1

Filed 11/23/22 Conservatorship of S.H. CA1/2

NOT TO BE PUBLISHED IN OFFICIAL REPORTS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 This opinion has not been certified for publication or 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

FIRST APPELLATE DISTRICT

DIVISION TWO

Conservatorship of the Person of 

S.H.

PUBLIC GUARDIAN OF CONTRA 

COSTA COUNTY,

Petitioner and Respondent,

v.

S.H.,

Objector and Appellant.

 A163073

 (Contra Costa County

 Super. Ct. No. P2000157)

S.H. appeals from an order reappointing a conservator of his person

with the authority to make medical treatment decisions on his behalf 

pursuant to the Lanterman-Petris-Short Act (LPS Act) (Welf. & Inst. Code, 

§ 5000 et seq.).

1 His sole contention is that the evidence is insufficient to 

support the trial court’s finding that he lacks the capacity to give informed

consent to treatment. We affirm. 

BACKGROUND

S.H. suffers from schizoaffective disorder. In criminal proceedings 

1 Undesignated statutory references are to the Welfare and Institutions 

Code.
2

brought against him in 2018, S.H. was deemed mentally incompetent to 

stand trial, and the county conservator investigator was ordered to initiate 

conservator proceedings for him in accordance with the LPS Act. On April 

28, 2020, the trial court appointed the Public Guardian of Contra Costa 

County (Public Guardian) as conservator of S.H.’s person, found him gravely 

disabled, and empowered the Public Guardian to place him in a locked 

facility and make medical decisions on his behalf. As that conservatorship 

period expired, on March 17, 2021, the Public Guardian petitioned to be 

reappointed as conservator. 

S.H. contested the petition and asked for a bench trial, which the court 

held on June 15, 2021. Two witnesses testified: psychologist and county 

Deputy Conservator Andrew Smith, Ph.D., an expert in grave disability, and 

psychologist Jennifer Weinstein, Psy.D., an expert in psychology and grave 

disability. 

Dr. Smith testified first. He was appointed as the conservator of S.H., 

whom he had known for two and a half months. They had spoken on the 

phone and met twice, once in March 2021 over Zoom, and another time in 

May 2021 in person at the secured mental health rehabilitation facility where

S.H. was placed. During the two meetings, Dr. Smith assessed S.H. for grave 

disability. 

In Dr. Smith’s opinion, S.H. was gravely disabled. The basis of Dr. 

Smith’s opinion was “nuanced,” in that while S.H. gave practical responses 

regarding how he would obtain food, clothing, and shelter if he were out in 

the community, he “did not have the functionality currently to carry out those 

plans . . . .” As an example, Dr. Smith observed that although S.H. was able 

to associate being incarcerated with shelter, this response “gave [Dr. Smith]

pause,” because prior to his incarceration, S.H. was homeless, “living in a 
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field . . . without a tent, so no real protection from the elements, and he 

himself had told [Dr. Smith] he wasn’t doing well.” 

Dr. Smith also observed that S.H. exhibited paranoia and blunted 

emotional affect. When discussing S.H.’s current placement, he was 

“persistent about wanting to be in an open program,” stressing he did not 

want oversight by others and did not want much in the way of treatment. 

When asked whether his past or future behavior would affect his ability to 

maintain placement, S.H. became tense and upset and refused to talk. 

Similarly, when Dr. Smith asked about S.H.’s insight into the need for 

medications, he became “surprisingly defensive,” stating, “ ‘I don’t wanna talk 

about that right now. I’ll talk about that at the court date. I just don’t want 

too many more questions. I want to keep some things incognito.’ ” Dr. Smith 

“use[d] the word paranoid” to describe this reaction, “because it did seem to 

be beyond and above what reasonable people might talk about in that 

situation, in that setting, that [he was] his conservator trying to take care of 

him and make sure his needs are met . . . .” 

Counsel asked Dr. Smith whether S.H. had insight into his mental 

health disorder. Dr. Smith replied that S.H. was able to show appreciation 

for some of the treatment and services he had been receiving at the facility, 

such as meals and staff assistance. “At the same time, he seemed to be 

lacking insight into the fact that [Dr. Smith] was his conservator.” Dr. Smith 

also found S.H. lacked insight into his triggers and emotions in connection 

with prior aggressive acts. He based this on S.H.’s responses regarding

physical altercations that he had with other people at the facility. S.H. 

attributed one altercation to people “acting weird around him,” and another 

altercation to him having “mania.” Dr. Smith found these responses were not 

“reasonable explanation[s]” for hitting someone. Also, when during the Zoom 
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meeting Dr. Smith brought up a prior sexual offense, S.H. refused to talk, 

stood up, and ended the meeting. 

Dr. Smith opined that S.H. “would not do well in an open program.” He

believed S.H.’s current placement in a secured facility was appropriate 

because it provided intensive treatment and was equipped to respond to a 

person who becomes aggressive. Dr. Smith also had concerns that if he were 

not conserved, S.H. would not continue his treatment and medications and

symptoms would reoccur.

Dr. Weinstein testified next. She interviewed S.H. for grave disability 

in a 35-to-40-minute meeting over Zoom in late May 2021. After reviewing 

the conservator’s notes, S.H.’s medical records from his facility, and her own 

interview notes, Dr. Weinstein diagnosed S.H. with schizoaffective disorder, 

which “includes two diagnoses, a psychotic disorder, such as schizophrenia, 

and a mood disorder, such as bipolar disorder or depression.” The symptoms 

of the schizophrenia component include thought disorder, perceptual 

disturbances such as hallucinations or delusions, and paranoia. “These 

symptoms alter one’s ability to differentiate between reality and fantasy and 

maintain orientation in reality thus impairing decision-making, judgment, 

planning, and cognition function.” The symptoms of the mood disorder 

component include abruptly changing moods and emotional reactivity, which 

can also impair decision-making, planning, and judgment. 

Dr. Weinstein found that S.H. had “a lack of insight and understanding 

into the nature of his psychiatric needs.” Although he stated he had a mental 

disorder, he was only able to understand it in “a non-concrete and abstract 

way.” As Dr. Weinstein explained it, “[W]hen I asked about his reasons for 

detainment or reasons for referred to . . . the current facility, he just stated 

what happened; . . . I asked many different ways, and he was not able to 
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explain why, what it was that occurred that caused him to require that 

treatment. He just stated that he was picked up and put in . . . .” 

Dr. Weinstein also provided opinions concerning S.H.’s recent physical 

altercations. Based on her review of S.H.’s records, she found the incidents 

indicated S.H.’s lack of control over aggressive or angry impulses. Dr. 

Weinstein described that the altercations stemmed from S.H.’s paranoia or 

fear that someone was harming him or his belongings and a response that 

was an impulsive and physically aggressive. She also observed that S.H.’s 

statements to staff after the altercations showed he did not understand the 

gravity of the problem or his contribution to the interaction. 

S.H. was on two antipsychotic medications, which Dr. Weinstein 

explained are designed to help reduce paranoid thinking and agitation and 

improve impulse control. S.H. acknowledged that he took his medication 

with staff assistance, that the medication “ ‘keeps [him] from getting violent’ ” 

and “ ‘helps [him] a lot,’ ” and that he “ ‘take[s] [his] pills’ ” when he gets 

anxiety. However, when Dr. Weinstein asked S.H. about his knowledge of 

the medications, he refused to continue talking to her. 

Dr. Weinstein testified that were S.H. to stop taking his medications, 

he may experience an increase in his symptoms of paranoia, emotional 

reactivity, and aggression, which in turn would require a higher level of care. 

An increase in such symptoms, she explained, could also result in a 

psychiatric hold or even arrest or jail time. 

Like Dr. Smith, Dr. Weinstein concluded that S.H. was gravely 

disabled. She stated that his lack of insight into his mental disorder 

prevented him from understanding the nature of his psychiatric needs. As 

examples, she pointed to S.H.’s 10-year history of homelessness, trouble with 

emotional reactivity particularly in interactions with other people, his 
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desired plan to exit the current facility without any psychiatric care or 

support, and his low engagement in his current rehabilitation program. Dr. 

Weinstein explained that S.H.’s “psychotic symptoms cause him to have 

trouble thinking and following through with a rational plan to maintain 

stability in the community.” As such, she did not believe he could rationally 

advocate for himself in order to obtain his basic needs. 

Dr. Weinstein testified that in addition to medication management, 

meaningful treatment for S.H. included participating in other sections of the 

rehabilitation program in which he was enrolled, such as group therapy and 

recreational activities. Another “very important piece of his treatment,” she

added, was for him to meet one on one with a mental health professional and 

talk through specific issues, as it would enable him to “reflect or process . . . 

what happened . . . and plan for a different approach next time . . . .” S.H. 

struggled in this area, however. Dr. Weinstein pointed out that when she 

asked S.H. about prior incidents involving aggression, he responded by 

calling her “a whack job” and walking away from the meeting. This behavior 

demonstrated not only reactivity and anger, but also an inability to “talk 

through incidents of aggression” and “to understand further how to better 

regulate his emotions in the future.” Dr. Weinstein added that he was “not 

quite able to do that yet.” 

Following that testimony and closing arguments, the trial court 

announced its decision. It found (1) beyond a reasonable doubt that S.H. 

remained gravely disabled; (2) by clear and convincing evidence that several 

disabilities should be imposed, including the right to refuse or consent to 

medical treatment; and (3) S.H.’s current placement was the least restrictive 

and most appropriate level of care. On June 30, S.H. filed a notice of appeal. 

On July 21, the court issued a written order reappointing the Public 
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Guardian as conservator for the one-year period commencing on April 28, 

2021, as well as a letter of conservatorship. The order reiterated the findings 

made at trial. It also set forth the Public Guardian’s duties as conservator. 

And regarding the medical treatment disability, the court found: “There is 

clear and convincing evidence that [S.H.] lacks the capacity to refuse or 

consent to treatment related specifically to [his] being gravely disabled, 

including psychotropic medications, because [he] is incapable of making 

rational decisions and lacks the mental capacity to rationally understand the 

nature of his . . . psychiatric / medical condition, the proposed treatment, and 

the attendant risks.”2

DISCUSSION

Mootness

As a threshold matter, we must determine whether S.H.’s appeal is 

moot. The conservatorship that is the subject of this appeal expired on April 

2 An order granting a letter of conservatorship is an appealable order. 

(Prob. Code, § 1301, subd. (a); Conservatorship of D.C. (2019) 39 Cal.App.5th 

487, 493.) Here, it is unclear which order constitutes the final order for 

purposes of appeal. Although the court at the June 15 trial made its oral 

pronouncement and stated, “That will be the order,” it issued a minute order 

that same day, which noted, “Order to follow.” Then, on July 21, the court 

issued a letter of conservatorship and written order, which contained several 

provisions not included in its June 15 oral pronouncement, such as 

reappointment of the conservator, the scope of the conservator’s duties, and 

additional findings on the medical treatment disability. To the extent the 

July 21 order is the final order for purposes of appeal, it appears S.H.’s notice 

of appeal filed on June 30 was premature. However, we have authority to 

treat it as filed after entry of the court’s July 21 order. (See Cal. Rules of 

Court, rule 8.104(d)(2) [“The reviewing court may treat a notice of appeal 

filed after the superior court has announced its intended ruling, but before it 

has rendered judgment, as filed immediately after entry of judgment”]; see 

also id., rule 8.104(e) [the word “judgment” under these rules “includes an 

appealable order if the appeal is from an appealable order”].) 
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28, 2022, technically mooting this appeal. However, “[b]ecause a 

conservatorship is relatively brief (one year) in comparison with the appellate 

process,” we will hear this appeal as one raising an issue that “is one capable 

of recurring, yet of evading review because of mootness.” (Conservatorship of 

Susan T. (1994) 8 Cal.4th 1005, 1011, fn. 5.) We therefore conclude, as have 

other courts, that it is appropriate to consider the issue in this case. (See, 

e.g., Conservatorship of K.P. (2021) 11 Cal.5th 695, 705, fn. 3; 

Conservatorship of G.H. (2014) 227 Cal.App.4th 1435, 1439–1440; 

Conservatorship of Joseph W. (2011) 199 Cal.App.4th 953, 960; 

Conservatorship of George H. (2008) 169 Cal.App.4th 157, 161, fn. 2.) 

The Merits

Turning to the substance of the appeal, S.H.’s sole contention is that

insufficient evidence supports the order limiting his right to refuse or consent 

to treatment related to his grave disability. We disagree.

A court may establish or renew a conservatorship under the LPS Act if 

a person is “gravely disabled” (§ 5350), meaning the person, as a result of a 

mental health disorder, is unable to provide for her or his basic personal 

needs for food, clothing, or shelter. (§ 5008, subd. (h)(1)(A).) However, a 

finding of grave disability, by itself, does not justify imposing an order 

allowing involuntary medical treatment. (See Conservatorship of S.A. (2020) 

57 Cal.App.5th 48, 55 (S.A.); Riese v. St. Mary’s Hospital & Medical Center

(1987) 209 Cal.App.3d 1303, 1312–1313 (Riese); § 5005.) “A competent adult 

has the right to refuse medical treatment, including the right to refuse 

psychotropic drugs.” (S.A., supra, 57 Cal.App.5th at p. 55, citing In re Qawi

(2004) 32 Cal.4th 1, 14.) Section 5357 sets forth various legal “disabilities” a 

conservator may seek to impose, including a limitation on “[t]he right to 

refuse or consent to treatment related specifically to the conservatee’s being 
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gravely disabled.” (§ 5357, subd. (d); S.A., at p. 55.)

A court may order involuntary medical treatment if clear and 

convincing evidence shows the conservatee is incompetent to give or withhold 

informed consent. (See S.A., supra, 57 Cal.App.5th at p. 55, citing Riese, 

supra, 209 Cal.App.3d at pp. 1322–1323.) In In re Qawi, supra, 32 Cal.4th at 

pages 17–19, our Supreme Court approved this court’s decision in Riese, 

which listed factors a court must consider to determine whether a 

conservatee is incompetent. Those factors include “(a) whether the patient is 

aware of his or her situation (e.g., if the court is satisfied of the existence of 

psychosis, does the individual acknowledge that condition); (b) whether the 

patient is able to understand the benefits and the risks of, as well as the 

alternatives to, the proposed intervention . . . ; and (c) whether the patient is 

able to understand and to knowingly and intelligently evaluate the 

information required to be given patients whose informed consent is sought 

(§ 5326.2) and otherwise participate in the treatment decision by means of 

rational thought processes.” (Riese, at pp. 1322–1323.) 

On review of an order imposing a disability on the right to refuse or 

consent to treatment, “[w]e must determine whether the record contains 

substantial evidence from which a reasonable trier of fact could have made 

the finding of high probability demanded by this clear and convincing 

standard of proof. (Conservatorship of O.B. (2020) 9 Cal.5th 989, 1005, 1009.) 

We do not reweigh evidence. (Id. at p. 1008.) We presume in favor of the 

judgment the findings of fact necessary to support it. (Conservatorship of 

George H.[, supra,] 169 Cal.App.4th [at p.] 165].)” (S.A., supra, 

57 Cal.App.5th at p. 56.) 

Using the factors set forth in Riese, we conclude substantial evidence 

supports the trial court’s finding that S.H. was not competent to give 
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informed consent to medical treatment. 

While S.H. acknowledged that he had a mental disorder, Dr. Weinstein 

and Dr. Smith concluded, and S.H. does not dispute, that he lacked insight 

into the nature of his disorder. For example, when asked about the reasons 

for being placed in his current facility, S.H. “just stated that he was picked up 

and put in” and could not explain why. In addition, S.H.’s unreasonable 

explanations for getting into physical altercations with others at the facility

indicated a lack of insight into his triggers and emotions related to

aggression. Thus, there was ample evidence that S.H. lacked insight into his 

mental condition. 

Because of this lack of insight, S.H. was distrustful and sometimes 

hostile to his evaluators, preventing him from confronting his symptoms and 

participating in a discussion about his psychiatric needs, much less the 

benefits and risks of specific components of his treatment. During his 

interviews, S.H. was paranoid, which was symptomatic of his diagnosis. He

responded defensively to questions about his impulsive and aggressive 

behavior, his placement at the facility, and medications. For instance, S.H. 

refused to respond to what “seemed fairly like a rather simple question” 

about his insight into the need for medications. Similarly, when asked about 

his prior acts of aggression, he became tense and refused to continue the 

discussion. In his meeting with Dr. Weinstein, in particular, S.H. got angry 

at her, called her “a whack job,” and walked away from the meeting. On the 

topic of his placement at the facility, he pushed for his release and stated he 

did not want oversight or much in the way of treatment, without providing 

any explanation on how he would obtain psychiatric support for such a plan. 

And, as with other topics, he became tense and declined to talk further. 

Dr. Smith added that S.H.’s paranoid responses reflected his inability 
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to perceive that Dr. Smith was his conservator, and therefore a person “trying 

to take care of him and make sure his needs are met . . . .” In a similar vein, 

Dr. Weinstein added that S.H.’s behavior indicated he was unable to talk 

with a mental health professional, which is itself a “very important piece of 

his treatment.” 

The record therefore demonstrates that due to his lack of insight into 

his disorder, S.H. could not be expected to be able to understand the benefits 

and risks of treatment, intelligently evaluate information about treatment, 

and rationally participate in the treatment decision. 

S.H. nonetheless contends the evidence does not support the order 

imposing the medical treatment disability because there is “no evidence that 

[he] was at risk of becoming non-compliant with medication or refusing 

treatment.” S.H. also points to evidence that he was able to recognize some of 

the benefits of his medication. We are not persuaded. 

Regarding the first point, S.H. makes much of the fact that he complied 

with his medications, but he overlooks that medication management, while 

significant, was but one component of his treatment. And the record discloses

he was resistant to other aspects of treatment. Specifically, in addition to 

medication management, Dr. Weinstein explained, one-on-one talk therapy 

with a mental health professional was “a very important piece of his 

treatment.” Dr. Weinstein found that S.H. struggled with this, as illustrated 

by him directing his anger and name calling at her. Other aspects of his

treatment included participating in programs provided at the facility, such as 

group therapy and recreational activities. However, S.H.’s participation in 

these activities was low. Thus, the evidence indicates that S.H., though 

compliant with medications, was not receptive to other aspects of his 

treatment. Indeed, as noted, S.H. expressed to Dr. Smith that he wanted to 
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leave the facility and did not want much in the way of treatment. 

As for S.H.’s second point, it is true that he gave coherent responses to 

certain questions in his evaluations, such as acknowledgment of the benefits 

of medications and care at the facility, which were indicative of some level of 

insight into his situation. At the same time, however, Dr. Smith observed 

that while S.H.’s responses “superficially look[ed] good on the surface,” he 

exhibited paranoia, blunted emotional affect, and a thought process that “was 

perhaps not as good as . . . expected.” Dr. Weinstein also found that although 

S.H. was able to identify events that occurred prior to being placed in the 

facility, he was unable to understand the reasons for his placement and 

referral to treatment. Dr. Weinstein therefore found that S.H.’s insight into 

his disorder and psychiatric needs was “minimal.” And “if his insight into his 

needs . . . is minimal,” she explained, “then his ability to independently meet 

his own treatment needs is minimal as well.” The record thus permits a 

finding that although S.H. at times showed a linear thought process, he did 

not have sufficient mental capacity to make informed decisions about 

treatment. 

In sum and in short, we conclude substantial evidence supports the 

trial court’s finding by clear and convincing evidence that S.H. was not 

competent to refuse or consent to treatment related to his grave disability. 

DISPOSITION

The order is affirmed. 
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_________________________

Richman, Acting P. J.

We concur:

_________________________

Miller, J.

_________________________

Van Aken, J. *

Conservatorship of S.H. (A163073)

*Judge of the San Francisco Superior Court, Judge Christine Van Aken, 

sitting as assigned by the Chief Justice pursuant to article VI, section 6 of the 

California Constitution.