr. Stembridge opined, K.H. "is in fairly good shape because she is just coming from a locked facility where she is administered regular injections of anti-psychotic medications." She nonetheless continues to have delusions about microscopic children living on her body and persecutory/auditory delusions concerning a woman who speaks to her and "goes into the community and kills children."
K.H. is administered an injection of Haldol every 30 days to treat her psychotic symptoms. She told Dr. Stembridge that she does not need her medicine, does better without it, and that she prefers to take "herbal medicines." She nonetheless reported that taking her medication helps her because it helps her receive her supplemental security income (SSI) check.
In Dr. Stembridge's opinion, K.H. would not take her medicine in an unstructured setting, noting "[s]he has had a history of going off [her] medications which has contributed to the numerous psychiatric hospitalizations she has required because she becomes profoundly psychotic without the medication and quite dysfunctional and really a danger to herself. Because of some of the delusions, she stops bathing, doesn't want to sit down, and there has [sic] been times when she stopped eating and so forth." K.H. does not believe she needs treatment, "[a]nd if she goes off the treatment, then she very rapidly decompensates, and we have seen it over and over many times over the years so that she becomes completely gravely disabled and becomes unable to take care of herself."
Dr. Stembridge opined K.H.'s plans regarding housing, food, and clothes were "reasonably viable." However, he thought it was extremely "unlikely" she would remain medication compliant and refrain from taking methamphetamine, and "[w]hen that happens she decompensates and becomes profoundly psychotic, such that she cannot take care of herself." The problems associated with K.H.'s self-medicating were seen most recently in her removal from a family care facility and subsequent placement in an inpatient unit and then escalation to the third facility because "she needed a higher level of care." Dr. Switzer also believed K.H.'s history of not taking her prescribed medicine and self-medicating supported the need to continue the conservatorship. He noted that K.H. was receiving her medication through an "injectable" because she was medically noncompliant in taking it orally.
Thus, while he thought K.H. would initially be able to care for her own food, he thought that after she stopped taking her medicine and/or took methamphetamine "she would not be able to provide adequately for her needs." Dr. Stembridge concluded if K.H. lived on her own, she would not be able to provide for her own food, clothing, and shelter. Even so, Dr. Stembridge was "very comfortable recommending going to a lower level of care. At this point, she doesn't need a locked psychiatric facility any longer because she is stable on her medication." Finally, Dr. Stembridge would be "very happy to recommend that she go back to a supervised family care facility, demonstrate a period of stability."
Dr. Switzer testified on K.H.'s behalf that whether K.H. was gravely disabled was "complicated" because her placement in a locked facility kept her from being gravely disabled. Dr. Switzer did not know whether K.H. would be able to provide for her food, shelter, and clothing outside of the conservatorship. She thought that K.H. should remain subject to a conservatorship because her history spanning over 30 years suggests she would not take her medicine if the conservatorship ended. Absent an order for medication K.H. does not consistently take her medicine and also self-medicates with methamphetamine, which exacerbates her psychosis. Dr. Switzer believes K.H. was still gravely disabled because of the significance of her illness, as well as the history showing a tendency not to take her medicine and self-medicate with methamphetamine.
K.H. testified on her own behalf regarding her plans for how to care for herself should she be released from conservatorship. On cross-examination, she explained she needed a second opinion concerning her diagnosis of schizoaffective disorder because only the first of 14 doctors actually diagnosed her, and anyway, "they were quacks." K.H. believes she suffers from hyperbolic syndrome, which she obtained from bats biting her back in the early 1980s. K.H. does not use methamphetamine to control her hyperbolic syndrome; she uses a "hyperbolic syndrome megatromer," which is a "device that treats a syndrome, like China Syndrome, Down's Syndrome, Restless Leg Syndrome."
She believes she can "function just fine without" the Haldol and that it is "breaking down [her] health system . . . ." If she were released from conservatorship, it would be her right to stop taking the Haldol. However, she would still take it because she is "addicted to it." When asked about her medication plan, K.H. explained she would go to Sutter-Yuba Mental Health for her injections "[i]f they shorten up their needle" because the long needles they use to administer her medicine "hurts very badly." She admitted her refusal to take her previous prescriptions for Depakote and Zyprexia had to be forcibly administered those drugs, but is "comfortable with the Haldol . . . even though it's painful to get the injections."
K.H. testified she has three million microscopic children living on her, and Catherine Strong threatens to kill both K.H. and her microscopic children. If K.H. were released from conservatorship, she would use a previously obtained and maintained restraining order to keep herself and her children safe from Strong. When she previously lived independently, someone would break into her house and tear it up whenever she went to mental health for her medication. She believes it was possible Strong and people related to her may have been involved.
Finally, Helen L. testified that K.H., who was her daughter, could not stay with her if she were released from conservatorship. She would help K.H. by giving her small amounts of money a few times a month and could drive K.H. to her medical and psychiatric appointments. Helen L. would also tell K.H. she has to go to mental health to take her medicine.
Thereafter, the jury found that K.H. "is presently gravely disabled due to a mental disorder," and the trial court entered a judgment on the verdict. While the trial court did not make any specific findings on the requested special disabilities, the order reappointing the Public Guardian imposed special disabilities restricting her from having a driver's license, entering contracts, refusing treatment, possessing firearms or other deadly weapons, and voting.
DISCUSSION
I
The Grave Disability Finding
K.H. argues the jury's grave disability finding is not supported by substantial evidence because both testifying experts agreed K.H. was not gravely disabled, and "[i]t was only their speculation about what might happen in the future that led them to conclude that K.H. was presently gravely disabled, despite their testimony to the contrary." She contends despite her past failure to take medicine, the Public Guardian failed to demonstrate a causal link that this failure would result in her inability to care for her own food, clothing, and shelter.
The LPS Act is a civil commitment scheme that provides for short-term detention of mentally disordered individuals. (§ 5000 et seq.) An LPS Act conservatorship may be established for any person who is gravely disabled as a result of a mental disorder. (§ 5350.) "Gravely disabled" is defined, in pertinent part, as "[a] condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter." (§ 5008, subd. (h)(1)(A).) "[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." (§ 5350, subd. (e)(1).) "Grave disability must be proven beyond a reasonable doubt to establish and to renew LPS conservatorships. [Citations.]" (Conservatorship of Johnson (1991) 235 Cal.App.3d 693, 696.)
On appeal, a grave disability finding is reviewed for substantial evidence. (Conservatorship of Carol K. (2010) 188 Cal.App.4th 123, 134.) Substantial evidence may consist of the testimony of a single witness, and includes "evidence that is reasonable, credible, and of solid value, [including] circumstantial evidence. [Citation.]" (Ibid.) In conducting this review, "[w]e review the record as a whole in the light most favorable to the trial court judgment. . . ." (Ibid.)
K.H. relies on the rule that it must be shown the person "is presently gravely disabled and not that [s]he may relapse and become gravely disabled in the future. [Citation.]" (Conservatorship of Guerrero (1999) 69 Cal.App.4th 442, 446 (Guerrero), italics added.) She argues, where the evidence establishes a person is not presently gravely disabled, but may become so because of a future failure to take medication, an LPS conservatorship cannot be established on that ground alone. (Conservatorship of Benvenuto (1986) 180 Cal.App.3d 1030, 1033 [conservatee was presently able to provide for food, clothing, and shelter, but given propensity to not take medication, would likely "regress and become gravely disabled in a fairly short period of time" if released]; Conservatorship of Murphy (1982) 134 Cal.App.3d 15, 17-18 [conservatee was presently capable of managing his own affairs, but if released would likely relapse into alcohol abuse and become gravely disabled in the future].) However, K.H.'s argument fails to recognize that a lack of insight into one's mental illness combined with a history of not taking medicine and an inability to care for one's food, clothing, and shelter without that medicine does substantiate a finding that the person is presently gravely disabled. (Guerrero, at pp. 446-447; ["but for the medication, which Guerrero would not take without supervision, Guerrero was presently gravely disabled"]; Conservatorship of Walker (1989) 206 Cal.App.3d 1572, 1577 (Walker) [substantial evidence supported reappointment where conservatee had no insight into his mental illness, would not take medication if released, and could not care for himself without that medicine].)
Stembridge opined that because of her schizoaffective disorder, K.H. would not be able to provide for her own food, clothing, and shelter if living independently. This conclusion is supported by the record.
Stembridge also testified concerning K.H.'s limited insight into her mental illness, which indicated to him her lack of belief that she needs to continue her treatment and that she will rapidly decompensate if she discontinues that treatment. K.H. also told Dr. Stembridge she does not need her psychiatric medication and does better without it.
K.H.'s very lengthy history of failure to take her medicine and self-medicate with narcotics is supported by the testimony of both Dr. Stembridge and K.H.'s expert, Dr. Switzer.
K.H.'s argument that Dr. Stembridge and Dr. Switzer both believed K.H. was not presently gravely disabled, ignores these experts qualified those opinions based upon K.H.'s placement in a locked facility. In fact, Dr. Switzer testified that "within that setting there is no way [K.H.] could be gravely disabled. Everything is provided there." Dr. Stembridge also noted that her antipsychotic medication is injected there, and the record shows she receives those shots every 30 days.
The testimony that K.H. was not gravely disabled when locked in a facility does not disprove or otherwise invalidate the testimony from the same experts that K.H. was presently gravely disabled for purposes of the LPS Act. When questioned by the court regarding whether K.H. was presently gravely disabled, Dr. Stembridge responded, "She is gravely disabled. She's doing better right now because she is medication compliant. Over the long run I think she for now remains gravely disabled." Dr. Switzer, although earlier testifying she did not know whether K.H. would be able to provide for her food, clothing, and shelter outside of a conservatorship, likewise opined K.H. was still gravely disabled because of the significance of her illness, as well as the history showing a tendency not to take her medicine and self-medicate.
Given the, substantial evidence of grave disability the evidence fully supports the jury's verdict.
II
The Special Disabilities
K.H. argues "that the trial court failed to afford [her] the fundamental right of due process on the question of whether special disabilities should be imposed on her" because "[t]he public guardian never presented evidence specific to the requested special disabilities nor made any arguments for their imposition."
"If a person is found gravely disabled and a conservatorship is established, the conservatee does not forfeit legal rights or suffer legal disabilities merely by virtue of the disability. (§ 5005; [Walker, supra,] 206 Cal.App.3d [at p.] 1578.) The court must separately determine the duties and powers of the conservator, the disabilities imposed on the conservatee, and the level of placement appropriate for the conservatee. (§§ 5357, 5358.) The party seeking conservatorship has the burden of producing evidence to support the disabilities sought, the placement, and the powers of the conservator, and the conservatee may produce evidence in rebuttal." (In re Conservatorship of Christopher A. (2006) 139 Cal.App.4th 604, 612.)
But there is no legal requirement that the court state the reasons for each order and the usual rules of appeal apply thus, we presume in favor of the judgment the findings of fact necessary to support the judgment if supported by the record. (Conservatorship of George H. (2008) 169 Cal.App.4th 157, 165 (George H.).)
"However, the record must disclose that the trial court was aware of the finding it was required to make before imposing the disabilities, that it considered the evidence proffered on the issue, and that it in fact made the finding." (K.G. v. Meredith (2012) 204 Cal.App.4th 164, 179.)
As we understand her argument, appellant contends that her right to due process of law was violated because the public guardian did not present evidence "specific" to the requested disabilities nor did the expert witnesses who testified at the hearing speak to the appropriateness of imposing the disabilities.
We find nothing in the law that requires the public guardian to address specifically each requested legal disability, present evidence specific to that disability or specifically to argue in favor of it. As noted above, it is sufficient if the court's judgment is adequately supported by the record.
Significantly, the court entered its order finding K.H. gravely disabled and ordered the disabilities "[a]fter examining the petition and hearing the evidence. . . ." Thus the court was aware of the petition's request for an order of disabilities, heard the evidence establishing that K.H. remained gravely disabled and the reasons therefore and entered the order regarding specific disabilities. Given that, it is sufficient if the record as a whole supports the court's order regarding disabilities. We hold that it does.
The trial court ordered that K.H. did not: (1) have the right to enter into contracts, (2) have the right to refuse appropriate medication, (3) have the right to possess a license to drive a motor vehicle, (4) have the right to possess a firearm, or (5) have the right to complete an affidavit of voter registration.
Respondent concedes that the record does not support the last disability relating to voting.
Turning to the remaining disabilities, Dr. Stembridge testified that K.H. has delusions about microscopic children on her body and persecutory/auditory delusions about a woman who speaks to her and then goes into the community to kill children. Due to her delusions, she stops bathing, resists sitting down and stops eating. She is medically noncompliant which requires that her psychiatric medications be injected.
K.H. testified, among other things, that she actually suffered from "hyperbolic syndrome" which was caused by bats biting her in the 1980s, that she has three million microscopic children living on her, and that another woman threatens to kill K.H. and her microscopic children.
The evidence amply demonstrates that K.H. remains delusional and is gravely disabled and is susceptible to undue influence. These facts support the disability precluding her from entering into contracts and the disability that she should not have the right to refuse appropriate medications. The evidence also amply shows that, given her delusions, she would likely be a danger to herself and others if she were allowed to drive a car or possess firearms.
Finally, K.H. in challenging the special disabilities orders, relies on the Fifth District Court of Appeal's decision in Walker, supra, 206 Cal.App.3d 1572. That reliance is misplaced.
In Walker, the court found that the record was unclear and that no factual basis was specifically offered to support the disabilities imposed. To the extent Walker can be read to require that there must be evidence offered on each of the petition's requests for disabilities specifically, we disagree. The better view is stated in George H.'s holding that it is sufficient if the evidence presented during the hearing as a whole supports the court's judgment, including its decision on the request for specific disabilities. (George H. supra, 169 Cal.App.4th at p. 165.) It does so here.
DISPOSITION
The trial court's order that appellant shall not have the right to complete an affidavit of voter registration is reversed. In all other respects, the judgment is affirmed.
HULL, J.
We concur:
RAYE, P. J.
ROBIE, J.