Filed 9/15/16 P. v. Gambord CA5

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IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIFTH APPELLATE DISTRICT

THE PEOPLE,

Plaintiff and Respondent,

v.

JEFFREY GAMBORD,

Defendant and Appellant.

F070669

(Super. Ct. No. 14CRAD682209)

OPINION

THE COURT*

APPEAL from an order of the Superior Court of Fresno County. Jonathan B. 

Conklin, Judge.

Robert Navarro, under appointment by the Court of Appeal, for Defendant and

Appellant.

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

General, Niromi W. Pfeiffer, and Karli Eisenberg, Deputy Attorneys General, for 

Plaintiff and Respondent.

-ooOoo-

 

* Before Gomes, Acting P.J., Detjen, J. and Franson, J.
2.

Appellant Jeffrey Gambord, a sexually violent predator, appeals from a 

December 1, 2014, order authorizing the Department of State Hospitals (DSH) to 

involuntarily administer psychotropic medications to treat his bipolar disorder. We 

affirm.

FACTS AND PROCEDURAL SUMMARY

The Petition

On September 4, 2014, DSH petitioned the superior court for an order compelling 

involuntary treatment of Gambord with psychotropic medication pursuant to In re 

Calhoun (2004) 121 Cal.App.4th 1315. The petition alleged that Gambord was admitted 

to Coalinga State Hospital (CSH) on September 19, 2006, pursuant to Welfare and 

Institutions Code section 6604. The petition stated he was diagnosed with Bipolar I 

Disorder, Current Episode Manic, and was involuntarily administered psychotropic 

medication pursuant to an in-house panel determination conducted on April 10, 2014. 

The petition further alleged that Gambord had a history of noncompliance with taking 

psychotropic medication, continued to demonstrate a lack of insight into his mental 

illness and his need for psychotropic medication, was unable to reason and understand the 

gravity of his actions, and was incompetent to refuse medical treatment. Moreover, he 

presented a danger to others when not medicated with psychotropic medication, 

threatening staff and exposing himself to female staff. Finally, the petition alleged there 

were no less intrusive methods to render him non-dangerous than administration of 

psychotropic medication. 

The Hearing

Dr. Risley

Dr. Dawn Risley, a psychiatrist at CSH, testified that Gambord was her patient and 

she saw him multiple times per day. She diagnosed him with “Bipolar I Disorder, most 

recent episode manic with psychotic features.” He had an “[e]xpansive, elevated and 

irritable mood lasting greater than one week with pressured speech and a need to keep 
3.

talking; racing thoughts; engaging in behavior that has the potential for dangerous 

consequences; easily distractibility, psychomotor agitation[;] [¶] ... [¶] [f]light of ideas [; 

a]nd increase in goal-directed activity.” When she discussed this diagnosis with him, he 

disagreed, stating he suffered only from anxiety. He minimized the criteria and could not 

see how bipolar symptoms related to him. 

Dr. Risley testified that the normal treatment for Gambord’s condition included a 

mood stabilizer paired with a second generation antipsychotic medication. She had 

discussed this treatment with Gambord; however, he believed he did not need either 

medication and said he would only take Klonopin, which according to Dr. Risley would 

not treat his illness. On many occasions, he stated he would stop taking his medications, 

and then he did. He said he would not take his medications if he went to court or jail. He 

said he would only agree to take medications if they were administered at subtherapeutic 

dosages. 

Dr. Risley testified that Gambord was not currently taking any medication because 

Dr. Risley had no further court order. She stopped Gambord’s lithium because a test 

demonstrated an electrical abnormality of his heart. She explained that all medications 

carry risks, but the benefits outweighed the risks for Gambord because he needed the 

medication. He was in an institution for the gravely mentally ill where treating disorders 

was the main concern. Gambord was able to understand the risks and benefits of a 

medication, but not as it pertained to him. He believed he was not mentally ill and did 

not need medication. But he was in fact very mentally ill. He did not have the ability to

understand and evaluate whether to take his medication, and he lacked the capacity to 

make his own decisions regarding his medication treatment. 

Gambord was transferred to another level of care because he made repeated calls 

to several senators and they wanted him to stop. He was placed on one-to-one care and 

his telephone privileges were taken away, except for approved numbers. 
4.

Defense Evidence

Officer Rabaut

Police Officer Charles Rabaut testified that he worked at CSH for three and onehalf years as the chief of police and three years as a supervising senior special 

investigator. Gambord had functioned as a confidential informant for him, providing 

information about crimes being committed, including those involving Mr. M. 

Apparently, a police report naming Gambord as a confidential informant was provided to 

one of the patients by an attorney and the report was later recovered inside CSH. As a 

result, Gambord’s life was threatened and he was physically assaulting in the hallway. 

He was called a rat. Gambord continued to call Officer Rabaut and provide information 

for a few years. Gambord seemed normal, rational, and logical. Some employees were 

involved in the criminal activities he reported. He also expressed concern that CSH was 

mistreating patients. He tried contacting authorities and legislators because he wanted to 

prevent a particular person from being appointed as the director of CSH. In addition, he 

considered starting a concierge dry cleaning service for the employees at CSH, which 

Officer Rabaut thought was unusual. 

Gambord

Gambord testified that he had only two 15-minute encounters with Dr. Risley. 

She later explained to him that he was going to be forcibly medicated because he had 

been threatening people in Sacramento and they were afraid. She said he was a danger to 

them. He denied threatening any senators. She explained that he was bipolar and needed 

medication. He told her about his other problems, but she said they would not cause 

bipolar disorder. She accused him of not taking responsibility for his behavior and not 

having insight into what he was doing. 
5.

When Gambord was taking lithium and other drugs, he suffered from many side 

effects. He would consider taking other medications if he could start with smaller doses 

and see if he had side effects. 

Gambord did not believe he was bipolar, but he thought his anxiety would benefit 

from medication. He could speak calmly when given the time to explain himself. And 

when he did get excited, he could calm himself back down. Often the situations at CSH 

provoked excited behavior in patients. Sometimes he needed to show his anger to be 

taken seriously at CSH. 

That morning, he asked to take an Ativan because he was nervous about the 

hearing. He testified that he was not allowed to take it because “they” wanted the court 

to see him in his “full manic state or something.” 

Gambord had written a critical report on CSH and posted it on his website. 

Dr. Risley told him his website was full of typical manic stuff. He told her he had 

received a lot of compliments about his website, but she said it was totally manic. She 

would not listen to the things he said about CSH and its crimes. Gambord started 

contacting legislators regarding what was happening at CSH. His first goal was to 

prevent the appointment of a particular administrator at CSH; the second was to initiate 

an investigation into deaths occurring at CSH. 

He was also considering starting a concierge-type service for CSH employees that 

might include dry cleaning, expanded food service, and car detailing. 

He once protested CSH’s prohibition against video contact between patients and 

their terminally ill family members. He was granted approval to visit with his father via 

video. 

Gambord informed Officer Rabaut that a patient, Mr. M, was going to stab another 

patient. Officer Rabaut sent the police. At trial, Officer Rabaut testified to protect 

Gambord’s identity, and Mr. M. was convicted. But Mr. M. found the report and 

discovered Gambord’s identity. Mr. M. then threatened Gambord, who had no choice but 
6.

to negotiate with him. Gambord would buy him sodas and leave them in the bathroom 

where there were no cameras. Eventually, Gambord decided to stop. He told the director 

he was going to stop paying off Mr. M. and he expected the hospital to protect him. 

After that, he was threatened, assaulted, and called names. He was still housed with 

Mr. M. Gambord tried to keep to himself for his own safety. 

On cross-examination, Gambord said he probably had several mental illnesses. 

He thought he might exhibit some of the symptoms of bipolar disorder, but he had not 

had the opportunity to explore it because Dr. Risley would not discuss it with him. He 

did think he had anxiety and post-traumatic stress disorder. He explained: “I may have 

bipolar. I just am not convinced. I’m open to the idea of somebody convincing me that 

there’s not a differential diagnosis of anxiety versus bipolar, you know.” He explained 

that he refused to take the prescribed medication because of side effects he was suffering, 

including weight gain, arrhythmias, high blood sugar, confusion, and dizziness. 

After hearing this evidence and argument by counsel, the superior court granted 

the petition to forcibly medicate Gambord. The following occurred:

“THE COURT: I’ve read and considered my notes.· A couple 

observations.· Mr. Gamboa [sic] is clearly bipolar.· He’s clearly manic.· 

And I don’t mean that as a criticism of you, sir. You’ve acknowledged it.· 

You acknowledged you’re bipolar.· You know, sometimes when I’m 

conducting these hearings I listen for very telling quotes and testimony.· 

And there’s two of them that struck me.· One of them—and I acknowledge 

that there may be some animosity between Dr. Risley and Mr. Gamboa 

[sic].· That was obvious from the testimony.· I’m not stating that as a 

criticism, but there, obviously, is some—maybe some animosity between 

the two both ways.· I’m not saying just from Mr. Gamboa [sic] to 

Dr. Risley, perhaps from Dr. Risley to Mr. Gamboa [sic] as well.

“But one of her quotes was:· His behavior is uncontrollable because 

he’s manic.· And then Mr. Gamboa [sic] stated in his testimony, and it was 

almost a passing conversation, where he said they didn’t want to give me 

my meds this morning because they wanted the court to see what I’m like 

when I’m manic.· Well, that’s exactly the behavior that was displayed in 

court today.
7.

“Um, so I agree with you, [defense counsel], Mr. Gamboa [sic] 

appears to be a highly intelligent man.

“[DEFENSE COUNSEL]: Excuse me.· Gambord.

“THE COURT: ·Gambord.· I apologize.· Highly intelligent.· But 

he’s more than driven and he’s more than passionate.· That is what is of 

greatest concern of the court.· Now, I’m trying to balance that concern 

against his medical well-being.

“While I’m going to order the forced med, I’m going to approve the 

order for lack of capacity, because I do not believe he has the capacity to 

make a rational decision about his medication. Um, I believe that that—

any medication issues are—still have to be governed by appropriate 

medical treatment.· So my order can in no way be read or heard to put Mr. 

Gambord at risk, if this—the—and I apologize.· I forget the medical term 

for the heart condition.

“[DEFENSE COUNSEL]: QT—

· “THE COURT: ·QTCs. ·If the QTCs occur, and it appears that Mr. 

Gambord is at medical risk, then I’m ordering that he be constantly 

monitored—his medical condition be constantly monitored.· If at any time 

the medical risks do outweigh the benefits of the medication they are 

ordered to be ceased.

“I’m not a doctor.· I don’t believe any court has the ability to say 

continue this medication if it puts the defendant at risk.· I’ve not heard 

testimony today that establishes he is at risk for continuing medication.· 

The doctor stated, though it was—the question was stated in the negative so 

initially it was misstated, but she stated the benefits of the medication 

outweigh the risks.· And that’s what the evidence appears to establish 

today.

“It is, frankly, just striking to the court, and I think we all—because 

it’s been previously established that Mr. Gambord has been off his 

medication now for some time.

· “[DEFENSE COUNSEL]: Correct.

“THE COURT: And, um, he is surely no better. And it appears to 

this court, based upon observation, that his behavior is, um, continuing to 

deteriorate in the sense of the manic behavior and the bipolar symptoms, 

the—I tried to keep track of the criteria that the doctor utilized when she 
8.

was listing the description of bipolar. And those behaviors were exhibited 

even in court today.

“So I am finding that the defendant lacks the appropriate capacity to 

make the decisions. And I’m approving the forced medication order.” 

On December 16, 2014, Gambord filed a notice of appeal. 

DISCUSSION

A competent adult has a common law and constitutional right to refuse medical 

treatment, including the administration of antipsychotic drugs. (In re Qawi (2004) 32 

Cal.4th 1, 14.) An involuntarily committed patient may be forcibly treated with 

antipsychotic medication if a court has determined that he is not competent to refuse 

treatment. (Ibid.; In re Calhoun, supra, 121 Cal.App.4th at p. 1354.) The superior court 

shall determine competence to refuse treatment by clear and convincing evidence, “so 

clear as 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.)

A judicial determination of competency to refuse treatment involves consideration 

of three factors: (1) whether the patient is aware of his situation and acknowledges his 

condition; (2) whether he understands the benefits and risks of treatment as well as 

alternatives to treatment; and (3) whether he is able to understand and evaluate the 

information regarding informed consent and participate in the treatment decision by 

rational thought processes. (Riese v. St. Mary’s Hospital & Medical Center (1987) 

209 Cal.App.3d 1303, 1322-1323.)

The standard of review for an order authorizing the involuntary administration of 

antipsychotic medication is substantial evidence. (People v. Fisher (2009) 

172 Cal.App.4th 1006, 1016.) “In considering a challenge to the sufficiency of the 

evidence ... we review the entire record in the light most favorable to the judgment to 

determine whether it contains substantial evidence—that is, evidence that is reasonable, 
9.

credible, and of solid value—from which a reasonable trier of fact could [make its 

findings]. [Citation.] We presume every fact in support of the [ruling that] the trier of 

fact could have reasonably deduced from the evidence. [Citation.] If the circumstances 

reasonably justify the trier of fact’s findings, reversal ... is not warranted simply because 

the circumstances might also reasonably be reconciled with a contrary finding. 

[Citation.] ‘A reviewing court neither reweighs evidence nor reevaluates a witness’s 

credibility.’ ” (People v. Albillar (2010) 51 Cal.4th 47, 59-60.)

Here, while there was evidence that Gambord was articulate and intelligent, there 

was also evidence reasonably justifying the court’s finding that he was manic and bipolar,

not simply passionate and driven. Dr. Risley explained that he exhibited several bipolar 

symptoms, and the superior court stated it observed many of them during the hearing. 

Defendant was aware he struggled with mental illness, and he was willing to treat his 

anxiety, but he did not accept the bipolar diagnosis or his need for medication of that 

illness. He acknowledged his condition to only a limited extent, conceding he might have 

some bipolar symptoms, but he continued to deny the diagnosis and stated he would be 

willing to try medication only in subtherapeutic dosages. The evidence established he 

was not aware of his bipolar illness and his need for medication of that illness, and was 

not able to rationally participate in the treatment decision. Thus, we conclude the record 

contains substantial evidence supporting the superior court’s finding that Gambord was 

not competent to refuse treatment. Furthermore, we defer to the superior court’s ability 

to observe Gambord’s behavior and gauge the witnesses’ credibility, recognizing that 

without that ability, we are in no position to question the court’s observations or reweigh 

the evidence before it.

DISPOSITION

The superior court’s order is affirmed.