Filed 7/26/22 P. ex rel. State Dept. of State Hospitals v. S.F. CA2/6

NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS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has not been certified for publication or ordered published for purposes of rule 8.1115.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

SECOND APPELLATE DISTRICT

 DIVISION SIX

THE PEOPLE ex rel. STATE 

DEPARTMENT OF STATE 

HOSPITALS,

 Plaintiff and Respondent,

v.

S.F.,

 Defendant and Appellant.

2d Crim. No. B317820

(Super. Ct. No. 21MH-0003)

(San Luis Obispo County)

S.F. appeals from the trial court’s order compelling his 

involuntary medication with antipsychotic drugs. S.F. contends 

the medication order should be vacated because there was 

insufficient evidence that he lacks the capacity to make informed 

decisions about his medical treatment. We affirm.
2

FACTUAL AND PROCEDURAL HISTORY

S.F. was committed to Atascadero State Hospital in June

2020 as an offender with a mental health disorder (OMHD).1 

(See Pen. Code, § 2962 et seq.) In January 2021, the Department 

of State Hospitals petitioned the trial court to order S.F. to 

undergo involuntary treatment with antipsychotic medications 

pursuant to In re Qawi (2004) 32 Cal.4th 1 (Qawi) and Welfare 

and Institutions Code section 5300 et seq. The court granted the 

petition, and ordered that S.F. be involuntarily medicated for up 

to one year. 

In January 2022, the Department petitioned the trial court 

to renew the order compelling S.F.’s involuntary medication. The 

petition alleged that S.F. has been diagnosed with schizoaffective 

disorder, bipolar type, and suffers from auditory hallucinations, 

persecutory delusions, and disorganized behavior and thought 

processes, among other allegations. He does not believe he needs

treatment because he does not have a mental disorder and does 

not benefit from antipsychotic medication. 

Dr. David Fennell testified as an expert at the hearing on 

the Department’s renewal petition. He said that S.F. was 

diagnosed with schizoaffective disorder in his late teens or early 

20’s. The disorder primarily manifests itself as auditory 

hallucinations, which S.F. describes as a “natural ability to hear 

voices” or telepathy. 

S.F. exhibits irritation, agitation, and paranoia, including 

the belief that others wish to do him harm. He has a history of 

noncompliance with his medication regimen and a history of 

becoming angry and irritable to the point of getting into physical 

1 OMHDs were previously termed “mentally disordered 

offenders” or “MDOs.” (Pen. Code, former § 2962, subd. (d)(3).)
3

and verbal confrontations. His mental disorders are currently 

being treated with three medications. 

Dr. Fennell said that S.F. does not believe that he has a

mental disorder and believes that he is being wrongly medicated. 

When S.F. does not take his medications he experiences more 

severe hallucinations and paranoia and has less ability to keep 

his temper. When he complies with his medication regimen he

hears voices less often; is less guarded, paranoid, and distracted; 

and does not lose his temper as easily. 

On cross-examination, Dr. Fennell testified that S.F.’s 

concerns about the side effects of his medications are legitimate. 

But S.F. lacks the ability to understand how to minimize these 

side effects because he does not believe that he has a mental 

disorder. This also prevents him from rationally weighing the 

benefits of the medications he is prescribed. 

Dr. Fennell concluded that S.F. requires treatment with 

antipsychotic medications, is incompetent to refuse them, and 

should continue to be administered the medications 

involuntarily. The trial court agreed, and granted the 

Department’s petition to involuntarily medicate him for up to one

year. 

DISCUSSION

S.F. contends the involuntary medication order should be 

vacated because there was insufficient evidence that he is 

incapable of making decisions about his medical treatment. We 

disagree.

A court may order an OMHD to be involuntarily treated 

with antipsychotic medication if it determines that the offender is 

“incompetent to refuse medical treatment.” (Qawi, supra, 32 

Cal.4th at p. 27.) Determining whether an OMHD is incompetent 
4

to refuse treatment requires consideration of three factors: (1) 

whether the offender is aware of and acknowledges their mental 

disorder; (2) whether the offender is “able to understand the 

benefits and the risks of, as well as the alternatives to, the 

proposed intervention”; and (3) whether the offender is “able to 

understand and . . . evaluate the information required to be given 

patients whose informed consent is sought . . . 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 (Riese).) We 

review a determination that an offender is incompetent to refuse 

medical treatment for substantial evidence. (People v. Fisher

(2009) 172 Cal.App.4th 1006, 1016.)

Substantial evidence supports the determination that S.F. 

is incompetent to refuse medical treatment. Dr. Fennell testified 

that S.F. suffers from schizoaffective disorder, with symptoms 

including auditory hallucinations, paranoia, irritation and 

agitation, and the belief that others wish to harm him. He also 

said that S.F. refuses to acknowledge his mental disorder, and 

instead believes that he is telepathic and does not need 

medication. S.F. did not counter Dr. Fennell’s testimony at the 

Qawi hearing, but argued his awareness that he has the “gift” of 

being able to hear voices means that he has the capacity to refuse 

treatment. The first Riese factor weighs in favor of the trial 

court’s medication order.

So do the second and third. Because he refuses to accept 

that he suffers from a mental disorder, S.F. does not understand 

the risks and benefits of his medications. He believes his 

medications “ha[ve] literally nothing to do with” any

improvements in his condition, “denies strongly that there are
5

any benefits associated” with them, and instead believes they 

only cause him harm. S.F.’s refusal to acknowledge his disorder 

also hinders his ability to discuss alternatives to his medication 

regimen, including adjusting his current dosages to help mitigate 

some of the side effects. It thus prevents him from being able to 

rationally evaluate and participate in his treatment decisions. 

The second and third Riese factors weigh in favor of the trial 

court’s medication order.

This case is unlike Conservatorship of Waltz (1986) 180 

Cal.App.3d 722, on which S.F. relies. The conservatee in Waltz

feared undergoing electroshock treatment during his psychotic 

episodes. (Id. at p. 732.) But he also feared undergoing the 

treatment during his nonpsychotic episodes. (Ibid.) He 

additionally acknowledged he had a mental disorder, understood 

that he was undergoing treatment, understood that his doctors 

believed the treatment was helping him, understood the potential 

risks of that treatment, and understood that he could refuse it. 

(Ibid.) These understandings undercut the trial court’s 

determination that the conservatee could not give informed 

consent. (Id. at p. 734.)

In contrast to the Waltz conservatee, here, the evidence 

does not show that S.F. has nonpsychotic episodes during which 

he understands that he has a mental disorder and the treatments 

he is undergoing. To the contrary, S.F. consistently refuses to 

acknowledge his mental disorder. He does not understand the 

risks and benefits of his medications, and cannot participate in 

his treatment decisions. Substantial evidence thus supports the 

trial court’s determination that he lacks the capacity to refuse 

medical treatments.
6

DISPOSITION

The trial court’s order compelling S.F.’s involuntary 

treatment with antipsychotic medication, entered January 21, 

2022, is affirmed.

NOT TO BE PUBLISHED.

GILBERT, P. J.

We concur:

YEGAN, J.

PERREN, J.
Michael L. Duffy, Judge

Superior Court County of San Luis Obispo

______________________________

Gerald J. Miller, under appointment by the Court of 

Appeal, for Defendant and Appellant.

Rob Bonta, Attorney General, Cheryl L. Feiner, Assistant 

Attorney General, Gregory D. Brown and Jordan R. Beres, 

Deputy Attorneys General, for Plaintiff and Respondent.