Opinion
D072751
04-12-2018
THE PEOPLE, Plaintiff and Respondent, v. JUAN D. CHAVEZ, Defendant and Appellant.
Stephen M. Hinkle, under appointment by the Court of Appeal, for Defendant and Appellant. Xavier Becerra, Attorney General, Julie L. Garland, Assistant Attorney General, Eric A. Swenson and Genevieve Herbert, Deputy Attorneys General, for Plaintiff and Respondent.
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.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. Nos. SCS167911, SCS149245) APPEAL from a judgment of the Superior Court of San Diego County, Amalia L. Meza, Judge. Affirmed. Stephen M. Hinkle, under appointment by the Court of Appeal, for Defendant and Appellant. Xavier Becerra, Attorney General, Julie L. Garland, Assistant Attorney General, Eric A. Swenson and Genevieve Herbert, Deputy Attorneys General, for Plaintiff and Respondent.
Juan D. Chavez appeals a judgment entered after the jury determined that he was a mentally disordered offender (MDO) and the court recommitted Chavez to the Department of State Hospitals for one year. Chavez contends that certain expert witness testimony was admitted in violation of People v. Sanchez (2016) 63 Cal.4th 665 (Sanchez) and, as such, his due process right to confrontation was violated, warranting reversal. We conclude that any error was harmless and affirm the judgment.
FACTUAL AND PROCEDURAL BACKGROUND
In 2000, Chavez pled guilty to robbery (Pen. Code, § 211) and was granted three years formal probation. While on probation in 2002, Chavez exhibited a deadly weapon to a police officer to resist arrest (§ 417.8). The court then sentenced Chavez to prison for four years.
Statutory references are to the Penal Code unless otherwise specified.
In 2009, Chavez was admitted to Atascadero State Hospital under section 2962 as an MDO. Per sections 2970 and 2972, Chavez's commitment was extended for one year in May 2010 and then again in March 2011. In June 2011, Chavez was transferred to Metropolitan State Hospital. Chavez's commitment was extended each year after his transfer through April 11, 2017.
He had been transferred to Patton State Hospital by that time.
However, before the end of his commitment date in 2017, the San Diego County District Attorney petitioned to extend Chavez's involuntary commitment as an MDO under sections 2970 and 2972. Chavez's first trial ended with the trial court declaring a mistrial on April 6, 2017, after the jury was unable to reach a verdict. On August 22, 2017, a jury found true the allegations that Chavez is an MDO. The court thus granted the People's petition to extend Chavez's commitment to the state hospital for one year.
Chavez timely appealed.
DISCUSSION
I
CHAVEZ'S INVOLUNTARY COMMITMENT
A. Chavez's Contentions
Chavez contends the court violated both state evidentiary laws and his due process right to confrontation when it permitted two expert witnesses to testify at trial to case-specific facts based on inadmissible hearsay.
The California Supreme Court defined case-specific facts as "those relating to the particular events and participants alleged to have been involved in the case being tried." (Sanchez, supra, 63 Cal.4th at p. 676.)
B. Background
Before trial, Chavez moved to prohibit expert witnesses from testifying about "out of court statements of other non-testifying experts." Specifically, Chavez argued the expert witnesses should not be permitted to testify about opinions, descriptions of behavior, and diagnosis made by doctors or mental health professionals who were not testifying at trial, and thus, not subject to cross-examination.
During oral argument regarding this issue, the court indicated that it would "follow the rules of evidence[]" and "be strict about making sure we comply with [Sanchez, supra, 63 Cal.4th 665]," but the court indicated it would not "force upon both sides kind of a tunnel presentation[,] which really interferes with the jury's ability to search for the truth in this case."
Counsel each addressed the scope of what they believed Sanchez, supra, 63 Cal.4th 665 allowed, and the court summarized its position as follows:
"All right. So I'm going to ask both sides, given what the Court's inclination is - - and I'm telling you that that's how we are going to proceed in this case. If you deviate from that, both sides speak up, state your objection, and we'll talk about it at sidebar. But if you're in compliance, then no need to raise an objection. It's reserved for the record, given what your in limine positions are."
Below, three experts (Dr. Bruce Karp, Dr. Sanjay Rao, and Dr. Joshua Tartaglione) testified on behalf of the People. Chavez takes issue with the testimony of Karp and Rao.
Karp was the first expert witness to testify at the recommitment trial. To form his opinion, he relied on his examination of Chavez, information provided by Chavez during their interviews, and various records, including Patton State Hospital records, San Diego County jail records, and a certified copy of Chavez's criminal record.
Karp was Chavez's treating psychologist at Patton State Hospital for nearly a year, ending in February 2017. His role on Chavez's treatment team was to meet with Chavez and assist him in understanding his illness. Karp met with Chavez's treatment team daily to discuss his progress. He had five individual sessions with Chavez and chatted with him multiple times a week in passing. Karp explained that most of the treatment at Patton State Hospital is done through group therapy. While Chavez attended some of the group therapy sessions, he did not attend as often as his treatment team preferred.
Karp did not subject Chavez to "extensive testing," but he interviewed Chavez, reviewed his records, and analyzed tests conducted by other doctors. Karp noted that one of his colleagues conducted "a full psychological evaluation" of Chavez. During his sessions with Chavez, Karp reviewed Chavez's history of violence. They discussed five prior violent incidents where Chavez was the aggressor. Karp testified that Chavez showed no remorse, but rather expressed his view that the victims "deserved it." Karp believed this showed Chavez lacked insight into his mental illness because he did not understand that his mental illness made him act improperly.
Karp observed Chavez exhibit symptoms associated with his mental disorder. Karp admitted that Chavez "hasn't hit anyone for the last two years, and that's a good point in his favor[,]" but Karp stated that Chavez remains delusional, which "is a big deal[]" and "more important in terms of safety." Karp explained that someone who is delusional "might do something dangerous again."
While at Patton State Hospital, Chavez was reluctant to take the medications recommended to him and did not demonstrate that he understood the connection between his medication and mental illness. Karp described how Chavez's mental illness causes his mood to fluctuate and his psychotic symptoms to wax and wane. If Chavez does not take his medication, he will have future psychotic episodes.
Karp reviewed records from Patton State Hospital, including instances of refusal to take medication and instances of psychotic symptoms. Other records Karp reviewed included Chavez's criminal history, his mental health diagnosis, evidence of current mental state, and medications prescribed and history of medication noncompliance, records of acts of violence, and evidence of lack of insight. Based on his review of those records, Karp learned of Chavez's mental health history before Chavez was admitted to Patton State Hospital.
Karp testified that Chavez's mental illness began to manifest at age 16. He began getting delusions then and had been hospitalized many times with psychotic symptoms. In addition, Karp stated that many of Chavez's episodes of violence "seem[] to be connected to his mental illness."
Karp diagnosed Chavez with schizoaffective disorder, bipolar type, and antisocial personality. In addition, Karp noted Chavez's history of abusing various substances. Karp explained that an individual who suffers from a psychotic severe mental disorder and abuses alcohol or drugs is at a greater risk to reoffend.
Karp also testified about Chavez's criminal record. He stated that Chavez had a true finding of residential burglary and vandalism at age 14. Karp noted that Chavez often ran away from court placements. As an adult, Chavez suffered two felony convictions: shoplifting vodka that "turned into a robbery" and assault of a police officer.
In the first felony conviction, Chavez tried to steal bottles of vodka from a store, and when employees tried to stop him, Chavez threw a bottle at the head of one employee. Chavez was intoxicated at the time. In the second offense, Chavez got into a fight with his mother's boyfriend, punching him in the face 15 times. His mother called the police, and Chavez brandished a knife at officers, saying "kill me." Officers tasered Chavez to subdue him. After serving time in prison, Chavez was paroled to the state hospital in 2006, and declared an MDO in 2009.
Karp opined that Chavez met the criteria for an MDO because he still had a severe mental illness that causes him to lose touch with reality. Chavez's psychosis is not in remission because he still experiences symptoms and has not demonstrated that he has coped with his mental illness. In Karp's opinion, Chavez represents a substantial danger of physical harm to others. He explained that his opinion was based on seven factors: Chavez's past violence; his lack of insight; his substance abuse issues; his ongoing psychosis; his lack of remorse; his lack of understanding that he needs to take medicine; and he suffers from an antisocial personality disorder. Because of these factors, Karp believed Chavez was likely to reoffend.
Rao, the court ordered psychiatrist, evaluated Chavez at San Diego Central Jail on February 7, 2017. Additionally, he reviewed records from Patton State Hospital and the San Diego County jail. During his interview with Chavez, Chavez stated that he was experiencing psychotic symptoms for the first time in eight months. He told Rao that if he was released into the community, he would not take all of the medication recommended to him. He also stated that he was not interested in participating in a conditional release program because he would have to follow too many rules. He believed he would be fine in a less restrictive setting. Chavez was calm and cooperative with Rao. His eye contact was appropriate, but Rao believed Chavez's speech was a little "pressured[,] . . . like he was trying to get a lot of words out of his mouth[,]" "but can't get them out fast enough." Rao observed no evidence of hallucinations. Chavez was focused during the meeting.
Based on San Diego County jail records, Rao stated that Chavez had been refusing medication while at the jail. Rao did not believe Chavez's reason for not taking medication was "genuine." Rao opined that Chavez's insight was poor because he failed to recognize that he has a mental illness, minimized the illness he did have, believed he did not require medication that was recommended to him, and commented that he would not need any community-based outpatient care. Based on his review of the records and Chavez's own statements, Rao further opined that Chavez had poor judgment. Rao explained that Chavez had difficulty following his recommended treatment plan. Chavez also told Rao that he did not want to take medication or participate in outpatient care.
Rao identified several different antipsychotic medications that were appropriate for Chavez's treatment. Rao acknowledged that these medications can cause side effects, but stated that by rejecting those medications, Chavez was showing poor insight.
Rao opined that Chavez has a severe mental illness, namely schizoaffective disorder. Based on his review of the records and interviews with Chavez, he reasoned that Chavez suffers from psychotic symptoms, such as delusions, and components of bipolar disorder, such as mania and irritability. Rao further opined that Chavez is not in remission because he still experiences psychotic symptoms. Rao concluded that Chavez therefore presents a substantial danger of physical harm to others. He does not recognize that he needs treatment for his illness, and he does not understand the consequences of not complying with his recommended treatment plan in various settings. Rao ultimately opined that Chavez met the criteria for an MDO.
Rao acknowledged that, during his interview of Chavez, Chavez was appropriately groomed and did not threaten Rao. Chavez acknowledged that he had a mental illness (schizophrenia, bipolar, paranoia) and responded in the affirmative when Rao asked him if he had a psychiatric diagnosis. When Chavez came to the jail, he was being prescribed three different medications. Rao also acknowledged that, while Chavez did not want to go to the controlled release program, he did want to go to a board and care facility, which is a facility for individuals with mental health conditions.
Chavez complained to Rao about the side effects of the prescribed medications. He noted that stelazine gave him blurred vision and made him clumsy.
On cross-examination, Chavez's trial attorney asked Rao about the content of several documents Rao reviewed. To this end, in response to questions from Chavez's counsel, Rao testified that, based on his review of weekly progress notes, while Chavez was at Patton State Hospital, his behavioral interactions were pleasant and cooperative. Rao stated that the notes indicated the nurses observed Chavez "as having no aggression towards others and staff[.]" Rao testified that the records pertaining to Chavez while he was housed at Metropolitan State Hospital indicated that he had " 'not harmed anyone or himself in quite some time.' " Rao also testified that he was aware that for the last couple of months, Chavez has been refusing medications, but has not been acting in a threatening manner.
Tartaglione was the final expert to testify on behalf of the People. He is a psychiatrist at San Diego County jail. He evaluates inmates and prescribes medications. He treated Chavez on three occasions and conducted a medical evaluation. Tartaglione discussed with Chavez the risks, benefits, alternatives, and expected side effects of recommended medications, but Chavez refused to take them.
After meeting with him on a few occasions, Tartaglione believed Chavez suffered from psychosis that affected his ability to think rationally, linearly, and logically about the risks and benefits of medications in relation to his illness. Tartaglione observed Chavez's paranoia and illogical speech and thought process. He opined that Chavez should be taking psychotropic medications.
Tartaglione evaluated Chavez for being a danger to himself and others. Although Tartaglione did not find him to present a danger in a jail setting, he did not evaluate him to determine if he would pose such a risk if he was free in the community, unsupervised.
C. MDO Law
"The Mentally Disordered Offender Act (MDO Act), enacted in 1985, requires that offenders who have been convicted of violent crimes related to their mental disorders, and who continue to pose a danger to society, receive mental health treatment during and after the termination of their parole until their mental disorder can be kept in remission. ( [ ] § 2960 et seq.) . . . [T]he purpose of the scheme is to provide MDOs with treatment while at the same time protecting the general public from the danger to society posed by an offender with a mental disorder." (In re Qawi (2004) 32 Cal.4th 1, 9.)
" 'Accordingly, "[a]s a condition of parole, a prisoner may be designated and civilly committed as an MDO for involuntary treatment of a 'severe mental disorder' if certain conditions are met." ' [Citation.] These conditions include: ' "the prisoner has a severe mental disorder" that "is not in remission, or cannot be kept in remission without treatment," and which "was one of the causes or was an aggravating factor in the prisoner's criminal behavior"; "the prisoner has been in treatment for the severe mental disorder for 90 days or more within the year prior to his or her parole release day"; and "by reason of his or her severe mental disorder the prisoner represents a substantial danger of physical harm to others." '
"The initial MDO commitment can be continued. 'Not later than 180 days prior to the termination of parole, or release from prison,' the district attorney may petition the court to continue MDO treatment for one year. (§ 2970.)
"Section 2972 sets forth the procedures for the hearing of a petition for continued MDO treatment. 'The court shall conduct a hearing on the petition. . . ,' and the prisoner has the right to a jury trial. (§ 2972, subd. (a).) 'The standard of proof under this section shall be proof beyond a reasonable doubt . . . .' (Ibid.) The People are represented by the district attorney, and the prisoner has the right to representation by the public defender. (§ 2972, subd. (b).) The court shall continue commitment for one year if the trier of fact finds that 'the patient has a severe mental disorder, that the patient's severe mental disorder is not in remission or cannot be kept in remission without treatment, and that by reason of his or her severe mental disorder, the patient represents a substantial danger of physical harm to others.' (§ 2972, subd. (c).)" (People v. Gregerson (2011) 202 Cal.App.4th 306, 313-314.)
D. Chavez's Challenges to Expert Testimony Based on Case-Specific Hearsay
In Sanchez, our high court concluded that Evidence Code sections 801 and 802 do not permit an expert to relate to a fact finder case-specific facts about which the expert has no independent knowledge to support the expert's trial testimony. (Sanchez, supra, 63 Cal.4th at pp. 670, 676.) The court considered the admissibility of a gang expert's description of a defendant's contacts with police that was based on "case-specific hearsay" for which no admissible evidence was offered. (Id. at pp. 673-674.) The court overruled prior case law that had permitted the admission of such testimony to establish the basis of the expert's opinion. (Id. at p. 679 [stating that prior "paradigm [permitting an expert to relate case-specific facts to the jury] is no longer tenable because an expert's testimony regarding the basis for an opinion must be considered for its truth by the jury"]; italics omitted.) Rather, the court concluded that permitting an expert to relate such case-specific facts to the jury constitutes the recitation of hearsay. (Id. at p. 685 ["when the gang expert testified to case-specific facts based upon out-of-court statements and asserted those facts were true because he relied upon their truth in forming his opinion, he was reciting hearsay"].)
The court summarized its holding as follows:
"In sum, we adopt the following rule: When any expert relates to the jury case-specific out-of-court statements, and treats the content of those statements as true and accurate to support the expert's opinion, the statements are hearsay. It cannot logically be maintained that the statements are not being admitted for their truth." (Sanchez, supra, 63 Cal.4th at p. 686.)
The court further explained:
"If an expert testifies to case-specific out-of-court statements to explain the bases for his opinion, those statements are necessarily considered by the jury for their truth, thus rendering them hearsay. Like any other hearsay evidence, it must be properly admitted through an applicable hearsay exception. Alternatively, the evidence can be admitted through an appropriate witness and the expert may
assume its truth in a properly worded hypothetical question in the traditional manner." (Sanchez, supra, 63 Cal.4th at p. 684.)
"Although Sanchez is a criminal case, it also applies to civil cases-such as this one-to the extent it addresses the admissibility of expert testimony under Evidence Code sections 801 and 802." (People v. Bona (2017) 15 Cal.App.5th 511, 520 [determining Sanchez, supra, 63 Cal.4th 665 applies to trials regarding MDO commitments].)
In this case, Chavez contends that because two of the three experts (Karp and Rao) testified as to case-specific facts based on inadmissible hearsay in explaining their opinions, they violated the rule set forth in Sanchez. (Sanchez, supra, 63 Cal.4th at p. 686.) As a threshold matter, the People contend we should not reach this issue because Chavez forfeited this claim because he did not object to the specific challenged testimony below. (People v. Dykes (2009) 46 Cal.4th 731, 756.) On the record before us, we do not conclude that Chavez forfeited his challenges here.
In a motion in limine, Chavez raised evidentiary rules under Sanchez, supra, 63 Cal.4th 665 and the extent to which expert witnesses could testify about case-specific hearsay. The court allowed the parties to thoroughly discuss the issue and stated it would "strictly" follow Sanchez. It then encouraged the parties to object if the other party deviated from the requirements of Sanchez. Yet, it also told the parties the issues were "reserved for the record, given what your in limine positions are." In light of the court's comments, it is less than clear if the court was giving the parties a continuing objection or requiring them to object. As such, we do not believe it fair to find forfeiture and will address Chavez's arguments on the merits.
Chavez maintains the court erred in permitting the People to introduce case-specific hearsay during Karp's and Rao's testimony at trial as follows:
1. Karp testified that Chavez was taking medication to treat psychosis.
2. Karp diagnosed Chavez with schizophrenic disorder although he admitted that he did not conduct "extensive testing" of Chavez.
3. Karp detailed Chavez's history of substance abuse, when his mental illness manifested, and history of violence based on reports and records written by third parties.
4. Karp offered details about Chavez's juvenile and criminal record. He also stated that Chavez would typically run away from court placements.
5. Karp testified that Chavez had refused his medication in jail and was showing more psychosis as a result. Chavez believes the fact that he refused to take medication is found in properly admitted business records, but no such hearsay exception applies to testimony concerning Chavez showing more psychosis.
6. Rao testified that Chavez suffers from a severe mental illness, his symptoms wax and wane, the symptoms can be prominent or not obvious, Chavez is not in remission, and he represents a substantial danger of physical harm to others. Chavez argues that Rao's testimony on these matters must be based on case-specific hearsay reports prepared by someone else because Chavez did not show any signs of mental illness to Rao.
7. Rao testified about treatments recommended for Chavez, doctors suggesting that Chavez take certain medications, and Chavez's poor insight and bad judgment. Chavez argues that this testimony is based on case-specific hearsay found in various reports.
E. Whether the Trial Court Improperly Admitted Hearsay in Violation of Sanchez
Before addressing Chavez's seven claims of error under Sanchez, supra, 63 Cal.4th 665, we believe it prudent to briefly restate the rules set out by our high court in that case. The court rejected the not-for-the-truth limitation when applied to expert basis testimony and adopted in its place the following rule: "When any expert relates to the jury case-specific out-of-court statements, and treats the content of those statements as true and accurate to support the expert's opinion, the statements are hearsay. It cannot logically be maintained that the statements are not being admitted for their truth." (Sanchez, supra, 63 Cal.4th at p. 686, fn. omitted.) The court also set forth certain guidelines for admissible and inadmissible expert basis testimony. Experts may rely on background information accepted in the field of expertise, information within their personal knowledge, and nontestimonial hearsay properly admitted under a statutory hearsay exception. (Id. at p. 685.) An expert may also "rely on hearsay in forming an opinion, and may tell the jury in general terms that he did so. . . . [¶] What an expert cannot do is relate as true case-specific facts asserted in hearsay statements, unless they are independently proven by competent evidence or are covered by a hearsay exception." (Id. at pp. 685-686; italics omitted.)
The court imposed additional limitations, not applicable here, on testimonial hearsay statements offered by the prosecution in a criminal case. (Sanchez, supra, 63 Cal.4th at p. 680.)
Thus, in Sanchez, supra, 63 Cal.4th 665, the California Supreme Court distinguished when an expert testified about case-specific facts, essentially repeating those facts to the jury for the truth of the matter asserted, from when an expert relies on hearsay to form his or her opinion, but does not discuss the details of that hearsay. The former situation violates Sanchez, unless a hearsay exception applies or the case-specific facts can be independently proven. The latter circumstance does not violate Sanchez.
Here, Chavez has presented some examples that violate Sanchez, supra, 63 Cal.4th 665 and some that do not. For example, Chavez takes issue with Karp's opinion that Chavez has schizophrenic disorder, bipolar type. Chavez contends Karp did not do "extensive testing" of Chavez; therefore, Karp's opinion came from records and testing of other doctors. However, Sanchez does not prohibit Karp from relying on hearsay to form his opinion. Indeed, Chavez provides no authority that would preclude a psychologist from relying on medical records to reach an opinion as to the condition of an individual, especially, when as is the case here, the psychologist has treated the individual and personally interacted with him. (Cf. People v. Roa (2017) 11 Cal.App.5th 428, 451 (Roa).)
Additionally, in a conversation with Rao, Chavez admitted that he had been diagnosed with schizophrenia and bipolar disorder.
Likewise, we find no Sanchez violation regarding Rao's testimony that Chavez suffers from a severe mental illness, his symptoms wax and wane, the symptoms can be prominent or not obvious, Chavez is not in remission, and he represents a substantial danger of physical harm to others. Chavez does not argue that Rao relayed case-specific hearsay to the jury as part of his opinions, but instead, claims his opinions "must have been based on case specific hearsay reports prepared by somebody else, as [Chavez] did not show any signs of a mental illness to Rao." However, an expert can rely on hearsay in forming his opinions. Sanchez did not change that rule. (Sanchez, supra, 63 Cal.4th at p. 685; Roa, supra, 11 Cal.App.5th at p. 451.) Chavez's attorney could probe the basis of Rao's opinion and did so on cross-examination, asking him several questions about the content of certain documents on which Rao relied in forming his opinion.
Also, to the extent that Rao's testimony that Chavez's symptoms wax and wane, his symptoms can be prominent or not obvious, and Chavez is not in remission could be considered case-specific facts based on hearsay (e.g., another doctor's report), we note that Karp, who treated Chavez, testified as to these very issues based on his interactions with Chavez. As such, the facts underlying Rao's testimony were independently proven by Karp's testimony, and Rao could relate those facts to the jury as a basis of his opinion. (Sanchez, supra, 63 Cal.4th at p. 684; Roa, supra, 11 Cal.App.5th at p. 450.)
In addition, we find no Sanchez violation based on Karp's testimony that Chavez was taking medications to treat psychosis. Chavez does not take issue with the evidence that he was prescribed certain medications because he admits that fact appears in admissible business records. Nevertheless, he insists Karp's testimony regarding the purpose of taking the medication (to treat psychosis) was case-specific hearsay. We disagree. Karp testified that Chavez was prescribed seqoquel and stelazine. Then Karp was asked if he knew what those medications were used to treat. Karp responded that the medications treat psychosis. He offered this testimony, not based on his review of the records, but his own personal knowledge. Expert witnesses may testify as to matters with their personal knowledge. (Sanchez, supra, 63 Cal.4th at p. 675.)
Also, Chavez's challenge to Karp's testimony is without merit for the additional reason that Tartaglione, who met with Chavez while he was at San Diego County jail to discuss taking certain medications, testified that Chavez suffered from psychosis.
Chavez also takes issue with Rao's testimony to the extent Rao discussed treatments recommended for Chavez, doctors suggesting Chavez take certain medications, and Chavez's poor insight and bad judgment. Chavez argues that this testimony is based on case-specific hearsay found in various reports. Although it appears that various reports indicate what medication doctors prescribed and Chavez's refusal to take those medications, Chavez's argument glosses over the fact that San Diego County jail records as well as medication refusal slips were entered into evidence without substantive objection. The medication refusal slips showed what medications had been prescribed to Chavez and that he refused to take them. In addition, Chavez told Rao that he does not believe he needs to take any medication that had been prescribed. Thus, the fact that Chavez was prescribed certain medications and refused to take the medications was independently established by admissible evidence beyond Rao's testimony. Thus, there was no Sanchez violation regarding Rao's testimony about Chavez being prescribed certain medications and refusing to take them. (Sanchez, supra, 63 Cal.4th at p. 684.)
Chavez's challenge to Rao's testimony on this issue is somewhat curious. Karp and Tartaglione treated Chavez. Both testified that Chavez refused to take his medication. In addition, Chavez told Karp, Rao, and Tartaglione that he did not want to take his medication.
Likewise, we are not troubled by Rao's opinion that Chavez lacked insight and exhibited bad judgment. Rao based his opinion on Chavez's comments to him "minimizing the illness he did have" and "that he didn't require medication that was being recommended to him" as well as Rao's review of the records. Put differently, Rao opined that Chavez lacked awareness of the extent of his mental illness and that he refused to take medication to treat his mental illness. Such testimony did not involve relating case-specific hearsay to the jury. There was no Sanchez violation.
Although we find much of the challenged testimony did not violate Sanchez, we do find that at least one of the expert witnesses (Karp) did relate case-specific facts to the jury. This evidence included case-specific facts regarding Chavez's history of substance abuse, when his mental illness manifested, and details of Chavez's previous juvenile and criminal offenses. In addition, Karp testified, based on another doctor's report, that Chavez experienced further psychosis when he stopped taking his medication. Admission of expert testimony relating these case-specific facts to the jury was error. (Sanchez, supra, 63 Cal.4th at pp. 684-686.)
F. Prejudice
Having determined that some of Karp's testimony was admitted in error, we must evaluate whether such error prejudiced Chavez. Chavez maintains that the admission of the case-specific hearsay violated his Sixth Amendment right to confrontation, and as such, we must analyze his claim of prejudice under the harmless beyond a reasonable doubt error standard in Chapman v. California (1967) 386 U.S. 18 at page 24. The People counter that the proper standard is found in the less stringent harmless error standard under People v. Watson (1956) 46 Cal.2d 818 at page 836 (Watson). The People have the better argument.
MDO recommitment proceedings are civil in nature, not criminal, and "[t]here is no right to confrontation under the state and federal confrontation clause in civil proceedings." (People v. Otto (2001) 26 Cal.4th 200, 214; see People v. Bona, supra, 15 Cal.App.5th at p. 520; Roa, supra, 11 Cal.App.5th at p. 455.) Moreover, application of the rules of evidence does not implicate the federal constitutional rights to present a defense or to confront witnesses. (See People v. Fudge (1994) 7 Cal.4th 1075, 1102-1103; People v. Hall (1986) 41 Cal.3d 826, 834.)
Here, Chavez has not demonstrated that the erroneously admitted evidence violated any of his rights under the federal Constitution. Therefore, we apply the harmless error standard under Watson, supra, 46 Cal.2d 818. Per that standard, any error is harmless unless it is reasonably probable the appellant would have received a more favorable result absent the alleged error. (See People v. Seumanu (2015) 61 Cal.4th 1293, 1308; Watson, supra, at p. 836.) On the record before us, we conclude that Chavez has not shown he has been prejudiced by the admission of evidence in violation of Sanchez, supra, 63 Cal.4th 665.
For example, Chavez challenges Karp's testimony where he stated that Chavez stopped taking his medication and showed more psychosis as a result. Although Karp's testimony about Chavez showing more psychosis violated Sanchez, supra, 63 Cal.4th 665, it was based on a report prepared by Tartaglione. In fact, Karp explicitly referenced Tartaglione in his testimony. And Tartaglione testified at trial and Chavez could have questioned him about the report. Thus, we find the admission of this portion of Karp's testimony did not prejudice Chavez. He had the opportunity to question the author of the report about which Karp testified.
Similarly, we are not persuaded that Chavez was prejudiced by the admission of case-specific hearsay that: (1) Chavez's mental illness began to manifest at age 16; (2) Chavez has a history of substance abuse; (3) Chavez suffered a true finding for residential burglary and vandalism at age 14; (4) there was a connection between incidents of violence and Chavez's mental illness; and (5) Chavez typically ran away from court placements. Karp testified about this information based on his review of certain records. Even in the absence of this evidence, there is not a reasonable probability that Chavez would have received a better result. The improperly admitted evidence was not especially damaging, especially when compared to the admissible evidence.
During cross-examination, Chavez's trial attorney asked Karp about several case-specific facts found in reports, especially about Chavez's previous criminal offenses and history of violence. Counsel also asked Karp to review progress notes prepared by nurses and confirm what the notes stated. In this sense, he asked Karp to testify about case-specific hearsay. --------
Karp testified about five instances of violence that involved Chavez as the aggressor. Karp stated that Chavez showed no remorse, but rather expressed his view that the victims "deserved it." Karp's testimony was based on his interactions with Chavez and what Chavez told him. Chavez's statements to Karp led Karp to believe that Chavez lacked insight into his mental illness because he did not understand that his mental illness made him act improperly.
Additionally, the jury heard evidence that Chavez still experienced psychotic symptoms, such as delusions and paranoia, and exhibited illogical speech and thought processes. Karp and Rao both opined that Chavez's psychosis was not in remission. They both found that Chavez lacked insight into his mental illness, particularly because he refused to take the medication recommended to him. All three of the expert witnesses opined that Chavez should be taking medication to treat his psychosis. Also, Karp and Rao both testified that Chavez presented a substantial danger to others, and therefore, qualified as an MDO.
Despite this evidence, Chavez argues that we should find prejudice because this was a "close case." To support his position, he cites to the court's comments: "I didn't know how they [the jurors] were going to go," and "I think it was close." However, Chavez does not provide the context for the court's comments. The court made these comments after the jury provided its verdict and left the courtroom. In addition, the petitioner's counsel directly addressed Chavez and suggested that he take his medicine and follow his treatment as recommended by his doctors and he would get his "ticket out of this." When Chavez did not appear to be receptive to counsel's comments, the court then added:
"Hold on. Mr. Chavez, I've never had your case before. Listen to me. Take your medication. That's all you have to do. I'm sure your lawyer is telling you the same thing [petitioner's counsel] just told you. You don't want to hear it from [petitioner's counsel]. Hear it
from one of us. Just take your medication. I didn't know what the jury was going to do. I think it was close."
The court then repeated its suggestion that Chavez take his medication two more times before it advised Chavez of his appeal rights. Thus, the court's comments appear to be encouragement to Chavez to take his medication more than a comment on the strength of the evidence supporting Chavez's recommitment as an MDO.
Finally, although we do not weigh evidence on appeal and have not engaged in any weighing here, it is worth noting that the expert witnesses' opinions about Chavez were uncontroverted. Chavez did not offer any witnesses whatsoever. He did not call an expert witness to opine that he was not suffering from a mental illness, his mental illness was in remission, or that he did not need to take medication to treat his illness. Chavez did not testify himself. As such, the evidence supporting the judgment here was overwhelming. For this additional reason, any error was harmless.
DISPOSITION
The judgment is affirmed.
HUFFMAN, J. WE CONCUR: McCONNELL, P. J. IRION, J.