Conservatorship
of Nicole O.
Filed
1/9/13 Conservatorship of Nicole O. CA4/1
California Rules of Court, rule
8.1115(a), prohibits courts and parties from citing or relying on opinions not
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COURT OF
APPEAL, FOURTH APPELLATE DISTRICT
DIVISION ONE
STATE OF CALIFORNIA
Conservatorship of the
Person of NICOLE O.,
SAN DIEGO COUNTY
HEALTH AND HUMAN SERVICES AGENCY
Petitioner and Respondent,
v.
NICOLE O.,
Objector and Appellant.
D062440
(Super. Ct. No.
MH107355)
APPEAL
from an order of the Superior
Court
of
San
Diego County, Gale E. Kaneshiro, Judge. Affirmed.
Thirty-five-year-old
Nicole O. appeals a judgment establishing a conservatorship of her person
pursuant to the Lanterman-Petris-Short Act (the LPS Act) (Welf. & Inst.
Code, § 5000 et seq.).
name="_ftnref1" title="">[1] She contends that the
Agency (the Agency) failed to present substantial evidence to (1) establish
that she was "presently gravely disabled" and (2) support the court's
order placing her in a closed, locked facility.
We disagree and affirm the judgment.
FACTUAL
AND PROCEDURAL BACKGROUND
Nicole
was diagnosed with schizoaffective disorder when she was 16 and was
hospitalized multiple times from 1995 to 2005 as a result thereof. After being hospitalized four times in four
months in 2005, a conservatorship was established over Nicole in November based
on a jury finding that she was gravely disabled. Nicole was placed in an inpatient treatment
program at the Alpine Special Treatment Center (the Alpine Center).
Nicole
was hospitalized several more times the following year and in June 2007, a
conservatorship was temporarily established over her and she was placed at the
Cresta Loma inpatient treatment program.
The conservatorship was later terminated, however, after a jury
determined that Nicole was not presently gravely disabled and she moved to an
independent living facility.
Nicole
was hospitalized at the University of California San Diego (UCSD) Medical
Center's
psychiatric unit in August 2007 and returned to Cresta Loma under another
temporary conservatorship, but that conservatorship was terminated in December
2007 based on a jury determination that she was not gravely disabled. After being discharged, Nicole went to Mexico
for several weeks. When she returned to
the United States,
she was picked up at the border in a psychotic and malnourished state and with
a severe wound on one wrist. She was
hospitalized several more times in 2008 as a result of her failure to take her
medications.
In May
2009, Nicole began consistently taking her medications, which included a
monthly antipsychotic injection (Prolixin), and thereafter she was able to live
on her own in an apartment, although she had trouble managing her money,
spending so much on clothing or knickknacks that she did not have enough for
food. Further, in late 2010 she stopped
complying with her medication regimen and was hospitalized for her symptoms
several times in 2011. In August 2011,
Nicole was evicted from her apartment (which was dirty, unkempt and had many
holes punched in the walls) and she went with her father to live in Rosarito
Beach, Mexico. Unfortunately, she did not take Prolixin
while there and she ended up homeless in Tijuana.
In
early 2012, Nicole returned to San
Diego and in March she sought
treatment for a cold at UCSD. (All
further dates are in 2012 except as otherwise noted.) She presented as having delusions, paranoia,
hallucinations and disorganized thinking and suffering from malnourishment and
was admitted to UCSD's psychiatric facility.
She was treated by a team of doctors, including Dr. Louisa Steiger. In May, Nicole was transferred from UCSD to the
Alpine Center.
In the
interim, the Agency filed a petition to establish a conservatorship over
Nicole, and a temporary conservator was appointed for her. Judge Frederick Maguire held a hearing on the
Agency's petition in May, wherein Dr. Steiger testified that Nicole suffered
from schizoaffective disorder, bipolar type, and, as a result, was subject to
hallucinations, and paranoid, delusional and disorganized thinking. Although Nicole complied with her medication
plan while hospitalized, Dr. Steiger opined that, based on her history and
limited insight into her mental illness, Nicole would not continue to be
medically compliant if unsupervised and thus would not be able to consistently
provide for herself on an independent basis.
Dr. Steiger also testified that the least restrictive level of placement
for Nicole was a closed, locked facility, at least for a four-month period; Dr.
Steiger also indicated that if Nicole continued to do well during that period,
she might qualify for a change in placement thereafter.
Nicole
testified at the hearing, indicating that she had been consistently taking
Prolixin for her disorder, except during her most recent time in Mexico when it
was too inconvenient for her to come back to the United States, and that she
ultimately returned to UCSD specifically to get a Proxilin shot. She testified that she was "very, very
capable" of providing for her own shelter, food and clothing, as she had
"for years," and planned to live in a board and care facility or a
single occupancy room hotel if she was not placed into a conservatorship.
Judge
Maguire found that Nicole suffered from a mental disorder and, based on her
state when she appeared at UCSD and the
needed several months of consistent treatment to allow her to reach a baseline
point with her mental illness, sustained the Agency's petition, appointed a
conservator for Nicole and ordered her to be placed in a closed, locked
facility. Nicole thereafter demanded a
jury trial on the issue of whether she was gravely disabled.
At
trial, Dr. Steiger gave similar testimony as she had at the hearing before
Judge Maguire as to Nicole's diagnosis and its consequences, noting that
Nicole's mental illness had impaired her ability to provide food, clothing and
shelter for herself in the past. Dr.
Steiger also testified that schizoaffective disorder would affect Nicole's
ability to independently maintain her medication regimen because it caused her
difficulties in processing information about her disorder and resulting
behaviors and because in the past she had denied having a psychiatric
condition. Although Nicole complied with
her medication plan during her most recent two-month hospitalization and her condition
had improved "dramatically" as a result, Dr. Steiger opined that,
based on Nicole's history and limited insight into the severity of her mental
illness, Nicole would not continue to take her medications if unsupervised and,
as a result, she would not be able to consistently provide for herself on an
independent basis.
Nicole's
mother, L.K., also testified about Nicole's diagnosis and history, indicating
in part that although her daughter did well with medication, she did not
believe that Nicole could live independently given Nicole's frequent medication
noncompliance over the years. Although
Nicole had lived with L.K. on and off until 2005, she was unable to do so after
that time because of her aggressive and occasionally violent behavior, although
L.K. kept in frequent in-person and telephone contact with her since then. L.K. also testified that although Nicole was
good at getting into board and care or other housing situations, they usually
did not last for more than one or two months because Nicole would go off of her
medications and then leave. Finally,
L.K. testified about Nicole's difficulties in managing money and said that
since August 2011 she had been administering Nicole's Social Security benefits,
which she used to pay for Nicole's food and shelter when Nicole was not
institutionalized.
name="_ftnref2" title="">[2]
Nicole
also took the stand, testifying that she knew she had schizoaffective disorder
and had been taking Proloxin consistently for six years to treat it, although
she felt that her prior delusions (many of which she denied having) resulted
from stress rather than medication noncompliance. She opined that she was
"absolutely" capable of providing food, clothing and shelter for
herself and that she would continue to take her medications if she was not
placed in a conservatorship. She also
admitted that she was in a much better mental state at the time of trial than
she was when most recently admitted to UCSD.
The
jury found that Nicole was presently gravely disabled. Trial Judge Gale Kaneshiro adopted Judge
Maguire's findings and order establishing the conservatorship for a year and
requiring Nicole to be placed in a closed and locked facility. Nicole appeals.
DISCUSSION
The
LPS Act governs the involuntary detention,
evaluation and treatment of persons who, as a result of a mental disorder,
are dangerous or gravely disabled. (§
5150 et seq.) It authorizes the superior
court to appoint a conservator for one who is determined to be gravely disabled
(§ 5350 et seq.), so that he or she may receive individualized treatment,
supervision and placement. (§
5350.1.) A person is " 'gravely
disabled' " within the meaning of the LPS Act if, as a result of a mental
disorder, she "is unable to provide for . . . her basic personal needs for
food, clothing, or shelter." (§
5008, subd. (h)(1)(A); see generally Conservatorship
of John L. (2010) 48 Cal.4th 131, 142.)
1.
Present Grave Disability
In
proceedings under the LPS Act, the Agency must prove beyond a reasonable doubt
that the proposed conservatee is presently gravely disabled. (Conservatorship
of Roulet (1979) 23 Cal.3d 219, 235; Conservatorship
of Jones (1989) 208 Cal.App.3d 292, 302-303.) Nicole challenges the sufficiency of the
Agency's evidence to establish her grave disability (i.e., that she suffered
from a mental disorder that rendered her unable to provide for basic personal
needs for food, clothing or shelter) at the time of the hearing. (§ 5350; see also § 5008, subd.
(h)(1).) In the face of such a
challenge, we review the evidence in the light most favorable to the Agency and
must affirm the judgment if there is substantial evidence to support it. (See Conservatorship
of Johnson (1991) 235 Cal.App.3d 693, 697; Conservatorship of Murphy (1982) 134 Cal.App.3d 15, 18.)
A
trier of fact may not rely on a perceived likelihood that the proposed
conservatee will stop taking the medications prescribed to treat her mental
illness as the sole basis for determining that she is presently gravely
disabled; however, it may rely on her past failure to take mental health
medications when prescribed, coupled with evidence that she lacks insight as to
her mental illness, as a basis for making such a finding if it determines that
she will not take her medication unless she is required to do so and that her
mental disorder makes her unable to provide for her needs for food, clothing or
shelter. (Conservatorship of Guerrero (1999) 69 Cal.App.4th 442, 446-447;
Cal.App.3d 1572, 1577.)
Although
not uncontroverted, the Agency's evidence showed that Nicole was hospitalized
at least 20 times in the 14 years prior to the current trial and that many of
these hospitalizations arose from her failure to take the medications
prescribed for her disorder and the resulting deterioration of her mental
condition. Further, Dr. Steiger
testified that Nicole had limited insight into the extent and severity of her
mental illness, indicating that Nicole had at times denied having any
psychiatric condition. The limited
nature of Nicole's understanding of her disorder was also illustrated by her
trial testimony that she had only stopped taking her prescribed medications on
a few occasions in the preceding years and that stress, rather than her failure
to take the medications, was what caused her to become delusional. This evidence supports a conclusion that
Nicole consistently had not complied with the medication regimen established
for her by her physicians unless she was under the supervision of hospital
staff and that she would continue to do so in the future.
Similarly,
the evidence of Nicole's frequent psychotic breaks, her recurring inability to
maintain consistent housing and the number of occasions on which she was found
to be substantially malnourished supported a finding that when Nicole was not
taking her medications, her mental disorder rendered her unable to provide for
her needs for food, clothing or shelter.
The
foregoing evidence amply supports the jury's determination that Nicole was
presently gravely disabled as of the time of trial.
2.
Facility
After
a person is found to be gravely disabled as the predicate for establishing a
conservatorship under the LPS Act, the court must place the conservatee in a
"suitable facility," which is defined as "the least restrictive
residential placement available and necessary to achieve the purpose of [the]
treatment." (§ 5358, subd.
(c)(1).) The determination of the
appropriate placement must be based on the recommendations of the conservator
and the evidence presented at trial. (§§
5356-5358.)
Based
on Nicole's consistent history of noncompliance with her
was living in other settings, the conservator recommended that she be placed in
a closed, locked treatment facility.
Similarly, Dr. Steiger testified that such a placement was necessary
because of the likelihood that Nicole would leave a less restrictive placement
and again become noncompliant with her medications. This evidence is sufficient to support the
trial court's order placing Nicole in a closed, locked facility.
DISPOSITION
The
judgment reappointing the conservator is affirmed.
HUFFMAN, J.
WE
CONCUR:
McCONNELL, P. J.
BENKE,
J.
name="_ftn1" title="">[1] All
further statutory references are to the Welfare and Institutions Code except as
otherwise noted.
name="_ftn2" title="">[2] When
she was able to make the necessary arrangements, L.K. would pay such funds
directly to the third parties who provided Nicole with shelter and food because
if she provided the funds to Nicole, Nicole tended to use the money to buy
clothes, trinkets or coffee rather than food.
