Cal. Dep't of State Hosps. At Coalinga v. C.G.

Decision Date08 February 2018
Docket NumberF076028
CourtCalifornia Court of Appeals Court of Appeals
PartiesCALIFORNIA DEPARTMENT OF STATE HOSPITALS AT COALINGA, Plaintiff and Respondent, v. C.G., Defendant and Appellant.


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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.



APPEAL from an order of the Superior Court of Fresno County. Kimberly Gaab, Judge.

Rudy Kraft, under appointment by the Court of Appeal, for Defendant and Appellant.

Xavier Becerra, Attorney General, Julie Weng-Gutierrez, Senior Assistant Attorney General, Ismael A. Castro and Brenda A. Ray, Deputy Attorneys General, for Plaintiff and Respondent.



Appellant C.G., a mentally disordered offender (MDO), previously was subject to an involuntary medication order. He contends substantial evidence does not support the superior court's July 3, 2017 order that he be involuntarily medicated. We disagree and affirm.


On May 24, 2017, the Department of State Hospitals (DSH) filed a petition to renew an order to compel involuntary treatment with antipsychotic medication of C.G. The petition alleged that C.G. was committed to DSH-Coalinga as an MDO; that he is diagnosed with Schizoaffective Disorder; and has a history of noncompliance with taking antipsychotic medication. Symptoms of his diagnosis exhibited by C.G. included delusions that he is a fictional spy character, the United Nations Security General, and the anti-Christ. C.G. had stated that his brain was replaced by a cell phone and he wanted to be in "solar flare form."

It also was alleged C.G. demonstrates a lack of insight into his mental illness, and consequently, does not believe he has any symptoms of a psychiatric illness. C.G. was "at times" refusing medications stating, "I don't think it is working. It is too strong."

The petition further alleged C.G. is incompetent to refuse medical treatment, does not understand the benefits and risks of treatment, and is unable to participate in treatment decisions. Attached to the petition is a verification signed by Dr. Alaric Frazier, stating, "The contents of the petition are true based on personal knowledge and review of the medical history, diagnosis, and treatment of this individual."

The trial court appointed the public defender to represent C.G. and ordered all DSH medical records of C.G. be provided to defense counsel. A hearing on the petition was set for July 3, 2017.

At the July 3, 2017 hearing, Dr. Ravi Chand testified as an expert witness; the parties stipulated to his qualification as an expert. Chand is a staff psychiatrist at DSH-Coalinga. He personally interviewed C.G. for 30 to 45 minutes and reviewed C.G.'s medical records. Chand also interviewed C.G.'s psychiatrist, his treatment team, level of care staff, and medication person. Upon completion of these interviews and medical record review, Chand diagnosed C.G. as having paranoid schizophrenia.

According to Chand, the symptoms that C.G. exhibited that supported the diagnosis were that he was "very paranoid" and "very guarded" in his interview, had a "restricted affect," and appeared preoccupied. Additionally, C.G. "appeared to have disorganization of his thought process." Chand opined that C.G. "had residual symptoms of schizophrenia, although they were not full-blown," and could "keep his thoughts together and present fairly well" which could "give the Court a false impression of Mr. [G.] having insight."

When Chand interviewed C.G., C.G. told him "that he does not have any psychiatric symptoms." Chand testified he disagreed with that assessment. C.G. admitted he had paranoid schizophrenia in the past, but stated he had no "psychiatric symptoms at the present time." Chand stated the "ordinary course of treatment" for people with C.G.'s diagnosis was "[u]sually seven out of ten patients would need treatment for life."

Chand opined that C.G. did not understand the risks or benefits to taking his medication. In his interview with C.G., Chand did not observe any physical side effects from the prescribed medications C.G. was taking and C.G. did not complain of any side effects. C.G. has been "highly functional, which typically paranoid schizophrenia patients can be with appropriate treatment." Chand testified that C.G.:

"clearly lacks insight into the mainstay of his treatment, which is psychiatric meds. The capacity, you know, the basic understanding of the nature of his psychiatric illness, the risk and benefits of his psychiatric meds, risk and benefits of alternatives to psychiatric meds, possible consequences of no treatment, and attending some groups or perhaps some leisure activities alone as alternatives are not going to alleviate the symptoms of his psychosis."

At one point in his testimony, in responding to a question, Chand referred to a statement made to him by Dr. Frazier about C.G. Defense counsel objected as calling for hearsay and the trial court sustained the objection. This is the only objection made by the defense to any of Chand's testimony.

On cross-examination, Chand testified he did a full examination of C.G. C.G.'s "medication person" told Chand that C.G. recently had refused some of his medications. C.G. told Chand that if he had a choice, he would not take Haldol and Risperdal. He would take Clozaril.

Chand acknowledged these medications could have serious side effects, including drooling, "Parkinsonian side effects, stroke, heart attack, diabetes, obesity, hypertension," but noted C.G. had not complained about any side effects and Chand had noticed no side effects. Chand also indicated C.G. did not have diabetes or high cholesterol. Chand acknowledged there are different antipsychotic medications with differing risks, but noted "some of the medications work better for certain patients than others."

C.G. was selective about taking Clozaril and selective about how much of the drug he would take. C.G. was on a dosage of Clozaril that is "very safe as far as metabolic syndrome" and "almost has no Parkinsonian side effects." The Haldol was to "augment the effects of Clozaril." C.G. had to have a regimen of blood work on a regular basis while on the medication.

Supplemental antipsychotics were generally "very important" in treatment decisions. The attending psychiatrist could accede to C.G.'s demands to remove medications other than Clozaril and increase the Clozaril. If the attending believed that increasing Clozaril would increase the risk of seizures, drooling, excessive sedation, or falling down and incurring fractures, then an alternative such as augmentation with other drugs would be chosen.

Chand agreed that C.G. "has a lot of experience with different medications and their effects on him personally." Chand also opined, "the very fact that he ended up onClozaril, which means it's the last stop for him." Chand would not alter the combination of medications C.G. was currently taking because "he's doing well, and he's safe. And safety is a major factor in a maximum security forensic hospital."

Chand opined that C.G. had vacillating insight, but presented fairly well and could hold a conversation. The goal at DSH-Coalinga was to use "least restrictive measures" to treat a patient. When a patient is "resistant to insight," more extreme measures have to be used. In Chand's opinion, C.G. needed to be on involuntary medication to enhance his functioning and safety.

Without medication, C.G. would not receive the full benefits of treatment. "[A]bout 70 percent of his D2 receptors" needed to be blocked in order to "control the psychotic symptoms." C.G.'s intermittent insight meant he would reject medication at some points, but not others. Chand opined that C.G. probably would not ever reach a point where his insight was not intermittent. Regardless, C.G. had not reached that point as of the date of the hearing and needed to continue on involuntary medication.

C.G. also testified at the hearing. C.G. had been at DSH-Coalinga since 2010; previously he was at Atascadero. Before being placed in a state hospital, C.G. was not taking any antipsychotic medication.

Dr. Frazier was C.G.'s treating psychiatrist. C.G. was not opposed to taking medication; he was opposed to being forced to take medication. He admitted refusing to take medication in the past, on two occasions, because he "didn't want to take the medication." He did not want to be subject to an involuntary medication order "[b]ecause if I do want to skip a medication day, they can force it on me."

When asked if he thought he had symptoms of paranoid schizophrenia, he stated, "So far today I haven't had any thoughts of people being out to get me or anything like that, so I don't see how I'm paranoid schizophrenic." He acknowledged having symptoms in the past, including delusions, because of his use of "crystal meth."

C.G. felt he could weigh the risk of taking medication and make his own decision. If he was subject to a forced medication order, he "can't go to CONREP or anything like that." When asked if he could comply without an order, C.G. responded, "I'm trying to do the best mental health possible. Trying to have a clean, crisp mental health. So I don't know what to do."

On cross-examination, C.G. answered that he had a mental illness and that illness was paranoid schizophrenia. He still testified, though, that his illness was a result of use of "crystal meth" and that his delusions were "in the past."

The superior court found that C.G.'s testimony was "inconsistent in his understanding of what his diagnosis is and whether he suffers from paranoid schizophrenia." The superior court noted that at one point, C.G. testified he "couldn't see how he...

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