1

Filed 8/29/14 P. v. Greer CA3

NOT TO BE PUBLISHED

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 This opinion has not been certified for publication 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

THIRD APPELLATE DISTRICT

(Butte)

----

THE PEOPLE,

Plaintiff and Respondent,

v.

CHEYENNE GREER,

Defendant and Appellant.

C072904

(Super. Ct. No. CM013638)

Defendant Cheyenne Greer appeals the denial of her petition to transfer her to 

outpatient treatment pursuant to Penal Code section 1026.2.1 She contends she met her 

initial burden of establishing a prima facie case that she would not present a danger to 

others if she were released under the supervision of the conditional release program 

(CONREP) and the People did not produce sufficient evidence to rebut that presumption. 

We disagree and affirm the order of the trial court.

 

1 Undesignated statutory references are to the Penal Code.
2

BACKGROUND

In February 2000 defendant, responding to command hallucinations, killed her 

three-month old daughter by smothering her with a pillow and then attempted to kill 

herself by driving her car into a pole. Defendant had stopped taking her medications 

shortly after becoming pregnant and stopped seeing her therapist. At the time of the 

crime, Dr. Kent Caruso evaluated defendant and diagnosed her as schizophrenic. Dr. 

Caruso reported defendant suffered from hallucinations and paranoia. He attributed her 

murder of her child and attempted suicide to a “perfect storm” of college, family 

problems, relationship difficulties, stress from having to care for her child and hormonal 

and chemical imbalances. Defendant was acquitted of murder by reason of insanity and 

committed to the California Department of State Hospitals. In 2003, defendant 

transferred to Napa State Hospital (Napa). In September 2011, defendant filed a petition 

requesting a transfer from Napa to outpatient care under section 1026.2 as the first step in 

a restoration of sanity proceeding. 

Defendant’s history at Napa demonstrated numerous periods of aggressive, 

inappropriate behavior, and destabilization. In 2007, defendant was “extremely paranoid 

and agitated . . . . She had a number of incidences [sic], one where she . . . attempted to 

kick a male peer, another time where she did assault a female and was placed in fivepoint restraints . . . . She was having a very difficult time with her symptoms. They were 

quite active in 2007.” She was also having visual and auditory hallucinations. There 

were acts of “aggression with female peers” and “paranoid symptoms around her 

roommates at the time. [¶] . . . [¶] [S]he would cycle through periods of being afraid, 

specifically afraid of certain female peers.” She was also verbally aggressive with female 

peers. She thought the treatment team was trying to poison her and became aggressive

with staff. Her aggression was due to her psychosis, usually hallucinations or delusions. 

In 2008 “she expressed aggressive behavior by yelling at a peer.” She also exhibited 

hypersexual behavior that was against the unit rules, “involving inappropriate touching 
3

of peers” and staff. In 2011, she “was having problems with thinking that she was being 

molested by her roommate, had tactile hallucinations.” The hospital had to move her and 

adjust her medication. She did not like her medication and stopped taking it. She was 

placed on a different medication. In May 2011, “she began paranoid focus on another 

roommate who she believed was sexually molesting her while she slept.” She believed 

the roommate was giving her spiritual babies. She also had delusions she was pregnant. 

In 2012, defendant was assigned to Dr. Carol Humphreys’ caseload. Dr. 

Humphreys is a unit psychologist at Napa. At that time, a treatment plan was designed 

for defendant, which defendant was working on, including engaging in treatment groups 

and completing her Wellness and Recovery Action Plan (WRAP). Defendant’s triggers 

include family dilemmas, “any kind of situation that she feels out of control in” and 

“ruminating on her past.” Her precursors include irritability, hypersexuality and 

supernatural spirits talking to her. As to her relapse prevention plan, Dr. Humphreys 

noted defendant had a “number of things that she has been able to demonstrate off and on

. . . that she uses when she begins to feel interpersonally stressed.” 

Defendant had occupational training at a beauty parlor in the hospital which was 

helpful to, as well as motived, her. However, there were also times when, because of her 

manic periods and paranoia, she would have to be “pulled” from her job, as it was not a 

safe place for her to work. Those manic periods were characterized by obvious flights of 

ideas, pressured speech, paranoid thoughts, and responses to auditory hallucinations. 

One outward sign of these hallucinations occurred when defendant giggled, laughed, and 

talked to herself in the hallway, in her room and in group sessions. “The paranoia would 

be an escalating experience of feeling afraid, of really questioning other people’s 

motives, of feeling fearful for herself that someone’s treating her unjustly, poorly, being 

frightened.” Dr. Humphreys and defendant spoke often about defendant’s difficulties 

with her supervisor. Defendant was “extremely uncomfortable” talking to her supervisor 

and, “within just a week or two period [of] time it went from a slight irritation to what 
4

[Dr. Humphreys] felt was quite paranoid that [defendant] could not even go to her job.” 

Defendant repeatedly spoke with Dr. Humphreys about eventually wanting a “normal 

life,” and to get married and have children. Although they also spoke about the risk 

having children represented, defendant still “seemed to want that.” 

Dr. Humphreys recommended against outpatient treatment for defendant. Dr. 

Humphreys acknowledged she had previously supported transfer of defendant to an open 

unit, as she had generally good behavior and was one of the higher functioning patients. 

She acknowledged they were not seeing signs of verbal or physical aggression in 

defendant and defendant was attempting to use her coping skills. Defendant was 

cooperative with her medications, participating in her groups and developed a relapse 

prevention plan. Nonetheless, as of May 2012, Dr. Humphreys believed there “were still 

episodes of [defendant] feeling guarded or suspicious or paranoid.” Dr. Humphreys 

remained “concerned that her symptoms were still breaking through. And . . . concerned 

over the fact that [she] spoke with [defendant] many, many times about her giggling and 

laughing and talking to herself in the hallway. And [Dr. Humphreys] always asked 

‘What was that about?’ And [defendant] almost always said she was thinking of a 

boyfriend on another unit and that that made her laugh and that she was thinking of other 

things. And [Dr. Humphreys] felt there was a lack of insight around whether or not those 

were related to her symptoms. . . . [¶] . . . [Dr. Humphreys] thought she was starting to 

show some insight around [her symptoms]. But, [Dr. Humphreys] didn’t feel it was a 

long enough period of time.” Based on defendant’s quickly escalating concerns and 

paranoia regarding her supervisor, her breakthrough symptoms of hallucinations and 

“talking” with supernatural spirits, her irritability, hypersexuality, and insufficient 

duration of stability with her medication, and the similarity of these symptoms to those 

she was displaying at the time of her offense, Dr. Humphreys concluded defendant would 

be a risk if released to outpatient status because she would be without the intense 

structure and support obtainable in a state hospital like Napa. 
5

Dr. Leif Skille became defendant’s primary treating psychiatrist at Napa in May 

2012. He testified that defendant had been diagnosed with schizophrenia and reported 

she “struggled with depression in the past superimposed upon ongoing psychotic illness.” 

Her primary symptoms are hallucinations and delusions. Dr. Skille reported defendant 

was “quite psychotic” in May 2012. “She was having spiritual warfare, she was having 

multiple symptoms.” In June 2012, she was “hallucinating as we were speaking,” seeing 

things and hearing voices she described as “positive” and “Goddesses.” She denied these 

voices were part of her mental illness, but claimed they were just a “ ‘spiritual 

connection.’ ” She thought her thoughts could be heard by other people and believed 

other people could put thoughts in her head. She believed the television was giving her 

special messages. In July 2012, defendant reported “people are shooting bullets in 

spiritual warfare.” Dr. Skille reported over the years, when defendant starts to get 

paranoid, she can become agitated and as that psychotic agitation increases, she can be 

aggressive. 

Dr. Skille hoped defendant could eventually be recommended for outpatient status, 

but did not think she was ready yet. He indicated he would want to see better control 

over her hallucinations and delusions, particularly because they expressed similar 

religious themes “which led to her ending her child’s life.” He also believed she needed 

improved insight into her mental illness. Although she recognized she had a mental 

illness, she did not recognize when she was experiencing symptoms of that illness. He 

was also concerned about her comments to Dr. Martin2 expressing an interest in getting 

pregnant. She had suggested she would stop taking her medications so as not to harm the 

fetus, and was not worried about the risk as she now had social support. Dr. Martin 

concluded defendant did not appreciate “the significance of her mental illness and how it 

 

2 Dr. Martin is another of defendant’s treating doctors.
6

played a role in her instant offense.” Dr. Skille concluded defendant did not understand 

“how risky it is to just stop her meds and get pregnant again.” Dr. Skille thought 

defendant was “underappreciating the totality of her mental illness.” 

The court appointed independent expert Dr. Kent Caruso for defendant. Dr. 

Caruso originally examined defendant as part of her NGI3 evaluation. For this 

evaluation, he met with defendant twice, once in January 2012 and once in October 2012. 

He also reviewed reports dating back to 2010. Dr. Caruso diagnosed defendant as 

schizophrenic. Dr. Caruso reported at the time of the offense, defendant had no 

psychopathy or sociopathy, she was not violent and had not exhibited violent behavior in 

the community or committed any other criminal acts. He described the committing 

offense as having occurred while she was having some family problems and relationship 

difficulties, she was increasingly stressed and anxious during the pregnancy and after the 

birth of the baby she did not have much insight and “started becoming paranoid and 

delusional.” He believed, “absent that perfect storm, that set of circumstances, the 

stressors in her life at that time of college, relationship problems, and having the baby, 

the hormonal and chemical changes in her body, and then having to be a mother, that 

absent that combination of stressors, she’s not really inclined to be a danger to others.” 

He was unaware of any acts of aggression or violence during her commitment. He 

acknowledged she could become suspicious and paranoid at times, but “I think all of us 

can. . . . But I don’t think I’ve ever read anything that said she’s been a danger to staff or 

aggressed upon staff or been a danger to other patients at Napa.” Dr. Caruso reported 

defendant recognized she had a mental illness and needed medication and had developed 

a wellness recovery plan. Defendant becoming pregnant again, Dr. Caruso warned, 

would be her “most predictable trigger to any future violent behavior” and if she were to 

 

3 Not guilty by reason of insanity.
7

become pregnant again, he would be concerned about her release. In the interview, he 

told defendant having another child would be a very bad idea, and she gave what he 

described as an appropriate and pragmatic response, acknowledging she should not have 

a baby. Dr. Caruso expected her condition would improve in a change of environment, 

including reduction of symptoms that “seem to keep arising here and there.” He did 

acknowledge, however, that she had “some de-stabilization” when she had previously 

been moved to a different unit as she was uncomfortable with the changes. But, he 

explained “she was just feeling that she didn’t have some of the opportunities for 

consistency and continuity and maybe ongoing, good ongoing therapeutic relationship or 

rapport with staff members. And then, of course, this, in turn, affected her mood and her

thoughts about her improvement or her program.” Dr. Caruso was unaware of the 

incidents in 2007 or 2008. As to the 2008 incident of verbally aggressive behavior of 

“yelling at a peer,” Dr. Caruso stated, “I yell at my kids sometimes.” He was not aware 

of a report that she was placed in restraints after assaulting a peer in 2007. Nor was he 

aware of reports that she had “attempted to kiss a male peer on the lips.” In response, he 

indicated, “I’ve got to smile because those are very normal behaviors for people even in 

mental institutions and correctional settings.” Dr. Caruso concluded defendant was ready 

to be released to the outpatient program. 

After considering the evidence, the trial court denied the petition to transfer to 

outpatient placement “[b]ased on everything that’s been presented, primarily the 

testimony of Dr. Skille.” 

DISCUSSION

Defendant contends the trial court erred in denying her petition as “the record is 

lacking in evidence that [she] would present a danger to others if under the supervision of 

the [conditional release] program.” We find the record contains ample evidence 

supporting the trial court’s order.
8

A defendant found not guilty by reason of insanity may thereafter be released from 

the state hospital upon the occurrence of one of three events: “(1) the restoration of sanity 

pursuant to the provisions of section 1026.2; (2) expiration of the maximum term of 

commitment, which means ‘the longest term of imprisonment which could have been 

imposed for the offense or offenses of which the person was convicted’ (§ 1026.5, subd. 

(a)(1)); or (3) approval of outpatient status pursuant to the provisions of section 1600 et 

seq. (§ 1026.1; see People v. Soiu (2003) 106 Cal.App.4th 1191, 1194-1195 (Soiu).)”

(People v. Dobson (2008) 161 Cal.App.4th 1422, 1432.) Here, after being found not guilty by 

reason of insanity and committed to a state hospital, defendant sought release based upon 

restoration of sanity pursuant section 1026.2. “Such a petition involves a two-step 

process. [Citations.] The first step requires the person to apply for release to the superior 

court of the county from which the commitment was made. (§ 1026.2, subd. (a).) . . . 

Once the application is filed, the court must conduct a hearing, commonly called the 

outpatient placement hearing. (§ 1026.2, subd. (a); see Soiu, supra, 106 Cal.App.4th at 

pp. 1196–1197.) [¶] At the outpatient placement hearing, which is the type of hearing 

that was held in this case, the applicant must demonstrate [she] will not ‘be a danger to 

the health and safety of others, due to mental defect, disease, or disorder, while under 

supervision and treatment in the community.’ (§ 1026.2 , subd. (e) []; see Soiu, supra, 

106 Cal.App.4th at p. 1196.)” (Dobson, supra, 161 Cal.App.4th at p. 1432, italics 

omitted.) “The applicant has the burden of proof by a preponderance of the evidence. 

[Citations.]” (Dobson, supra, 161 Cal.App.4th at p. 1433.) 

“ ‘Outpatient status is not a privilege given the [offender] to finish out [her]

sentence in a less restricted setting; rather it is a discretionary form of treatment to be 

ordered by the committing court only if the medical experts who plan and provide 

treatment conclude that such treatment would benefit the [offender] and cause no undue
9

hazard to the community.’ [Citation.]” (People v. Sword (1994) 29 Cal.App.4th 614, 

620 (Sword).)4 

“We review the court's order for an abuse of discretion. (People v. Cross (2005) 

127 Cal.App.4th 63, 73.) ‘Under that standard, it is not sufficient to show facts affording 

an opportunity for a difference of opinion. [Citation.] “... [D]iscretion is abused only if 

the court exceeds the bounds of reason, all of the circumstances being considered.” ’ 

(Ibid.)” (People v. Bartsch (2008) 167 Cal.App.4th 896, 900.) 

As each doctor noted, defendant has shown improvement over the years and 

demonstrated good behavior on occasion. Nonetheless, despite being in a highly 

structured and supervised environment, she continues to have breakthrough symptoms of 

her mental illness which result in aggressive and inappropriate behavior. These periods 

of aggressive behavior are fueled by her continued hallucinations and delusions:

hallucinations and delusions which are similar in character to those she was experiencing 

when she murdered her child, and which she denies are caused by her mental illness. 

When she murdered her child, defendant was experiencing hallucinations, religious

themed delusions, and extreme paranoia. Throughout her time in Napa, she experienced

hallucinations and delusions which resulted in aggressive behavior, against both peers 

and staff, serious enough to require physical restraint. As recently as 2012, she continued 

to experience auditory hallucinations, religious delusions, and paranoia. Her incidents of 

 

4 Defendant points out Sword was a case under section 1600, approval of outpatient 

status, not section 1026.2, restoration of sanity. However, as Sword noted, “Outpatient 

status is a prerequisite to a finding that sanity has been restored. (§ 1026.2.) 

‘Subdivision (e) of section 1026.2 sets up a two-step process for processing an 

application for release: first, a determination of whether the applicant should be placed in 

a local program, and later, after a year in such a program, a determination of whether the 

applicant's sanity has been restored.’ [Citations.]” ( Sword, supra, 29 Cal.App.4th at p. 

620.) Thus, the statement in Sword is equally applicable to the first step in the 

proceedings for restoration of sanity under section 1026.2 as it is to proceedings for 

approval of outpatient status.
10

paranoia included sexual themes including molestation and pregnancy. As recently as 

June of 2012, she denied her delusions were part of her mental illness, but claimed they 

were just a “ ‘spiritual connection.’ ” While defendant received occupational training, 

she also had to be removed from that job based on paranoid delusions. Those delusions 

led to the conclusion she could not safely continue in her job. While operating under 

paranoid delusions, defendant was aggressive with both peers and staff. At one point, the 

aggression was serious enough she had to be placed in restraints. This aggressive 

behavior is evidence that defendant would be a risk if placed in outpatient treatment. 

Defendant has identified triggers of her mental illness, however, she lacks insight into her 

mental illness and specifically that her symptoms are a manifestation of that mental 

illness. Nor does she appreciate the role her mental illness played in her killing her child. 

Every evaluating doctor recognized the risk defendant would present should she get 

pregnant again. In addition to exhibiting hypersexualized behavior, defendant giggled 

and laughed while having apparent delusions about her “boyfriend” and stated her 

interest in having another child. Dr. Skille concluded defendant did not understand the 

risk of stopping her medications and getting pregnant again. When considered in context, 

it is a reasonable inference defendant’s hypersexualized behavior and lack of insight into 

her mental illness are evidence of a risk if she were released to outpatient status. 

Moreover, both the hypersexual and aggressive conduct indicates an inability to follow 

the rules of the institution, even in a highly structured and supervised setting. This 

inability raises a reasonable inference of risk if defendant were released to outpatient 

status. Drs. Humphreys and Skille were optimistic defendant may eventually be moved

safely to outpatient status, but felt she needed to exhibit better insight into her mental 

illness, better control of her symptoms and a longer period of stability on her 

medications.

Given this record, we conclude the trial court acted neither arbitrarily nor 

capriciously in denying defendant’s petition for conditional release into CONREP. (See 
11

People v. Sword, supra, 29 Cal.App.4th at p. 626.) Rather, the trial court's decision was 

based on the substantial evidence presented at the hearing that defendant “would be a 

danger to the health and safety of others, due to mental defect, disease, or disorder, if 

under supervision and treatment in the community.” (§ 1026.2, subd. (e).)

DISPOSITION

The order of the trial court denying defendant’s petition for conditional release 

into CONREP is affirmed.

 NICHOLSON , Acting P. J.

We concur:

 DUARTE , J.

 HOCH , J.