Opinion
2d Civ. No. B299936
07-09-2020
CONSERVATORSHIP OF the Person and Estate of J.O. PUBLIC GUARDIAN OF THE COUNTY OF VENTURA, Plaintiff and Respondent, v. J.O., Objector and Appellant.
Jean Matulis, under appointment by the Court of Appeal, for Objector and Appellant J.O. Leroy Smith, County Counsel, Martha Jennifer Wolter, Assistant County Counsel, for Plaintiff and Respondent.
NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.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. No. 56-2018-00510862 MH-CN-VTA)
(Ventura County)
J.O. appeals the trial court's post-jury trial order reappointing a conservator of his person and estate pursuant to the Lanterman-Petris-Short Act (LPS Act) with the authority to refuse or consent to medical treatment. (Welf. & Inst. Code, § 5000 et seq.) Appellant contends the evidence is insufficient to support the findings that he is gravely disabled and that he lacks the capacity to give informed consent for medical treatment related to that disability. We affirm.
All further statutory references are to the Welfare and Institutions Code.
FACTS AND PROCEDURAL HISTORY
Appellant is a 56-year-old man with a longstanding diagnosis of schizoaffective disorder bipolar type. In June 2018, following numerous psychiatric admissions under sections 5150 and 5250, the Ventura County Public Guardian was appointed as the conservator of appellant's person and estate with the authority to consent to the administration of antipsychotic medication. In May 2019, the Ventura County Public Guardian filed a petition for reappointment of the conservatorship under section 5361. Appellant exercised his right to a jury trial.
Appellant testified that he believed he had been misdiagnosed with schizoaffective disorder and that he instead suffered from Attention Deficit Hyperactivity Disorder (ADHD) and needed to take Ritalin. When confronted with the fact that he was currently taking Depakote and Zyprexa for his schizoaffective disorder, appellant insisted he was not taking either drug because "[i]t just doesn't look like the pill and it doesn't feel like it."
Appellant also testified that although he was chronically homeless, he was expecting to receive a large commission from a hotel development in which he had been involved on the island of Saipan. He also stated that Social Security back payments were accumulating in a bank account in Hawaii and that the balance of the account was at least $85,000. If he were no longer under a conservatorship, his plan was to return to Saipan where he had previously lived. Appellant said: "I'm on the verge of being a millionaire out on Saipan. I need to get out there." He was willing to continue seeing a psychiatrist in Saipan but wanted his medication changed to Ritalin. He was also convinced that a businessman in Saipan, whom he described as "a Chinaman that dislikes me because I quit working for him," had bribed one of appellant's doctors to have him hospitalized. He believed he could take care of himself because he received approximately $2,900 every month in social security benefits, knew how to cook eggs and steak and make a peanut butter sandwich, and could go to Walmart or Old Navy to buy clothing.
Dr. Joseph Vlaskovits, a psychiatrist at Hillmont Psychiatric Center, testified that appellant had 14 prior psychiatric admissions since 2016. Based upon his prior treatment of appellant, his review of appellant's extensive medical records, and his evaluation of appellant approximately one week prior to trial, Dr. Vlaskovits concluded that appellant continued to be gravely disabled and thus met the criteria for continued conservatorship. The doctor described appellant as "profoundly delusional" with an "irrational thought process." Appellant is chronically homeless and lacked the ability to provided himself with food, shelter and clothing. While at Hillmont, he had to be pressured to bathe and was "quite disorganized in his thinking." Although appellant believed he should be taking Ritalin for ADHD, the doctor opined that taking the drug "would put him, in all likelihood, in a more psychotic and manic state and compensate his overall mental state very quickly."
Dr. Vlaskovits concluded that appellant's stated plan of returning to Saipan was not viable due to his mental disorder and that appellant would stop taking medication if the conservatorship were not continued. Appellant was paranoid, delusional, and lacked insight into his mental condition. Dr. Vlaskovits was of the opinion that appellant needed to be taking both Zyprexa and Depakote or similar medications and that taking Ritalin in addition to these medication would destabilize him.
Deputy Public Guardian Enrique Guebarra, who had advocated on behalf of appellant during his conservatorship, testified that he would have known of any Social Security back payment award appellant had received and that he had no knowledge of any such award.
At the conclusion of the trial, the jury found beyond a reasonable doubt that appellant was gravely disabled in that he (1) "has a mental disorder"; (2) "is unable to provide for his basic personal needs of food, clothing or shelter"; and (3) "is unwilling or unable . . . to accept meaningful treatment." The trial court proceeded to reappoint the Ventura County Public Guardian as conservator of appellant's person and estate. The court also found that appellant lacked the capacity to to give informed consent for medical treatment related to his grave disability and granted the conservator the authority to administer antipsychotic medication to him.
DISCUSSION
Grave Disability
Appellant contends the evidence is insufficient to support the jury's finding that he was presently gravely disabled. We disagree.
To establish a conservatorship under the LPS Act, the public guardian must prove the proposed conservatee is gravely disabled beyond a reasonable doubt. (§ 5350; Conservatorship of Smith (1986) 187 Cal.App.3d 903, 909.) "[T]o establish that a person is gravely disabled, the evidence must support an objective finding that the person, due to mental disorder, is incapacitated or rendered unable to carry out the transactions necessary for survival or otherwise provide for his or her basic needs of food, clothing, or shelter." (Conservatorship of Carol K. (2010) 188 Cal.App.4th 123, 134; see § 5008, subd. (h)(1)(A).)
"In reviewing a conservatorship, we apply the substantial evidence standard to determine whether the record supports a finding of grave disability. The testimony of one witness may be sufficient to support such a finding. [Citation.] We review the record as a whole in the light most favorable to the trial court judgment to determine whether it discloses substantial evidence. Substantial evidence, which is evidence that is reasonable, credible, and of solid value, also includes circumstantial evidence. [Citation.]" (Conservatorship of Carol K., supra, 188 Cal.App.4th at p. 134.) "Substantial evidence includes circumstantial evidence and the reasonable inferences flowing therefrom. [Citation.]" (Conservatorship of Walker (1989) 206 Cal.App.3d 1572, 1577.)
Substantial evidence supports the finding that appellant is gravely disabled. After evaluating appellant and reviewing his records, Dr. Vlaskovits concluded he was gravely disabled. The doctor also opined that appellant's plans if he were to be released from the conservatorship were not viable because they were based upon delusions regarding his finances and mental state. Appellant stated his belief that he has at least $85,000 in a bank account, but it is apparent that no such account exists. Appellant also alluded to commissions he is due to receive from a hotel development in Saipan, but he did not offer any supporting proof. His testimony reflects that he also lacks insight into his mental disorder and only takes his prescribed medications because he is compelled to do so. Dr. Vlaskovits concluded that appellant would not take his medications if he were released from the conservatorship, which would further undermine his ability to provide for his basic needs.
The question of grave disability cannot be considered in a vacuum but rather "in the context of suitable alternatives, upon a consideration of the willingness and capability of the proposed conservatee to voluntarily accept treatment and upon consideration of whether the nondangerous individual is capable of surviving safely in freedom by himself [or herself] or with the help of willing and responsible family members, friends or other third parties. [Citation.]" (Conservatorship of Davis (1981) 124 Cal.App.3d 313, 325.) Appellant's denial and lack of comprehension regarding his psychiatric condition, his unwillingness to accept medications and treatment for that condition, and his inability to plan to provide himself with food, clothing, or shelter, constitutes sufficient evidence to support the finding that he is gravely disabled. Conservatorship of Smith (1986) 187 Cal.App.3d 903, which appellant cites in support of his claim, is plainly inapposite.
Lack of Capacity
Appellant contends the evidence was also insufficient to support the finding that he lacks the capacity to refuse or consent to medical treatment related to his grave disability. We are not persuaded.
We reject the Public Guardian's assertion that appellant waived or forfeited this claim by failing to raise it in the trial court. See In re K.F. (2009) 173 Cal.App.4th 655, 660, citation omitted ["Sufficiency of the evidence has always been viewed as a question necessarily and inherently raised in every contested trial of any issue of fact, and requiring no further steps by the aggrieved party to be preserved for appeal"].)
A finding of grave disability is not sufficient, by itself, to justify the imposition of the special disabilities enumerated in section 5357. (§ 5005; Riese v. St. Mary's Hospital & Medical Center (1987) 209 Cal.App.3d 1303, 1312-1313 (Riese).) The conservatee retains the rights and privileges covered by the special disabilities unless the trial court, after making separate findings of incapacity to support the imposition of the special disabilities, imposes those disabilities and confers corresponding authority on the conservator. (Conservatorship of George H. (2008) 169 Cal.App.4th 157, 165.) This includes the right to refuse or consent to medical treatment. (Riese, at p. 1313.) Because the special disabilities deprive the conservatee of substantial constitutional rights, due process must be afforded before the rights are compromised. (§§ 5357, 5358; Conservatorship of Christopher A. (2006) 139 Cal.App.4th 604, 612.) "'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.' [Citation.]" (George H., at p. 165.) In other words, there must be evidence in the record to support each of the disabilities imposed. (Id. at pp. 165-166.)
In determining whether a gravely disabled person is incapable of making treatment decisions, courts consider "(a) whether the patient is aware of his or her situation (e.g., if the court is satisfied of the existence of psychosis, does the individual acknowledge that condition); (b) whether the patient is able to understand the benefits and the risks of, as well as the alternatives to, the proposed intervention . . . ; and (c) whether the patient is able to understand and to knowingly and intelligently evaluate the information required to be given patients whose informed consent is sought (§ 5326.2) and otherwise participate in the treatment decision by means of rational thought processes." (Riese, supra, 209 Cal.App.3d at pp. 1322-1323.)
In light of these factors, the record amply supports the conclusion that appellant was incompetent to refuse or consent to treatment regarding his grave disability. Appellant has consistently denied that he suffers from schizoaffective disorder and also denied he was taking the medications he is prescribed to treat that disorder. Moreover, Dr. Vlaskovits testified that appellant would quickly decompensate if he did not take his medication. In light of this evidence, the trial court did not err in finding that appellant lacked the capacity to make decisions about treatment for his disorder.
Contrary to appellant's assertion, it is of no moment that Dr. Vlaskovits did not specifically opine that appellant lacked the capacity to make decisions about his treatment. The doctor's testimony, when considered in conjunction with appellant's own testimony, clearly conveyed that appellant did not understand the need for taking his prescribed medications, and that he also lacked the ability to participate in treatment decisions by means of rational thought processes. Accordingly, the trial court did not err in authorizing the conservator to administer antipsychotic medication to appellant.
Oral argument in this case was heard by telephone. Counsel appeared on appellant's behalf. Appellant, who was listening to the argument by telephone, repeatedly interrupted the proceedings to voice his own beliefs. Several admonitions by the court and his attorney to refrain from interrupting were unsuccessful. After repeated warnings, argument was ended and the matter was ordered submitted. --------
DISPOSITION
The judgment is affirmed.
NOT TO BE PUBLISHED.
PERREN, J. We concur:
YEGAN, Acting P.J.
TANGEMAN, J.
Anthony J. Sabo, Judge
Superior Court County of Ventura
Jean Matulis, under appointment by the Court of Appeal, for Objector and Appellant J.O.
Leroy Smith, County Counsel, Martha Jennifer Wolter, Assistant County Counsel, for Plaintiff and Respondent.