Filed 7/10/26 Conservatorship of B.L. CA1/2
NOT TO BE PUBLISHED IN OFFICIAL REPORTS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 This opinion has not been certified for publication or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.
IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
FIRST APPELLATE DISTRICT
DIVISION TWO
Conservatorship of the Person of B.L.
PUBLIC GUARDIAN OF CONTRA
COSTA COUNTY,
Petitioner and Respondent,
v. A174460
B.L.,
(Contra Costa County
Objector and Appellant. Super. Ct. No. P24-01135)
After B.L. was declared gravely disabled for the second time, the court
reappointed a conservator over B.L.’s person, found by clear and convincing
evidence that B.L. lacked the capacity to consent to medical treatment, and
precluded B.L. from refusing treatment related to his disability, including the
administration of psychotropic medication.
On appeal, B.L. does not contest the court’s grave disability finding but
challenges the portion of the court’s order precluding B.L. from refusing
treatment related to his grave disability. Because the order is supported by
substantial evidence from which a reasonable trier of fact could have made
the requisite findings by a high degree of probability, we affirm.
1
BACKGROUND
In June 2024, then 60-year-old B.L. was discovered “laying” in a local
park “in a completely disorganized state, covered with feces and insects.”
B.L. “was incoherent and unable to verbalize how he would take care of
himself and provide himself with food, clothing and shelter.” B.L. was placed
on a “5150” hold1 and taken by ambulance to the Contra Costa County
Regional Medical Center, where he was diagnosed with schizophrenia.
Upon admission, B.L. was “initially very agitated and uncooperative.”
He admitted to auditory hallucinations and “talk[ed] about being under a tree
with a woman with leprosy” but was otherwise “[u]nable to engage in further
interview.” B.L. agreed to take medication and was able to calm down “after
some redirection from [medical] staff.”
Over the following days, B.L. received “antipsychotics and mood
stabilizer[s]” but generally “remain[ed] agitated, constantly wandering all
over the unit and engaging in lots of behavioral outbursts,” which required
emergent “intramuscular injections and seclusion.” B.L. would also clog
toilets and “defecat[e] on milieu” and then “track[ ] feces all over the unit.”
Healthcare workers continued to increase B.L.’s medication and, after
approximately a month, B.L.’s “psychotic symptoms [were] diminishing in
intensity” and he “appear[ed] to be stabilizing.”
1 A 5150 hold refers to Welfare and Institutions Code sections 5150 and
5151, which permit a person to be taken into custody and detained for 72
hours if there is probable cause to believe that person is a danger to themself
or others because of a mental disorder. (Folsom Police Dept. v. M.C. (2021)
69 Cal.App.5th 1052, 1057.) Further undesignated statutory references are
to the Welfare and Institutions Code.
2
I. Initial Conservatorship
In July 2024, the Public Guardian for Contra Costa County (the Public
Guardian) petitioned for appointment of a temporary conservator and
conservatorship over B.L.’s person pursuant to the Lanterman-Petris-Short
Act (the LPS Act; §§ 5350, 5352, 5352.1). A temporary conservator was
appointed, and B.L. was transferred to a secured healthcare facility
(Crestwood) pending hearing. At the subsequent hearing on the petition for
conservatorship, B.L. objected and demanded a trial, which commenced on
August 26, 2024.2
On the second day of trial (August 27, 2024), B.L. agreed to the
establishment of a conservatorship with the understanding that it would last
up to one year, beginning that day. B.L. also requested an intervening
placement hearing, seeking a step down to an unsecured board and care
facility. The court set a placement hearing for September 2024, at which it
found that a board and care facility was the least restrictive placement. The
court also imposed several disabilities including, without objection, a
disability prohibiting B.L. from refusing “treatment related specifically to
[B.L.’s] being gravely disabled, including psychotropic medications” and
prohibiting B.L. from refusing “routine medical treatment unrelated” to being
gravely disabled.
By December 2024, B.L. had been accepted into a board and care
facility, but in January 2025, his transfer was “paused by the facility” due to
a “medical issue.” At the recommendation of his doctor, B.L. underwent an
endoscopy, which showed that B.L. had recently ingested “a bible verse, a
dollar bill, and playing cards.” B.L. admitted to eating the bible verse
2 B.L. initially demanded a jury trial but subsequently waived that
right and agreed to a court trial.
3
because “ ‘I thought God would help me’ ” but denied ingesting the other
items.3 B.L.’s doctor expressed concern that his pica behavior would
“ ‘progress into something unmanageable once [B.L.] steps down to a lower
level of care.’ ” Based on the endoscopy results, the board and care facility
rescinded B.L.’s admission, “stating PICA is outside of their scope of
practice.”
At a subsequent placement hearing in April 2025, the parties informed
the court that B.L. had exhausted his options for less restrictive board and
care facilities, which were unable to manage B.L.’s medical concerns. Thus,
the Public Guardian filed a notice to change B.L.’s placement level to a more
restrictive placement. B.L. objected, and the court set a contested hearing.
II. Reappointment Petition
In June 2025, the Public Guardian filed a petition for reappointment of
a conservator over B.L. with declarations from two licensed physicians, who
opined that B.L. remained gravely disabled due to a “medical disorder.” B.L.
requested a court trial, and the parties agreed to first try the reappointment
petition with the placement hearing “trailing.” The trial occurred between
July 21 and July 23, 2025.
After hearing motions in limine, the court admitted over objection
B.L.’s medical records from the Contra Costa County Regional Medical
Center and Crestwood.4 The Public Guardian called two witnesses:
3 B.L. subsequently stated that he had eaten about 12 pages of the
Bible. A social worker also discovered results from a 2017 colonoscopy that
“indicated bible verses were found inside of [B.L.’s] digestive tract at that
time.” We will adopt B.L.’s terminology and refer to the ingestion of nonfood
items as pica or pica behavior.
4 On appeal, B.L. does not raise any challenges to the trial court’s
rulings on his objections or any specific medical record admitted or excluded,
thus we do not detail the court’s in limine rulings in this opinion.
4
stipulated expert Shahbaz Khan, M.D. and deputy conservator Jamie Flores.
B.L. did not present any witnesses or documentary evidence.
A. Expert Testimony of Dr. Khan
Khan, a physician specializing in psychiatry, worked in private practice
and part time at Contra Costa County’s adult mental health clinic, providing
evaluations, diagnosis, and treatment for patients with severe mental illness.
Khan met with B.L. twice before the July 2025 trial—in August 2024 and in
June 2025, each time for 45 minutes—at the request of the Public Guardian.
Additionally, Khan reviewed notes from B.L.’s conservators, B.L.’s medical
records, and B.L.’s “ ‘Mental Health Face Sheet,’ which summarizes . . .
[B.L.’s] mental health facility encounters . . . over the past 10, 15 years.”5
Based on medical records and interviews with B.L., Khan believed B.L.
suffered from “chronic schizophrenia.” Schizophrenia is a “severe,” “chronic,”
and “long-term” impairment of “the brain functioning and psychological
functioning that is characterized by hallucinations, delusions, disorganization
of thoughts, catatonic-type behaviors, [and other] negative symptoms.” In
contrast to “other situations where people do hear voices,” someone
experiencing chronic schizophrenia is unable to recognize that the voices are
not real and believes that the voices “truly are talking to this person.” Khan
described this as a lack of “ ‘insight,’ ” which is the ability “to distinguish
whether one’s experience is [an] impairment of their psychological processes,
thought process, or not.” Khan explained that delusions “are another
category of symptoms of severe impairment in schizophrenia where a person
has [an] alteration in their belief system, which is psychotic in nature, in
5 Khan clarified that “encounters” referred to “hospitalizations, stays in
mental health facilities,” and other records “reflecting [an] inability or ability
to be independent or not independent in terms of shelter and living.”
5
which a person believes in things that are not real and typically are negative
in character.”6
Khan testified that psychiatric medications are the primary means of
treating the symptoms of schizophrenia with additional support from therapy
and counseling. According to Khan, while counseling can help “in managing
the symptoms,” the principal treatment is psychiatric medication to “help
reduce both the intensity, frequency, and the symptoms itself.”
Khan then identified and discussed four of the “six different”
psychiatric medications B.L. was prescribed and taking according to medical
records: clozapine, haloperidol, valproic acid, and benztropine. Clozapine
addresses “pretty much all” the major symptoms of schizophrenia, including
hallucinations, delusions, and mood instability. B.L. was prescribed “divided
doses,” meaning he would take different doses of clozapine twice during the
day. Due to its side effects, individuals taking clozapine require at least
monthly blood tests to obtain the medication, which is dispensed in monthly
or weekly supplies. Haloperidol, which B.L. took daily, treats delusions and
hallucinations and is given “as an adjunct if another primary medication, like
clozapine, may not be enough for the treatment of schizophrenia.” Valproic
acid, which B.L. took twice daily in different quantities, helps stabilize mood
swings and reduce agitation. B.L. also took two pills a day of benztropine,
which treats the physical side effects, such as stiffness, shakes, and tremors,
brought on by the original psychiatric medications.
Turning to the interviews, Khan described B.L. as “polite and friendly”
but displaying “symptoms of schizophrenia, like delusions of grandiosity,
6 “[N]egative in character mean[s] something in the form of persecution,
threats, and having this feeling and belief that people are out to get you, hurt
you, attack you, or kill you, or demean you-type of experiences.”
6
delusions of [persecution], and disorganization of thoughts.” While B.L. was
“alert and awake,” “he did not seem to be able to recall what the date was or
even what place he was at. He had some vague idea that he was in a
hospital-type setting.” B.L.’s “speech was disorganized” and “tangential at
times,” but B.L. “acknowledge[d] that he has schizophrenia” and “mentioned
that he heard voices in the past.” When asked about paranoia, B.L. gave
Khan “different answers at different times,” either disavowing paranoia or
admitting to “some amount of paranoia where the voices would put him down
and threaten him and say negative things.”
Khan testified that B.L. “has not lived independently ever” and that
B.L. had spent “a very long period of time” in “different facilities – mental
health facilities, hospitals,” in addition to experiencing homelessness “almost
for 31 years or so.” As for income, B.L. told Khan he received “Social Security
income” and mentioned “several times” that he was a famous guitarist
playing for bands like “Van Halen and Led Zeppelin.”7 However, B.L.
claimed he did not have “access” to his music income, which Khan described
as “delusion upon delusion, of having both grandiosity as well as persecution
where that money was somehow being held back.”
When asked about how to procure clothing and food, B.L. indicated “he
could go to clothing stores” and “to grocery stores or buy sandwiches.” B.L.
“didn’t have any clear plan” for shelter and “talked about somebody finding
him shelter or housing, one form [or] another, but no clear answers, no clear
plans.”
7 Khan “reality tested” this belief by asking follow-up questions.B.L.
claimed he was Jimmy Page, and his roommate was Robert Plant. Khan
described B.L. as being “determined and comfortable” in his belief that he
was Jimmy Page; thus, Khan “labeled it as a grandiose delusion.” At a
different meeting, B.L. claimed to be the lead guitarist of Van Halen.
7
Khan asked B.L. if he would take medication on his own, and B.L.
agreed. Still, according to Khan, medical records reflected “bizarre types of
behaviors,” such as “yelling in the hallway [of the hospital] naked,” which
Khan opined were “indicative of lack of insight; lack of understanding into his
condition; lack of ability to remain within social norms of decency, clothing;
and making delusional statements.” Khan noted that B.L. was, at the time,
“in a supervised facility” with “therapeutic dosages [of medication] being
prescribed” but “still [having] breakthrough symptoms of agitation,
aggression, unpredictable, bizarre behavior,” which “ reflect[ed] . . . a very
severe case of a severe mental disorder.”
Khan also believed B.L.’s pica behavior was “very indicative of not just
bizarre, but dangerous behavior.” Medical records from May 2025 noted that
B.L. “swallowed some papers” because, as B.L. told the social service worker
at the time, “ ‘that is my medication.’ ” Khan explained “that a person with
this much impairment is not able to understand and places themselves at
risk because of the nonfood quality of whatever they’re ingesting that can be
toxic to their body.” In Khan’s opinion, B.L.’s inability to understand that his
“symptoms arise from impairments of physical, psychological nature in the
brain” was “indicative” that B.L. “does not have any plan to take medications,
may not be cooperative in taking medications, and . . . may not be able to see
or appreciate the benefit of medications.”
Because of B.L.’s “breakthrough symptoms” despite a “significantly
high amount of treatment,” Khan opined that, if unsupervised, B.L. “would
[not] continue taking [his] medications.” B.L.’s breakthrough symptoms “lead
to lack of insight and cooperation in taking medications and even some delay
or disruption in any of [B.L.’s] medications can further deteriorate the level of
cooperation and insight and make things worse.”
8
Additionally, taking multiple medications in different quantities at
different times of the day “is a very complex and difficult task for any
person,” so B.L.’s disorganization of thought increased the risk of a disruption
in medication, which would “lead[ ] to more disruption and more impairment”
and, in turn, would inhibit B.L.’s “ability to take care of [his] food, clothing,
and shelter.”
B. Testimony of Deputy Conservator Flores
As deputy conservator for the Public Guardian, Flores oversaw the care
of conservatees, including B.L., and ensuring they had food, clothing, and
shelter.
Flores testified that B.L. said he would continue taking his medication
and would participate in mental health treatment “in the community,” but
B.L. could recall the names of only two of his medications. On several
occasions, B.L. told Flores that he had eaten nonfood items, such as paper,
dollar bills, and cotton balls. B.L. explained he had eaten toilet paper and
cotton balls because he was not “getting the pain medication that he needs”
and “believed the toilet paper would help him.”
When Flores asked how B.L. would get food if released to an unsecured
facility, B.L. stated he would go to a food bank but could not explain how he
would get there since he did not have a car. B.L. did not have a plan for
shelter if he was not conserved and stated he would go and buy his clothing
but provided no plan or details.
C. The Court’s Ruling and Imposition of Disabilities
After hearing closing argument on July 23, 2025, the court found B.L.
gravely disabled and granted the Public Guardian’s reappointment petition,
placing B.L. under a conservatorship until August 26, 2026. Based on its
review of the records, the court expressed a “concern as to [B.L.’s] ability to
9
continue to take medication when not supervised” and found that B.L.’s
symptoms interfered with his ability to provide himself with food, clothing,
and shelter.
The court then found the imposition of specific disabilities was
supported “by clear and convincing evidence.” As relevant to this appeal, the
court imposed a disability prohibiting B.L. from refusing “treatment related
specifically to [B.L.’s] being gravely disabled, including psychotropic
medications,” as well as a disability prohibiting the right to refuse “routine
medical treatment unrelated to remedying or preventing the reoccurrence of
[B.L.’s] being gravely disabled.”
At the subsequent contested placement hearing in August 2025, the
court found the least restrictive placement for B.L. was a secured facility.8
B.L. filed a timely notice of appeal.
DISCUSSION
In this appeal, B.L. challenges only one aspect of the reappointment
proceedings: “the trial court’s order imposing the disability that removed
[B.L.’s] right to refuse and consent to medical treatment related to his
disability.”
Once an individual has been declared gravely disabled, “[t]he LPS Act
specifically authorizes the court to designate certain ‘disabilities’ to which a
conservatee may be subject, including decisional disabilities relating to
medical treatment.” (K.G. v. Meredith (2012) 204 Cal.App.4th 164, 170,
citing § 5357.) These disabilities include “depriving the conservatee of ‘[t]he
right to refuse or consent to treatment related specifically to the conservatee’s
being gravely disabled’ ” and of “ ‘[t]he right to refuse or consent to routine
8 Because B.L. does not challenge the placement determination, we do
not detail the related testimony or proceedings.
10
medical treatment unrelated to remedying or preventing the recurrence of
the conservatee’s being gravely disabled.’ ” (K.G., at p. 170.) Absent a court
order imposing these disabilities, a conservator may not require a
conservatee to consent to medical treatment. (Ibid. [noting an emergency
exception not applicable here].)
“A court may order involuntary medication if clear and convincing
evidence shows the conservatee is incompetent to give or withhold informed
consent.” (Conservatorship of S.A. (2020) 57 Cal.App.5th 48, 55.) In making
that decision, the trial court considers “whether the conservatee lacks mental
capacity rationally to understand the nature of the medical problem, the
proposed treatment, and its attendant risks.” (Id. at p. 56, citing In re Qawi
(2004) 32 Cal.4th 1, 18.) If a patient’s health would be “greatly jeopardized”
without treatment and “the patient shows absolutely no appreciation of the
gravity of his situation, an inference can be drawn the patient understands
neither his illness nor the need for treatment.” (Conservatorship of Waltz
(1986) 180 Cal.App.3d 722, 728.)
On review, we evaluate “whether the record contains substantial
evidence from which a reasonable trier of fact could have made the finding of
high probability demanded by [the] clear and convincing standard of proof.”
(Conservatorship of S.A., supra, 57 Cal.App.5th at p. 56, citing
Conservatorship of O.B. (2020) 9 Cal.5th 989, 1005, 1009.) We do not reweigh
the evidence, and we presume all factual findings necessary to support the
judgment were made. (Conservatorship of S.A., at p. 56.)
Here, there is substantial evidence in the record indicating that B.L.
lacked mental capacity to rationally understand the nature of his diagnosis,
his medications, and the risks of stopping his medication. (Conservatorship
of S.A., supra, 57 Cal.App.5th at p. 56.) Although B.L. nominally
11
“acknowledge[d]” his schizophrenia diagnosis, Khan’s uncontradicted
testimony established that B.L. “lack[ed an] understanding of his condition.”
As Khan described, B.L. was “determined and comfortable” in his “grandiose
delusions” and in the belief that his delusions were true. B.L. did not
recognize that his symptoms (e.g., the voices and delusions) were not based in
reality and was therefore unable to “see or appreciate the benefit of his
medications.” Accordingly, to the extent B.L. acknowledged that he suffered
from schizophrenia, Khan believed B.L. was simply repeating “what others
have told [B.L.]” and lacked any “actual understanding or insight that there
is an impairment in the mental function.” Due to B.L.’s lack of insight into
his diagnosis, Khan opined that if B.L. was “released and independent in the
community,” he would not continue taking his medications.
Moreover, Khan explained that B.L. was experiencing “breakthrough
symptoms of agitation, aggression, unpredictable, [and] bizarre behavior”
while being prescribed “therapeutic dosages” of his medications “in a
supervised facility.” As Khan testified, B.L.’s medications required B.L. to
“adher[e] to a regiment [that] is a very complex and difficult task for any
person.” However, B.L. was able to identify only “a couple” of medicines that
he was taking and could not describe a plan for complying with his medicine
regimen when living independently. Thus, Khan opined it would be “highly
unlikely that [B.L. would] maintain a regular intake of these medications”
without supervision. The resulting effect of a missed dose would compound
“the frequency, amplitude, and intensity” of B.L.’s breakthrough symptoms
and impede B.L.’s ability to understand his diagnosis or secure food, clothing,
and shelter.
Additionally, B.L.’s pica behavior and belief that by consuming nonfood
items he was taking his medicines greatly jeopardized B.L.’s health and “can
12
be toxic” to the body. During his interviews, B.L. stated that he ate pages
from the Bible because he thought it was medication that “would help with
the pain.” As the unrebutted testimony of Khan established, while a patient
may learn from medical professionals and family members that medications
are likely to reduce their symptoms, their “core and fixed delusions and
hallucinations don’t go away.” In B.L.’s case, his longstanding and
continuous pica behavior, even while medicated in a secured facility, based on
his belief that nonfood items would “help” him reflected “all dimensions of
impairment, from being bizarre and illogical, to a nature of dangerousness in
behavior that can lead to medical and physical harm.”
In sum, the record reflects that B.L. not only fails to appreciate his
diagnosis and need for medication but also continues to experience
breakthrough symptoms that inhibit his ability to give informed consent.
Moreover, B.L.’s ongoing pica behavior poses an independent risk that
greatly jeopardizes B.L.’s health and, coupled with his inability to appreciate
the gravity of his situation, supports an inference that B.L. lacks an
understanding of his diagnosis and need for treatment. (Conservatorship of
Waltz, supra, 180 Cal.App.3d at p. 728.) Thus, considering the clear and
convincing standard, we conclude substantial evidence supports B.L.’s
involuntary medication order.
B.L. argues to us that medical records show he was polite and
compliant in taking his medications. While medical records support this
statement in part, they also show that other times B.L.’s “mood fluctuat[ed]
quickly from calm to angry and loudly yelling,” and B.L. had been noted as
“verbally aggressive” to at least one healthcare provider. Similarly, although
B.L. often accepted medication when prompted, he could also become agitated
and disruptive, requiring intramuscular injections and seclusion. Ultimately,
13
general politeness and partial compliance with directions do not demonstrate
that B.L. rationally appreciated his diagnosis or the need for treatment,
which is the focus of our inquiry on appeal. (Conservatorship of S.A., supra,
57 Cal.App.5th at p. 56.)
Additionally, the three cases B.L. cites in favor of reversal are
unhelpful: Conservatorship of S.A., supra, 57 Cal.App.5th 48;
Conservatorship of D.C. (2019) 39 Cal.App.5th 487; and Conservatorship of
Walker (1989) 206 Cal.App.3d 1572. (See also City of San Diego v. Boggess
(2013) 216 Cal.App.4th 1494, 1502 [“the specific facts” of other cases are
“unhelpful” when reviewing for substantial evidence].) In Conservatorship of
S.A. and Conservatorship of D.C., the courts affirmed the involuntary
medication orders where the conservatee lacked insight into their
schizophrenia diagnosis, like B.L. (Conservatorship of S.A., at pp. 51, 54–58;
Conservatorship of D.C., at pp. 490, 493–495.) In Conservatorship of Walker,
the court remanded for further proceedings because, unlike in B.L.’s case,
“the basis for the court’s [involuntary medication] order . . . is unclear on this
record.” (Conservatorship of Walker, at pp. 1578–1579.) Thus, neither B.L.’s
arguments nor his cited authority persuade us that the trial court’s
involuntary medication order lacks the requisite evidentiary support, taking
into account the clear and convincing standard of proof.
DISPOSITION
The order imposing the disability of involuntary medication as to grave
disability is affirmed.
14
DESAUTELS, J.
We concur:
RICHMAN, ACTING P. J.
MILLER, J.
Conservatorship of the Person of B.L. (A174460)
15