Filed 8/18/23 State Dept. of State Hsopitals v. R.C. CA5

NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS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 This opinion has not been certified for publication 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

FIFTH APPELLATE DISTRICT

STATE DEPARTMENT OF STATE 

HOSPITALS,

Petitioner and Respondent,

v.

R.C.,

Defendant and Appellant.

F085696

(Super. Ct. No. 22CEPR01444)

OPINION

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.
2.

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 petition1to 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. 
3.

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 
4.

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 
5.

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 
6.

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.
7.

DISPOSITION

R.C.’s appeal is dismissed.