Opinion
A169936
10-29-2024
THE PEOPLE, Plaintiff and Respondent, v. DANIEL BELTRAN, Defendant and Appellant.
NOT TO BE PUBLISHED
(Alameda County Super. Ct. No. 02-053313)
DOUGLAS, J. [*]
Daniel Beltran appeals from an order following a bench trial recommitting him as an offender with a mental health disorder (OMHD). (Pen. Code, §§ 2970, 2972). Beltran contends substantial evidence does not support the trial court's finding that he represented a substantial danger of physical harm to others because of his severe mental disorder. We affirm.
OMHD prisoners "were previously described as mentally disordered offenders, or MDO's. (See, e.g., People v. Blackburn (2015) 61 Cal.4th 1113, 1116.) The Legislature recently changed this terminology to 'offender with a mental health disorder.' (Pen. Code, § 2962, subd. (d)(3); Stats. 2019, ch. 9, § 7.)" (Conservatorship of Eric B. (2022) 12 Cal.5th 1085, 1095, fn. 3.) For simplicity's sake, we use the term "OMHD" for all relevant periods of time. All further undesignated statutory references are to the Penal Code.
I. BACKGROUND
A. Underlying Offense
The qualifying offense occurred on or about April 12, 2002, while Beltran was in custody on a residential burglary charge. Beltran was lying on the bottom bunk while his cellmate (the victim) was shadow boxing in front of the mirror. Without provocation, the victim grabbed Beltran by the shirt and shook him. The victim released Beltran and went back to shadow boxing. Beltran pushed the emergency call button, however there was no response from staff.
The victim grabbed Beltran a second time and began shaking him. Beltran began fighting with the victim and punched him in the face approximately eight times with a closed fist. Beltran then knocked the victim to the ground, straddled him, and began banging the victim's head against the concrete floor. When the victim began bleeding, Beltran stopped the assault and pushed the emergency call button again. There was no response. Beltran returned to his bed and waited approximately 10 minutes before he got up and attempted to stop the bleeding by placing a towel on the victim's left eyebrow. Beltran returned to his bed; staff arrived approximately 30 minutes later. The victim died from his injuries.
Beltran later told police he was having problems with his cellmate. Beltran said," 'I couldn't sleep, and the voices told me to kill him.' "
In December 2003, Beltran was convicted of voluntary manslaughter and sentenced to 16 years in state prison.
B. OMHD Commitment
In February 2016, Beltran was transferred from prison to Atascadero State Hospital as an OMHD under section 2962. The maximum commitment date was February 24, 2022. Beltran twice stipulated to extending his commitment for an additional year. In April 2023, Beltran was transferred to Coalinga State Hospital.
In August 2023, the People filed the most recent petition for recommitment. The petition alleged Beltran "continues to suffer from a severe mental disorder"; the "severe mental disorder is not in remission and cannot be kept in remission without continued treatment"; and the "severe mental disorder renders him a substantial danger of physical harm to others." The petition requested Beltran's OMHD commitment be extended for one year, until February 24, 2025.
1. Recommitment Trial
In February 2024, Beltran, then 44 years old, waived his right to a jury trial and agreed to have the allegations tried before a judge. The prosecution submitted two medical reports and the abstract of judgment for the underlying offense. The prosecution also presented testimony from the medical professionals who authored the reports. The defense did not present any evidence.
At trial, counsel stipulated to a "Sanchez waiver," to allow for admission of records containing case-specific hearsay. (People v. Johnson (2020) 55 Cal.App.5th 96, 99, fn. 2; see People v. Sanchez (2016) 63 Cal.4th 665.)
Dr. Amanda Dutton, a clinical psychologist at Coalinga State Hospital, testified as an expert in the field of psychology, qualified to render an opinion as to whether Beltran met the criteria as an OMHD. In July 2023, Dr. Dutton conducted a recommitment evaluation of Beltran. Based on her evaluation, which consisted of an interview with Beltran and review of all available records pertaining to him, Dr. Dutton concluded Beltran was not eligible for release.
Dr. Dutton opined that Beltran has schizophrenia, a "severe mental disorder" that substantially impairs his thoughts, perception, behaviors, emotional processes, or judgment. During Dr. Dutton's interview with Beltran, he was "very disorganized," was "displaying delusional beliefs," had "very limited insight," and "struggled to follow along in conversation" and "answer questions appropriately." At various points during the interview, Beltran's answers to questions were unintelligible to the point that the Spanish interpreter was unable to provide a translation. Beltran also appeared "internally preoccupied" meaning he was likely hearing voices in his head.
When asked about his diagnosis, Beltran responded that he had schizophrenia, but "in the very same sentence said, [']I am already fine.[']" He reported he used to hear voices but did not anymore, explaining," 'I killed one and I hang myself.'" Throughout the interview, Beltran said" 'I heard voices and that's why I killed him,'" repeating this phrase "over and over again." When asked what might happen if he stopped taking his medications, Beltran said," '[N]othing. I would be fine.'" When asked when he had last heard voices, Beltran responded," '[W]ell, yesterday, but they were dreams.' "
In her forensic report, Dr. Dutton wrote Beltran's symptoms have included auditory hallucinations, including "hearing voices which instruct him to kill himself and other people." Beltran also reported experiencing visual hallucinations, including "seeing shadows at the time of his offense which instructed him to fight and kill the victim." He experienced a variety of delusions, including his "belief that 'God implanted a long-distance communications device in his body; belief that he lives in Paris[']; belief that he is a doctor and a prophet; belief that he owns a temple; [belief] that it was 1959; preoccup[ation] with thoughts about space, space ships, and radars; statements that he was in outer space; statements regarding 'the four who would emerge from the stone of the world to kill more people.' "
Beltran exhibited symptoms of paranoia, including a belief that others intended to harm or kill him, and belief the police were planning to kill him if he returned to the community. He also exhibited bizarre behaviors, such as urinating and defecating on the floor. Beltran's symptoms included disorganized thinking, aggression, anxiety, suicidal ideation, poor hygiene, limited insight, and social isolation. Dr. Dutton opined these symptoms substantially impaired Beltran's thinking, reality perception, emotional processes, judgment, and behaviors.
"Based on the symptoms that he displays on a daily basis," Dr. Dutton concluded Beltran's schizophrenia was not in remission. Beltran was "highly symptomatic" and unable to control those symptoms even with medication or other treatment. He required assistance with activities of daily living, including showering and brushing his teeth. He had not been attending core treatment programs while in the hospital. Although he had been compliantly taking his medications while in the hospital, Dr. Dutton believed Beltran lacked the insight necessary to know when to take his "PRN," or "as needed" medication for agitation.
PRN stands for the Latin term "pro re nata". (See Merriam-Webster Dict. Online <https://www.merriam-webster.com/dictionary/pro%20re%20nata> [as of Sep. 20, 2024].)
In her report, Dr. Dutton wrote that Beltran continued to meet the requirements for schizophrenia and had failed to follow his prescribed treatment plan. During their interview, Beltran's answers to questions often either did not make sense or were entirely unintelligible. He repeatedly referenced having killed someone or something in response to hearing voices, saying that others were trying to kill him and he needed to kill them first. He did not know the reason for his placement in the state hospital and denied having a mental illness.
In Dr. Dutton's clinical opinion, Beltran currently represented a substantial danger to others due to his severe mental disorder. Beltran's qualifying offense took place when he was in custody pending a first-degree burglary offense. While incarcerated, he had three or four other violent, aggressive write-ups. Although he had not been aggressive or violent in the last year and had not had any serious incident reports since his transfer to Coalinga State Hospital, Dr. Dutton opined he would continue to represent a substantial danger to the community if released.
Dr. Dutton explained that Beltran remained "highly symptomatic" with "very limited insight," and "the symptoms that he is currently displaying within the hospital are similar to what he was displaying at the time of the qualifying offense." Although people who experience auditory hallucinations do not always represent a danger to others, Beltran's limited insight into his condition had previously caused him to engage in violence in response to hearing voices. Additionally, nothing in Beltran's medical records indicated he would be physically unable to carry out a violent act.
Dr. Dutton conceded Beltran had been regularly experiencing auditory hallucinations over the last year but had not acted out in an aggressive fashion during that time. Nevertheless, Beltran indicated that were he to be released from the hospital, he would not continue taking his medication and would not seek out treatment or other support. Without "the little bit of help that he does currently have," his symptoms would increase and he would "likely" respond with violence and aggression.
Dr. Dutton testified that Beltran lacked a release plan. The purpose of the plan is to assist patients in remaining sober and to help them identify mental health resources in the community. Dr. Dutton explained these plans are important because they demonstrate whether or not a patient has the insight to "think futuristically about how they are going to continue with treatment outside the walls of the hospital." Beltran also declined to participate in the conditional release program (CONREP) once in the community.
Dr. Dutton noted Beltran's history of substance abuse, noncompliance with treatment in the hospital, and failure to complete a relapse prevention plan. She acknowledged that participation in programming was complicated somewhat by the fact that Beltran is a Spanish speaker; however, she stressed that Spanish language services are available at Coalinga State Hospital.
In her report, Dr. Dutton detailed Beltran's criminal and disciplinary history, as well as his history of substance abuse. She wrote that during the current review period, Beltran continued to display the same signs and symptoms of mental illness that were "foundational to his previous offenses." Due to his poor insight into his condition and refusal to participate in treatment, Beltran had "not yet acquired the skills necessary to safely manage his mental health symptoms and substance abuse" and continued "to represent a risk of harm to the community."
Dr. Arash Shadfar, a staff psychiatrist at Coalinga State Hospital, had been Beltran's treating psychiatrist since April 2023. Dr. Shadfar saw Beltran at least once a month. Dr. Shadfar received reports from Beltran's treatment team, which included a psychologist, a therapist, social workers, and nursing staff.
Dr. Shadfar diagnosed Beltran with schizophrenia. Beltran reported auditory hallucinations, including hearing the voice of God. Recently, Beltran reported only hearing voices while dreaming, "but he also has many symptoms of schizophrenia."
Beltran regularly takes two anti-psychotic medications and one antidepressant, the "most important" medication being the anti-psychotic Clozapine, which requires regular labs and monitoring to identify and manage potential side effects. Beltran had been responding "relatively well" to these medications and had not been showing any "acute or active symptoms" of schizophrenia, or "symptoms that cause severe behavioral problems."
Dr. Shadfar explained that even with medication, Beltran still exhibited "negative [e]ffects of schizophrenia" and reported "having hallucinations sometimes." Since becoming Dr. Shadfar's patient, Beltran had been compliant with his medication and had not shown any signs of aggression. However, Dr. Shadfar believed that without medication, Beltran "would [be] very likely to decompensate" and would have "more severe psychotic symptoms and also aggression." Dr. Shadfar opined that schizophrenics are six times more likely to be aggressive than the general population.
Dr. Shadfar authored Beltran's treatment plan, which set forth Beltran's medical history and diagnoses. His risk for suicide while in the hospital was rated as "low," but various risk factors for self-harm were noted, including Beltran's history of suicide attempts, which Beltran denied took place. Additionally, his risk for violence, aggression, and assault was rated as "low," but various risk factors for violence were identified. Those factors included his "mental state, impulsivity, poor insight, and substance use."
The treatment plan notes Beltran "appears to have had two actual suicide attempts. The first attempt appears to be in his late teens/early twenties while in jail in the United States via throwing himself off a top bunk with the goal of hitting his head on the toilet. The second attempt was in 2002 via hanging. Both attempts appear to be driven by auditory hallucinations telling him to kill himself." Beltran also self-reported one interrupted suicide attempt at age 16 when he attempted to run through a train track, but friends stopped him.
Although Beltran denied currently experiencing homicidal urges, he "has a history of grandiose and persecutory delusions (i.e.," 'the police told me to kill my cellmate, or they would tell [my cellmate] to kill me' "), which he continued to demonstrate during the current interview." He "reported ongoing auditory hallucinations" and "is regularly observed responding to internal stimuli."
The treatment plan notes Beltran's most recent act of violence was an incident of "Battery on an Inmate" in 2011 when he was in state prison. While in prison, he had two other incidents of "Mutual Combat" in 2005 and 2007. He does not have any significant familial support in the United States. He had been compliant with his medication regimen, "appears polite and courteous to staff," and "interacts minimally well with staff and peers in a more appropriate and respectable manner." "[G]ood social skills" was listed as a strength.
The treatment plan identified six factors needed for a safe transition to the community: Beltran would need to demonstrate that he was managing his schizophrenia by (1) developing an understanding of his auditory hallucinations and adhering to a medication regimen for a period of at least six months, (2) developing three coping responses to manage his mental disorder in a community setting, (3) participating in substance abuse treatment, (4) sustaining a "significant period of non-assaultive behavior" and compliance with treatment, (5) developing a discharge plan, and (6) demonstrating intent to comply with the terms of mandatory supervision. The first four items were designated as "[partially met]," and the last two were designated as "[not met]."
2. The Court's Ruling
The court remarked "it is striking and shocking how much time has passed from the commitment offense" but noted that according to CALCRIM No. 3457, a recent act of violence was not required to justify recommitment. Although Beltran had not had a violent incident since 2011, the court believed there was "more to the analysis than has he kept his hands off of other people?" "For instance, there was some suggestions he continues to make threats, even though they might be to himself."
CALCRIM No. 3457 sets forth the criteria for recommitment pursuant to section 2970, along with definitions of terms used. As relevant the instruction provides, "[A substantial danger of physical harm does not require proof of a recent overt act.]"
The court observed that Dr. Dutton based her opinion of Beltran's dangerousness primarily on recent records and on her interview with Beltran. Further, Beltran's continued auditory hallucinations, combined with his lack of insight into his condition, formed the basis for both doctors' concern that Beltran continued to pose a danger to the community. Although the qualifying offense on its own did not make Beltran currently dangerous, the court expressed "great concern" about "the lack of treatment and the continuing display of symptoms."
Based on "all the information" submitted, the court found the People had "met the burden" and extended Beltran's commitment as an OMHD for one year, until February 24, 2025.
II. DISCUSSION
Beltran contends the evidence is insufficient to support the finding that he represented a substantial danger of physical harm to others by reason of his severe mental disorder. We disagree.
A. Applicable Law and Standard of Review
For certain offenders with severe mental health disorders who have been convicted of specified crimes, the OMHD statutory scheme authorizes commitment for compulsory treatment by the Department of State Hospitals as a condition of parole. (§ 2962.) And "if the parolee's or prisoner's severe mental health disorder is not in remission or cannot be kept in remission without treatment" at the conclusion of the parole term (§ 2970, subd. (a)), the district attorney may petition the superior court to order "continued involuntary treatment for one year" (§ 2970, subd. (b)).
At the recommitment trial, "[i]f the court or jury finds that the patient has a severe mental health disorder, that the patient's severe mental health disorder is not in remission or cannot be kept in remission without treatment, and that by reason of the patient's severe mental health disorder, the patient represents a substantial danger of physical harm to others, the court shall order the patient recommitted to the facility." (§ 2972, subd. (c).)
The standard of proof at a recommitment proceeding under section 2972 is proof beyond a reasonable doubt. (§ 2972, subd. (a)(2).) Upon finding the prosecution has met its burden, the recommitment shall be for one year from the expiration of a previous commitment. (§ 2972, subd. (c).)
Our role on appeal is a limited one. "In considering the sufficiency of the evidence to support [OMHD] findings, an appellate court must determine whether, on the whole record, a rational trier of fact could have found that defendant is an [OMHD] beyond a reasonable doubt, considering all the evidence in the light which is most favorable to the People, and drawing all inferences the trier could reasonably have made to support the finding." (People v. Clark (2000) 82 Cal.App.4th 1072, 1082.) It is not our function to reweigh the evidence or redetermine witness credibility. (People v. Poe (1999) 74 Cal.App.4th 826, 830.)
B. Substantial Evidence Supports the Court's Dangerousness Finding
Beltran does not challenge the findings that he has a severe mental disorder - schizophrenia - that is not in remission or cannot be kept in remission without medication. The sole issue on appeal is whether substantial evidence supports the trial court's finding beyond a reasonable doubt that Beltran represents a substantial danger of physical harm to others.
Section 2962 does not define a "substantial danger of physical harm" except by specifying that this element "does not require proof of a recent overt act." (§ 2962, subd. (g); see In re Qawi (2004) 32 Cal.4th 1, 24.) However, our Supreme Court has instructed that, while" 'substantial danger of physical harm to others' is without definition," "[i]n context, it appears to mean a prediction of future dangerousness by mental health professionals." (In re Qawi, supra, 32 Cal.4th at p. 24.) Further, courts have recognized that "[a] single psychiatric opinion that a person is dangerous because of a mental disorder constitutes substantial evidence to justify the extension of the commitment." (People v. Williams (2015) 242 Cal.App.4th 861, 872.)
Here, a forensic psychologist and Beltran's treating psychiatrist each testified that due to Beltran's severe mental health disorder, he posed a substantial risk of harm to others. Dr. Dutton testified Beltran represented a substantial danger to the community if released because he does not agree he needs medication or continued treatment. Although Beltran believed he was "fine," he remained highly symptomatic, displaying the same auditory hallucinations that were the foundation of the qualifying offense. Dr. Dutton also noted Beltran has paranoid beliefs that others may try to harm or kill him if he returns to the community. Based on his limited insight into his severe schizophrenia, coupled with having no relapse plan in place, plus not being amenable to CONREP, Dr. Dutton opined that Beltran had not yet acquired the skills necessary to manage his mental health disorder and he continued to represent a risk of harm to the community. Further, at age 44, Beltran was not otherwise physically unable to harm another person.
Dr. Shadfar testified that even with medication, Beltran was still having hallucinations. While Beltran had not shown any signs of recent aggression, Dr. Shadfar believed that without medication, Beltran "would [be] very likely to decompensate" and would have "more severe psychotic symptoms and also aggression." Dr. Shadfar opined that schizophrenics are six times more likely to be aggressive than the general population.
Although no expert described any recent instance of Beltran being dangerous to others, such evidence is not required. (§ 2962, subd. (g).) [" '[S]ubstantial danger of physical harm' does not require proof of a recent overt act"].) Although we agree with Beltran that his "risk of danger to others, not his own welfare, is what was at issue," the trial court properly considered the risk of self-harm in determining his dangerousness to others. (People v. Johnson (2020) 55 Cal.App.5th 96, 110 (Johnson).) It was not that much of a leap for the court to infer that Beltran's auditory hallucinations would not be confined to self-harm if he were released into the community given his lack of insight into his schizophrenia, combined with his belief that he did not need medication and the absence of a relapse plan. (Cf. People v. Williams, supra, 242 Cal.App.4th at pp. 873, 867 [patient's refusal of treatment for prostate cancer suggested "that he did not value his own life, let alone the lives of others," and "could make him 'reckless and careless' if released"].) In any event, there is substantial evidence that Beltran's delusions and hallucinations have not been limited to self-harm. He reported" 'experiencing auditory hallucinations, in the past, that would tell him that others are trying to kill him, so he needs to try to "kill them first."' "
Absent the structure of a secure, institutional environment, Beltran would be unable to manage his symptoms and would pose a substantial risk of physical harm to others. Beltran's lack of a relapse plan and his disinterest in participating in CONREP increases the risk of harm to others. Thus, the trial court's findings on Beltran's public-safety risk have substantial evidentiary support.
The cases cited by Beltran are inapposite and do not compel a contrary conclusion. Johnson reversed a commitment extension order where the record was devoid of evidence suggesting the 69-year-old mentally disordered offender's decompensation in an unsupervised setting would lead to violence, particularly in light of the fact that he had spent 11 years in the community and had stopped taking his medication for substantial periods of time with no violent repercussions. (Johnson, supra, 55 Cal.App.5th at pp. 108-109.) Moreover, the defendant in Johnson was in partial remission, was able to take care of himself, and had not committed a violent act in 30 years. (Id. at pp. 101, 104, 111.) The court found "[s]uch a complete absence of violent or aggressive behavior over a long period of time is necessarily an important, objective factor that must not be ignored when determining an [OMHD] defendant's dangerousness." (Id. at p. 110.)
In the present case, there is evidence showing that Beltran had not engaged in any violent or aggressive behavior in over a decade. Although this is not an insubstantial amount of time, unlike in Johnson, Beltran was not in remission - partial or otherwise. Rather, the 44-year-old Beltran was actively hallucinating even while medicated. Beltran was also acutely paranoid to the point where he maintained a kill or be killed attitude.
In People v. Jenkins (2023) 95 Cal.App.5th 142 (Jenkins), the defendant challenged her recommitment as an OMHD, arguing that there was no substantial evidence that she represented a substantial danger of physical harm to others. (Jenkins, at pp. 151-152.) The appellate court agreed, finding "there [was] no evidence [Jenkins had] been violent or physically aggressive since her commitment offense in 1999," more than two decades before the recommitment proceedings. (Id. at p. 151, italics added.) At the time of the hearing, Jenkins was almost 70 years old, in poor health, and had started to use a wheelchair due to decreased mobility. (Id. at p. 153.)
People v. Redus (2020) 54 Cal.App.5th 998 (Redus) involved the recommitment of a defendant found not guilty by reason of insanity (NGI). On appeal, the court concluded the prosecution failed to "provide the required link" between the defendant's "mental illness and his purported difficulty in controlling his potentially dangerous behavior." (Redus, at p. 1013.) Redus noted there had "not been a hint of violence, threatening behavior, or aggressiveness of any kind" by the 73-year-old defendant - a" 'fragile old man'" - for more than four decades, "even through [conditional] releases and medication lapses." (Id. at pp. 1011-1012.)
In People v. Cheatham (2022) 82 Cal.App.5th 782 (Cheatham), another NGI recommitment case, the appellate court found insufficient evidence to support a finding that the defendant had serious difficulty controlling potentially dangerous behavior because of his mental disorder. (Cheatham, at p. 786.) Evidence showed that while Cheatham's medication did not stop his symptoms altogether in that he still heard voices, his medication made him better able to manage his symptoms. (Ibid.) Unlike here, Cheatham did not express doubts that he had a mental disorder and did not experience homicidal thoughts. (Id. at p. 792.) Also, Cheatham was not actively delusional at the time of the recommitment proceedings and had "no history of violence at all." (Ibid.) Cheatham asserted he would participate in Alcoholics Anonymous, would not relapse, and would rely on medication to help him cope with his auditory hallucinations. (Id. at p. 788.)
In Johnson, Jenkins, Redus, and Cheatham, unlike here, there was an absence of any evidence bridging the gap from a purely theoretical risk of danger to a real and substantial risk. Based on Beltran's symptoms, history, and other characteristics, including his lack of insight and stated preference to discontinue his medication upon release, a rational trier of fact could have found beyond a reasonable doubt that Beltran continued to be an OMHD. (People v. Clark, supra, 82 Cal.App.4th at p. 1082.)
Finally, we are not persuaded by Beltran's attempts to reargue the evidence. Beltran argues there is no evidence that he ever engaged in violence in the community. Rather, his violent acts all occurred in custodial settings. Also, he contends there is no evidence his rule violations in prison were connected to his mental health disorder. Beltran highlights the fact that his last aggressive act was in 2011. He further argues Dr. Dutton's assessment that he is prone to aggression when symptomatic and overwhelmed is not supported by the record. Beltran points to the fact that during the qualifying offense he twice hit the emergency button in his cell.
By these arguments, Beltran is essentially asking us to re-weigh the evidence. "Under our substantial evidence standard of review, we defer to the trial court's implicit credibility findings and accept all reasonable inferences from the evidence." (People v. Oliver (2023) 90 Cal.App.5th 466, 482.) Our role is not to reweigh the evidence, judge the credibility of witnesses, or resolve evidentiary conflicts. (See In re Caden C. (2021) 11 Cal.5th 614, 640.) Rather, determinations are" 'upheld if . . . supported by substantial evidence, even though substantial evidence to the contrary also exists and the trial court might have reached a different result had it believed other evidence.'" (Ibid.)
Viewed in the light most favorable to the judgment, the evidence is sufficient to support the court's finding that beyond a reasonable doubt Beltran posed a substantial danger of physical harm to others if released.
III. DISPOSITION
The trial court's order extending Beltran's OMHD commitment for one year, until February 24, 2025, is affirmed.
We concur: STREETER, Acting P.J., GOLDMAN, J.
[*] Judge of the Superior Court of California, County of Contra Costa, assigned by the Chief Justice pursuant to article VI, section 6 of the California Constitution.