Court Opinion

ID: 9378538
Source: CourtListenerOpinion
Date Created: 2023-03-10 19:02:46.528476+00
Date Added: 2024-06-11T17:17:21.902512
License: Public Domain

Filed 3/10/23 P. v. Chavez CA4/1
                  NOT TO BE PUBLISHED IN OFFICIAL REPORTS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
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                COURT OF APPEAL, FOURTH APPELLATE DISTRICT

                                                 DIVISION ONE

                                          STATE OF CALIFORNIA

 THE PEOPLE,                                                          D080465

           Plaintiff and Respondent,

           v.                                                         (Super. Ct. Nos. SCS167911 &
                                                                      SCS149245)
 JUAN DANIEL CHAVEZ,

           Defendant and Appellant.

         APPEAL from an order of the Superior Court of San Diego County,
Kimberlee A. Lagotta, Judge. Affirmed.

         Laura Arnold 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, Kathryn
A. Kirschbaum and Collette C. Cavalier, Deputy Attorneys General, for
Plaintiff and Respondent.
      Juan Daniel Chavez, appeals from an order extending his civil

commitment as a mentally disordered offender (MDO) under Penal Code1
sections 2970 and 2972. He contends: (1) his constitutional right to due
process was violated because the petition on which he was tried did not allege
he had serious difficulty controlling the behavior that rendered him a
substantial danger of physical harm to others and the court did not instruct
the jury on this requirement, and (2) the jury’s finding is not supported by
sufficient evidence. Respondent submits that the statutory language
adequately conveyed the kind and degree of risk the jury had to find to extend
the MDO commitment, and that substantial evidence supports the verdict.
We affirm the order.
               FACTUAL AND PROCEDURAL BACKGROUND
      On August 1, 2000, Chavez pled guilty to robbery in violation of section
211. Two years later, he pled guilty to exhibiting a deadly weapon to a police
officer to resist arrest in violation of section 417.8. He further admitted to
personally using a deadly weapon during the commission of that offense.
Chavez was committed to the California Department of Corrections and
Rehabilitation but was subsequently determined to be an MDO and
involuntarily confined to a state hospital for treatment. The district attorney
sought and received multiple one-year extensions of Chavez’s commitment.
      On December 18, 2020, the district attorney filed a petition pursuant to
section 2970 to extend Chavez’s commitment by another year—from April 11,
2021, to April 11, 2022. Chavez requested a jury trial on the petition but, due
to delays related to the Covid-19 pandemic, the trial did not begin until
March 8, 2022.

1     All further undesignated statutory references are to the Penal Code.
                                        2
      At trial, the district attorney presented testimony from numerous
experts addressing the question of whether Chavez had a severe mental
disorder that was not in remission and could not be kept in remission without
continued treatment, and whether because of his severe mental disorder,
Chavez represented a substantial danger of harm to others. In considering
whether Chavez had a severe mental disorder that could not be kept in
remission without treatment, the jury was instructed to focus on the period
between March 8, 2021, and March 8, 2022.
A.    Chavez’s Diagnosis
      Two court-appointed psychologists examined Chavez prior to March
2021 and rendered opinions as to his mental illness. Dr. David Bloch
diagnosed Chavez with schizophrenia, while Dr. Randy Stotland diagnosed
him with schizoaffective disorder, bipolar type. Dr. John Johnson, a
psychologist at Patton State Hospital (Patton), explained that to be diagnosed
with schizophrenia, an individual must experience delusions and
hallucinations that impact daily functioning over a period of at least six
months. He further explained that schizoaffective disorder is essentially
schizophrenia with additional “symptoms of bipolar disorder such as mania,
rapid speech, pressured speech, tangential thinking, things of that nature.”
In Chavez’s case, Dr. Stotland said he diagnosed Chavez with schizoaffective
disorder because his emotions vacillated between mania and depression or
anger.
B.    Treatment at Patton State Hospital
      Chavez was in sheriff’s custody prior to the one-year time frame at issue
in this case and was returned to Patton on March 11, 2021. Dr. Marc
Peterson, a psychiatrist, admitted Chavez to Patton at which time he said
Chavez was agitated and became “very focused” on a nurse he thought had

                                        3
done bad things to him in the past. He described Chavez as “very hostile and
threatening” and said the nurse had to leave the area because Chavez kept
yelling negative things at her. Because of this behavior, Dr. Peterson
administered emergency medications to calm Chavez. When he remained
agitated after 90 minutes, Dr. Peterson gave him a second dose, which
ultimately calmed him enough so that officers could remove his handcuffs.
      Dr. Peterson explained that schizophrenia is “a thought disorder where
people experience reality different[ly] than the average person.” He said that
sometimes a schizophrenic person will feel better and stop taking their
medication, at which point they could become dangerous if the symptoms of
their mental illness cause them to be dangerous—he said, “it really comes
down to the individual.” In the short term, he indicated that studies link
things like agitation, yelling, increased emotions, and running around flailing
their arms to immediate violence in the next five to ten minutes.
      Chavez was soon moved to the acute unit. On March 14, 2021, Chavez
became agitated and was yelling at a Patton employee. A psychiatric
technician testified that staff members were unable to calm him. He recalled
Chavez saying, “what are you going to do? You going to take me down? If you
come at me, I’m going to fight you.” When Chavez then raised his fists in a
“fighting stance,” staff members put him in a five-point restraint to protect
employees in the hallway and the three other patients who were in the room
with him. A staff member then applied a spit mask because Chavez was
spitting at a person nearby. Chavez continued to yell and tense up in his
restraints, so he was given emergency medication to subdue him.
      The next day, Dr. Johnson assessed Chavez and concluded that he was
not ready to be removed from restraints because he remained in a state on the
border between “psychotic aggression and instrumental aggression.” He

                                       4
explained that psychotic aggression usually meant the patient was
“responding to voices to hit, to harm, to do something, oftentimes to reduce the
voices themselves,” while instrumental aggression involved behaving
aggressively to get what the person wants. Dr. Johnson noted that Chavez
was impulsive, unable to stay focused, did not seem to even know why he was
there, and was “not concerned about the harm that may have befallen the
staff member.” By March 17, 2021, Patton doctors had received court
authorization to involuntarily medicate Chavez for a short period of time.
      Dr. Dey, a staff psychologist at Patton, described her impressions from
brief interactions with Chavez between March and August 2021. She said he
greeted her daily when she arrived on the unit and was polite, but she had
difficulty ascertaining exactly what he was requesting because “[h]is speech
was always very disorganized.” She reported that Chavez said he was
confused by his own thoughts. He also said he experienced auditory and
visual hallucinations, but his disorganized speech prevented Dr. Day from
understanding what he saw or heard. However, on one occasion, he expressed
a persecutory delusion about being neutered or having his scrotum cut, which
concerned her because she said anyone who believes they might be harmed
(mentally ill or not) may feel the need to defend themselves.
      Dr. Dey noted that Chavez only attended about 23 percent of the
treatment groups to which he was assigned. She reported that Chavez
contacted various departments within the hospital and left multiple messages
a day displaying rapid speech and disorganized thinking, but that he did not
have any incidents of aggression once he arrived in her unit. She said his
“level of disorganization [was] one of the most severe” she had seen and that it
concerned her because “when somebody has that level of disorganization,
usually those individuals are not able to accurately perceive their

                                       5
surroundings and think correctly about different situations they’re in.” She
did not believe he had any insight into the fact that he needed medication, as
evidenced by the fact that he told her he did not plan to continue taking
medication when he no longer had to do so.
      A licensed clinical social worker at Patton, Kim Braxton, testified that
Chavez came to her office at least every other day to talk. She said “[h]e was
always disorganized and always confused.” She reported that Chavez told her
he heard voices, but that he dealt with voices that made him mad by ignoring
them or calling his mom. She also indicated he used coping strategies like
talking, writing, walking, or listening to music. Nonetheless, she opined in a
report that he was not able to use his positive coping strategies “to prevent
himself from physically assaulting other people for at least a twelve-month
period.”
      Ms. Braxton said Chavez voluntarily took his medications, but only
intermittently, and she did not think he understood their importance or how
they “reduce[d] the frequency of his auditory hallucinations and paranoid
ideations.” She also noted that he was not yet able to describe how his mental
illness led to his crimes. But she testified that his behavior seemed the same
whether he was on or off of his medications and she never felt threatened by
him. She also indicated that he had a “good rapport” with her and other
patients in his group and that no one had reported any conflicts with Chavez
or that they felt unsafe around him.
      Dr. Basant Singh, a staff psychiatrist at Patton, assessed Chavez’s
progress on May 7, 2021. At that time, Chavez was not under the involuntary
medication order, but was taking his medication, and was calm. Dr. Singh
noted that Chavez was dysphoric, which he explained was “a combination of
irritability, anxiety, depression, and [a] feeling of uneasiness.” He began

                                       6
treating Chavez with a mood stabilizer and, when it appeared effective,
changed his diagnosis from schizophrenia to schizoaffective disorder.
      In August 2021, Dr. Jenna Tomei, a senior psychologist specialist in
forensics at Patton who explained that her role is to “use psychological
concepts to answer legal questions,” was asked to evaluate whether Chavez
met the criteria for his commitment at Patton to be extended. She did not
meet with Chavez, but she reviewed his legal documentation, jail records,
medical records, and progress notes from Patton. In her report, she concluded
that Chavez had schizoaffective disorder, bipolar type; it was not in remission;
he did not have a plan for managing his mental illness or other stressors out
in the community; and he represented a substantial danger of physical harm
to others due to his mental health disorder. She explained that “[j]ust because
somebody might have a history of violence or mental illness doesn’t
necessarily mean they’re going to be violent in the future,” but “they really
need the insight into what happened and a good understanding and a good
plan in place in order for the same things not to happen again,” and Chavez
did not have those things.
C.    Medical Reports from San Diego County Jail
      Chavez was moved to San Diego County Jail in August 2021 for court
appearances and remained there through March 2022. Dr. Anthony Cruz, a
jail psychiatrist, explained that they generally cannot force individuals to
continue taking the medications prescribed by state hospitals. During the two
years he treated Chavez during his stays in jail, he noted that Chavez
sometimes refused some or all of his medications, which caused him to suffer
mania, psychosis, disorganized thinking, and pressured speech. Dr. Cruz said
he had seen Chavez do well with medication and knew he had the capability
to be stable but said Chavez lacked insight into his severe mental disorder.

                                        7
He clarified that Chavez always wanted help and was agreeable to Dr. Cruz’s
medication recommendations, but implied Chavez was more focused on the
side effects of the medications than treatment of his mental illness. In
Dr. Cruz’s opinion, Chavez did not present a danger to others because he was
always polite and other jail staff had not reported that Chavez had ever
behaved in a violent or aggressive manner.
      Jennifer Alonzo, a licensed clinical social worker at the jail, believed
Chavez took his antipsychotic medication from August 2021 to March 2022,
though he sometimes refused a certain medication and requested a medication
change. She saw him at least every other week and said she never felt in
danger around Chavez, nor had she witnessed or heard of him making any
threats or being involved in any assaults. Ms. Alonzo noted that when Chavez
stopped taking his medications and decompensated during a prior
incarceration, he kept busy by writing, talking to her, walking, listening to
music, and watching television. But she acknowledged it was “questionable”
whether Chavez understood that he would always have a severe mental
disorder and would have to take medication for the rest of his life.
D.    Examinations By Court-Appointed Psychologists
      Two court-appointed psychologists were asked to examine Chavez in
2020, and then provide several follow-up reports during the time the case was
delayed due to the pandemic.
      a. Dr. Bloch
      Dr. Bloch examined Chavez twice by video while Chavez was confined in
jail and diagnosed him as schizophrenic. He reported that on December 1,
2020, Chavez “rant[ed] and rav[ed] like a lunatic” and appeared angry and
agitated. He said that Chavez walked back and forth towards the camera,
explaining that this type of pacing “is a very common characteristic of people

                                        8
who can be dangerous” because they may confront the other person physically.
Dr. Bloch stated that most of what Chavez said was incomprehensible “word
salad,” which he explained was “[g]arbled speech that was difficult to
understand” because “[t]he words and phrases . . . wouldn’t logically follow
each other.”
      Dr. Bloch opined that Chavez was in a state of psychosis, which he
defined as “a mental state that is characterized by a very significant
detachment from perception of reality or characterized by inability for one to
control oneself both mentally and physically.” He said a person in this state
“has ideations that include[] hallucinations perhaps or delusions . . . and has
great difficulty or perhaps cannot at all discern between a [delusion] they’re
having and reality or hallucinations they’re having and reality.” When asked
whether individuals in a state of psychosis are typically violent towards
others, Dr. Bloch responded, “Not usually. No.” With regard to Chavez
specifically, he noted that he did not believe Chavez was taking his
medications at the time and concluded that he met the MDO criteria. He
further opined that Chavez lacked insight into his mental illness, which
prevented him from regulating his behavior and having insight into his need
for treatment. As a result, Dr. Bloch said Chavez represented a substantial
danger to others because, for example, he could “have [a] hallucination where
a voice is telling him . . . go harm that person” or “a [delusion] that somebody’s
going to attack him and he better attack first.”
      In his February 10, 2021 report regarding a subsequent video interview
while Chavez was at the jail, Dr. Bloch said Chavez again ranted nonstop; was
loud, angry, and incomprehensible; and made obscene hand gestures.
      During a May 7, 2021 video interview conducted once Chavez returned
to Patton and was “pretty calm,” Chavez read a prepared statement, “had

                                        9
some sense that this was a situation where he should be cooperative and
polite,” and appeared to have some insight into his mental illness and need for
treatment. However, Chavez’s speech then became increasingly rapid and
switched to word salad. Dr. Bloch noted that Chavez “expressed some
delusional ideations by saying [Dr. Bloch] was coordinat[ing] and directing his
body.” Dr. Bloch ultimately opined that Chavez continued to meet the MDO
criteria.
      Dr. Bloch reviewed Chavez’s Patton records and prepared a report on
September 3, 2021, at which point he noted Chavez had made progress that
might warrant a reexamination. Nonetheless, the records did not change his
opinion that Chavez continued to meet the MDO criteria. He came to the
same conclusion in a February 25, 2022 report after reviewing Chavez’s jail

records.2 Dr. Bloch noted that the jail records contained notes from
psychiatrists, and he found them “very remarkable” because Chavez “was
described as a model patient, he was cooperative, which was not always the
case before. He was calm. He was pleasant. Described as polite,
respectful. . . . . A very different Mr. Chavez that (sic) I experienced.” He
viewed this difference as something “of great concern” that “in and of itself
warrant[ed], in [his] opinion, a more thorough psychiatric examination.”
Although another evaluation did not occur, Dr. Bloch opined that because
Chavez did not fully grasp that he has a severe mental illness and that he will
need treatment for the rest of his life, he is certain Chavez will stop taking his
medication if released and “revert to becoming acutely psychotic.” He also
expressed that, although he never obtained an explanation of the difference in
Chavez’s behavior, the way he thought about it was that “as soon as a certain

2     Dr. Bloch subsequently acknowledged that he had not reviewed records
from licensed clinical social worker Alonzo.
                                       10
kind of situation . . . presents itself, it exceeds his ability to control himself.
And so he explodes into this psychotic, ranting episode, which is not
characteristic of the way he is.”
      Dr. Bloch also pointed out that during his examinations, he is looking at
a “sample of behavior” and that, because Chavez wants to get out of the
hospital, he would expect him to “act in some way to indicate that he’s in
control of himself, that he’s better, that he’s doing well, that he doesn’t
need— any longer need[] to be at the hospital.” Instead, Chavez “rants and he
raves and shouts and yells and paces up and down and flails his arms and
swears and makes obscene gestures, demands to leave the room and so on.”
Dr. Bloch said this tells him that when Chavez “is experiencing some kind of
stressor, that he is unable to control his conduct or behavior.” But Dr. Bloch
also acknowledged with regard to Chavez’s behavior in the courtroom, “Right
now he’s great.”
      When asked “Is it reasonable that a person with schizophrenia who has
incoherent speech patterns is also not dangerous?” Dr. Bloch responded,
“Absolutely. The vast majority of people who have . . . mental illnesses are not
at all dangerous.”
      b. Dr. Stotland
      Dr. Stotland first met with Chavez in 2020, at which time Chavez was
suffering command hallucinations that told him to pray (he followed the
commands and prayed). When Dr. Stotland asked about his mental illness,
Chavez told him it was a problem with the environment. He next assessed
Chavez by video in February 2021, and in person on March 20, 2021. During
the latter meeting, Chavez again reported command hallucinations wherein
children called his name and told him not to pray, and “rulers” commanded
him to do things. This concerned Dr. Stotland because such command

                                          11
hallucinations can result in dangerous behavior. He stated the Chavez had an
IQ of 80 and opined that he had an undiagnosed and untreated learning
disability which impaired his ability to learn from therapy groups, fill out
relapse prevention plans, and navigate through his illnesses. However, he
was unable to complete his examination because Chavez declined to continue.
      Dr. Stotland opined at that time that Chavez met the MDO criteria and
posed a substantial danger because he had not participated in treatment
adequately, had poor judgment and insight, and lacked adequate remorse. He
renewed this opinion after his two-and-a-half-minute video conversation with
Chavez on May 19, 2021, during which Chavez began as cordial, then said
something angry about pandering against the government, then politely said
thank you and got up and left.
      The court subsequently asked Dr. Stotland to review updated records
from Patton and the jail and opine as to whether they changed his view. In
reports from September 2021 and February 2022, Dr. Stotland confirmed his
opinion that Chavez continued to meet the MDO criteria.
E.    Jury Verdict and Recommitment Order
      On March 15, 2022, the jury found the allegations of the petition to be
true, and the court issued an order extending Chavez’s commitment by one
additional year. Chavez timely appealed.

                                       12
                                 DISCUSSION
                                        I
                                Legal Principles
      “An MDO proceeding is civil, rather than criminal, in nature.” (People
v. Fisher (2009) 172 Cal.App.4th 1006, 1013.) “The Mentally Disordered
Offender Act (MDO Act), enacted in 1985, requires that offenders who have
been convicted of violent crimes related to their mental disorders, and who
continue to pose a danger to society, receive mental health treatment during
and after the termination of their parole until their mental disorder can be
kept in remission. [Citation.] Although the nature of an offender’s past
criminal conduct is one of the criteria for treatment as [an MDO], the MDO
Act itself is not punitive or penal in nature. [Citation.] Rather, the purpose of
the scheme is to provide MDO’s with treatment while at the same time
protecting the general public from the danger to society posed by an offender
with a mental disorder.” (In re Qawi (2004) 32 Cal.4th 1, 9.)
      If the individual’s severe mental health disorder is not in remission or
cannot be kept in remission without treatment after the initial term, the
district attorney may file a petition asking the superior court to continue
involuntary treatment for an additional year. (§ 2970, subds. (a) & (b).) Each
yearly extension requires the court or jury to find beyond a reasonable doubt
that “the patient has a severe mental health disorder, that the patient’s
severe mental health disorder is not in remission or cannot be kept in
remission without treatment, and that by reason of the patient’s severe
mental health disorder, the patient represents a substantial danger of
physical harm to others.” (§ 2972, subds. (a)(2) & (c).)

                                       13
                                        II
                       The Jury Instructions Were Sufficient
      Chavez argues that Penal Code sections 2970 and 2972, unless
construed as requiring “serious difficulty controlling behavior,” violate state
and federal constitutional due process guarantees. Respondent appears to
concede this point, stating “[t]he jury was properly instructed using the
appropriate statutory language and that language adequately conveyed to the
jurors the requirement of a mental health disorder that causes serious
difficulty in controlling violent behavior.” The two parties’ positions conflict in
that, while Respondent contends that the instruction given, CALCRIM 3457,
necessarily implied a finding that Chavez had serious difficulty controlling his
behavior, Chavez believes that a supplemental instruction was required to
satisfy due process.
      “A court must instruct on the general principles of law that are relevant
to the issues in a given case. Instructions, therefore, must disclose the
principles that are closely and openly connected with the facts and are
necessary for the jury’s understanding and deliberation of the case.” (People
v. Beeson (2002) 99 Cal.App.4th 1393, 1401.) We review claims of
instructional error de novo. (People v. Thomas (2023) 14 Cal.5th 327, 361.)
      Here, Chavez asserts the court was required to instruct the jury sua
sponte that it had to find Chavez posed a substantial danger of physical harm
because of a severe mental disorder which caused him to have serious
difficulty controlling his behavior. Chavez acknowledges that in addressing
the same MDO statutory scheme, the court in People v. Putnam (2004) 115
Cal.App.4th 575 (Putnam) rejected this argument. However, Chavez asserts
Putnam’s holding should be reconsidered in light of subsequent clarification of
the law.

                                        14
      The United States Supreme Court has long recognized the need for
commitment statutes explaining, “The state has a legitimate interest under
its parens patriae powers in providing care to its citizens who are unable
because of emotional disorders to care for themselves; the state also has
authority under its police power to protect the community from the dangerous
tendencies of some who are mentally ill.” (Addington v. Texas (1979) 441 U.S.
418, 426.) While the court acknowledged that “civil commitment for any
purpose constitutes a significant deprivation of liberty that requires due
process protection” (ibid), it has determined that
civil confinement of mentally ill and dangerous offenders does not offend due
process if these individuals are unable to control their behavior. (Kansas v.
Hendricks (1997) 521 U.S. 346, 358.) Moreover, the state does not have to
prove that the offender has a total lack of control; proof of “serious difficulty in
controlling behavior” is sufficient. (Kansas v. Crane (2002) 534 U.S. 407, 412–
413 (Crane).)
      In People v. Williams (2003) 31 Cal.4th 757, 759 (Williams), our
Supreme Court applied the due process standard established in Crane to a
civil commitment scheme under California’s Sexually Violent Predators Act
(SVPA) (Welf. & Inst. Code, § 6600 et seq.). The defendant in Williams
contended reversal of his commitment was required because the statutory
language of the SVPA did not include the federal constitutional requirement
of proof of a mental disorder that causes serious difficulty in controlling
behavior, and the court did not instruct the jury on the requirement of a
volitional impairment. (Williams, supra, at p. 764.)
      The Supreme Court rejected the defendant’s position, explaining that
“[b]y its express terms, the SVPA limits persons eligible for commitment to
those few who have already been convicted of violent sexual offenses against

                                        15
multiple victims [citation], and who have ‘diagnosed mental disorder[s]’
[citation] ‘affecting the emotional or volitional capacity’ [citation] that
‘predispose[] [them] to the commission of criminal sexual acts in a degree
constituting [them] menace[s] to the health and safety of others’ [citation],
such that they are ‘likely [to] engage in sexually violent criminal behavior’
[citation]. This language inherently encompasses and conveys to a fact finder
the requirement of a mental disorder that causes serious difficulty in
controlling one’s criminal sexual behavior.” (Williams, supra, 31 Cal.4th at
p. 759.) The court concluded that because the jury instructions tracked the
statutory language, no additional instruction was necessary. (Id. at p. 777.)
      In Putnam, an appellate court acknowledged that Williams, supra, 31
Cal.4th 757, pertains to a different statutory scheme, but concluded its
rationale likewise applied to an MDO proceeding. The Putnam court
explained that “[i]n the MDO context, just as in the SVPA context, instructing
the jury with the applicable statutory language adequately informs the jury of
the kind and degree of risk it must find to be present in order to extend an
MDO commitment. The instructions here informed the jury that in order to
find that appellant had a severe mental disorder, it had to find that he had ‘an
illness or disease or condition that substantially impair[ed] [his] thoughts,
perception of reality, emotional process, or judgment, or which grossly
impair[ed] [his] behavior.’ Moreover, in order to find that the disorder was not
in remission, the jury had to find that ‘the overt signs and symptoms of the
severe mental disorder’ were not under control. Finally, the jury was
instructed that it had to find that ‘by reason of such severe mental disorder,
[appellant] represents a substantial danger [of] physical harm to others.’
Italics added.)” (Putnam, supra, 115 Cal.App.4th at p. 582.)

                                         16
      The court concluded, “Given these instructions, taken as a whole, we
conclude beyond a reasonable doubt [citation] that the jury could not have
sustained the section 2970 petition in this case without having found that, as
a result of appellant’s mental disorder, he suffered from a seriously and
substantially impaired capacity to control his behavior, and that, for this
reason, he represented a substantial danger of physical harm to others. In
other words, the instructions given here, which tracked the language of the
MDO statute, necessarily encompassed a determination that appellant had
serious difficulty in controlling his violent criminal behavior, and thus, as in
Williams, separate instructions on that issue were not constitutionally
required. [Citation.]” (Putnam, supra, 115 Cal.App.4th at p. 582.) The court
did not reach the issue of whether such an instruction might be appropriately
given if requested. (Id. at p. 583.)
      Here, as in Putnam, supra, 115 Cal.App.4th 575, the jury was
instructed that to find Chavez an MDO, it must find: “one, he has a severe
mental disorder; two, the severe mental disorder is not in remission and
cannot be kept in remission without continued treatment; and three, because
of his severe mental disorder, he presently represents a substantial danger of
physical harm to others.” The court further explained that “[a] severe mental
disorder is an illness or disease or condition that substantially impairs the
person’s thought perception of reality, emotional process or judgment or that
grossly impairs his or her behavior or that demonstrates evidence of an acute
brain syndrome for which prompt remission in the absence of treatment is
unlikely.” Finally, the jury was instructed that “[r]emission means that the
external signs and symptoms of the severe mental disorder are controlled by
either psychotropic medication or psychosocial support.”

                                        17
      We agree with the court in Putnam, supra, 115 Cal.App.4th 575 that
these instructions, which comport with MDO law, necessarily required a jury
finding that Chavez’s mental disorder caused serious difficulty in controlling

his violent behavior.3 Thus, his recommitment as an MDO met due process
standards.
      Our holding is not inconsistent with In re Howard N. (2005) 35 Cal.4th
117 (Howard N.) cited by Chavez to support his claim of reversible error. In
Howard N., the court addressed Welfare and Institutions Code section 1800 et
seq., which allowed continued civil commitment with the Youth Authority of
an individual who was “physically dangerous to the public because of his or
her mental or physical deficiency, disorder, or abnormality.” (Id. at p. 126.)
Unlike the MDO statutes, the statute at issue did not provide any definition of
“mental . . . deficiency, disorder, or abnormality.” (Id. at p. 136.) Because the
statutory language did not expressly require a demonstration that the
individual had serious difficulty controlling his dangerous behavior, the court
“constru[ed] the existing language to include such a requirement” in order to
“preserve the constitutionality of the statutory scheme.” (Id. at pp. 132, 135.)
By contrast, although the MDO statutes also do not contain the exact words
“serious difficulty controlling behavior,” they do provide definitions of “severe
mental disorder” and “remission,” which, when coupled with the mandated
level of dangerousness, inherently require a finding of a control impairment.
We find these definitions sufficient because, as the high court advised in
Crane, “there may be ‘considerable overlap between a . . . defective
understanding or appreciation and . . . [an] ability to control . . . behavior.’ ”

3     Because Chavez’s trial counsel did not request a separate control
impairment instruction, we also decline to reach the issue of whether such an
instruction might appropriately be given if requested.
                                         18
(Crane, supra, 534 U.S. at p. 415 [quoting the American Psychiatric
Association Statement on the Insanity Defense, 140 Am. J. Psychiatry 681,
685 (1983)] in discussing “psychotic” individuals].) This overlap is why the
court has not ordinarily “distinguished for constitutional purposes among
volitional, emotional, and cognitive impairments” in considering civil
commitment. (Ibid. [although the court acknowledged it had not had occasion
to “consider whether confinement based solely on ‘emotional’ abnormality
would be constitutional”].) Instead, the court’s precedents provide “that
within wide boundaries, state legislators may define this difficult-to-articulate
concept as they wish.” (Williams, supra, 31 Cal.4th at pp. 773–774 [noting
that the Kansas SVPA statute at issue in Hendricks and Crane was upheld as
written and the court did not suggest it could be “constitutionally applied only
with supplemental instructions, in language not chosen by Kansas’s
legislators, pinpointing the impairment-of-control issue”].) Within this

framework, we conclude that no additional instruction was required.4
                                       III
                   Substantial Evidence Supports the Verdict
      Chavez argues that, even if we embrace the holding of Putnam, the
judgment still must be reversed for lack of substantial evidence.
      When reviewing a challenge to a civil commitment based on insufficient
evidence, we consider the entire record in the light most favorable to the
judgment to determine whether a reasonable trier of fact could have found

4      Chavez also urged us to reverse the judgment based on the fact that the
petition to extend Chavez’s commitment did not contain the control
impairment language. Because we conclude the jury instruction satisfied due
process and the jury necessarily found Chavez had a control impairment, any
error in failing to include the “serious difficulty controlling behavior” language
in the petition was harmless error. (See Chapman v. California (1967) 386
U.S. 18, 24; People v. Hurtado (2002) 28 Cal.4th 1179, 1194.)
                                       19
beyond a reasonable doubt that the defendant met the requirements for the
commitment. (In re Anthony C. (2006) 138 Cal.App.4th 1493, 1503.) We
presume in support of the judgment the existence of every fact the jury could
reasonably deduce from the evidence. (People v. Nelson (2011) 51 Cal.4th 198,
210.) If the circumstances reasonably justify the jury’s findings, reversal is
not warranted merely because the circumstances might also be reasonably
reconciled with a contrary finding. (Ibid.) It is the exclusive province of the
jury to determine credibility and to resolve evidentiary conflicts and
inconsistencies. (People v. Young (2005) 34 Cal.4th 1149, 1181.)
      The People presented evidence that multiple psychiatrists and
psychologists have diagnosed Chavez with either schizophrenia or
schizoaffective disorder. Medical personnel who interacted with him at Patton
and the jail testified that these disorders manifested themselves in symptoms
including severely disorganized speech, command hallucinations, delusional
ideations, and volatile emotions. They also noted that Chavez does not
consistently take his prescribed psychotropic medication to control his
symptoms. On two occasions within a year of the trial, Chavez engaged in
behavior a jury could reasonably find indicated he had serious difficulty
controlling the behavior that rendered him a substantial danger of physical
harm to others.
      The first incident occurred in the Patton intake unit when he became
fixated on a nurse. The jury heard that Chavez could not be released from
handcuffs until he answered Dr. Peterson’s questions and demonstrated that
he was calm. But Chavez was unable to break his focus from the nurse to
answer Dr. Peterson’s questions or stop yelling negative things and behaving
in a threatening manner. The yelling became so extreme the nurse had to
leave. Although Dr. Peterson testified that most people are able to “self-

                                       20
regulate their behavior” and be released from their handcuffs without
receiving emergency medication, Chavez was so agitated and threatening that
he required two doses to calm him down.
      The second incident occurred three days later, when he became agitated
and was angrily yelling at a Patton staff member. Chavez somewhat
discounts this event because no evidence was presented regarding the
circumstances which precipitated his agitation and verbal challenge, and he
did not actually assault anyone. But regardless of the precipitating events,
the evidence showed that Chavez did not respond to staff questioning or
efforts to calm him. Instead, he escalated the risk of physical harm by raising
his fists and inviting staff to fight him. Further, the fact that Chavez did not
actually assault anyone is immaterial because the jury was instructed that
they could find Chavez represented a substantial danger of physical harm
without proof of a recent overt act. On these facts, the jury could reasonably
infer that his severe mental illness prevented him from realizing that, for
safety reasons, hospital staff could not ignore a patient threatening a fight in
the vicinity of other patients and staff. Moreover, after just learning three
days earlier that he would not be released from physical restraints until he
was calm, Chavez was unable to connect the dots and control his behavior
after being placed in a five-point restraint. Instead, he continued to yell and
then spit at staff. From this evidence, a jury could conclude Chavez had
serious difficulty controlling his dangerous behavior.
      In light of these two incidents alone, a reasonable trier of fact could
have found beyond a reasonable doubt that Chavez met the requirements for
continued commitment. The evidence showed Chavez had schizophrenia, a
severe mental disorder. It was not in remission, as illustrated by the fact that
Chavez was not consistent with his medication and continued to experience

                                       21
disorganized thoughts and speech, hallucinations, delusions, and emotional
volatility. Finally, a jury could find the symptoms he exhibited represented a
substantial danger of physical harm to those around him and that he had
serious difficulty controlling his behavior. Dr. Peterson testified that studies
link things like agitation, yelling, increased emotions, and running around
flailing their arms to immediate violence in the next five to ten minutes.
Because Chavez exhibited these behaviors in both incidents and was unable to
regulate his subsequent anger and threatening behavior, a jury could
reasonably infer Chavez continued to represent a substantial danger to
others.
      Although, as Chavez points out, evidence from later in the year
indicates that his behavior improved, if the evidence reasonably justifies the
jury’s findings, we are not required to reverse merely because the
circumstances might also reasonably justify a contrary finding. (Nelson,
supra, 51 Cal.4th at p. 210.) Furthermore, nearly all the witnesses testified
that Chavez sometimes refused to take his medication and lacked insight into
the fact that he had a mental illness and would need to take medication for
the rest of his life to control his symptoms. Chavez even expressly told
Dr. Dey that he did not plan to continue taking medication when he no longer
had to do so. Dr. Bloch and Dr. Cruz explained that when Chavez does not
take medication, he suffers psychotic behavior, mania, disorganized thinking,
and pressured speech. As Dr. Bloch explained, a psychotic state is
“characterized by inability for one to control oneself both mentally and
physically.” And while the jury heard testimony that some schizophrenic
individuals are able to regulate their dangerous behavior with coping skills
instead of medication, Chavez attended only 23 percent of the treatment
groups that might have taught him such skills. Even Ms. Alonzo, who

                                       22
generally testified favorably for Chavez, acknowledged that he has “limited”
coping skills in terms of knowing what to do when he is experiencing a manic
episode and that they have not discussed how he would cope with a
hallucination. If the jury credited this testimony, it could reasonably have
concluded that Chavez continued to meet the MDO criteria throughout the
year.
                                DISPOSITION
        The commitment order is affirmed.

                                                            McCONNELL, P. J.

WE CONCUR:

HUFFMAN, J.

IRION, J.

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