Conservatorship of the Person and Estate of K.P. PUBLIC GUARDIAN OF LOS ANGELES, as Conservator, etc., Petitioner and Respondent, v. K.P., Objector and Appellant.
S258212
IN THE SUPREME COURT OF CALIFORNIA
June 28, 2021
Second Appellate District, Division Two B291510; Los Angeles County Superior Court ZE032603
Justice Corrigan authored the opinion of the Court, in which Chief Justice Cantil-Sakauye and Justices Liu, Cuellar, Kruger, Groban, and Jenkins concurred.
Conservatorship of K.P.
S258212
Opinion of the Court
The Lanterman-Petris-Short Act (LPS Act or Act;
I. BACKGROUND
The Los Angeles County Superior Court established a conservatorship for 23-year-old K.P. in May 2008 and renewed it annually over the next nine years. In April 2018, the county‘s public guardian (Public Guardian) filed
A psychologist from K.P.‘s residential facility testified that he suffered from schizophrenia, with auditory hallucinations and paranoid delusions. For example, on the morning of trial he asked to enter a witness protection program because he believed a fellow resident was planning to attack him. In another incident, K.P. chased and threatened someone he believed had intentionally hit him with a basketball. He could not be redirected and was hospitalized. K.P. also displayed “grossly disorganized behaviors,” lack of motivation, and difficulty speaking and socializing. The psychologist concluded K.P. lacked significant insight into his disorder. He minimized his symptoms and believed they were caused by medications. His mother had expressed the same belief. K.P. resisted taking his prescriptions or participating in therapy and other services. The psychologist concluded K.P. could not provide for his basic needs without medication and did not believe he would take them consistently or correctly without a conservator‘s supervision. The day before trial, K.P. almost gave himself a double dose of one potentially toxic pharmaceutical. The psychologist believed K.P. needed round-the-clock supervision and lacked the initiative and insight necessary to obtain treatment himself. Although he had opportunities to do so, K.P. had never left the facility without his therapist or mother.
K.P.‘s mother understood that he had a mental illness. If he were released from the conservatorship, she testified that she would help him take his medications and attend therapy appointments. She could not provide housing but would help him find a place to live.
K.P. also testified. He had not lived outside a hospital or treatment facility since 2013. After some conflicting answers, he agreed to stay in his current placement until he could find a place to live. K.P.‘s mother had previously been his conservator but later became homeless and moved away. K.P. agreed he needed a psychiatrist and said he would see a therapist if released, but he denied having any mental illness. He thought his problems might stem from a childhood brain injury. K.P. asserted he did better without his psychiatric drugs and said he would not take them if released from the conservatorship. To supplement his Social Security benefits, K.P. planned to become an entrepreneur.
The court gave two Judicial Council of California Civil Jury Instructions (CACI) relevant to the issue here. CACI No. 4000, as given, stated: “The Office of the Public Guardian claims that [K.P.] is gravely disabled due to a mental disorder and therefore should be placed in a conservatorship. In a conservatorship, a conservator is appointed to oversee, under the direction of
CACI No. 4002, as given, explained the meaning of “gravely disabled“: “The term ‘gravely disabled’ means that a person is presently unable to provide for his or her basic needs for food, clothing, or shelter because of a mental disorder. [¶] Psychosis, bizarre or eccentric behavior, delusions or hallucinations are not enough, by themselves, to find that [K.P.] is gravely disabled. He must be unable to provide for the basic needs of food, clothing, or shelter because of a mental disorder. [¶] If you find [K.P.] will not take his prescribed medication without supervision and that a mental disorder makes him unable to provide for his basic needs for food, clothing, or shelter without such medication, then you may conclude [K.P.] is presently gravely disabled. [¶] In determining whether [K.P.] is presently gravely disabled, you may consider evidence that he did not take prescribed medication in the past. You may consider evidence of his lack of insight into his medical condition. [¶] In determining whether [K.P.] is presently gravely disabled, you may not consider the likelihood of future deterioration or relapse of a condition. [¶] In determining whether [K.P.] is presently gravely disabled, you may consider whether he is unable or unwilling voluntarily to accept meaningful treatment.” (Italics added.)
K.P. requested a modification of CACI No. 4000 to require, as a separate element, a finding that he was “unwilling or unable voluntarily to accept meaningful treatment.” He argued the final sentence of CACI No. 4002 directing the jury‘s attention to this issue was inadequate because it was “thrown in at the bottom of [a] less consequential later jury instruction.” The court denied the request, observing that resistance to voluntary treatment is appropriately considered as an aspect of grave disability but is not a separately required element that must be proven.
The jury found that K.P. was gravely disabled, and the reappointment petition was granted. On appeal, K.P. challenged the refusal to modify CACI No. 4000. The Court of Appeal concluded there was no error. We granted review and now reach the same conclusion.3
Although couched as a complaint about jury instructions, K.P. essentially claims that a finding of unwillingness or inability to accept voluntary treatment is required for a conservatorship to be established. This is a legal question subject to de novo review. (John L., supra, 48 Cal.4th at p. 142; see Conservatorship of P.D. (2018) 21 Cal.App.5th 1163, 1167.) Our goal in construing the LPS Act is to effectuate the Legislature‘s intent. (John L., at p. 143.) We consider individual statutes in the context of the entire Act so that each part may be harmonized and given effect. (See Moyer v. Workmen‘s Comp. Appeals Bd. (1973) 10 Cal.3d 222, 230; Conservatorship of Joseph W. (2011) 199 Cal.App.4th 953, 963.)
A. Overview of the LPS Act
The LPS Act has many purposes, including “end[ing] the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders” (
The overall statutory scheme describes a detailed, calibrated system for intervention when circumstances indicate a person may be suffering from a mental health disorder. In addition to conservatorships, the Act permits 3-day, 14-day, and 30-day involuntary detentions for intensive treatment.4
1. Chapter 2: Involuntary Detentions
Under chapter 2 of the Act, those gravely disabled by a mental health disorder may be held for up to 72 hours for evaluation and treatment. (
Someone certified for a 14-day or 30-day detention has the right to a prompt certification review hearing. (
As an alternative to a certification review hearing, those detained have the right to habeas corpus review. (
2. Chapter 3: Conservatorships
Chapter 3 of the Act goes on to provide for the imposition of a conservatorship under specifically described circumstances. A “series of temporary detentions may culminate in a proceeding to determine whether the
Section 5352 sets out the requirements for a professional recommendation to initiate conservatorship proceedings. The first paragraph of section 5352 addresses recommendations for individuals who have already been detained for evaluation and treatment under chapter 2. When the professional in charge of an agency providing comprehensive evaluation, or of a facility providing intensive treatment, “determines that a person in his or her care is gravely disabled as a result of mental disorder or impairment by chronic alcoholism and is unwilling to accept, or incapable of accepting, treatment voluntarily, he or she may recommend conservatorship to the officer providing conservatorship investigation of the county of residence of the person prior to his or her admission as a patient in such facility.” (
The recommendation standards are different for those presently receiving outpatient treatment, however. The second paragraph of section 5352, which addresses outpatients, does not mention a willingness or ability to accept treatment. Under that paragraph, the professional agency in charge of “providing comprehensive evaluation or a facility providing intensive treatment, or the professional person in charge of providing mental health treatment at a county jail, or his or her designee, may recommend conservatorship for a person without the person being an inpatient in a facility providing comprehensive evaluation or intensive treatment, if both of the following conditions are met: (a) the professional person[,] or another professional person designated by him or her[,] has examined and evaluated the person and determined
Under either paragraph of section 5352, the professional‘s recommendation simply starts the conservatorship process. If the county‘s investigative office agrees with the recommendation, it initiates court proceedings. (
Proposed conservatees have the right to a jury trial to determine whether they are gravely disabled. (
The court must terminate a conservatorship before the one-year period expires, however, if a progress review determines that “the goals [of treatment] have been reached and the person is no longer gravely disabled.” (
If a conservatorship is still needed at the end of the one-year term, the conservator may petition for reappointment. (
B. Statutory Analysis
Reading chapter 3‘s provisions together, it is clear the Act requires consideration of willingness or ability to accept voluntary treatment only when a professional recommends the initiation of conservatorship proceedings for a person who is currently being treated as an inpatient (
Nor does the Act make amenability to voluntary treatment an issue that must be separately decided at trial. Section 5350 authorizes the court to appoint a conservator “for a person who is gravely disabled as a result of a mental health disorder.” (See also
The Legislature amended section 5350 in 1989 to clarify that there is no grave disability if a proposed conservatee can survive safely with the assistance of responsible friends, family members, or others willing and able to help meet these basic needs. (See
Theoretically, someone who is willing and able to accept voluntary treatment may not be gravely disabled if that treatment will allow the person to meet the needs for food, clothing, and shelter. Under the statutory scheme, however, this is an evidentiary conclusion to be drawn by the trier of fact. If credible evidence shows that a proposed conservatee is willing and able to accept treatment that would allow them to meet basic survival needs, the fact finder may conclude a reasonable doubt has been raised on the issue of grave disability, and the effort to impose a conservatorship may fail. It may be necessary in some cases for the fact finder to determine whether the treatment a proposed conservatee is prepared to accept will sufficiently empower them to meet basic survival needs. In some cases of severe dementia or mental illness, there may simply be no treatment that would enable the person to “survive safely in freedom.” (Early, supra, 35 Cal.3d at p. 255; see Conservatorship of Symington (1989) 209 Cal.App.3d 1464, 1467 (Symington).)10 As a practical matter, evidence about amenability to voluntary treatment will generally be in the proposed conservatee‘s
counties “to negate all reasonable doubts as to the possible existence of” a treatment the person might voluntarily accept would be counter-productive and potentially contrary to the goals of the Act. (Early, at p. 254.)11
Our reading of the statutes is consistent with statements in a number of conservatorship cases observing that the “only” question at trial is whether the proposed conservatee is unable to provide for essential needs due to a mental illness. (Roulet, supra, 23 Cal.3d at p. 232; Conservatorship of P.D., supra, 21 Cal.App.5th at p. 1168; see Conservatorship of Jesse G. (2016) 248 Cal.App.4th 453, 460-461.) However, K.P. points to other cases to support a contrary conclusion. We now address these arguments.
C. K.P.‘s Argument and Reliance on Contrary Authority
In support of his position that inability or unwillingness to accept voluntary treatment must be separately proven at trial, K.P. points to a single statutory provision and early cases construing it. He cites section 5352, which, as noted, requires a professional determination of such inability or unwillingness before the professional recommends conservatorship for a person receiving inpatient treatment. As explained above, this reliance is misplaced. By its terms, section 5352 speaks only to a professional decision to recommend that a conservatorship be established. That recommendation, if accepted, is followed by a structured investigation that may culminate in a trial on grave disability and, if a conservatorship is imposed, on the court‘s determination whether confinement is necessary.
K.P. relies on two cases from the 1980s that held resistance to voluntary treatment is an additional element that must be proven before conservatorship can be imposed. Conservatorship of Davis (1981) 124 Cal.App.3d 313 (Davis) was a public guardian‘s appeal from a finding that the proposed conservatee was not gravely disabled. The trial court had given a special instruction at Davis‘s request stating, “‘before you may consider whether Mary Davis is gravely disabled you must first find that she is, as a result of a mental disorder, unwilling or unable to accept treatment for that
Two years later, we approved one of the Davis holdings: that grave disability cannot be established if the person can safely survive with the capable assistance of others. (Early, supra, 35 Cal.3d 244.) That holding was consistent with United States Supreme Court precedent that a state “cannot constitutionally confine . . . a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.” (Id. at pp. 251-252, quoting O‘Connor v. Donaldson (1975) 422 U.S. 563, 576.)
Early concluded this constitutional principle had been incorporated into the LPS Act (Early, supra, 35 Cal.3d at p. 252) and reasoned that section 5008‘s definition of grave disability “was intended to encompass a consideration of whether the person could provide these basic needs with or without the assistance of willing and responsible family members, friends, or other
Early did not address Davis‘s related holding about a voluntary treatment element. Although the trial court had refused to give an instruction like the one in Davis, requiring a finding on voluntary treatment before consideration of grave disability, we did not decide whether that refusal was erroneous because the evidence showed Early had consistently refused treatment for his disorder. (Early, supra, 35 Cal.3d at pp. 255-256.) Nevertheless, there are parallels between the third party assistance considered in Early and acquiescence to voluntary treatment, in that treatment professionals may provide assistance that enables a person to meet survival needs. As we held with regard to third party assistance in Early, evidence of a proposed conservatee‘s amenability to voluntary treatment is relevant and should generally be admitted for the fact finder‘s consideration. (See id. at p. 254; see also Davis, supra, 124 Cal.App.3d at p. 325.) Such evidence will defeat a conservatorship if it raises a reasonable doubt about whether the person is gravely disabled.
K.P. also relies on Conservatorship of Walker (1987) 196 Cal.App.3d 1082 (Walker). There, the jury was instructed: “If you find that John Thomas Walker can survive safely in freedom by himself or with the help of this available, willing and responsible family member, friend or other third party and that John Thomas Walker is willing and capable of accepting voluntary treatment, then you must find that John Thomas Walker is not gravely disabled.” (Id. at p. 1091, italics omitted.) The Court of Appeal found fault with this instruction. (Id. at p. 1092.) Relying on section 5352 and Davis, it held that a conservatorship may be established only upon proof of both grave disability, as defined in section 5008, and unwillingness or inability to accept voluntary treatment. (Walker, at pp. 1092-1093.) Because Davis established that a “proposed conservatee has the right to have a jury determine all the issues relevant to the establishment of the conservatorship” (Walker, at p. 1092, citing Davis, supra, 124 Cal.App.3d at p. 324), the court reasoned: “The jury should determine if the person voluntarily
As K.P. acknowledges, other cases have declined to follow Davis and Walker. The first, Symington, supra, 209 Cal.App.3d 1464, involved a bench trial. The trial court found the proposed conservatee gravely disabled and observed that it was unnecessary to decide in addition whether she was willing or able to accept voluntary treatment. (Id. at p. 1466.) Symington challenged the absence of this finding on appeal, asserting that grave disability “‘by definition includes an unwillingness and/or inability on the part of the proposed conservatee to voluntarily accept treatment for the mental disorder . . . .‘” (Id. at p. 1467.) The Court of Appeal expressed doubt that a finding of unwillingness or inability to accept treatment was required, explaining that this language is not found elsewhere in the conservatorship statutes but only in section 5352, a provision “apparently designed to allow treatment facilities to initiate conservatorship proceedings at the time a patient is accepted where the individual may prove uncooperative. It appears to have been enacted for that limited purpose, not as an additional element to be proved to establish the conservatorship itself.” (Symington, at p. 1467.) The court concluded section 5352‘s reference to unwillingness or inability to accept voluntary treatment “is not intended to be a legal term, but is a standard by which mental health professionals determine whether a conservatorship is necessary.” (Symington, at p. 1468.) Sensitive to the facts of the case before it, which involved an octogenarian with severe intellectual and memory impairment from senile dementia (id. at p. 1466), the court observed that “many gravely disabled individuals are simply beyond treatment. Under the interpretation of the statutory scheme urged upon us, they presumably could not be the subject of an LPS Act conservatorship at all.” (Id. at p. 1467.)
The issue did not resurface for 30 years, until K.P.‘s appeal here and Conservatorship of D.P. (2019) 41 Cal.App.5th 794, review granted and held February 11, 2020. In both cases, the juries were given a version of CACI No. 4000 that did not include unwillingness or inability to accept voluntary treatment as a required element for conservatorship. (D.P., at p. 799; Conservatorship of K.P., supra, 39 Cal.App.5th at p. 263.)13 However, both juries were also given a modified version of CACI No. 4002, which explained that they could consider willingness or ability to accept voluntary treatment in deciding whether the proposed conservatees were gravely disabled. (D.P., at p. 799; K.P., at p. 263.) On appeal, the courts determined these instructions accurately reflected the law. The court here found Symington‘s reasoning persuasive and agreed that section 5352 does not require additional proof. (K.P., at p. 268.) The Court of Appeal in D.P. also agreed with Symington‘s statutory analysis. (D.P., at pp. 802-803.) It further noted that section 5352 does not apply to reappointment petitions, and the applicable statute requires only a finding that the person ““remains gravely disabled.“” (D.P., at p. 804; see
Thus, even if a finding about amenability to voluntary treatment were required in the initial appointment of a conservator, there was no statutory basis for imposing it in reappointment proceedings. (D.P., at pp. 803–804.)
We agree with these recent decisions that Davis and Walker are not persuasive as to the role that acceptance of voluntary treatment appropriately plays in a conservatorship trial. As in Early, Davis was partially correct to the extent it held a trier of fact may consider a proposed conservatee‘s openness to treatment when evaluating whether the constraints of conservatorship are necessary under all attendant circumstances. Naturally, a trier of fact can consider all relevant evidence, which is defined as that “having any tendency in reason to prove or disprove any disputed fact that is of consequence to the determination of the action.” (
Particularly for those suffering from mental illness, openness to treatment may not be a fixed status. It may wax and wane depending on many variables, including medication status and the particulars of housing status or confinement. Evidence on the topic may also be disputed, or of
Thus, the Davis decision went too far to the extent it called for proof of an additional element not found in the statutory definition. Courts may not expand statutory language under the guise of interpretation. (In re Miller (1947) 31 Cal.2d 191, 199; see
D. Due Process
Finally, even assuming the LPS Act does not require it, K.P. contends state and federal due process principles prohibit the appointment of a conservator unless the state can prove beyond a reasonable doubt that the conservatee is unwilling or unable to accept treatment voluntarily.
“The liberty interests at stake in a conservatorship proceeding are significant.” (Ben C., supra, 40 Cal.4th at p. 540; see Roulet, supra, 23 Cal.3d at p. 228.) A conservatorship can result in involuntary confinement, which “‘entails a “massive curtailment of liberty” in the constitutional sense.‘” (Roulet, at p. 224.) A person found gravely disabled also faces stigmatization and the loss of personal rights like the freedom to drive, vote, enter contracts, and decide about medical treatment. (See Ben C., at p. 540; John L., supra, 48 Cal.4th at p. 150; see also
K.P. contends, “limiting the jury‘s consideration to the sole issue of grave disability as defined by the statute would seriously infringe on the conservatee‘s due process rights.” His argument takes an unduly narrow view
K.P. has not explained why a proposed conservatee‘s constitutional rights are not sufficiently protected by the fact finder‘s consideration of amenability to voluntary treatment in connection with grave disability, or why the state must instead be tasked with proving this issue separately. We have previously declined to create such a new requirement. Early held that a person who can provide for basic survival needs with assistance from others is not gravely disabled. This holding was constitutionally required under United States Supreme Court precedent. (See Early, supra, 35 Cal.3d at pp. 251–252, citing O‘Connor v. Donaldson, supra, 422 U.S. at p. 576.) Yet, though Early concluded evidence of third party assistance could be considered by the fact finder when offered, it also observed that “the burden of proving grave disability [as statutorily] defined could well become insuperable if those alleging such disability had to negate all reasonable doubts as to the possible existence of third party aid.” (Early, at p. 254.)
Similar to third party assistance, the fact finder may conclude there is no grave disability if a person is both willing and able to accept treatment that will ensure basic survival needs are met. Amenability to voluntary treatment is thus relevant to the ultimate question of grave disability. As in Early, we conclude evidence on the voluntary treatment issue is admissible for the fact finder‘s consideration. But the Legislature has not made resistance to voluntary treatment a separate element to be proven by the state, nor does any constitutional precedent require that it do so. It has long been held that the gravely disabled standard is constitutionally sufficient to justify the imposition of a conservatorship. (Conservatorship of Chambers (1977) 71 Cal.App.3d 277, 285.) K.P. has not demonstrated that more is required.
At the trial below, both the Public Guardian and K.P. presented evidence about K.P.‘s willingness and ability to accept voluntary treatment. A psychologist explained that K.P.‘s lack of insight into his schizophrenia would hinder his ability to continue with medications and therapy on a voluntary basis. The psychologist believed K.P. needed a conservator‘s supervision to ensure he would take his medications consistently and correctly. K.P. confirmed this assessment when he testified. He denied having a mental illness and admitted he would not continue taking his medications if released from conservatorship.
The court also gave appropriate instructions on how this evidence could be considered. After instructing on the Public Guardian‘s obligation to prove that K.P. had a mental disorder and was gravely disabled as a result (CACI No. 4000), the court gave a modified version of CACI No. 4002 that specifically referenced K.P.‘s willingness and ability to accept voluntary treatment. Because evidence on amenability to voluntary treatment was properly admitted, and the jury was properly instructed on its relevance, there was no error. The jury‘s finding of grave disability was sufficient to appoint a conservator.
III. DISPOSITION
The judgment is affirmed.
CORRIGAN, J.
We Concur:
CANTIL-SAKAUYE, C. J.
LIU, J.
CUÉLLAR, J.
KRUGER, J.
GROBAN, J.
JENKINS, J.
See next page for addresses and telephone numbers for counsel who argued in Supreme Court.
Name of Opinion Conservatorship of K.P.
Procedural Posture (see XX below)
Original Appeal
Original Proceeding
Review Granted (published) XX 39 Cal.App.5th 254
Review Granted (unpublished)
Rehearing Granted
Opinion No. S258212
Date Filed: June 28, 2021
Court: Superior
County: Los Angeles
Judge: Robert S. Harrison
Counsel:
Christopher L. Haberman, under appointment by the Supreme Court, and Christian C. Buckley, under appointment by the Court of Appeal, for Objector and Appellant.
Mary C. Wickham, County Counsel, Rosanne Wong and Joyce M. Aiello, Assistant County Counsel, Jose Silva, Principal Deputy County Counsel, and William C. Sias, Deputy County Counsel, for Petitioner and Respondent.
Counsel who argued in Supreme Court (not intended for publication with opinion):
Christopher L. Haberman
Attorney at Law
P.O. Box 521
Visalia, CA 93279
(559) 384-0703
William C. Sias
Deputy County Counsel
500 West Temple St., Suite 648
Los Angeles, CA 90012
(213) 407-4947