Pub. Guardian of Contra Costa Cnty. v. S.H. (In re S.H.)
| Decision Date | 23 November 2022 |
| Docket Number | A163073 |
| Parties | Conservatorship of the Person of S.H. v. S.H., Objector and Appellant. PUBLIC GUARDIAN OF CONTRA COSTA COUNTY, Petitioner and Respondent, |
| Court | California Court of Appeals Court of Appeals |
Conservatorship of the Person of S.H.
PUBLIC GUARDIAN OF CONTRA COSTA COUNTY, Petitioner and Respondent,
v.
S.H., Objector and Appellant.
A163073
California Court of Appeals, First District, Second Division
November 23, 2022
NOT TO BE PUBLISHED
(Contra Costa County Super. Ct. No. P2000157)
RICHMAN, ACTING P. J.
S.H. appeals from an order reappointing a conservator of his person with the authority to make medical treatment decisions on his behalf pursuant to the Lanterman-Petris-Short Act (LPS Act) (Welf. &Inst. Code, § 5000 et seq.).[1] His sole contention is that the evidence is insufficient to support the trial court's finding that he lacks the capacity to give informed consent to treatment. We affirm.
BACKGROUND
S.H. suffers from schizoaffective disorder. In criminal proceedings
brought against him in 2018, S.H. was deemed mentally incompetent to stand trial, and the county conservator investigator was ordered to initiate conservator proceedings for him in accordance with the LPS Act. On April 28, 2020, the trial court appointed the Public Guardian of Contra Costa County (Public Guardian) as conservator of S.H.'s person, found him gravely disabled, and empowered the Public Guardian to place him in a locked facility and make medical decisions on his behalf. As that conservatorship period expired, on March 17, 2021, the Public Guardian petitioned to be reappointed as conservator.
S.H. contested the petition and asked for a bench trial, which the court held on June 15, 2021. Two witnesses testified: psychologist and county Deputy Conservator Andrew Smith, Ph.D., an expert in grave disability, and psychologist Jennifer Weinstein, Psy.D., an expert in psychology and grave disability.
Dr. Smith testified first. He was appointed as the conservator of S.H., whom he had known for two and a half months. They had spoken on the phone and met twice, once in March 2021 over Zoom, and another time in May 2021 in person at the secured mental health rehabilitation facility where S.H. was placed. During the two meetings, Dr. Smith assessed S.H. for grave disability.
In Dr. Smith's opinion, S.H. was gravely disabled. The basis of Dr. Smith's opinion was "nuanced," in that while S.H. gave practical responses regarding how he would obtain food, clothing, and shelter if he were out in the community, he "did not have the functionality currently to carry out those plans ...." As an example, Dr. Smith observed that although S.H. was able to associate being incarcerated with shelter, this response "gave [Dr. Smith] pause," because prior to his incarceration, S.H. was homeless, "living in a
field . . . without a tent, so no real protection from the elements, and he himself had told [Dr. Smith] he wasn't doing well."
Dr. Smith also observed that S.H. exhibited paranoia and blunted emotional affect. When discussing S.H.'s current placement, he was "persistent about wanting to be in an open program," stressing he did not want oversight by others and did not want much in the way of treatment. When asked whether his past or future behavior would affect his ability to maintain placement, S.H. became tense and upset and refused to talk. Similarly, when Dr. Smith asked about S.H.'s insight into the need for medications, he became "surprisingly defensive," stating," 'I don't wanna talk about that right now. I'll talk about that at the court date. I just don't want too many more questions. I want to keep some things incognito.'" Dr. Smith "use[d] the word paranoid" to describe this reaction, "because it did seem to be beyond and above what reasonable people might talk about in that situation, in that setting, that [he was] his conservator trying to take care of him and make sure his needs are met ...."
Counsel asked Dr. Smith whether S.H. had insight into his mental health disorder. Dr. Smith replied that S.H. was able to show appreciation for some of the treatment and services he had been receiving at the facility, such as meals and staff assistance. "At the same time, he seemed to be lacking insight into the fact that [Dr. Smith] was his conservator." Dr. Smith also found S.H. lacked insight into his triggers and emotions in connection with prior aggressive acts. He based this on S.H.'s responses regarding physical altercations that he had with other people at the facility. S.H. attributed one altercation to people "acting weird around him," and another altercation to him having "mania." Dr. Smith found these responses were not "reasonable explanation[s]" for hitting someone. Also, when during the Zoom
meeting Dr. Smith brought up a prior sexual offense, S.H. refused to talk, stood up, and ended the meeting.
Dr. Smith opined that S.H. "would not do well in an open program." He believed S.H.'s current placement in a secured facility was appropriate because it provided intensive treatment and was equipped to respond to a person who becomes aggressive. Dr. Smith also had concerns that if he were not conserved, S.H. would not continue his treatment and medications and symptoms would reoccur.
Dr. Weinstein testified next. She interviewed S.H. for grave disability in a 35-to-40-minute meeting over Zoom in late May 2021. After reviewing the conservator's notes, S.H.'s medical records from his facility, and her own interview notes, Dr. Weinstein diagnosed S.H. with schizoaffective disorder, which "includes two diagnoses, a psychotic disorder, such as schizophrenia, and a mood disorder, such as bipolar disorder or depression." The symptoms of the schizophrenia component include thought disorder, perceptual disturbances such as hallucinations or delusions, and paranoia. "These symptoms alter one's ability to differentiate between reality and fantasy and maintain orientation in reality thus impairing decision-making, judgment, planning, and cognition function." The symptoms of the mood disorder component include abruptly changing moods and emotional reactivity, which can also impair decision-making, planning, and judgment.
Dr. Weinstein found that S.H. had "a lack of insight and understanding into the nature of his psychiatric needs." Although he stated he had a mental disorder, he was only able to understand it in "a non-concrete and abstract way." As Dr. Weinstein explained it, "[W]hen I asked about his reasons for detainment or reasons for referred to . . . the current facility, he just stated what happened; . . . I asked many different ways, and he was not able to
explain why, what it was that occurred that caused him to require that treatment. He just stated that he was picked up and put in ...."
Dr. Weinstein also provided opinions concerning S.H.'s recent physical altercations. Based on her review of S.H.'s records, she found the incidents indicated S.H.'s lack of control over aggressive or angry impulses. Dr. Weinstein described that the altercations stemmed from S.H.'s paranoia or fear that someone was harming him or his belongings and a response that was an impulsive and physically aggressive. She also observed that S.H.'s statements to staff after the altercations showed he did not understand the gravity of the problem or his contribution to the interaction.
S.H. was on two antipsychotic medications, which Dr. Weinstein explained are designed to help reduce paranoid thinking and agitation and improve impulse control. S.H. acknowledged that he took his medication with staff assistance, that the medication" 'keeps [him] from getting violent'" and" 'helps [him] a lot,'" and that he" 'take[s] [his] pills'" when he gets anxiety. However, when Dr. Weinstein asked S.H. about his knowledge of the medications, he refused to continue talking to her.
Dr. Weinstein testified that were S.H. to stop taking his medications, he may experience an increase in his symptoms of paranoia, emotional reactivity, and aggression, which in turn would require a higher level of care. An increase in such symptoms, she explained, could also result in a psychiatric hold or even arrest or jail time.
Like Dr. Smith, Dr. Weinstein concluded that S.H. was gravely disabled. She stated that his lack of insight into his mental disorder prevented him from understanding the nature of his psychiatric needs. As examples, she pointed to S.H.'s 10-year history of homelessness, trouble with emotional reactivity particularly in interactions with other people, his
desired plan to exit the current facility without any psychiatric care or support, and his low engagement in his current rehabilitation program. Dr. Weinstein explained that S.H.'s "psychotic symptoms cause him to...
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