Court Opinion

ID: 9829200
Source: CourtListenerOpinion
Date Created: 2023-09-01 19:04:49.489519+00
Date Added: 2024-06-11T09:10:37.697064
License: Public Domain

Filed 9/1/23
                       CERTIFIED FOR PUBLICATION

               COURT OF APPEAL, FOURTH APPELLATE DISTRICT

                                DIVISION ONE

                           STATE OF CALIFORNIA

 THE PEOPLE,                                D081246

         Plaintiff and Respondent,

         v.                                 (Super. Ct. No. SCE202417)

 RHONDA LYNN JENKINS,

         Defendant and Appellant.

       APPEAL from an order of the Superior Court of San Diego County,
Kenneth K. So, Judge. Reversed with directions.
       Rebecca P. Jones, 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, Kathryn Kirschbaum and Elana Miller Steele, Deputy Attorneys
General, for Plaintiff and Respondent.
       Rhonda Lynn Jenkins appeals from an order following a bench trial
recommitting her as a mentally disordered offender pursuant to Penal Code
sections 2970 and 2972. 1 Jenkins contends substantial evidence does not
support the trial court’s finding that she represented a substantial danger of
physical harm to others because of her severe mental disorder. After careful
review of the record, we agree. The mental health experts who evaluated
Jenkins expressed concern that she is not ready to leave the hospital due to
her mental illness and level of functioning, and that she has unrealistic
expectations about the challenges she would face. They nevertheless failed to
identify any history of dangerous behavior beyond her commitment offense in
1999 or explain how their concerns translate into difficulty controlling her
dangerous behavior. Because there is insufficient evidence to support a
finding beyond a reasonable doubt that Jenkins currently represents a
substantial danger of physical harm to others, we reverse the court’s order
recommitting her for an additional year.
                FACTS AND PROCEDURAL BACKGROUND
      A.    Underlying Offenses
      In 1999, in response to paranoid ideation, Jenkins attacked her 82-
year-old landlord with a hammer and caused three skull fractures. She also
imprisoned him on her apartment floor for six hours without emergency
medical care. She was convicted of attempted murder, with offense
enhancements for using a deadly weapon and great bodily injury on a person
70 years or older (§§ 187, subd. (a), 664, 12022, subd. (b)(1), 1192.7(c)(8), &
12022.7, subd. (c)). She was also convicted of false imprisonment of an elder
(§ 237, subd. (b), 368, subd. (f)) and willful cruelty to elder resulting in great
bodily injury (§ 368, subd. (b)(l)). She was sentenced to 17 years in state
prison.

1     Undesignated statutory references are to the Penal Code.
                                         2
        B.    Mentally Disordered Offender Commitment
        In November 2014, Jenkins was transferred from prison to a state
psychiatric hospital for treatment as a mentally disordered offender under
section 2962. Her commitment was extended in 2017, 2018, 2019, 2020, and
2022.
        In July 2022, the most recent petition for recommitment was filed
under section 2970. The petition alleged that Jenkins “is still suffering from
a severe mental disorder which is not in remission or cannot be kept in
remission without treatment, and by reason of such mental disorder
represents a substantial danger of physical harm to others.” The petition
requested a year extension of her involuntary treatment.
        Jenkins denied the allegations in the petition. At her request, two
doctors were appointed to do an independent expert evaluation.
        In November 2022, the allegations were tried to a judge. The
prosecution submitted three medical expert reports into evidence and did not
present any live witnesses. The parties stipulated to the experts’
qualifications, to the receipt of their reports into evidence, and that the court
“may consider the reports in their totality.” The defense presented the
testimony of Jenkins and her treating psychologist.
        C.    Expert Reports and Testimony
        The medical experts agree that Jenkins suffers from a severe mental
disorder, schizoaffective disorder (bipolar type). Jenkins acknowledges and
does not dispute this diagnosis.
              1.    Dr. Jason Rowden
        Dr. Rowden, a forensic psychologist, recommended that Jenkins’s
commitment be extended. In his opinion, Jenkins lacks insight into the
nature and severity of her illness and downplays it. Although Jenkins

                                        3
acknowledges that the commitment offense was “violent” and claims that it
“will never happen again,” she continues to struggle with depression and
anxiety, “remains focused on somatic delusions, and she maintains paranoid
beliefs about her landlord and this paranoia is evident on the unit as well
with her interactions with her peers and unit staff.” Based on her
uncontrolled symptoms, Dr. Rowden concluded Jenkins’s mental disorder was
not in remission.
      Dr. Rowden noted that Jenkins wanted to decrease or eliminate her
psychiatric medications, had limited insight into them, and had difficulty
discussing them with her treating psychiatrist. She had several medication
changes over the past year and disagreed with some of the changes.
Dr. Rowden opined that Jenkins “remains a substantial danger of physical
harm to others due to her lack of insight into her ongoing symptoms,
difficulty refraining from engaging in violent behavior and poor insight into

her mental illness.” 2 Her “limited insight . . . could benefit from further
refining her understanding.”
      In Dr. Rowden’s opinion, Jenkins continues to pose a substantial
danger of physical harm to others if released. She committed her underlying
offenses in response to paranoid ideation and does not understand the factors
that led to her violent behaviors. When Jenkins was asked about her risk for
future dangerous behavior, she stated, “Financial problems is a big problem.”
According to Dr. Rowden, she has poor insight into her risk for dangerous
behavior and does not appreciate the role her mental disorder played in
increasing her risk of dangerous behavior.

2     Dr. Rowden’s report did not explain the factual basis for his conclusion
that Jenkins had “difficulty refraining from engaging in violent behavior.” As
discussed below, other than the original offense, the record does not describe
any further violent behavior by Jenkins.
                                        4
            2.    Dr. Nicole Friedman
      Dr. Friedman, a psychologist, was one of two experts designated to

conduct an independent evaluation of Jenkins. Her report 3 included a
discussion of her review of Dr. Rowden’s report, the CONREP hospital liaison
report, her interview with Jenkins, and her own recommendations.
      After summarizing other evaluators’ reports, Dr. Friedman discussed
her 53-minute interview with Jenkins. Jenkins was in a wheelchair and
seemed to be overweight. Dr. Friedman reported that Jenkins was oriented
during the interview and correctly identified her diagnosis. Jenkins correctly
noted that she was at Patton because she committed a crime in 1999 and that

she served 14 years in prison. 4 She also correctly identified her symptoms at
the time of the offense. Jenkins noted that at Patton, she “had ‘learned to
deal with things,’ such as ‘having a support system and needing to be on
medication my whole life.’ ” When asked about discharge, Jenkins described
her desire to live in a board and care, continue with her medications and
therapy, and get support from a church group. Dr. Friedman noted that
Jenkins “stated when she committed the crime she was scared and alone and
didn’t have anyone supporting her and she doesn’t want to go through that
again.”

3     Confusingly, the cover page for Dr. Friedman’s report states the reason
for the referral to her was to “evaluate whether sanity has been recovered
pursuant to Penal Code sections 2970 and 2972.” Neither code section refers
to the recovery of sanity, nor was recovery of sanity a basis for the referral to
her.

4     Dr. Friedman’s report seemed to suggest that Jenkins misstated her
time in prison: “She said she went to prison for fourteen years, not
seventeen.” Although Jenkins was sentenced to 17 years, in fact, she served
14 years, as Jenkins correctly noted to Dr. Friedman.
                                        5
      Nowhere in her report did Dr. Friedman offer an opinion as to whether
Jenkins posed a substantial danger of physical harm to others. Her only
discussion of any potential for violence was her statement that Jenkins’s
“lack of insight into her mental illness” and her lack of “an appropriate level
of psychiatric stability” were barriers for discharge. “Without appropriate
psychiatric stability, this puts her at risk for violence given her history.” Dr.
Friedman recommended that “Ms. Jenkins continue with her current level of
treatment in a controlled setting to give her, and the community, greater
security, and stability.”
              3.   Dr. Stacy Berardino
      Dr. Berardino, a clinical forensic psychologist, opined that Jenkins
cannot be safely treated or released in the community and recommended that
her commitment be extended. Dr. Berardino reported that Jenkins “was
cooperative” and she acknowledged that she has schizophrenia and identified
her symptoms, including “paranoid delusions, depression, bipolar depression,
[and] being afraid.”
      Jenkins nevertheless continues to deny “aspects of her symptoms and
the seriousness of such despite records clearly documenting differently.”
Dr. Berardino stated that she had not reasonably followed her treatment
plan. Jenkins had notable medication changes the year before trial and
wanted to reduce or stop psychotropic medications entirely. She has
continued to exhibit symptoms of her mental illness and has continued
paranoid beliefs about her landlord. Her paranoia is evident on the unit and
with staff.
      Dr. Berardino opined that Jenkins continued to represent a substantial
danger to others based on her severe mental disorder. Dr. Berardino noted
her history of failing to comply with prescribed medications and of aggressive

                                         6
behavior, her desire to reduce her medications and her tendency to argue
with her psychiatrist about necessary changes. Jenkins lacks insight into her
symptoms and the need for medications, what might happen if she stops
medications and the relationship between her mental illness and potential
future dangerousness. She does not accept responsibility for interpersonal
problems, is unable to identify triggers for her aggression and lacks an
adequate relapse prevention plan and a reasonable discharge plan.
            4.    Dr. Kimberly Claggett
      Dr. Claggett testified on Jenkins’s behalf as her treating psychologist.
At the time of trial, she had been seeing Jenkins for approximately 11
months in weekly individual therapy sessions. While initially more guarded
and depressed, Jenkins has been “much more open” and “receptive to
feedback” in the two to three months before the trial. Her mood improved, as
has her behavior, and her acceptance of treatment and criticisms. She
testified that she was not aware of any issues of Jenkins refusing to take her
medications.
      Dr. Claggett recommended that Jenkins remain at the psychiatric
hospital but believes that she could be ready for discharge within the next
year. A conditional release program that provides additional support would
be more appropriate than unconditional discharge, although Jenkins is
opposed to participating in such a program. Dr. Claggett was not asked to
opine as to whether Jenkins posed any risk of danger or violence to others,
and she did not testify as to any such risk.
      D.    Jenkins’s Testimony
      Appearing by Zoom from the state hospital, Jenkins acknowledged she
has a mental illness and testified that she agrees with the doctors’ diagnosis
and takes all her medications voluntarily. She felt ready to be discharged to

                                       7
a nursing home or board and care facility, explaining that she needed
physical help in addition to mental health treatment. Due to her concern
about getting adequate treatment for her physical illnesses and other health
concerns, she did not want to be released to a conditional release program.
        E.    The Court’s Findings
        After “receiving evidence” and “considering the arguments of counsel,”
the trial court found that Jenkins “is still suffering from a severe mental
disorder that is not in remission or cannot be kept in remission without
treatment, and by means of her severe mental disorder represents a
substantial danger of physical harm to others.” The court did not offer any
further explanation regarding those findings.
        The court extended Jenkins’s commitment date until November 27,
2023.
                                  DISCUSSION
        Jenkins contends there was insufficient evidence to support the
extension of her commitment to the state hospital. After a careful review of
the record, we agree. Under the applicable standard of review, there is not
substantial evidence to support a finding beyond a reasonable doubt that
Jenkins poses a substantial danger of physical harm to others, and therefore
her commitment should not have been extended for an additional year.
        A.    Relevant Legal Principles
        A mentally disordered offender proceeding is “civil, rather than
criminal, in nature.” (People v. Fisher (2009) 172 Cal.App.4th 1006, 1013.)
“The Mentally Disordered Offender Act . . . 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

                                          8
kept in remission. [Citation.] Although the nature of an offender’s past
criminal conduct is one of the criteria for treatment as a mentally disordered
offender . . . , [the] Act itself is not punitive or penal in nature. [Citation.]
Rather, the purpose of the scheme is to provide [mentally disordered
offenders] 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).)
      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
beyond a reasonable doubt that the defendant met the requirements for the
commitment. (In re Anthony C. (2006) 138 Cal.App.4th 1493, 1503.) While
inferences may constitute substantial evidence in support of a judgment, they
must be the probable outcome of logic applied to direct evidence; mere
speculative possibilities or conjecture are infirm. (People v. Herrera (2006)
136 Cal.App.4th 1191, 1205.) “ ‘ “ ‘ “A legal inference cannot flow from the
nonexistence of a fact; it can be drawn only from a fact actually

                                          9
established.” ’ ” ’ ” (Ibid.) “[I]n determining whether the record is
sufficient . . . the appellate court can give credit only to ‘substantial’ evidence,
i.e., evidence that reasonably inspires confidence and is ‘of solid value.’ ”
(People v. Bassett (1968) 69 Cal.2d 122, 139.)
      An involuntary civil commitment requires proof beyond a reasonable
doubt that the person’s mental disorder causes serious difficulty in
controlling dangerous behavior “in order to distinguish those persons who are
subject to civil commitment from those persons more properly dealt with by
the criminal law.” (In re Howard N. (2005) 35 Cal.4th 117, 122, 132).
      B.    Analysis
      1.    Jenkins Only Challenges the Court’s Dangerousness Finding

      With regard to the findings the trier of fact must make before the
criteria for recommitment as a mentally disordered offender are satisfied,
Jenkins does not challenge the court’s determinations that she has “a severe
mental disorder that is not in remission or cannot be kept in remission
without treatment.” Jenkins only challenges the court’s finding that, by
reason of her mental disorder, she “represents a substantial danger of
physical harm to others.” (§ 2972, subd. (c).)
      2.    There is No Evidence Jenkins Has Been Violent Since 1999

      We agree with Jenkins that her commitment offense is the only
evidence in the record that she has ever been violent or dangerous. Although
the mental health experts report that Jenkins has a “significant history of
violence” and “difficulty controlling her aggressive behavior,” there is no
evidence she has been violent or physically aggressive since her commitment
offense in 1999. The reports describe incidents of “interpersonal difficulties
with staff and patients,” but there is no evidence Jenkins was violent or

                                        10
physically aggressive in any of those incidents, and instead she was described
as a victim who did not respond with any violence.
      Dr. Claggett explained that Jenkins had been in two altercations with
other patients in the year before trial, and that Jenkins “was the victim both
of those fights.” The other patients who attacked Jenkins are “pretty
psychotic.” One of the other patients “was responding to internal stimuli,
and [Jenkins] reported it to the psychiatrist. That patient then became
overly paranoid that [Jenkins] was trying to sabotage her release, and . . . hit
her because of that.” The other patient had been in “several fights since she’s
fought” Jenkins, and “because of [the other patient’s] aggressiveness and for
safety issues, . . . [she] was placed in a side room on her own,” and was placed
in a “five-points restraints[, which] means that she’s restrained down by both
of her wrists, her waist and her feet,” but nevertheless “continued to target”
Jenkins.
      Dr. Rowden and Dr. Friedman discuss an incident where Jenkins
explained that she “didn’t argue with” her roommate who was “yelling and
calling” Jenkins names and “tried to kick” and “threaten[ed]” to beat
[Jenkins] up.” Jenkins tried to tell a staff member at the hospital. In
another incident, Jenkins became agitated due to chest pains she was
experiencing. She banged on the unit door, stating, “[G]et me out of here! I
need help!” She stated that she “was having chest pains, why weren’t they
taking me to the hospital, they told me the ambulance is coming and it never
came.”
      A couple weeks before trial, Jenkins had to change rooms because her
roommates complained that she “was being mean, telling them what to do”
and her behavior “trigger[ed] the other three patients in the room.” Jenkins
explained that one roommate was “stealing things . . . off my bed” and one

                                       11
roommate would “be quiet until I laid down to go to bed and she start[ed]
talking to herself then.” The roommate also told her “not to talk to the
[doctor].” Jenkins “told the staff” and also “asked [the roommate] to be quiet
and the next day [the roommate] said she didn’t want me in the room
anymore.” Dr. Claggett explained that “some of the patients felt like
[Jenkins] was kind of bossing them around, telling them what to do, and in
particular, one of the more psychotic patients started to get a little bit fixated
on her, so she was moved out of the room for that reason.”
      Our review of the record shows that Jenkins did not act with physical
aggression or violence in any of the described incidents. Although
Dr. Friedman and Dr. Rowden note that Jenkins “failed to take any
responsibility for her actions in the conflicts in the room,” that does not mean
she is violent or has difficulty controlling physical aggression. “Such a
complete absence of violent or aggressive behavior of any kind over a long
period of time is necessarily an important, objective factor that must not be
ignored when determining a [mentally disordered offender’s] dangerousness.”
(People v. Johnson (2020) 55 Cal.App.5th 96, 110 (Johnson).)
      3.    Jenkins’s Behavior Has Continued to Improve and Her Health
            Has Deteriorated

      Since these incidents, Jenkins’s interactions with other roommates
“have improved” and any disagreements were “kind of normal
disagreements.” She has shown improved ability to discuss disagreements
without pointing blame and her behavior toward staff has also “greatly
improved.” She has “definitely been much more open” and “receptive to
feedback.” Her “mood has generally improved,” as has her behavior, and her
acceptance of treatment and criticisms.
      “[S]he’s now in a quieter place, has higher functioning roommates and
seems to be doing better there.” Dr. Claggett and Jenkins have discussed
                                       12
discharge planning. “[H]er emotional kind of liability, which is the swings in
emotions, and her interactions with other people . . . have hugely
improved, . . . [but] will benefit from a little more work in that area.” “[I]n
the past, [Jenkins] has presented as kind of abrasive towards others,” but
there has been “a huge turnaround in that to the point that, . . . even the
patients are responding differently. She’s the unit mom these days.
Everybody calls her mom.”
      Additionally, at the time of trial, Jenkins was “almost 70 years old” and
“her health is starting to go downhill.” “[W]ithin the past year, she’s started
using a wheelchair.” “[S]he does talk of a lot of . . . chronic physical pain . . . .
[S]he has issues with her knees.” “She’s discussed with [Dr. Claggett] some
ongoing jaw pain, [temporomandibular joint and muscle disorders]” and
“shoulder or clavicle pain as well.” The expert reports did not address
whether Jenkins’s age, declining health, or physical issues played any role in
their conclusion that she continued to pose a danger to others.
      “[C]onsidering the totality of the evidence presented at [Jenkins’s]
commitment extension trial,” including her lack of violence since 1999, her
improved behavior, her significant medical issues and her decreased mobility,
“a rational trier of fact could not have found beyond a reasonable doubt that
appellant ‘represents a substantial danger of physical harm to others.’ ”
(Johnson, supra, 55 Cal.App.5th at pp. 111–112; see also People v. Redus
(2020) 54 Cal.App.5th 998, 1011 (Redus) [noting that the trial court “had ‘a
problem’ with the proof that appellant had serious difficulty controlling his
dangerous behavior” where medical expert “described appellant as ‘a fragile
old man’ ” who “had ‘gone downhill physically’ ”].)

                                         13
      4.    The Expert Reports Are Insufficient to Establish That Jenkins
            Currently Poses a Substantial Danger of Physical Harm to Others

      Even though it is not necessary to have “proof of a recent overt act,”
(People v. McKee (2010) 47 Cal.4th 1172, 1203) the court cannot overlook “the
statutory requirement of proof beyond a reasonable doubt that the person
currently poses a substantial danger of physical harm to others.” ( Johnson,
supra, 55 Cal.App.5th at pp. 106–107.) Expert testimony can assist in
making this determination. (People v. Zapisek (2007) 147 Cal.App.4th 1151,
1165.) “But that does not mean an unsupported psychiatric opinion will
suffice.” (People v. Cheatham (2022) 82 Cal.App.5th 782, 791 (Cheatham).)
“[E]xpert medical opinion evidence that is based upon a ‘ “guess, surmise or
conjecture, rather than relevant, probative facts, cannot constitute
substantial evidence.” ’ ” (In re Anthony C. (2006) 138 Cal.App.4th 1493,
1504.)
      In Johnson, supra, 55 Cal.App.5th 96, a medical expert opined that the
defendant would be dangerous if released because he did not participate fully
in treatment, did not have a relapse prevention plan, did not have insight
into his illness and need for medication, was unlikely to take his medication
if released, and was likely to decompensate if he stopped taking his
medication. (Id. at p. 108.) That same expert, however, conceded on cross-
examination that the defendant had not demonstrated any violent behavior
in the past 30 years. (Ibid.) In reversing the recommitment order, the Court
of Appeal found that the record did not contain “any evidence that [the
defendant’s mental illness] would lead him to endanger others. Indeed, the
evidence shows that when he did stop taking his medication for two months,
although his symptoms of schizophrenia increased, he did not engage in any
violent behavior whatsoever.” (Id. at pp. 109–110, emphasis in original.)

                                      14
      In Redus, supra, 54 Cal.App.5th 998, one expert recommended that the
defendant be recommitted because he lacked insight into his disease, he
would have a high risk of violence if released into the community and did not
believe he needed medications. (Id. at pp. 1002–1004.) Another expert
believed the defendant was dangerous because he did not accept his need for
treatment or medications and was quietly angry inside the hospital. (Id. at
pp. 1004–1006.) Nonetheless, the Court of Appeal found there was
insufficient evidence that the defendant was dangerous as he “had not
committed a violent act since his commitment offense some 45 years earlier”
and had “controlled his dangerous behavior for decades, despite his ongoing
delusions and paranoia.” (Id. at pp. 1011–1014.)
      In Cheatham, supra, 82 Cal.App.5th 782, the medical experts testified
that the defendant “could return to substance abuse if released,” which could
lead him to “stop taking his medications” and increase “his mental health
symptoms.” (Id. at pp. 787–790.) The experts expressed concern that this
sequence of events would lead the defendant to “have serious difficulty
controlling his dangerous behavior.” (Id. at p. 790.) The defendant, however,
had never “committed a single violent, aggressive, or threatening act that
was attributable to his mental disorder.” (Id. at p. 794.) The Court of Appeal
reversed the commitment order after concluding that a “serious mental
disorder in and of itself cannot justify an extension of [the defendant’s]
commitment. To find otherwise would justify indefinite involuntary
commitments for all those who have a serious mental disorder without regard
to the actual risk of harm they pose to others because of their disorder.”
(Ibid.)
      The record here similarly lacks evidence that Jenkins has committed
any act of violence or physical aggression after her commitment offense in

                                       15
1999. Dr. Friedman, for example, cited Jenkins’s “lack of insight into her
mental illness” as “a barrier for discharge” and concluded her “lack of
psychiatric stability . . . puts her at risk for violence given her history.” But
Dr. Friedman does not identify any violence since the commitment offense,
and her conclusion that Jenkins remains “at risk for violence” does not meet
the statutory threshold that the defendant “represents a substantial danger
of physical harm to others.” (§ 2972, subds. (a)(2) & (c) [emphasis added].)
      Certainly Jenkins suffers from serious and ongoing mental health
issues. Certainly she would benefit from continued medication and
treatment. Certainly she will face serious challenges when she is discharged
from Patton State Hospital. Although serious and concerning, those realities,
without more, are insufficient to support a finding of substantial danger to
others beyond a reasonable doubt. As the Johnson court noted, “[t]he court
was understandably concerned about appellant’s ability to function and keep
himself safe if he were to stop taking his medication and decompensate after
being released from the hospital. However, appellant’s risk of danger to
others, not his own welfare, is what was at issue at his MDO recommitment
trial.” (Johnson, supra, 55 Cal.App.5th at p. 110.)
      We give due weight to Dr. Rowden’s statement that “the most accurate
predictor of future violence is one’s past history of violence.” However,
“speculation is not evidence, less still substantial evidence.” (People v.
Waidla (2000) 22 Cal.4th 690, 735.) Section 2972 requires more than a
conclusory speculation that a person who committed a violent offense in the
past might pose a substantial danger of violence two decades later.
      Similar to Redus, Johnson, and Cheatham, the record here shows the
medical experts believe that Jenkins should not be released because of her
lack of insight as to her mental illness and the violence of her offense of

                                        16
conviction. But after more than 23 years since that offense, the record is
devoid of sufficient evidence of additional violent conduct that would support
a finding beyond a reasonable doubt that her mental illness presents a
substantial danger of physical harm to others. We reverse the court’s order.
                               DISPOSITION
      Reversed with instructions to vacate the Order entered on
November 16, 2022, and to enter an order denying the petition filed on
July 26, 2022.

                                                                  KELETY, J.

I CONCUR:

McCONNELL, P. J.

                                      17
Buchanan, J., Concurring.
      I join the majority opinion without reservation. I write separately only
to comment on another troubling feature of the People’s evidence: their
experts failed to use any of the standard violence risk assessment tools in
formulating their opinions about Jenkins. Instead, they relied solely on their

own unstructured clinical judgment. 1 For decades, we have known that this

is a notoriously unreliable way of predicting future violence. In my view, the
time has come for courts to banish this demonstrably unsound practice in
civil commitment proceedings.
      “Psychiatric and psychological education and training does not typically
include courses in the prediction of dangerousness, and the professions have
themselves disclaimed expertise of the prediction of dangerousness.”
(Shuman, Psychiatric and Psychological Evidence, § 16:2 (Dec. 2022 update)
(Shuman).) “Studies of predictions by psychiatrists and psychologists in the
1960s and 1970s showed poor accuracy in judging whether persons with
mental disorders and sex offenders would be likely to be violent at some point
after release. Indeed, the most frequently cited conclusion was [Professor
John] Monahan’s statement that when mental health professionals predicted
that a person would be violent, they were twice as likely to be wrong as

1      In this opinion, I use the term “unstructured” to refer to risk
assessments “based solely on clinical experience and judgment of assessors
using informal and subjective methods, which are predominantly justified by
their training, expertise, and professional designations. [Citation.] This
approach is referred to as ‘unstructured’ because of its lack of explicit rules
for assessors, which increases its vulnerability to biases and as a consequence
its limited reliability and validity [citation].” (Wertz, et al., A Comparison of
the Predictive Accuracy of Structured and Unstructured Risk Assessment
Methods for the Prediction of Recidivism in Individuals Convicted of Sexual
and Violent Offense (2023) 35 Psychological Assessment No. 2, 152 (Wertz).)
right.” (Appelbaum, Reference Guide on Mental Health Evidence, in
Reference Manual on Scientific Evidence (3d ed. 2011) p. 849 & fns. 204, 205
(Reference Guide), citing Monahan, The Clinical Prediction of Violent
Behavior (1981) p. 60.)
      Nearly 50 years ago, our Supreme Court acknowledged this reality.
After reviewing relevant empirical studies and scientific literature, the court
declared the state of the evidence to be “ ‘unequivocal’ ” that “[n]either
psychiatrists nor anyone else have reliably demonstrated an ability to predict
future violence or ‘dangerousness.’ ” (People v. Burnick (1975) 14 Cal.3d 306,
327 (Burnick).) As the high court noted, “the same studies which proved the
inaccuracy of psychiatric predictions have demonstrated beyond dispute the
no less disturbing manner in which such prophecies consistently err: they
predict acts of violence which will not in fact take place (‘false positives’) thus
branding as ‘dangerous’ many persons who are in reality totally harmless.”
(Ibid.; see also People v. Murtishaw (1981) 29 Cal.3d 733, 768 (Murtishaw)
[“Numerous studies have demonstrated the inaccuracy of attempts to forecast
future violent behavior.”].)
      In the intervening half century, the use of unstructured clinical
judgments to predict a person’s risk of violence has not proven to be any more
accurate. But much work has been done to develop more reliable methods of
prediction. Specifically, researchers have identified known risk factors that
are empirically linked to violent behavior and incorporated them into
structured violence risk assessment instruments. (Reference Guide, supra, at
pp. 848–849.) “Among the best known of these are the HCR-20, the Violence
Risk Assessment Guide (VRAG), and the computerized Classification of
Violence Risk (COVR). A set of instruments also exists for the prediction of
the risk of future sexual offenses.” (Id. at p. 848, fns. omitted.)

                                         2
      These assessment tools now provide a structured framework for
analyzing some or all of the following four steps in predicting a person’s risk
of violence: (1) identifying the presence or absence of empirically valid risk
factors for violence, (2) establishing a method for measuring or scoring these
individual risk factors, (3) establishing a procedure for combining scores on
the individual risk factors into a total score, and (4) producing a final
estimate of violence risk. (Faigman, et al., 2 Modern Scientific Evidence: The
Law and Science of Expert Testimony (2022-2023 ed.) § 9:11 (Faigman); see
also id., § 9:17, at Table 2.) Though far from perfect, the predictive value of
various risk assessment tools has been validated in peer-reviewed studies.
(See, e.g., Cartwright, et al., Predictive Value of HCR-20, START, and Static-
99R Assessments in Predicting Institutional Aggression Among Sexual
Offenders, 42 Law & Hum. Behav. 13, 14 (2018) [“Meta-analytic research
shows that many violence risk assessment instruments can have good
validity in predicting violence”].)
      Modern methods for predicting violent behavior now vary according to
how many of these four steps they structure. At one end of the spectrum is
the “completely unstructured (‘clinical’) assessment,” which “structures none
of these four components.” (Faigman, supra, at § 9:11.) At the other extreme
is a “completely structured (‘actuarial’) assessment” tool such as the VRAG,
which structures all four steps. (Ibid.) Occupying a middle ground are
violence risk assessment tools such as the HCR-20 (which structures the first
two steps) and the COVR (which structures the first three steps). (Ibid.)
Risk assessment methods that combine a structured use of empirically
validated risk factors with professional judgment are often referred to as
“structured professional judgment.” (See Douglas, et al., Historical-Clinical-
Risk Management-20, Version 3 (HCR-20v3): Development and Overview, 13

                                        3
International Journal of Forensic Mental Health (2014) 93, 94 [describing
structured professional judgment approach].)
      Of these varying approaches, “there is widespread consensus among
researchers that the unstructured (‘clinical’) approach is the least accurate
and has only tenuous empirical support. Empirical studies find that
‘clinicians are able to distinguish violent from nonviolent patients with a
modest, better-than-chance level of accuracy,’ but that overall ‘clinicians are
relatively inaccurate predictors of violence.’ ” (Faigman, supra, at § 9:13, fns.
omitted; see also id., § 10:30 [stating as a “scientific certainty” that
predictions of sexual violence using actuarial instruments “are superior to
those based on unaided clinical judgment,” which “have never been shown to
exceed the accuracy exhibited by laypeople”].) “Clinical judgment
alone . . . has been criticized for being subjective and impressionistic, lacking
transparency, reliability and validity, and leading to idiosyncratic decisions
based on the experience of the assessor.” (Roychowdhury & Adshead,
Violence Risk Assessment as a Medical Intervention: Ethical Tensions (2014)
38 Psychiatric Bulletin 75, 80.)
      Earlier this year, a study published in a journal of the American
Psychological Association confirmed once again that structured risk
assessment tools are more reliable than unstructured clinical judgment. The
authors concluded: “In accordance with previously published results, the
results indicated a higher predictive accuracy for structured compared to
unstructured risk assessment approaches for the prediction of general,
violent, and sexual recidivism. Taken together, the findings underline the
limited accuracy of [unstructured clinical judgments] and provided further
support for the use of structured and standardized risk assessment
procedures in the area of crime and delinquency.” (Wertz, supra, at p. 152.)

                                         4
The authors further noted: “A number of previously published studies
consistently highlighted that unstructured assessments were significantly
more susceptible to biases [citations].” (Id. at p. 153.)
      In recognition of the validity of structured violence risk assessment
tools, the California Legislature and Judicial Council have explicitly endorsed
their use in a variety of contexts. (See, e.g., Pen. Code, § 290.5, subd. (a)(3)
[court may consider “the person’s risk levels on SARATSO static, dynamic,
and violence risk assessment instruments” in deciding whether to order
continued sex offender registration]; Pen. Code, § 1170.05, subd. (d)(4)
[making ineligible for alternative custody program those who are screened
“using a validated risk assessment tool and determined to pose a high risk to
commit a violent offense”]; Pen. Code, § 1170.06, subd. (d)(1) [same];
Pen. Code, § 1320.35 [allowing use of “pretrial risk assessment tool” that has
been validated as accurate, reliable, and unbiased using scientifically
accepted methods]; Cal. Stds. Jud. Admin., § 4.35 [allowing courts at
sentencing to use risk assessment instruments that have been validated as
accurate and reliable].) For parole hearings, a regulation requires state
psychologists to prepare reports that “shall incorporate structured risk
assessment instruments like the HCR-20-V3 and STATIC-99R that are
commonly used by mental health professionals who assess risk of violence of
incarcerated individuals.” (Cal. Code Regs., tit. 15, § 2240, subd. (a).)
      Yet courts have been slow to respond to these developments. Although
our Supreme Court long ago limited the use of unreliable opinion testimony
to predict a risk of future violence in capital cases (Murtishaw, supra, 29
Cal.3d at pp. 767–775), it has imposed no similar constraints in other
contexts. As this case demonstrates, unstructured clinical opinion evidence
continues to be deployed to deprive people of their liberty in civil commitment

                                        5
proceedings. “Unfortunately, civil commitment hearings have provided some
of the worst examples of unhelpful, conclusory psychiatric and psychological
testimony.” (Shuman, supra, at § 16:5.)
      In any other context, the use of such inherently unreliable and
speculative expert opinions would be barred. (See Sargon Enterprises, Inc. v.
University of Southern California (2012) 55 Cal.4th 747, 771–772 [discussing
trial court’s responsibility to act as gatekeeper to exclude unreliable expert
testimony].) Now that more reliable tools are available, I see no good reason
to continue allowing the use of such a manifestly inferior method of
predicting future violence—one that “brand[s] as ‘dangerous’ many persons
who are in reality totally harmless.” (Burnick, supra, 14 Cal.3d at p. 327.)
And even if admissible, unstructured clinical predictions of violence about
someone like Jenkins who has committed no violent act for decades should
not suffice to support a civil commitment and satisfy the requirement of
substantial evidence, i.e., evidence that is “ ‘reasonable in nature, credible,
and of solid value.’ ” (Conservatorship of O.B. (2020) 9 Cal.5th 989, 1006.) If
we know anything about such predictions, it is that they lack solid value.
      In 1975, when our Supreme Court first acknowledged the unreliability
of this type of evidence, it nevertheless declined to “go so far as to join in the
conclusion of certain well-known writers that in civil commitment
proceedings no psychiatrists should be permitted to give their opinions as to
future dangerousness and that any commitment based on such an opinion
constitutes a deprivation of liberty without due process of law.” (Burnick,
supra, 14 Cal.3d at pp. 327–328.) Yet even then, the court conceded that
these were “not the views of a radical fringe of either the psychiatric or legal
professions.” (Id. at p. 328, fn. 19.) The court quoted two of these
commentators as follows: “ ‘Justifying the deprivation of a person’s liberty on

                                         6
the basis of judgments and opinions that have not been shown to be reliable
and valid should be considered a violation of both substantive and procedural
due process. Certainly a procedure by which judges flipped coins to
determine who would be committed would offend our sense of fundamental
fairness. It is our contention that psychiatric judgments have not been
shown to be substantially more reliable and valid.’ ” (Ibid., quoting Ennis &
Litwack, Psychiatry and the Presumption of Expertise: Flipping Coins in the
Courtroom (1974) 62 Cal. L.Rev. 693, 743.)
      What has changed in the last half century is that we now have
evidence-based instruments at our disposal. No doubt, we will never be able
to predict future dangerousness with any precision or certainty. But we are
no longer compelled to rely on unstructured clinical judgments as a matter of
necessity. (See Murtishaw, supra, 29 Cal.3d at p. 772 [noting in 1981 that
“expert prediction, unreliable though it may be, is often the only evidence
available to assist the trier of fact” in determining whether someone is
dangerous].) We can instead insist on the use of structured risk assessment
tools that yield more dependable and less subjective results. We can also
require that these tools be properly validated and correctly implemented by
adequately trained clinicians. (See Faigman, supra, at § 9:14 [noting that
“[u]n-validated and poorly validated risk assessment instruments abound”
and “appropriate processes for implementing risk assessment instruments
are often violated in practice, especially in adversary contexts”].) And we
must be mindful of the limitations of these tools as well. (See Cal. Stds. Jud.
Admin., § 4.35(d)(4)(C) [requiring courts using a risk assessment tool at
sentencing to consider “any limitations of the instrument” including whether
“any scientific research has raised questions that the instrument unfairly
classifies offenders by gender, race, or ethnicity”].)

                                         7
      What we should not indulge anymore is the pretense that unstructured
clinical judgments are a defensible way of predicting future violence in civil
commitment proceedings.

                                                               BUCHANAN, J.

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