Filed 5/29/13 P. v. Nelson CA4/1
California
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COURT
OF APPEAL, FOURTH APPELLATE DISTRICT
DIVISION
ONE
STATE
OF CALIFORNIA
THE PEOPLE,
Plaintiff and Respondent,
v.
VERA NELSON,
Defendant and Appellant.
D061955
(Super. Ct.
No. SCD167943)
APPEAL from
an order of the Superior Court
of
County, Kerry Wells, Judge.
Affirmed.
Laurel M.
Nelson, under appointment by the Court of Appeal, for Defendant and Appellant.
Kamala D.
Harris, Attorney General, Dane R. Gillette, Chief Assistant Attorney General,
Julie L. Garland, Assistant Attorney General, James D. Dutton and Donald W.
Ostertag, Deputy Attorneys General, for Plaintiff and Respondent.
Vera Nelson
appeals from an order extending her involuntary
commitment as a mentally disordered
offender (MDO) for another year. She
argues there is insufficient evidence to support the MDO finding. She also contends the court erroneously
excluded evidence on the option of outpatient treatment, and applied the wrong
standard to decide the outpatient issue. We reject these contentions and affirm.
FACTUAL
AND PROCEDURAL BACKGROUND
Nelson
suffers from schizophrenia,
paranoid type; alcohol and cocaine dependence; and mild mental retardation.
2002 when she was living at a board and care facility. Nelson, who had been drinking heavily, got
into an argument with another female resident.
Nelson threw the woman across the room, punched her in the head and
chest, and repeatedly kicked her in the head, saying, " 'Get up, bitch.'
" Later, Nelson told the police
that she was very angry at the way she had been treated at the board and care
home; she took her anger out on the victim; she had a lot to drink; and she repeatedly
kicked the victim because the victim would not get up. The victim died four days later.
In 2004
Nelson pled guilty to voluntary manslaughter, and in March 2005 she was
committed to Patton State Hospital (Patton) as an MDO. (People
v. Nelson (2012) 209 Cal.App.4th 698, 703.)
From 2008 through 2011, her involuntary commitment was extended for
one-year periods. (Ibid.) In the current case,
the district attorney filed a recommitment petition on November 29, 2011. After a bench trial on May 10, 2012, the
court extended her commitment for another year, until March 19, 2013.
The
People's expert witnesses (psychologist Valerie Rice and psychiatrist Matthew
Carroll) reviewed Nelson's police and medical records, and personally
interviewed her in February 2012. Based
on information acquired from these sources, at trial they described her past
and current condition and behavior and provided their opinions concerning her
MDO status.
Nelson's
schizophrenia emerged in the 1980's or before, and prior to the 2002 commitment
offense she had numerous inpatient
persecutory delusions, hallucinations, thought disorganization, and extreme
impulse control problems. Her mental
illness also caused her to be guarded and suspicious of others and socially
isolated, and to have a "flat affect." Her persecutory delusions and illogical
thinking likely contributed to the commitment crime and other incidents. When she was free in the community, she had a
history of noncompliance with taking her medication, and had used cocaine and
alcohol on a daily basis for many years.
In 2011
(the year prior to the May 2012 trial), Nelson was involved in several
altercations with other patients and at times exhibited symptoms of her mental
illness. On January 2, 2011, she
complained to staff that her roommate's radio was too loud. A few minutes later, people were yelling for
staff to intervene, and when staff arrived at Nelson's room she was choking her
roommate. Nelson was escorted to another
room, but she tried to leave and attack her roommate again. She ran into a bathroom and attempted to
throw a trash can. Staff placed her in
restraints to control her.
Even though
Nelson was assigned a monitor to provide continual, one-on-one supervision, she
nevertheless again erupted into violence on January 4, 2011. When she went to another patient's room to
ask for something, a third patient yelled at her to get out of the room. Nelson grabbed this patient by both arms and
pushed her to the floor. Nelson's
supervising monitor intervened and escorted Nelson out of the room. About 10 minutes later, Nelson jumped up, ran
past the monitor, and grabbed the patient by the hair. Staff intervened and escorted Nelson to a
room. Nelson was agitated and was
kicking, swinging, spitting on staff, and stating, " 'I'm going to kill
all of you motherfuckers.' " Nelson
was placed in restraints and given an intramuscular injection.
In an
August 18, 2011 report, Patton staff gave Nelson a score of 40 on a
"Global Assessment of Functioning" (GAF) evaluation, which is defined
as involving some impairment, but which does not involve hallucinations,
delusions, or dangerousness.
name="_ftnref2" title="">[2] However, in this August report, Patton staff
also reported that they had observed Nelson engage in behavior that suggested
she was experiencing hallucinations or delusions, even though she denied that
this was occurring. Nelson was seen
having long conversations by herself, which could be a hallucinatory symptom of
a conversation with unseen others. She
was also displaying a flat affect, and was often suspicious and distrustful of
staff, avoided eye contact, and was socially isolative. Further, she exhibited disorganized behavior
which impacted her ability to care for herself.
In a
September 2011 report, Patton staff stated that she fluctuated in her
compliance with treatment and cooperation with staff; she intermittently
refused medical appointments and medications; at times she committed rule
violations and possessed contraband; and her group attendance and participation
were inconsistent. During this September
time period, Nelson told her treating psychiatrist that she was refusing her
medication because she believed she was going to die from a tumor.
was largely compliant with her treatment, but she continued to refuse
medication or other treatment on occasion.
In a November 2011 report, she was reported as being generally compliant
with staff and her treatment team.
In a
December 16, 2011 report, Patton staff again reported a GAF score of 40 and
stated that Nelson voluntarily took her medications. Dr. Rice agreed with the 40 GAF score. However, the December Patton report also
referenced an altercation between Nelson and another patient that occurred on
November 1 or 3, 2011, during which the patient called Nelson a "black
bitch" and Nelson then grabbed the patient's shirt.
In January
2012, Nelson was transferred from Patton to the county jail pending the May
2012 trial on the recommitment petition.
In January 5, 2012 discharge summary reports from Patton, staff reported
that Nelson was making "gradual progress" in her treatment; there was
no current evidence of delusional thinking; and she had not engaged in
"any assaults for a long time."
Although she had been noncompliant with some of her medications for her
physical conditions, she was compliant with her psychiatric medications. However, she still had "challenges with
living with others."
Jail
progress notes showed that while Nelson was housed at the jail from January
2012 until the May 2012 trial, she caused no problems and was compliant with
her medications.
Based on
their review of Nelson's medical records, the People's experts concluded that
Nelson had generally been cooperative with taking her psychiatric
medication. During the times when she
was uncooperative, she would take the medications with prompting. Dr. Carroll testified that her occasional
refusals to take her medication were a concern because of her potential for
violence.
Dr. Rice
assessed that since starting her involuntary treatment in 2005, Nelson had made
some progress; i.e., she participated more in the various programs, was fairly
compliant, and was cooperative most of the time. Dr. Carroll testified that her progress has
been "up and down[,]" with periods of relative stability and other
periods where she was doing poorly. The
relatively recent January 2011 incidents showed she was becoming "very
violent." However, over the last
year her performance had been "a little better."
When
interviewed by Drs. Rice and Carroll in February 2012, Nelson was cooperative,
pleasant, and calm. She did not report
any "positive symptoms" of schizophrenia, such as hallucinations or
delusions, and she did not engage in any overt behavior like screaming or
yelling. However, she displayed some
"negative symptoms" of schizophrenia, including "blunting"
of emotions or flat or restricted affect, sparse responses to questions,
confusion, and difficulty explaining herself.
Although she denied hearing voices, Dr. Carroll testified that when he
asked her a question she would sometimes just stare, which could indicate she
was responding to internal stimuli (i.e., voices in her head).
Dr. Rice
concluded that Nelson had limited insight into her mental illness. Although Nelson recognized that she has a
diagnosis of schizophrenia, she was unable to understand how her illness played
a role in her commitment offense and how it might make it difficult for her to
adjust to living outside of a highly structured environment. Similarly, Dr. Carroll testified that
although Nelson acknowledged that she needed treatment and medications, she did
not appear to understand the seriousness of her behavior and the crucial
importance of treatment.
When Dr.
Rice asked about her commitment crime in June 2002, Nelson said her friend fell
and hit her head on the coffee table while they were dancing; Nelson turned
around to see if her friend was all right; she held her friend in her arms and
wiped her head with towels because her head was bleeding; Nelson kept dancing;
and if she had not been so drunk she would have gotten help for her friend. Dr. Carroll testified that Nelson provided a
very vague description of the commitment offense, saying that she was drinking
and got into a fight. When Dr. Carroll
asked about her similar behavior in the hospital, she merely gave him a blank
stare and did not want to talk about it.
Drs. Rice
and Carroll acknowledged that in addition to her schizophrenia, Nelson's
cognitive delays, long-term substance abuse, and other factors (including a
brain injury) could contribute to her behaviors and symptoms. The doctors testified it was not possible to
separate out her various mental conditions, but her paranoid schizophrenia was
part of the cause of her symptoms and behavior.
Further, some of her symptoms were very indicative of schizophrenia
(including her bland affect), and some of her symptoms showed a condition that
was not attributable merely to mild mental retardation (including disorganized
speech, mood difficulties, repetitive speech, and social withdrawal).
Nelson told
the doctors that if she was released into the community she would like to live
with her sister in Kansas City and would be willing to see a psychiatrist. The doctors assessed that Nelson's plans were
not realistic. Dr. Rice did not think
Nelson would have adequate supervision and monitoring if she was in a less
structured environment. In Dr. Carroll's
view, she did not have a "good relapse prevention plan" but only
vaguely stated that she would go to her sister's place and her sister would
help her.
Although
Nelson's alcohol and cocaine dependence were currently in "institutional
remission," she did not have a plan to stay sober if released. When Dr. Carroll asked how she was going to
stay away from drugs, she vaguely responded that she would "just
stop" and not use them. Further,
although she told Dr. Carroll that she used to have a problem with
"crack" and get drunk a lot, when interviewed by Dr. Rice she
"greatly minimized" her past substance abuse, stating she only used
cocaine when she had money and she only drank alcohol "a little bit"
at parties.
Drs. Rice
and Carroll concluded that Nelson still met the MDO criteria because her severe
mental disorder was not currently in remission and she was a danger to others
as a result of her disorder. Nelson was
still displaying such schizophrenic symptoms as flat affect, disorganized
speech, confusion, being isolative and distrustful of others, and difficulties
regulating her anger and mood.
Concerning the danger caused by her severe mental disorder, the doctors
noted that her commitment offense was a violent crime of beating a person to
death, and she thereafter engaged in violence even though she was in a highly
structured and monitored hospital environment.
Further, the People's experts did not think she would be able to comply
with taking her medications if she was released in the community without
supervision, given that she was still struggling with lack of insight and she
only had vague plans if released.
Without her medications, she would most likely decompensate and become
dangerous. Also, if she used alcohol or
cocaine, this could cause impairment of judgment, lessening of impulse control,
counteraction of her medication, or failure to take her medication.
On
cross-examination, the People's experts acknowledged that under the standard
diagnostic manual (the DSM-IV-Text-Revision), the timeframe for evaluating
behaviors for remission is one year before the evaluation, and the January 2011
incidents were outside this time frame.
However, they noted the incidents were nevertheless relatively recent
(13 months before their February 2012 interviews and 16 months before the May
2012 trial). Dr. Carroll elaborated that
the one-year remission standard was for clinical, not litigation, purposes; and
in any event as a matter of common sense it was necessary to look at the
"big picture" when making an assessment.
Testifying
on her own behalf, Nelson stated that she knew she had paranoid schizophrenia,
but the last time she heard voices was "[l]ast year" and she had not
heard any voices "this year."
She explained that her medication had been changed in 2012 and the new
medication helped her a lot, worked better than her previous medication, and
helped her control her anger. She also
took classes that gave her tools to deal with her anger. She felt good and was not confused, and if
she were released from Patton she would continue to take her medications. She no longer had problems with drugs or
alcohol; had been attending AA and NA meetings; and knew she had to keep
attending these meetings. If released
she planned to go to Kansas City where she had family and where she would stay
in an outpatient mental health facility (called "Western Missouri")
until she could get her own apartment.
When asked
on cross-examination about the two altercations in January and the altercation
in November, at times she acknowledged she had been angry, but at other points
denied that she had been angry. When
denying that she had been angry, she claimed that instead she had been
"agitated" and "annoyed" or "trying to get [her] point
across." She recalled attacking the
patients during the January incidents, but claimed she did not fight with staff
when they intervened. She also testified
that getting angry at these things was in the past and she had become wiser and
grown up more. She acknowledged that her
commitment offense (which she called "the accident") was wrong and
stated she took responsibility for it, but she did not want to talk about the
details. She also denied feeling angry
during the commitment offense, saying that while the offense was happening she
felt sad and confused, and "wanted to get away from everything."
Trial Court's Ruling
In closing
arguments, the deputy district attorney argued that the January and November
2011 incidents showed Nelson still had a tendency towards violence and was
unable to deal with her anger even in a monitored environment; the expert
testimony established that her mental illness was not in remission; and whether
her new medication was working was a question for the future. The deputy district attorney stated that
although the January 2011 incidents occurred slightly more than one year before
the expert evaluations and trial, they were nevertheless relevant because the
more recent November 2011 incident was "framed" by the January
incidents and it would be irresponsible for an examining doctor not to take the
January incidents into account.
Nelson's
counsel argued that the People had not shown Nelson was still an MDO beyond a
reasonable doubt. In support, counsel stated
that a GAF score of 40 reflected some impairment but no risk of danger. Further, the only incident in the relevant
one-year time frame was the November incident, during which the other patient
was verbally aggressive and Nelson's conduct of grabbing the patient's shirt
did not rise to the level of physical violence or a serious threat. Nelson had been generally compliant with her
medications, and the symptoms that she displayed could be attributed to her
conditions other than schizophrenia.
Also, although the evidence showed her violence was caused by impulse
control and anger problems, there was no evidence that it was caused by
schizophrenic symptoms such as hearing voices or a break with reality.
The trial
court stated that it agreed with Dr. Carroll that even though the DSM manual
said the clinician should look to the past year when evaluating remission, the
clinician had to use common sense when making the evaluation and hence the
January 2011 incidents were relevant to the evaluation.
one-year period, there was evidence that she fluctuated in her medication
compliance even though she was generally compliant, and she was observed having
long conversations with herself which suggested delusional behavior. The court stated that although it appeared
that "things are improving[,]" it found the testimony of the two
doctors to be credible and reliable; Nelson was still an MDO beyond a
reasonable doubt; and her commitment should be extended for another year.
After the
court made the MDO finding, Nelson's counsel requested that the court consider
ordering outpatient treatment. In
response to the court's query, Nelson's counsel stated he did not have any
additional evidence to present on this issue.
The trial court declined to order outpatient placement, stating that it
was not convinced that Nelson "could be safely and effectively treated on
an outpatient basis at this time."
DISCUSSION
I.
Sufficiency of the Evidence
To obtain
another year of involuntary treatment based on an MDO finding, the People must
prove beyond a reasonable doubt that the person has (1) a severe mental
disorder, (2) the disorder "is not in remission or cannot be kept in
remission without treatment," and (3) "by reason of his or her severe
mental disorder, the patient represents a substantial danger of physical harm
to others . . . ."
(Pen. Code, § 2972, subds. (a), (c).)
establish that the person currently
meets the MDO criteria. (See
252; People v. Bell (1994) 30
Cal.App.4th 1705, 1710 [MDO criteria must be shown to exist as of the date of
the recommitment hearing].)
For
purposes of MDO status, a severe
include a personality disorder, mental retardation or other developmental
disabilities, or substance addiction or abuse.
(§ 2962, subd. (a)(2).) The
disorder is in remission when its overt signs and symptoms are controlled
either by psychotropic medication or psychosocial support. (§ 2962, subd. (a)(3).) When the disorder is in remission, it is
deemed to be unable to be kept in
remission without involuntary treatment if "during the year prior to the
question being before the . . . court" the person has
engaged in any of the following four actions:
(1) been physically violent except in self-defense; (2) made a serious
threat of substantial physical harm so as to cause a reasonable fear for
safety; (3) intentionally caused property damage; or (4) failed to voluntarily
follow the treatment plan. (§ 2962,
subd. (a)(3).)
Nelson
contends the record does not establish that she currently met the MDO criteria concerning remission and
dangerousness. She also asserts that the
record does not show her schizophrenia, as opposed to her other mental
conditions, was the cause of her
symptoms and behavior.
In
considering these contentions, we review the whole record in the light most
favorable to the judgment to determine whether a rational trier of fact could
find MDO status beyond a reasonable doubt.
(People v. Hannibal (2006) 143
Cal.App.4th 1087, 1096.) We draw all
reasonable inferences to support the trier of fact's findings, and defer to its
credibility resolutions. (
Concerning
the issue of current remission, the People's experts both opined that Nelson
was still evincing symptoms of schizophrenia.
Their opinions, which were credited by the trial court, are supported by
the record. About nine months before trial,
in an August 2011 report, Patton staff described Nelson as exhibiting symptoms
indicative of schizophrenia, including having lengthy conversations with
herself, displaying a flat affect, being distrustful and isolated, and engaging
in disorganized behavior. About six
months before trial, during the November 2011 incident, she grabbed a patient's
shirt, which was symptomatic of the impulse control and anger problems she had
repeatedly exhibited on previous occasions and which the doctors attributed to
her mental illness. About three months
before trial, during the February 2012 interviews with the People's experts she
exhibited typical "negative" symptoms of schizophrenia, including
flat affect, confusion, and sparse responses.
During Dr. Carroll's interview, she displayed signs of listening to
internal stimuli when she stared into space rather than answering his
questions. This evidence supports the
court's finding that her severe mental disorder was not currently in remission.
In support
of her challenge to the court's no remission finding, Nelson argues that the
experts agreed that during the February 2012 interviews she did not exhibit
positive symptoms of schizophrenia, such as delusions or hallucinations. The absence of overt positive symptoms during
the interviews does not defeat the other evidence showing that her illness was
not in remission, including her display of negative symptoms during the
interviews; her demeanor suggestive of internal stimuli during Dr. Carroll's
interview; her aggressive conduct in November 2011; and her symptomatic
behavior described by Patton staff in August 2011.
Nelson also
argues there was insufficient evidence to establish that she was currently
dangerous, as opposed to dangerous in the past.
We are not persuaded. In January
2011, Nelson engaged in a high level of violence against other patients on two
occasions. In November 2011, she was
again involved in an altercation involving physical contact with another
patient. Although the November incident
did not escalate to extreme violence, it nevertheless supported that only a few
months before trial she was still unable to refrain from using physical
aggression when she felt angry or provoked.
The finding
of current dangerousness is also supported by the doctors' assessments that she
lacked insight about the connection between her mental illness and her violent
behavior, and about the seriousness of her behavior and the importance of
treatment. The experts' opinions on lack
of insight are supported by Nelson's failure to mention her assaultive conduct
when describing the commitment offense to Dr. Rice, and her attempts to
minimize her anger when describing her assaultive conduct in her trial
testimony. Additionally, the current
dangerousness finding is supported by the doctors' concerns that she would not
take her medication if released into the community given her ongoing lack of
insight and her intermittent refusals in 2011 to take her medication while at
Patton.
To
generally undermine the evidentiary support for the court's no remission and
dangerousness findings, Nelson argues that the expert's opinions on these
issues were based on "stale information" because they relied on the
January 2011 altercations which occurred more than one year before the February
2012 evaluations and May 2012 trial.
There is no strict rule limiting the no remission and dangerousness
assessments only to incidents that occurred during the preceding one-year
period. Although the ultimate findings
must be based on the patient's condition at the time of trial
v. Bell, supra, 30 Cal.App.4th at p. 1710), past incidents may well be
relevant to fully evaluate the nature of the patient's condition and potential
for violence. (See People v. Cobb, supra, 48 Cal.4th at p. 252 ["defendant's
condition a year earlier is relevant" although "not dispositive"
on issues of current remission and dangerousness]; see also § 2962, subd. (f)
[" '[S]ubstantial danger of physical harm' does not require proof of a
recent overt act."].) The January
2011 incidents were close in time to the one-year period before the February
2012 interviews and the May 2012 trial, and the experts' consideration of the
January incidents does not undermine the evidentiary support for the court's
MDO finding based on the experts' opinions.
In a
related argument, Nelson argues that when rendering their opinions on remission
and dangerousness, the People's experts did not consider recent information
showing her medication had been changed and her behavior had improved. Although there was evidence showing Nelson's
behavior had improved, the physical aggression she displayed in November 2011,
coupled with the high level of violence she had displayed in January 2011,
support a finding that she was still dangerous and exhibiting signs of her
mental illness. The court could
reasonably infer that Nelson must display a longer period of consistent
nonaggression to warrant a finding that her illness was in remission and she
was no longer dangerous.
Finally,
Nelson argues that the record does not establish that her schizophrenia, as
opposed to her other mental conditions, was the cause of her symptoms and
behavior. The causative overlap between
her various mental conditions does not defeat the showing that her
schizophrenia was a significant factor causing her symptoms and behavior. The experts testified that although all her
conditions could contribute to her symptoms and behavior, her schizophrenia was
part of the cause. Given that she had
been suffering from acute schizophrenia for many years, the trial court could
reasonably infer that her schizophrenia was a substantial factor giving rise to
her symptoms and behavior. (See
Cal.App.4th 1310, 1321-1322 [causation defined based on substantial factor
test].) The fact that her other
conditions may also have contributed to her symptoms and behavior does not
defeat this finding.
II.
Outpatient Treatment
The Penal
Code contains provisions which permit certain types of mentally disordered
committees to be placed in a supervised outpatient community treatment program
when this placement is recommended by the inpatient treating hospital and/or by
the proposed outpatient community program, and then approved by the court. (§§ 1600-1604; People v. May (2007) 155 Cal.App.4th 350, 359-360.) Additionally, the Legislature has enacted a
distinct provision (§ 2972, subd. (d)) for MDO's which authorizes the court to
order outpatient placement even without the recommendation of the treating
hospital and community program. (
court "has authority to release the MDO for outpatient treatment so long
as it finds 'there is reasonable cause to
believe that the committed person can be safely and effectively treated on an
outpatient basis.' " (
When
requesting outpatient treatment, the MDO has the burden to show he or she is
suitable for this placement. (
Cal.App.4th 306, 315-316.) To meet this
burden, the MDO need not satisfy "the preponderance standard
of . . . more likely than not"; rather, the statutory
" 'reasonable cause' " standard merely requires "a strong
suspicion in a person of ordinary prudence that outpatient treatment would be
safe and effective." (
outpatient treatment at the time of an MDO recommitment trial, the MDO may
properly present evidence on the outpatient issue, including, for example,
relevant testimony or evaluations of treatment staff and community program
staff. (See People v. May, supra, 155 Cal.App.4th at pp. 359, 363.)
Nelson
asserts that we should remand this case to the trial court for a hearing on
whether she could safely be placed in outpatient treatment because the trial
court (1) precluded her from presenting evidence on the appropriateness of
outpatient treatment, and (2) failed to apply the correct standard for the
outpatient treatment issue.
In support
of her contention that she was not allowed to present evidence on the
outpatient issue, she cites a portion of the record where her counsel attempted
to ask Dr. Rice questions about whether she could be safely released in the
community if she was supervised by the outpatient community program
"CONREP." The deputy district
attorney objected to this evidence on relevancy grounds, arguing, among other
things, that the evidence was not relevant at this phase of the trial because
the suitability of CONREP was only an issue once Nelson was recertified as an
MDO. The trial court sustained the
objection.
At the
conclusion of the trial after the court made the MDO finding, Nelson's counsel
requested that the court consider ordering outpatient treatment. The court asked if this required the presentation
of additional evidence. The deputy
district attorney interjected that the
question was whether the court finds "there is reasonable cause to believe
that the person can safely and effectively be treated on an outpatient
basis[,]" and argued this finding was not warranted due to Nelson's
violence and the possibility she "could get better in the Patton
setting . . . ."
The court then asked Nelson's counsel if there was any additional
evidence he wanted to provide on this issue, and Nelson's counsel answered,
"No, Your Honor."
The court
then ruled, "Without any further evidence presented to the Court on this
issue, the only evidence that I have before me from the doctors' testimony is
that [Nelson] represents a substantial danger to others if released. And I
am not convinced that she could be safely and effectively treated on an
outpatient basis at this time. And
that's predominantly because of the concerns regarding her medication
compliance as well as her history that's documented in the reports of both
doctors, which include . . . this is not a recent
diagnosis. This is a chronic illness
that she's been suffering from. And in
the past, she's had numerous psychiatric admissions, including 5150
admissions." (Italics added.)
Contrary to
Nelson's assertion, the record shows that her counsel had a full opportunity to
present evidence on the outpatient issue.
Although the court precluded the evidence before it made the MDO finding, after
it made the MDO finding it explicitly invited her counsel to present evidence
on the outpatient issue. Her counsel
declined to present evidence at this latter juncture, and he made no indication
that he was deprived of the opportunity to present relevant evidence based on
the court's earlier ruling during Dr. Rice's testimony. There was nothing inherently wrong with the
court's initial ruling excluding the evidence, because if it had found she was
no longer an MDO she would have been discharged from her commitment and there
would have been no need to consider the outpatient treatment issue. Because the court gave Nelson an opportunity
to present evidence on the outpatient issue after it made the MDO finding,
Nelson has not shown error based on the court's earlier evidentiary ruling.
We are also
satisfied that the court applied the "reasonable cause to believe"
standard when resolving the outpatient issue.
This reasonable cause standard was expressly and correctly defined by
the deputy district attorney just before the court made its ruling. Although the court did not explicitly
reiterate the reasonable-cause-to-believe language when making its finding,
absent a contrary showing in the record, we assume the court was aware of and
applied the correct law. (
(1986) 178 Cal.App.3d 1026, 1032.)
DISPOSITION
The order is affirmed.
HALLER, J.
WE CONCUR:
McCONNELL, P. J.
IRION, J.
name="_ftn1" title="">[1] Nelson reads at about second grade level.
name="_ftn2" title="">[2] The 40 score is defined as "some impairment in reality
testing or communication or major impairment in several areas such as work or
school, family relations, judgment, thinking or mood." A score of 30 is defined as behavior
"considerably influenced by delusions or hallucinations or serious
impairment in communication or judgment or inability to function in almost all
areas." A score of 20 is defined as
"some danger of hurting self or others or occasionally fails to maintain
minimal personal hygiene or gross impairment in communication." A score of 10 is defined as "persistent
danger of severely hurting self or others or persistent inability to
maintain . . . minimal personal hygiene or serious suicidal
act with clear expectation of death."
