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Filed 3/4/15 State Dept. State Hospitals v. L.F. CA4/2 

NOT TO BE PUBLISHED IN OFFICIAL REPORTS 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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.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

FOURTH APPELLATE DISTRICT 

DIVISION TWO 

STATE DEPARTMENT OF STATE 

HOSPITALS, 

 Plaintiff and Respondent, 

v. 

L.F., 

 Defendant and Appellant. 

 E060569 

 (Super.Ct.No. FELSS1303948) 

 OPINION 

 APPEAL from the Superior Court of San Bernardino County. James M. Dorr, 

Judge. (Retired judge of the San Bernardino Super. Ct. assigned by the Chief Justice 

pursuant to art. VI, § 6 of the Cal. Const.) Affirmed. 

 Michele Anne Cella, under appointment by the Court of Appeal, for Defendant 

and Appellant. 

 Kamala D. Harris, Attorney General, Julie Weng-Gutierrez, Assistant Attorney 

General, and Richard T. Waldow and KristenT. Dalessio, Deputy Attorneys General, for 

Plaintiff and Respondent. 
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 Defendant and appellant L.F., a mentally disordered offender (MDO) as defined 

by Penal Code section 2960 et seq., appeals from an order authorizing plaintiff and 

respondent Department of State Hospitals, Patton State Hospital (Patton) to involuntarily 

administer psychotropic medications during L.F.’s treatment. He contends his due 

process rights have been violated because there is insufficient evidence to establish that 

(1) he meets the criteria for involuntary medication, and (2) he is dangerous due to his 

mental disorder. We reject his contentions and affirm. 

I. FACTS AND PROCEDURAL BACKGROUND 

 L.F. has been diagnosed with schizophrenia, paranoid type. On March 7, 2012, he 

was certified as an MDO pursuant to the Mentally Disordered Offender Act (Pen. Code, 

§ 2960, et seq.). Beginning on November 8, 2012, he was administered involuntary 

antipsychotic medications under an order rendered pursuant to In re Qawi (2004) 32 

Cal.4th 1 (Qawi); however, the order was set to expire on November 8, 2013.1 As a 

result, on September 13, 2013, Patton filed a verified petition seeking authorization to 

administer appropriate involuntary psychotropic medications to L.F. in the dosage and 

frequency deemed necessary. Counsel was appointed to represent L.F., and a hearing 

date was set, which was later continued to December 13, 2013. 

 On December 13, 2013, the trial court conducted a Qawi hearing. Both L.F. and 

his treating psychiatrist, Dr. Steven Galarza, testified. According to Dr. Galarza’s 

testimony, he is a staff psychiatrist at Patton and has been L.F.’s treating psychiatrist 

 1 The parties stipulated to continue the order to December 13, 2013. 
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since fall 2012. L.F. was, and remains, diagnosed with schizophrenia, paranoid type, 

characterized by debilitating symptoms, including “a significant history of delusions, 

hallucinations . . . causing a significant impairment in functioning.” L.F. “believes that 

people want to poison him, harm him, attack him, kill him.” He also suffers from 

delusions that he is a “descendent of someone important,” he has “millions of dollars,” 

the “members of the state hospital such as [Dr. Galarza] . . . are Nazis,” “judges are 

pirates,” and he is being kept against his will. 

 Although L.F. is currently under a court order that allows Patton to involuntarily 

medicate him, on occasion he refuses his medication, requiring the staff to “check his 

mouth to make sure he has swallowed the medication.” When he is on his medications, 

he is “less paranoid” and “less aggressive.” In contrast, when he refuses to take them, he 

“show[s] an increase in psychotic and aggressive symptoms.” Without an involuntary 

medication order, Patton is unable to prevent L.F. from refusing his medication. 

 Although Dr. Galarza acknowledged that the medications L.F. needs may have 

side effects,2 the doctor explained that he has chosen medications with the least side 

effects. Those medications have improved L.F.’s physical well-being, causing him to 

lose weight. Also, L.F. has “shown a greater participation in groups” while under 

treatment of the medications. To the extent L.F. experienced any significant side effects 

from taking the medications, Dr. Galarza would “lower the dose and look for alternatives 

[or] switch his medication around.” 

 2 Such side effects include weight gain, causing diabetes, high blood pressure and 

cholesterol problems, and decrease in white blood cell count. 
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 Based upon his discussions with and observations of L.F., along with examination 

of L.F.’s records, Dr. Galarza opined that L.F. does not have the capacity to effectively 

weigh the risks and the benefits of medication. L.F. “would choose to stop medications,” 

which would “dramatically escalate” his paranoid, aggressive symptoms. According to 

Dr. Galarza, even under the safety of Patton, L.F. “has been unable to control some of his 

behaviors.” To illustrate his concern, Dr. Galarza described an incident that occurred on 

November 24, 2013, a few weeks before the Qawi hearing. When another patient 

stepped on L.F.’s toe, L.F. hit the patient, injuring him. Both L.F. and the other patient 

were evaluated by the physicians, and the other patient’s injuries were consistent with a 

“hard hit.” Such assaultive behavior is consistent with L.F.’s paranoid feelings that he is 

under attack. More frequently, L.F. is verbally assaultive to staff members, “using racial 

terms and verbiage that’s frankly threatening,” while using his hand to mimic the use of a 

gun. Thus, Dr. Galarza opined that if the Qawi order is not extended, L.F. would present 

a danger to staff and other patients at Patton. 

 According to L.F.’s testimony, he does not want to take the medications, stating 

“it’s bad for my body, and I want the right to choose not to take [them].” When asked 

about the incident in November 2013, L.F. explained, “I can’t let people just assault me 

and abuse me and get away with it.” L.F. opined that Patton wanted to medicate him 

because they wanted to “alter” his mind. He stated: “They want to control my mind . . . 

and then . . . rehabilitate my mind and my brain . . . and send me to school and teach me 

new things and rehabilitate me into the community.” L.F. admitted that he has 

schizophrenia, but he opined that he could deal with his delusions with counseling. If 
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given the choice, he would not take the medications. He complained that because he had 

taken Zyprexa, he is now diabetic and must take insulin every day. Dr. Galarza never 

prescribed Zyprexa for L.F. 

 At the conclusion of the hearing, the trial court found that L.F. was incompetent 

and a danger to others, and ordered Patton to administer the necessary psychotropic 

medication involuntarily to L.F. 

II. DISCUSSION 

A. Applicable Law 

 Individuals in custody may refuse to take psychotropic medication. (Qawi, supra, 

32 Cal.4th at p. 14.) However, the right of a person committed as an MDO “to refuse 

antipsychotic drugs is qualified . . . .” (People v. Fisher (2009) 172 Cal.App.4th 1006, 

1013.) Such right of refusal may be overcome by a judicial determination that (1) the 

MDO is incompetent or incapable of making decisions about his or her medical 

treatment, or (2) the MDO is dangerous within the meaning of Welfare and Institutions 

Code section 5300. (Qawi, supra, at p. 27.) 

 “We review an order authorizing involuntary administration of antipsychotic 

medication for substantial evidence. [Citation.]” (People v. Fisher, supra, 172 

Cal.App.4th at p. 1016.) 

B. Substantial Evidence Supports the Trial Court’s Finding that L.F. is 

Incompetent or Incapable of Making Decisions About His Medical Treatment 

 L.F. argues the evidence is insufficient to show that he is incompetent. We 

disagree. 
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 Judicial determination of whether an MDO is competent to refuse antipsychotic 

medication focuses on three factors: (1) whether the patient is aware of his situation; 

(2) whether the patient understands the benefits and risks of the treatment; and 

(3) whether the patient is able to understand and knowingly, intelligently, and rationally 

evaluate and participate in the treatment decision. (Qawi, supra, 32 Cal.4th at pp. 17-18.) 

Here, there is substantial evidence that these factors each weigh in support of the trial 

court’s finding. 

 The evidence and all reasonable inferences therefrom support the trial court’s 

determination of incapacity. Dr. Galarza testified that L.F. suffers from delusions that are 

“grandiose,” believing that he is a “descendant of someone important”; he has “millions 

of dollars”; Patton’s staff members are “Nazis”; and judges are “pirates.” The doctor 

stated that such delusions cause a “significant impairment in [L.F.’s] functioning.” While 

L.F. points out that he acknowledged he has schizophrenia, such acknowledgment is 

irrelevant to whether the court’s decision is supported by substantial evidence. In 

deciding the sufficiency of the evidence, we draw all reasonable inferences from the 

record to support the judgment. (People v. Ochoa (1993) 6 Cal.4th 1199, 1206.) We do 

not weigh the evidence or decide the credibility of the witnesses. (Ibid.) 

 Dr. Galarza testified that Patton’s staff members have attempted to educate L.F. 

about his need for medication and the desired treatment course; however, L.F. remains 

unreceptive to the benefits of medication and his “insight remains limited and 

superficial.” While under court order to take his medication, L.F. refused, requiring staff 

to intervene and confirm that he had done so. Dr. Galarza pointed out that L.F. 
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demonstrates symptoms of paranoia and delusions (believing the hospital staff is out to 

harm him and his prescribed medication is poisoning him) while on medication, and 

opined that such symptoms would escalate without the medication. Thus, L.F. benefits 

from the medication. Nonetheless, he argues that he understands the benefits and risks of 

treatment as evidenced by his testimony that his current medications “poison” him, he 

contracted diabetes when he was prescribed Zyprexa, and he is willing to participate in 

counseling as a means of treatment. However, L.F. is not currently being prescribed 

Zyprexa and the side effects of his medications have been more positive than negative. 

Moreover, L.F. believes that Patton staff wants to medicate him in order to “control” or 

“alter” his mind. Thus, if given the choice, he would not take the medication. Based on 

the record before this court, the evidence supports a finding that L.F. was unable to 

understand the benefits and risks of medication and was unable to evaluate the proposed 

treatment. 

C. Substantial Evidence Supports the Trial Court’s Finding that L.F. Is Dangerous 

 L.F. asserts that complaints of foul language or conclusory statements about 

events that took place over a year ago are insufficient to show that he poses a 

“demonstrated danger.” He argues that his psychotic symptoms (irritability, grandiosity, 

and belief that Patton staff members are pirates) failed to indicate a physical danger to 

others. Additionally, he submits that the one incident where he hit a patient who had 

stepped on his toe is better characterized as an act of self-defense rather than a product of 

his mental disorder. We are not persuaded. 
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 In order for a trial court to determine an MDO to be a danger to others, Welfare 

and Institutions Code section 5300 requires “two types of findings of dangerousness.” 

(Qawi, supra, 32 Cal.4th at p. 20.) In addition to a finding of “‘demonstrated danger’ to 

others” as a result of mental disorder, Welfare and Institutions Code section 5300 

“requires a finding of recent dangerousness as evidenced by tangible acts or threats of 

violence.” (Qawi, supra, at pp. 20, 24.) “Demonstrated danger may be based on 

assessment of present mental condition, which is based upon a consideration of past 

behavior of the person within six years prior to the time the person attempted, inflicted, 

or threatened physical harm upon another, and other relevant evidence.” (Welf. & Inst. 

Code, § 5300.5, subd. (c).) A finding of recent dangerousness may consist of violent or 

threatening acts specified in section 5300 within the year prior to the commitment or 

recommitment. (Qawi, supra, at p. 28, fn. 7.) 

 The record contains substantial evidence of both types of dangerousness. 

Dr. Galarza described several incidents in which L.F. inflicted, attempted to inflict, and 

threatened to inflict substantial physical harm on others. The trial court could reasonably 

infer that hitting another patient constitutes the infliction or attempted infliction of 

substantial physical harm, even if L.F. claimed self defense. According to Dr. Galarza’s 

expert opinion, L.F. “feels like people are focusing on him. He misinterprets social cues 

and feels he’s under attack and he will react.” Because this incident occurred merely 

weeks before the Qawi hearing, it occurred during his most recent term of commitment. 

 The trial court could also infer that L.F.’s gesture of mimicking the use of a gun 

while threatening to shoot Patton’s staff members was a serious threat of substantial 
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physical harm. Dr. Galarza testified that “[v]ery frequently [L.F.] verbally assaults staff 

on my unit using racial terms and verbiage that’s frankly threatening.” The doctor 

observed that even with Patton’s 24-hour-a-day monitoring and safety measures, L.F. 

“had been unable to control some of his behaviors,” causing Dr. Galarza to fear that “off 

medications, these behaviors will be very dangerous actually.” 

 We conclude the record contains substantial evidence that L.F. poses a 

“demonstrated danger,” given his history of unprovoked assaultive behavior since being 

treated at Patton. 

III. DISPOSITION 

 The judgment is affirmed. 

 NOT TO BE PUBLISHED IN OFFICIAL REPORTS 

 HOLLENHORST 

 J. 

We concur: 

 RAMIREZ 

 P.J. 

 MCKINSTER 

 J.