Conservatorship Personnel v. J.M.

• Court: California Court of Appeals
• Writing for the Court: RENNER, J.
• Decision Date: 27 May 2015
• Docket Number: C077649
• Citation: Conservatorship Personnel v. J.M., C077649 (Cal. App. May 27, 2015)
• Parties: Conservatorship of the Person and Estate of J.M. EL DORADO COUNTY PUBLIC GUARDIAN, as Conservator, etc., Petitioner and Respondent, v. J.M., Objector and Appellant.

Conservatorship of the Person and Estate of J.M.EL DORADO COUNTY PUBLIC GUARDIAN, as Conservator, etc., Petitioner and Respondent, v. J.M., Objector and Appellant.

C077649

COURT OF APPEAL OF THE STATE OF CALIFORNIA THIRD APPELLATE DISTRICT (El Dorado)

May 27, 2015

NOT TO BE PUBLISHED

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

COPY

(Super. Ct. No. PMH20140082)

Joyce M. is subject to a Lanterman-Petris-Short Act (LPS Act)¹ conservatorship. On appeal, she challenges the trial court's finding that she is gravely disabled as a resultof a mental disorder and unable to provide for her basic personal needs of food, shelter, or clothing. She claims there is no substantial evidence to support the finding of grave disability. Joyce also contends the trial court lacked sufficient evidence to support the imposition of special disabilities denying her the rights and privileges to possess or carry firearms, possess a driver's license, enter into contracts, and give or withhold consent to medical treatment both related and unrelated to her grave disability. We affirm.

BACKGROUND

Grave Disability

Between April 28, 2014, and May 29, 2014, Joyce was placed on a section 5150 hold three separate times. Two of those holds were based on a finding that Joyce was gravely disabled and resulted in her being admitted to Woodland Memorial Hospital.² Joyce was admitted to Woodland Memorial Hospital on May 15, 2014, and released on May 23, 2014. She was then re-admitted on May 29, 2014, (again based on a finding she was gravely disabled) after less than six days at home. Joyce was not released from this section 5150 hospitalization during the pendency of these conservatorship proceedings. The current hospitalization occurred after the police department received an anonymous call to do a welfare check on Joyce. Law enforcement found her house disorganized, with broken windows and broken glass on the floor. She was not able to care for her basic needs.

Dr. Kanchanakin, a psychiatrist at Woodland Memorial Hospital, saw Joyce every day during both section 5150 commitments at that hospital. On the two occasions Joyce was released from the hospital she was given a discharge plan, which included medication. Joyce did not take her medication following discharge and, in both cases, was readmitted to a psychiatric hospital within two weeks. Based on his evaluation ofJoyce, Dr. Kanchanakin concluded Joyce was gravely disabled and not able to meet her basic needs for food, clothing, or shelter.

Dr. Kanchanakin diagnosed Joyce with bipolar disorder with psychotic features, most recently manic. He noted her thought processes were tangential, disorganized, and fragmented. She was delusional and had poor insight and judgment. Joyce struggled with delusions of erotic mania, inappropriate intrusiveness, rage attacks, and emotional lability. Joyce also had numerous physical ailments that required treatment, including adult onset kidney disease, chronic renal failure, hypertension, hyperthyroidism, osteoporosis, spinal stenosis, pre-diabetic condition, and peripheral neuropathy. Joyce's mental health history goes back 30-40 years with consistent diagnoses of bipolar disorder. Over the last 39 years, she's had approximately half a dozen "mental health episodes," spaced years or decades apart. Joyce's "episodes" included symptoms such as delusions, confusion, and abnormal behaviors. For over 20 years she had successfully been treated with Lithium as her primary psychotropic medication, until early 2014 when she was hospitalized for Lithium toxicity.

Joyce's husband died December 2013 and since that time there had been numerous calls to adult protective services as Joyce was having more trouble caring for herself. In late 2013 through early 2014 Joyce had an in-home caregiver, Armida. Armida came daily for two months and Joyce paid her $3,000 a month. Joyce fired Armida in March or April of 2014 because she thought Armida was lying to her and stealing from her. Officer Aaron Lopez, a deputy with the El Dorado County Sheriff's Department, was assigned to Joyce for crisis intervention. He responded to Joyce's home on two occasions for welfare concerns. In late April 2014 he responded to her call reporting that her daughter was trying to kill her. Lopez identified himself and told her he was there to investigate her call for service. She told him she did not want his help, called 911, and reported he was harassing her. She then abruptly indicated she was having chest pains and needed medical attention, so Lopez called for paramedics. Lopez's second visitcame after Joyce contacted an emergency call center, through a device worn around her neck, and reported that she was going to burn her house down. The call center asked law enforcement to conduct a welfare check. Lopez advised Joyce why he was there and she said she "would burn the house before they took the house away from her." Lopez noted there was debris in the house, a full urinal with an open lid in the living room, and dishes and Styrofoam everywhere. Joyce was appropriately dressed on both visits, there appeared to be edible food in the home, and there was running water and electricity. Joyce even offered Lopez some shrimp she had apparently purchased that day. Lopez did not place Joyce on a section 5150 hold after either of those visits.

Marlene Hensley, the LPS Investigator assigned to evaluate whether Joyce should be placed in a LPS conservatorship, testified as an expert in investigating LPS referrals, writing LPS referral reports, and making LPS recommendations.³ As part of her investigation she met with Joyce, reviewed records from Woodland Memorial Hospital,the County Conservator's Office, adult protective services reports, and police reports. She spoke with Joyce's psychiatrist at El Dorado County Mental Health, Dr. Joe Kanchanakin, the El Dorado County Director of Mental Health, Dr. Robert Price, and Joyce's son, ex-husband, and neighbors. She was also in constant contact with the social worker at Woodland Memorial Hospital. When considering whether to recommend an LPS conservatorship, Hensley considers: 1) whether there is a chronic and persistent severe mental illness; 2) whether the patient is willing to accept treatment, such as medication and case management; 3) the track record for compliance with the treatment program; and 4) whether the person can provide for their food, clothing, or shelter.

Hensley reported that during her most recent hospitalization, Joyce did not understand why she was hospitalized, refused to accept her bipolar diagnosis, and insisted she did not need medication. Joyce made it clear to Hensley that taking medication was not a significant consideration for her. Joyce refused to consider any alternative living arrangements. Her plan was to return home as she had after being discharged in the past. Joyce also lacked insight into her situation, she did not believe anything was wrong with her, and did not see any need to be in the hospital or talking about conservatorship. Joyce's statements, and her history of not staying on her medication upon being released from the hospital, indicated to Hensley that Joyce would not be compliant with treatment. Hensley discussed Joyce's plan for self-care with her. Joyce told Hensley she would drive to the store to get food and clothing. She would then "stand at the car and take one item at a time and throw it up on the porch one item at a time. She would climb up and she would carry it into the house bit by bit." Joyce had a suspended driver's license and utilized both a wheelchair and a walker.

Hensley expressed concern about Joyce's "inability or unwillingness to accept outside assistance, such as when she calls for the police, then doesn't let them in, and the IPS worker is fired and Adult Protective Services' assistance, those . . . we're fearful she would say no to [that assistance], once home." Based on the evidence of Joyce's mentalillness, her lack of insight into her mental illness and lack of compliance with medication, her unwillingness to accept assistance, and her three psychiatric hospitalizations within a one-month period, Hensley recommended Joyce be placed in conservatorship.

Mari Robertson, the El Dorado County public guardian, testified as an expert in planning for someone who is gravely disabled. Joyce received social security benefits of $1,650 per month, plus a teacher's pension of $1,300 per month. She had a reverse mortgage, $10,000 in a savings account, and Kaiser medical insurance. Joyce reported she would comply with mental health groups and go to the doctor. She would also have help at the house and getting to the grocery store, and she would try to find her former caregiver to help her again. She claimed her hospitalization was a mistake and that she did not need to be in a placement to treat her mental illness. Robertson visited Joyce's home and, although it was messy and needed to be cleaned, it "wasn't really terrible." She believed it was not entirely safe for someone with Joyce's physical limitations, and thought it would be best if the house could be retrofitted for Joyce's physical needs with guardrails, grab bars, and ramps. Robertson met with staff at the board and care home where Joyce was placed after the imposition of this conservatorship. Joyce was not taking her medications, and was refusing the psychotropic medication that had been prescribed. Joyce was also refusing to take penicillin to treat an abscessed tooth and refusing to take cough syrup. Joyce questioned her bipolar diagnosis. The doctor stated Joyce needed 24-hour supervision to ensure medication compliance. Robertson concluded it would not be sufficient for Joyce to hire her own...