Court Opinion

ID: 9942727
Source: CourtListenerOpinion
Date Created: 2024-02-21 20:04:09.003257+00
Date Added: 2024-06-11T13:48:28.966225
License: Public Domain

Filed 2/21/24
                        CERTIFIED FOR PUBLICATION

                COURT OF APPEAL, FOURTH APPELLATE DISTRICT

                                DIVISION ONE

                            STATE OF CALIFORNIA

 THE PEOPLE,                                 D081713

         Plaintiff and Respondent,

         v.                                  (Super. Ct. Nos. SCD291317,
                                             CD295871, MH119205,
 JENNIFER GARCIA,                            SCN426026)

         Defendant and Appellant.

       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.
(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.
                                       2
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

                                        3
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

                                        4
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.
                                       5
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

                                         6
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,

                                         7
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.)

                                        8
      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

                                        9
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

                                        10
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

                                        11
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.

                                         12
                                       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.)
                                       13
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

                                       14
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.

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