Filed 2/21/24

CERTIFIED FOR PUBLICATION

COURT OF APPEAL, FOURTH APPELLATE DISTRICT

DIVISION ONE

STATE OF CALIFORNIA

THE PEOPLE,

Plaintiff and Respondent,

v.

JENNIFER GARCIA,

Defendant and Appellant.

 D081713

 (Super. Ct. Nos. SCD291317, 

CD295871, MH119205, 

SCN426026)

APPEAL from an order of the Superior Court of San Diego County, 

Cindy D. Davis, Judge. Affirmed.

Paul R. Kraus, under appointment by the Court of Appeal, for 

Defendant and Appellant.

Rob Bonta, Attorney General, Lance E. Winters, Chief Assistant 

Attorney General, Charles C. Ragland, Assistant Attorney General,

Collette C. Cavalier and Sahar Karimi, Deputy Attorneys General, for 

Plaintiff and Respondent.

INTRODUCTION

Based on the opinion of a licensed psychiatrist and a licensed 

psychologist, the trial court found that Jennifer Garcia was mentally 

incompetent to stand trial and further found that she lacked the capacity to 

make decisions regarding the administration of antipsychotic medication. 
2

(Pen. Code,1 §§ 1368, 1369, 1370.) On appeal, Garcia alleges numerous

errors with the court’s order authorizing the state hospital to involuntarily 

administer antipsychotic medication to her. She also contends her trial 

counsel was ineffective in failing to object to the order. We affirm.

FACTUAL AND PROCEDURAL BACKGROUND

In July 2021, Garcia sent threatening text messages to a Child Welfare 

Services worker. Garcia threatened to abduct the worker, “cement” her, and 

“toss” her into a river for abducting and abusing Garcia’s children. In People 

v. Garcia, No. SCN426026, the San Diego County District Attorney charged 

Garcia with one count of making threats to a public officer (§ 71); and two 

counts of disobeying a court order (§ 273.6).

In August 2021, Garcia brought a large kitchen knife into juvenile 

court. Video surveillance showed that she had the weapon in her waistband 

when she walked into a courthouse restroom. The knife was later recovered 

from the restroom. In People v. Garcia, No. SCD291317, the San Diego 

County District Attorney charged Garcia with possessing a weapon in a 

courthouse (§ 171b, subd. (a)). 

In September 2021, Garcia pled guilty to violating section 71 in the 

threatening case and section 171b, subdivision (a) in the weapons possession 

case. The remaining counts were dismissed. In October 2021, the court 

sentenced Garcia to two years of formal probation and credit for time served 

in custody. In April 2022, the probation office reported that Garcia had 

violated probation and recommended revocation of probation in ex parte 

warrants for both cases. 

In June 2022, Garcia “stabbed a woman several times in the back, head 

and neck.” The attack resulted in “several lacerations to the victim” and 

1 All further undesignated statutory references are to the Penal Code.
3

required “staples and sutures to close” the wounds. In People v. Garcia, No. 

CD294930, the San Diego County District Attorney charged Garcia with 

attempted murder (§§ 664, 187, subd. (a)) and assault with a deadly weapon 

(§ 245, subd. (a)(1)). The felony complaint further alleged that Garcia 

personally used a deadly and dangerous weapon under section 12022, 

subdivision (b)(1) and personally inflicted great bodily injury under section 

12022.7, subdivision (a). 

At the consolidated preliminary hearing and probation violation 

evidentiary hearing in August 2022, Garcia’s counsel declared a doubt as to 

Garcia’s mental competence under section 1368. The trial court suspended 

the criminal proceedings for a determination of Garcia’s mental competence. 

Psychologist Valerie Rice, Ph.D., evaluated Garcia in September 2022 

and filed two reports: one on Garcia’s mental competency to stand trial and 

another on involuntary medications to restore competency. The report on 

Garcia’s mental competency diagnosed her with unspecified schizophrenia 

spectrum and other psychotic disorder. “Due to her delusions and thought 

disorganization, she was unable to demonstrate an understanding of the 

nature of the criminal proceedings.” “[D]ue to her symptoms of severe mental 

illness, she was unable to participate in a rational discussion of her legal 

cases.” The report concluded that Garcia “should be found incompetent to 

stand trial.” 

Dr. Rice’s report on involuntary medications referenced the evaluation 

for mental competency. It found that Garcia “is suffering from a severe 

mental disorder with psychotic features, which requires medical treatment 

with antipsychotic medication. Without appropriate treatment with 

antipsychotic medication, it is likely that the serious harm will come to the 

physical and/or mental health of [Garcia]. Due to her impaired mental 
4

health, [Garcia] is unable to make rational decisions regarding antipsychotic 

medication.” Dr. Rice’s report also found that Garcia had been “seen by the 

jail psychiatrist several times and prescribed multiple antipsychotic 

medications; however, she has been noncompliant with these medications, 

which have been subsequently discontinued.”

Following Garcia’s lack of agreement with Dr. Rice’s reports, the court 

ordered a second forensic evaluation from a different doctor. Forensic 

psychiatrist Sandeep Jouhal, M.D., evaluated Garcia in December 2022 and 

also filed two reports, one on Garcia’s mental competency and another on 

involuntary medication. Dr. Jouhal diagnosed her with unspecified psychosis 

and stimulant use disorder. Like Dr. Rice, Dr. Jouhal concluded Garcia’s

“symptoms of mental illness render [her] incapable of having a rational 

understanding of her charges or assist her legal counsel in preparation of her 

defense.” Dr. Jouhal’s involuntary medication report found that Garcia 

“lacks the capacity to make decisions regarding antipsychotic medications. 

The mental disorder requires medical treatment with antipsychotic 

medication at this time. If [Garcia’s] mental disorder is not treated with 

antipsychotic medication, it is possible that serious harm to [her] . . . physical 

or mental health . . . will result.” 

Later in December 2022, the court conducted a hearing regarding 

Garcia’s mental competency. Both parties stipulated to the qualifications of 

Dr. Rice and Dr. Jouhal and agreed that their reports could be entered into 

evidence. The court found Garcia was not mentally competent “based on both 

reports and the Court’s observations.” Regarding antipsychotic medication, 

the court stated that both doctors “believe that she really does need 

medication, . . . that she has had antipsychotic medication in the past, but 

she is now refusing it[,] . . . [and] without appropriate treatment, serious 
5

harm could come to her physically or mentally.” The court also noted that 

“[s]he does present potential danger to the health and safety of others.” 

DISCUSSION

I.

Substantial Evidence Supported the Involuntary Antipsychotic Medication 

Order

A court’s order authorizing a state hospital to administer antipsychotic 

medication involuntarily to a defendant will be upheld on appeal so long as it 

is supported by substantial evidence. (People v. Lameed (2016) 247 

Cal.App.4th 381, 397.) Our “review of the sufficiency of the evidence in 

support of a finding requiring clear and convincing proof must account for the 

level of confidence this standard demands.”2 (Conservatorship of O.B. (2020) 

9 Cal.5th 989, 995.) Accordingly, “the question before [us] is whether the 

record as a whole contains substantial evidence from which a reasonable fact 

finder could have found it highly probable that the fact was true.” (Id. at

pp. 995–996.)

Garcia contends that there are multiple reasons why substantial 

evidence did not support the trial court’s involuntary antipsychotic 

medication order. First, she disputes the sufficiency of the evidence of the 

third statutory condition for the court’s order: “if the defendant’s mental 

disorder is not treated with antipsychotic medication, it is probable that 

serious harm to the physical or mental health of the defendant will result.”

(§ 1370, subd. (a)(2)(B)(i)(I).) Second, she contends that Dr. Rice exceeded the 

2 Garcia argues that clear and convincing evidence is the applicable 

standard of proof. The People do not dispute Garcia’s contention. We are not 

aware of a published decision addressing the standard of proof in this context 

and assume without deciding that clear and convincing evidence is the 

applicable standard of proof.
6

scope of her license, in violation of section 1369, subdivision (a)(2)(B). Third, 

Garcia contends the opinions of Dr. Rice and Dr. Jouhal lacked statutorily 

required information, in violation of section 1369, subdivision (a)(2)(B) and 

subdivision (a)(2)(C). We disagree with Garcia on each of these points.

A. The Opinions of the Examining Doctors Provided Substantial 

Evidence That Serious Harm Would Probably Result Without 

Antipsychotic Medication

A trial court is required to permit involuntary administration of 

antipsychotic medication if it finds one of three sets of conditions to be true. 

(§ 1370, subd. (a)(2)(B)(i)(I)–(III) & (ii).) Here, the trial court found the 

evidence established the first of those sets of conditions: “Based upon the 

opinion of the psychiatrist or licensed psychologist offered to the court 

pursuant to subparagraph (A) of paragraph (2) of subdivision (a) of Section 

1369, [1] the defendant lacks capacity to make decisions regarding 

antipsychotic medication, [2] the defendant’s mental disorder requires 

medical treatment with antipsychotic medication, and, [3] if the defendant’s 

mental disorder is not treated with antipsychotic medication, it is probable 

that serious harm to the physical or mental health of the defendant will 

result.” (§ 1370, subd. (a)(2)(B)(i)(I).) Garcia disputes only the third 

condition—that she would probably suffer serious harm without 

antipsychotic medication.

The statute has additional specificity regarding the third condition. 

(§ 1370, subd. (a)(2)(B)(i)(I).) It explains that a probability of serious harm 

requires evidence that either (1) “the defendant is presently suffering adverse 

effects to their physical or mental health,” or (2) “the defendant has 

previously suffered these effects as a result of a mental disorder and their

condition is substantially deteriorating.” (Ibid.) The statute further states
7

that “a diagnosis of a mental disorder does not alone establish probability of 

serious harm.” (Ibid.)

Substantial evidence showed that Garcia was “presently suffering 

adverse effects to [her] physical or mental health.” (§ 1370, subd. 

(a)(2)(B)(i)(I).) Dr. Rice’s report on Garcia’s mental competency stated that 

Garcia exhibited symptoms of severe mental illness with “grandiose and 

paranoid delusions, mostly revolving around her belief that her children were 

being sex trafficked and CPS had made false allegations against her.” 

During her interview, Garcia said that “[s]omebody threw bleach in my eyes 

and glass in my eyes. I think they left a piece of glass in my forehead.”

Dr. Jouhal similarly observed Garcia’s “thought process was scattered and 

illogical,” and her “thought content was significant for bizarre and paranoid 

delusions.” Dr. Jouhal described Garcia as “uncooperative” and as “irritable, 

rambling extensively and difficult to interrupt.” During her interview, 

Garcia “became acutely agitated and [began] yelling,” including that “[t]here 

is human trafficking being run here, and I have already reported it!” Both 

doctors concluded Garcia suffers from a mental illness, her symptoms 

rendered her incapable of having a rational understanding of the charges 

against her, and she was incompetent to stand trial. They both also

determined she lacked the capacity to make decisions about her medication 

due to her impaired mental health. In making their determinations, both 

doctors relied on prior psychiatric reports, jail notes, the criminal case file, 

and their interviews with Garcia. 

Both doctors filed a report on involuntary medication that referenced 

their mental competency report and found that Garcia had “severe” mental 

illness that “requires treatment with antipsychotic medication.” Dr. Rice 

found that, “[w]ithout appropriate treatment with antipsychotic medication, 
8

it is likely that serious harm will come to the physical and/or mental health” 

of Garcia. Dr. Jouhal similarly found that if Garcia’s “mental disorder is not 

treated with antipsychotic medication, it is possible that serious harm to the 

physical or mental health of [Garcia] will result.” Further, Dr. Jouhal opined 

that “[a]ntipsychotics are in [Garcia’s] best medical interest in light of the 

medical condition.” Dr. Rice concluded that “the court may order involuntary 

medications under Penal Code Section 1370,” while Dr. Jouhal recommended

that Garcia “be given medications involuntarily under Penal Code Section 

1370.” 

The doctors’ reports separately and in combination provided 

substantial evidence that Garcia was presently suffering adverse effects to 

her mental health. The court relied on both reports when it issued the

involuntary antipsychotic medication order. The reports therefore provided

substantial evidence that the third condition of section 1370, subdivision 

(a)(2)(B)(i)(I), was satisfied.

Garcia argues that accepting the symptoms identified above as 

evidence of adverse effects to her mental health violates the statutory 

mandate that “a diagnosis of a mental disorder does not alone establish 

probability of serious harm to the physical or mental health of the

defendant.” (§ 1370, subd. (a)(2)(B)(i)(I).) We disagree. Garcia is correct that 

Dr. Rice and Dr. Jouhal relied on those symptoms in diagnosing her with 

severe mental illness. But that does not prevent those symptoms from 

providing evidence of adverse effects to Garcia’s health. The statute only 

requires not using the “diagnosis of a mental disorder” alone to establish 

probability of serious harm. (§ 1370, subd. (a)(2)(B)(i)(I), italics added.) It 

does not preclude using symptoms of the diagnosis to show adverse effects to 

Garcia’s health to establish a probability of serious harm. (See ibid.)
9

Garcia also contends that the doctors’ involuntary medication reports 

included “conclusory, perfunctory language” regarding the likelihood of 

serious harm to Garcia. She contends that those reports do not identify the 

alleged harm. But Garcia ignores those reports’ reference to the respective 

mental competency reports prepared and submitted contemporaneously and 

they “evaluated” Garcia regarding her “mental competency” and “opined” that 

she was not competent “to stand trial.” As we have explained, the referenced 

reports contained substantial detail regarding adverse effects to Garcia’s

health. Nothing in section 1370, subdivision (a)(2)(B)(i)(I), prevents the court 

from considering evidence contained in a contemporaneous report referenced 

by an opinion on involuntary antipsychotic medication.

We therefore conclude that substantial evidence supports the court’s 

findings.

B. Dr Rice’s Opinion Did Not Exceed the Scope of Her License

In her supplemental briefing on appeal, Garcia asserts that Dr. Rice 

offered an opinion that exceeded the scope of her license in violation of section 

1369, subdivision (a)(2)(B). We disagree.

An order permitting the involuntary administration of antipsychotic 

medication must be supported by a psychiatrist or licensed psychologist

(§ 1370, subd. (a)(2)(B)(ii)(I)–(II).) The requirements are set forth in section 

1369, which states that the psychiatrist or licensed psychologist “shall 

evaluate . . . whether treatment with antipsychotic medication . . . is 

appropriate for the defendant.” (§ 1369, subd. (a)(2)(A).) There are different 

requirements depending on whether the evaluator is a psychiatrist or a 

licensed psychologist. (Ibid.) When the evaluation is performed by a licensed 

psychologist, “if [that] psychologist examines the defendant and opines that 

treatment with antipsychotic medication may be appropriate, their opinion 
10

shall be based on whether the defendant has a mental disorder that is 

typically known to benefit from that treatment.” (Id., subd. (a)(2)(B).) The 

psychologist’s opinion “shall not exceed the scope of their license” and “is not 

a prescription for [the antipsychotic] medication.” (Ibid.) In contrast, when 

the evaluation is performed by a psychiatrist, the psychiatrist shall opine

whether “treatment with antipsychotic medication is appropriate,” and shall 

“inform the court of their opinion as to the likely or potential side effects of 

the medication, the expected efficacy of the medication, and possible 

alternative treatments.” (Id., subd. (a)(2)(C).)

Garcia contends that Dr. Rice exceeded the scope of her license when 

she opined that Garcia “is suffering from a severe mental disorder with 

psychotic features, which requires medical treatment with antipsychotic 

medication.” (Italics added.) Garcia asserts that Dr. Rice exceeded the limits 

of section 1369, subdivision (a)(2)(B), which she claims only allows 

psychologists to conclude treatment with antipsychotic medication “may be 

appropriate.” But the preceding provision (§ 1369, subd. (a)(2)(A)) provides

that psychologists “shall evaluate” whether treatment with antipsychotic 

mediation “is appropriate.” Accordingly, the “may be appropriate” language 

of section 1369, subdivision (a)(2)(B) does not limit licensed psychologists in 

the certainty with which they may express their findings.

On the contrary, the restriction on a psychologist’s opinion exceeding 

the scope of their license appears to be focused on the specific antipsychotic 

medication to be prescribed. This is supported by two elements of the 

statute. First, the provision regarding licensed psychologists explains that 

an “opinion about the potential benefit of antipsychotic medication” (in 

general) “is not a prescription for that medication.” (§ 1369, subd. (a)(2)(B).)

Second, the provision regarding psychiatrists has another requirement that 
11

they “inform the court of their opinion as to the likely or potential side effects 

of the medication, the expected efficacy of the medication, and possible 

alternative treatments.” (§ 1369, subd. (a)(2)(C).) The fact that licensed 

psychologists do not have such a requirement indicates that, while they

cannot opine about specific medications, they may opine as to whether 

antipsychotic medication generally “is appropriate.” We thus conclude that 

Dr. Rice did not exceed the scope of her license by opining that Garcia “is 

suffering from a severe mental disorder which requires medical treatment 

with antipsychotic medication.”

C. Dr. Rice’s and Dr. Jouhal’s Opinions Did Not Lack Statutorily Required 

Information

Garcia argues that Dr. Rice violated section 1369, subdivision (a)(2)(B), 

by failing to opine that Garcia “has a mental disorder that is typically known 

to benefit from that treatment.” But there is no such requirement in that 

provision; it merely provides that the opinion “shall be based on whether the 

defendant has a mental disorder that is typically known to benefit from that 

treatment.” (§ 1369, subd. (a)(2)(B), italics added.) Dr. Rice diagnosed Garcia 

as suffering from unspecified schizophrenia spectrum and other psychotic 

disorder and then concluded that her disorder “requires medical treatment 

with antipsychotic medication.” This suggests Dr. Rice understood Garcia’s

mental disorder was typically known to benefit from treatment with 

antipsychotic medication and based her opinion on that fact. Nothing else is 

required by section 1369, subdivision (a)(2)(B).

Garcia also contends that Dr. Jouhal’s opinion violated section 1369, 

subdivision (a)(2)(B) and section 1370 by failing to opine on “the likely or 

potential side effects of the medication.” Section 1369, subdivision (a)(2)(C) 

states, “the psychiatrist shall inform the court of their opinion as to the likely 
12

or potential side effects of the medication, the expected efficacy of the 

medication, and possible alternative treatments.” (§ 1369, subd. (a)(2)(C).)

Section 1370 provides that when determining whether to order involuntary 

medication based on the psychiatrist’s opinion, the court will consider 

whether the medication “is substantially likely to render the defendant 

competent to stand trial, the medication is unlikely to have side effects that 

interfere with the defendant’s ability to understand the nature of the 

criminal proceedings or to assist counsel in the conduct of a defense in a 

reasonable manner, less intrusive treatments are unlikely to have 

substantially the same results, and antipsychotic medication is appropriate 

in light of their medical condition.” (§ 1370, subd. (a)(2)(B)(i)(III).)

Here, Dr. Jouhal’s report contained the required information. It states, 

“Administration of antipsychotic medication is likely to restore the 

defendant’s competency to stand trial. Monitored medications are unlikely to 

interfere with the defendant’s ability to understand the nature of the current 

proceedings or to assist counsel in a rational manner. Less intrusive 

treatments are unlikely to have the same result. Antipsychotics are in the 

defendant’s best medical interest in light of the medical condition.” 

We thus conclude that Dr. Rice’s and Dr. Jouhal’s reports were proper 

under sections 1369 and 1370.
13

II.

The Error on the Superior Court Form Was Harmless

Garcia points to an error in the language of the Superior Court’s form 

order.3 The form has a box for the court to check if it finds that without 

treatment with antipsychotic medication, “it is possible that serious harm to 

the physical or mental health of the patient will result.” (Italics added.) This 

language is different than the statutory standard requiring a finding that “it 

is probable that serious harm to the physical or mental health of the 

defendant will result.” (§ 1370, subd. (a)(2)(B)(i)(I), italics added.) We 

conclude that it was a harmless error.

The parties agree that the error should be analyzed under the stricter 

Chapman standard, and we assume without deciding that Chapman applies.

(Chapman v. California (1967) 386 U.S. 18, 24; see also Sell v. United States 

(2003) 539 U.S. 166, 178 [“an individual has a ‘significant’ constitutionally 

protected ‘liberty interest’ in ‘avoiding the unwanted administration of 

antipsychotic drugs’ ”]; People v. Hill (2013) 219 Cal.App.4th 646, 652–653 

[applying Chapman to a statutory right in a civil commitment proceeding 

because “that right is protected by the due process clause of the federal 

Constitution”].) Under Chapman, the error must be “harmless beyond a 

reasonable doubt.” (Chapman, at p. 24.) Here, the form order purported to 

apply a “possible” standard that was less stringent than the statute’s 

“probable” standard.

During the hearing, the court explained that its findings were based on 

“two reports, one from Dr. Valerie Rice and one from Dr. Jouhal” and the 

3 The form order is “SUPCT MH-23 (Rev. 3-06)” and is titled, “Judgment 

of Mental Incompetency and Order for Commitment (Penal Code 1370 & 

1372(a)(2)).” (Capitalization omitted.)
14

court’s “observations.” Dr. Rice’s report applied the correct standard when 

she concluded “[w]ithout appropriate treatment with antipsychotic 

medication, it is likely that serious harm will come to the physical and/or 

mental health” of Garcia. Garcia concedes that “likely” has a substantially 

similar meaning to “probable.” Although Dr. Jouhal’s report stated that 

harm was “possible,” the court’s ruling considered both reports, its own 

observations, and the standard under section 1370. 

As discussed earlier, the doctors’ conclusions were supported by ample

evidence of the symptoms and harm Garcia has suffered due to her mental

disorder. Garcia has not identified any substantive weaknesses in the doctors’

reports nor any evidence contradicting their findings. Their findings and 

conclusions would have equally supported the court’s order if it had stated 

serious harm was “probable,” rather than merely “possible.” Accordingly, the 

form order’s error was harmless beyond a reasonable doubt.

III.

Garcia Was Not Prejudiced by Any Ineffectiveness of Counsel

Garcia’s final argument is that her attorney was ineffective when she 

failed to “object to the entry of an involuntary psychiatric medication order.” 

To succeed, Garcia needs to demonstrate that her counsel’s ineffective 

performance caused her prejudice. (Strickland v. Washington (1984) 466 U.S. 

668, 693; People v. Williams (1997) 16 Cal.4th 153, 215.) “Prejudice is shown 

when there is a reasonable probability that, but for counsel’s unprofessional 

errors, the result of the proceeding would have been different.” (Williams, at 

p. 215.) She has not shown prejudice here.

Garcia asserts “[a] more favorable outcome is reasonably probable 

because of the evidentiary weaknesses in the prosecution case.” However, we 

already evaluated and rejected the claimed weaknesses in connection with 
15

the third statutory condition. Further, even if Garcia’s trial counsel had 

objected, we have already concluded that the court would have made the 

same findings under the “probable” standard. Garcia has not established a 

reasonable probability that a different result would have occurred if her trial 

counsel had objected.

DISPOSITION

The order is affirmed.

McCONNELL, P. J.

WE CONCUR:

IRION, J.

DO, J.