Opinion
A156858
03-30-2020
Conservatorship of the Person of J.O. SAN MATEO COUNTY PUBLIC GUARDIAN, as Conservator, etc., Petitioner and Respondent, v. J.O., Objector and Appellant.
NOT TO BE PUBLISHED IN OFFICIAL REPORTS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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115. (San Mateo County Super. Ct. No. PRO108388D)
J.O. appeals from a trial court order appointing the San Mateo County Public Guardian (Public Guardian) as her conservator pursuant to the Lanterman-Petris-Short Act (Act). She contends insufficient evidence supports the grave disability finding (§ 5008) and three of the special disabilities imposed (§ 5357).
Welfare and Institutions Code, section 5000 et seq. Undesignated statutory references are to the Welfare and Institutions Code.
We disagree and affirm.
FACTUAL AND PROCEDURAL BACKGROUND
J.O. suffers from bipolar disorder with psychosis and has been prescribed antipsychotic and mood stabilizing medications. J.O. has been hospitalized as a result of her mental health disorder. From April to October 2018, J.O. was placed under a temporary Lanterman-Petris-Short (LPS) conservatorship.
J.O. was released from the hospital after the temporary conservatorship ended, but a few days later, she was rehospitalized. Shortly thereafter, the Public Guardian petitioned the superior court to establish a LPS conservatorship, alleging J.O. was gravely disabled as a result of a mental disorder and unable to provide for her basic needs. The petition also sought imposition of several special disabilities.
At a bench trial, the parties presented the following evidence: neuropsychologist Lyn Mangiameli, Ph.D., met with J.O. and talked with her treating psychiatrist. Mangiameli testified J.O. is gravely disabled. Her current diagnosis is "[b]ipolar mixed," with manic, depressive, and psychotic features. J.O. currently experiences symptoms in "three areas." First, J.O. has ongoing, long-term delusions: for example, J.O. thought health care providers were "terrorists" who were "putting down the Gaza Strip to stop her." Mangiameli opined J.O.'s delusions impart "sinister motives" to others and prevent J.O. from realistically assessing her circumstances. The second symptom J.O. displays is "bland affect," a characteristic of "psychotic depression." Third, J.O. lacks insight: she "has difficulty accepting" the nature of her illness. She does not accept bipolar disorder as an accurate diagnosis, and she denies having manic episodes.
Mangiameli testified J.O. is taking her prescribed medication, but noted the possibility she would stop taking the medication if she were not conserved, as she had on one prior occasion. When that happened, J.O. "ended up having to be rehospitalized." She "became very aggressive and threatening to staff and patients."
Mangiameli acknowledged J.O. had money to pay for transportation and short-term lodging, but opined she did not have an adequate plan for shelter because she did not have sufficient "emotional control" to maintain relationships "with landlords, with supermarket checkout people," and other people in the community who will help her "meet her needs." When J.O. was previously released into the community, she was rehospitalized "within . . . days;" according to Mangiameli, J.O. did not have a "plan for how she would manage herself to avoid that kind of circumstance again."
Mangiameli also opined J.O. should be subject to several legal disabilities. First, J.O. should not possess a driver's license because her medication "affects reaction time and can be sedating," and her delusions compromise her ability to understand "the motives and intentions of others." Second, J.O. should not enter into contracts because she has a hard time accurately perceiving "the nature of [her] reality." Third, J.O. should not refuse any type of medical treatment—either routine or specific to her grave disability—because she cannot rationally assess the value of that treatment and because her delusions affect her analytical decision making. Finally, J.O. should not possess firearms because her delusions impart "sinister motives to other people" and prevent her from making rational decisions.
J.O. testified she is depressed, but she denied experiencing manic episodes. She claimed she was "doing fine" after her temporary conservatorship ended, despite acknowledging she was confused and suggesting that men may have followed her from the hospital to her hotel. She also claimed her bipolar diagnosis was premised on fabrications. J.O. acknowledged needing medication for her mental illness and testified she would continue taking that medication if she were not conserved. She planned to "get a cab," stay at a hotel, and look for a job. J.O. had savings of $3,000 and received social security benefits.
The court granted the petition. It found J.O. gravely disabled, explaining: "I have listened to the testimony and reviewed the conservatorship investigation report filed . . . in connection with this case. . . . At the present time, [the] Court finds that the County has met its burden of proof beyond a reasonable doubt that [J.O.] is gravely disabled." The court also imposed the requested special disabilities.
DISCUSSION
The Act "governs the involuntary detention, evaluation, and treatment of persons who, as a result of mental disorder, are . . . gravely disabled. [Citation.] The Act authorizes the superior court to appoint a conservator of the person for one who is determined to be gravely disabled [citation], so that . . . she may receive individualized treatment, supervision, and placement [citation]. As defined by the Act, a person is 'gravely disabled' if, as a result of a mental disorder, the person 'is unable to provide for his or her basic personal needs for food, clothing, or shelter.' " (Conservatorship of John L. (2010) 48 Cal.4th 131, 142.)
"Grave disability must be proven beyond a reasonable doubt to establish and to renew LPS conservatorships." (Conservatorship of Johnson (1991) 235 Cal.App.3d 693, 696-697; Conservatorship of Carol K. (2010) 188 Cal.App.4th 123, 134 (Carol K.) [evidence must support "objective finding" of grave disability].) "The conservator must show the conservatee is presently gravely disabled," not merely that she "may relapse and become gravely disabled in the future." (Conservatorship of Guerrero (1999) 69 Cal.App.4th 442, 446.)
"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." (Carol K., supra, 188 Cal.App.4th at p. 134.) "Substantial evidence includes circumstantial evidence and the reasonable inferences flowing therefrom." (Conservatorship of Walker (1989) 206 Cal.App.3d 1572, 1577.)
I.
Grave Disability
J.O. acknowledges she suffers from a mental health disorder, but claims sufficient evidence does not establish she is gravely disabled, i.e., that she cannot provide for her basic needs as a result of that disorder. (Carol K., supra, 188 Cal.App.4th at p. 134.) We disagree. Mangiameli testified J.O. presently suffers from delusions that prevent her from realistically—and safely—assessing the circumstances around her. He also opined J.O. does not have the "emotional control" required to maintain relationships "with landlords, with supermarket checkout people," and other people necessary to "meet her needs." Additionally, Mangiameli noted that when J.O. was previously released into the community, she was rehospitalized "within . . . days," and that she did not have a "plan for how she would manage herself to avoid that kind of circumstance again." Finally, Mangiameli stated J.O. lacks insight into the nature of her mental illness: she does not accept bipolar disorder as an accurate diagnosis and denies having manic episodes. Together, this evidence establishes J.O. is gravely disabled: that as a result of her mental disorder, J.O. is unable to provide for her basic personal needs, specifically, food and shelter. (Conservatorship of John L., supra, 48 Cal.4th at p. 142; Conservatorship of M.B. (2018) 27 Cal.App.5th 98, 107-108 [sufficient evidence supported finding that minor was gravely disabled].)
J.O. points out that she is taking her medication, and notes she has financial resources and a plan to live independently. This argument is not persuasive because it overlooks the substantial evidence—discussed above—supporting the grave disability finding. It also misapprehends the standard of review. We cannot reweigh the evidence and substitute our judgment for the trier of fact. We must review the record in the light most favorable to the judgment. (Carol K., supra, 188 Cal.App.4th at p. 134.) Here, the trial court could reasonably infer that even though J.O. was taking her medication in a supervised setting and had a plan if she were released from the hospital, she still suffered from a mental health disorder that prevented her from providing for her basic needs.
J.O. claims the grave disability finding is premised on a fear of what might happen in the future if she stops taking her medication, rather than on her "present," medication-compliant, state. We disagree, for the reasons discussed in Conservatorship of M.B., supra, 27 Cal.App.5th at pages 107 to 108. This case is not, as J.O. suggests, like Conservatorship of Murphy (1982) 134 Cal.App.3d 15. There, the trial court premised a finding of grave disability solely on the " 'likelihood' " the conservatee would use alcohol in the future. (Id. at p. 18.) Here, J.O. had a history of failing to take prescribed medication, and Mangiameli testified J.O. is presently gravely disabled, even while medicated, because of her delusions, her inability to maintain relationships critical to her survival in an unsupervised setting, and because of her lack of insight into her mental illness. (Conservatorship of Guerrero, supra, 69 Cal.App.4th at pp. 446-447 [history of failing to take prescribed medication, coupled with a lack of insight into the individual's mental illness, may support grave disability finding].)
The only evidence supporting the grave disability finding was not—as J.O. claims—located in the conservatorship investigation report, which she claims is inadmissible. At trial, Mangiameli testified J.O. is gravely disabled based on his personal observation of J.O. J.O. also testified about her mental disorder and whether she could manage her own affairs if released from the hospital. The court listened to this testimony. It reviewed the investigation report but did not admit the document, nor base the grave disability finding on the report. For this reason, J.O.'s reliance on Conservatorship of Manton (1985) 39 Cal.3d 645 is misplaced. There, the court admitted—and the jury considered—a conservatorship investigation report "replete with hearsay" as "substantive evidence of [the conservatee's] condition." (Id. at p. 652.) That did not happen here.
To the extent J.O. suggests Mangiameli improperly testified about her prior psychiatric hospitalization, that claim is forfeited because J.O. failed to object at trial. (SCI California Funeral Services, Inc. v. Five Bridges Foundation (2012) 203 Cal.App.4th 549, 563-565.) Even if preserved, the argument fails. Any assumed error in admitting Mangiameli's testimony is harmless, because J.O. described the circumstances surrounding the prior hospitalization. (Conservatorship of K.W. (2017) 13 Cal.App.5th 1274, 1286.) --------
II.
Special Disabilities
Section 5357 authorizes the court to impose special disabilities on a conservatee, including those at issue here. (§ 5357, subds. (b)-(e).) " 'If a person is found gravely disabled and a conservatorship is established, the conservatee does not forfeit legal rights or suffer legal disabilities merely by virtue of the disability. [Citations.] The court must separately determine the duties and powers of the conservator, the disabilities imposed on the conservatee, and the level of placement appropriate for the conservatee. [Citations.] 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.' " (Conservatorship of George H. (2008) 169 Cal.App.4th 157, 165.)
The conservator, however, need not address each special disability by unique evidence directed at the particular disability, and the trial court is not required to make "a specific, on-the-record statement of the reasons for each order" regarding a special disability. (Conservatorship of George H., supra, 169 Cal.App.4th at pp. 165-166 [evidence supporting grave disability finding also supported order imposing special disabilities].) We affirm the imposition of special disabilities supported by substantial evidence. (Ibid.; Conservatorship of Amanda B. (2007) 149 Cal.App.4th 342, 347-348.)
J.O. challenges the sufficiency of the evidence supporting the imposition of the disabilities preventing her from entering into contracts and refusing medical treatment. First, we address the disability precluding J.O. from entering contracts (§ 5357, subd. (b)). Mangiameli opined J.O. should not be permitted to enter into contracts because her delusions impede her ability to accurately perceive reality and to make rational decisions. Mangiameli also testified J.O. imparts "sinister motives" to others, and lacks the "emotional control" necessary to form and maintain relationships. From this evidence, the court could reasonably infer J.O. was susceptible of undue influence, and therefore not capable of entering into contracts. (Civ. Code, §§ 1556 [persons of "unsound mind" not capable of entering into contracts]; 39 [incapacity based on an "unsound mind" includes persons susceptible to undue influence].)
Next we consider the disability precluding J.O. from making medical treatment decisions. (§ 5357, subds. (d), (e).) Factors the trial court must consider when imposing this disability are: "(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 [citation] and otherwise participate in the treatment decision by means of rational thought processes." (Riese v. St. Mary's Hospital & Medical Center (1987) 209 Cal.App.3d 1303, 1322-1323.)
Mangiameli opined J.O. should not be permitted to refuse medical treatment because she cannot assess the value of that treatment and because her delusions affect her analytical decision-making. Mangiameli also testified J.O. lacked insight into her illness: she did not accept bipolar disorder as an accurate diagnosis, and she denied having manic episodes. This testimony was corroborated by J.O.'s testimony. She testified she did not have manic episodes and suggested her bipolar diagnosis was premised on fabrications. Applying the factors listed above, this evidence amply supports the conclusion that J.O. is not capable of making medical decisions, both related, and unrelated, to her grave disability. (Conservatorship of Amanda B., supra, 149 Cal.App.4th at p. 345.)
DISPOSITION
The order appointing the Public Guardian as the conservator of J.O.'s person is affirmed.
/s/_________
Jones, P. J. WE CONCUR: /s/_________
Simons, J. /s/_________
Burns, J.