State Dept. of State Hsopitals v. R.C. CA5 ( 2023 )

Filed 8/18/23 State Dept. of State Hsopitals v. R.C. CA5
NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS
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IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
FIFTH APPELLATE DISTRICT
STATE DEPARTMENT OF STATE
HOSPITALS, F085696
Petitioner and Respondent, (Super. Ct. No. 22CEPR01444)
v.
OPINION
R.C.,
Defendant and Appellant.
THE COURT*
APPEAL from an order of the Superior Court of Fresno County. Brian M. Arax,
Judge.
Linda J. Zachritz, under appointment by the Court of Appeal, for Defendant and
Appellant.
Office of the State Attorney General, Sacramento, California, for Petitioner and
Respondent.
-ooOoo-
* Before Levy, Acting P. J., Franson, J. and DeSantos, J.
R.C. is a patient civilly committed under the Sexually Violent Predators Act
(SVPA) (Welf. & Inst. Code, § 6600 et seq.), committed at the State Department of State
Hospitals (DSH) at Coalinga. DSH petitioned for an order compelling involuntary
medical treatment of R.C. for a “severe left ventricular systolic dysfunction.” The
petition was granted and R.C. appeals.
R.C.’s counsel has outlined the relevant facts pursuant to Conservatorship of
Ben C. (2007) 40 Cal.4th 529. R.C. was notified of the nature of the brief filed by his
appellate counsel and afforded an opportunity to file a supplemental brief. He submitted
four documents in this case since that time. In those documents he: (1) contends doctors
unlawfully implanted an experimental device in his body which allows remote control of
his thoughts and actions, but he is nevertheless sane; (2) claims that no attorney
represents him and asks what recourse is available; (3) claims his attorney did not contact
him, that he was muted at the hearing on the petition, and that “[t]he ugly one” who
controls him limited his mental capacity to respond in this case; and (4) contends that his
attorney has not contacted him, that the incompetency proceedings were procedurally
flawed because he was muted during the hearing, and he was not adjudged incompetent
and therefore retains his right to refuse medical care. The People filed no responsive
brief. Finding that no reasonably arguable factual or legal issues exist, we dismiss R.C.’s
appeal.
BACKGROUND
On May 8, 2007, R.C. was committed to DSH Coalinga pursuant to Welfare and
Institutions Code section 6604.
On December 6, 2022, DSH filed a petition1 to compel R.C. to submit to
involuntary medical treatment for severe left ventricular systolic dysfunction by
1 In support of the petition, DSH filed declarations by a staff psychiatrist and staff
surgeon at DSH Coalinga. All of the factual allegations made in the petition were
supported by the declarations attached to the petition.
2.
placement of a Bivent Implantable Cardioverter Defibrillator (ICD) and other treatment.
The petition alleges that “[t]here are no medical alternatives to conducting this treatment.
Without the treatment, [R.C.] will continue to be at risk of progression to advanced
congestive heart failure which could result in his death.” The petition further alleges that
an order compelling the treatment is necessary because defendant’s diagnosed mental
health condition—schizophrenia and paraphilic disorder—which has caused symptoms
including “paranoid and somatic bizarre delusions, hallucinations, [and] disorganized
behavior,” resulted in his inability to understand the nature of and risks involved in his
medical condition. Defendant believes he is healthy and “instead focuses on his fixed
delusion of … ‘a wire in his back.’ His thought process and decision making are
influenced by his psychiatric symptomology, and he is not able rationally [to] make
decisions related to his mental or physical health.”
On January 18, 2023, the trial court conducted a hearing on the petition. The
parties agreed that the court could consider the declarations of the staff psychiatrist and
staff surgeon filed in support of the petition without taking testimony. R.C.’s counsel
explained that R.C. believes he is healthy, and his only medical problems come from a
“wire and chip in his back that he needs to have removed ….” R.C. was willing to
consent to medical procedures necessary to treat “immediate and life threatening”
conditions, but he did not believe that implantation of the ICD and other treatment sought
fell into that category. Counsel for DSH noted that the declarations submitted reflected
that R.C. had “several significant heart conditions” and implantation of the ICD was
necessary support “in order to continue him having this healthy functioning life.”
The trial court concluded that defendant had a heart condition that required
treatment and, due to his serious mental health condition, he was unable to make medical
decisions in his own best interest. He could not “evaluate the risks and the benefits of the
treatment proposed, nor c[ould] he adequately therefore provide an informed consent or
denial to that treatment.” Finally, the court found that there was no less-intrusive manner
3.
to provide effective treatment for defendant’s medical condition and implantation of the
ICD and postimplantation treatment were therefore necessary. Based on those findings,
the court granted the petition.
On January 25, 2023, defendant filed a notice of appeal.
DISCUSSION
As noted, R.C.’s counsel has filed a brief identifying no reasonably arguable
issues on appeal. We have exercised our discretion to proceed with this appeal and
review the record consistent with the standards set forth in Ben C. and People v. Serrano
(2012) 211 Cal.App.4th 496, 503–504. As the court in Ben C. described in the context of
a conservatorship appeal, when appointed appellate counsel finds no arguable issues,
“counsel need not and should not file a motion to withdraw. Instead, counsel should
(1) inform the court he or she has found no arguable issues to be pursued on appeal; and
(2) file a brief setting out the applicable facts and the law. Such a brief will provide an
adequate basis for the court to dismiss the appeal on its own motion.” (Conservatorship
of Ben C., supra, 40 Cal.4th at p. 544.)
Here, R.C.’s counsel has filed a brief outlining the facts and procedural history and
advising R.C. of his right to file a supplemental brief. We also informed R.C. of his right
to file a supplemental brief. As noted above, R.C. submitted four documents after we
informed him of his right to file a supplemental brief. We briefly summarize the issues
he has raised and explain why none provide a basis for relief in this case.
First, defendant contends that he was implanted with a “fixation device” but
contends that he is sane and presented evidence to prove his sanity. A competent adult
has a common law and constitutional right to refuse medical treatment. (In re Qawi
(2004) 32 Cal.4th 1, 14.) An involuntarily committed patient may be forcibly treated for
medical conditions if a court has determined that he is not competent to refuse treatment.
(Ibid.; In re Calhoun (2004) 121 Cal.App.4th 1315, 1354.) The superior court shall
determine competence to refuse treatment by clear and convincing evidence, “so clear as
4.
to leave no substantial doubt, [and] sufficiently strong to command the unhesitating
assent of every reasonable mind.” (Conservatorship of Waltz (1986) 180 Cal.App.3d
722, 733, fn. 14.)
After independent review of the record on this issue, we find that no reasonably
arguable factual or legal basis to challenge the sufficiency of the evidence exists. The
DSH Coalinga staff psychiatrist stated in his declaration that defendant had been
diagnosed with schizophrenia and paraphilic disorder. His symptoms include paranoia,
delusions, hallucinations, and disorganized behavior. “His delusions include the belief
that he was being controlled by the mafia and the government, he was equipped with a
battery pack that knocks him out, and that he had an implant in his teeth that controlled
his brain.” R.C. denies having medical issues and instead focuses on “his fixed delusion
of a removal of ‘a wire in his back.’ His thought process and decision making are
influenced by his psychiatric symptomology, and he is not able rationally [to] make
decisions related to his mental or physical health.”
Sufficient evidence supported the trial court’s conclusion that R.C. was not
competent to refuse treatment.
Second, R.C. contends that no attorney represents him and his appointed attorney
failed to return his calls. The record before us confirms that an attorney was appointed
on behalf of R.C. and filed a Ben C. brief on his behalf. R.C.’s attorney also states in her
declaration that she communicated with R.C. regarding her findings about the case and
sent a letter advising R.C. of the nature of the brief filed in this case and R.C.’s option to
file a supplemental brief. Defendant’s second letter identifies no basis for relief.
Third, R.C. again contends that his appellate attorney had not communicated with
him, he was placed on mute during the hearing on the petition, and he was unable to “use
[his] full potential of mind” because “[t]he ugly one” deliberately “jolts [him] and blocks
[his] own thoughts.” We have addressed his first contention and can offer no relief as to
his third contention. As to R.C.’s second contention, R.C.’s trial attorney represented
5.
that R.C. did “not wish to testify.” R.C. does not dispute that account in his response.
Further, the record does not indicate that R.C. was muted at the hearing on the petition,
but the record also does not indicate R.C. spoke at the hearing. Even assuming R.C. was
muted, no harm resulted. (See In re James F. (2008) 42 Cal.4th 901, 916–918.) At the
hearing, R.C.’s trial attorney represented that she had communicated with R.C. and R.C.
asked that the attorney make a statement on R.C.’s behalf. R.C.’s trial attorney relayed
that R.C. denied having a heart condition and believed that he has a “wire in his back or a
computer chip” that needed to be removed. R.C.’s trial attorney also conveyed that R.C.
would consent to emergency medical treatment for any immediate and life-threatening
medical issue, but he does not believe that he has a heart condition that requires
treatment. That position is consistent with R.C.’s position in his letters. Because R.C.
has identified no argument that he would have presented to the trial court that was not
already presented by his trial attorney, any error in muting him was harmless beyond a
reasonable doubt. Accordingly, R.C.’s third letter and the record before the court provide
no basis for relief.
Fourth, R.C. contends again that he was muted at the hearing on the petition and
contends for the first time that he was not judged incompetent to make his own medical
decisions. We have already addressed the issue of R.C. potentially having been muted at
the hearing on the petition. As to his second contention, he is mistaken. As described
above, the trial court considered the evidence presented by the staff psychiatrist and staff
surgeon and concluded that defendant had a mental condition that prevented him from
understanding the nature of his medical issues. The court further concluded that R.C.
required the proposed medical care and that no less invasive treatments were sufficient.
Clear and convincing evidence supported the court’s conclusions. (In re Qawi, supra, 32
Cal.4th at p. 14; In re Calhoun, supra, 121 Cal.App.4th at p. 1354; Conservatorship of
Waltz, supra, 180 Cal.App.3d at p. 733, fn. 14.) On that basis, the trial court
appropriately ordered treatment. R.C.’s fourth letter provides no basis for relief.
6.
DISPOSITION
R.C.’s appeal is dismissed.
7.