Filed 4/18/17 Conservatorship of K.M. CA3
NOT TO BE PUBLISHED

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.



IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
THIRD APPELLATE DISTRICT
(Placer)
----




Conservatorship of the Person and Estate of K.M. C083105


PLACER COUNTY PUBLIC GUARDIAN,

Petitioner and Respondent,

v.

K.M.,

Objector and Appellant.

(Super. Ct. No. SMH0000407)


K.M. appeals from a trial court order reappointing a conservator of her person and estate pursuant to the Lanterman-Petris-Short Act (LPS Act) and prohibiting her from exercising specified rights and privileges. (Welf. & Inst. Code, § 5000 et seq.) K.M. contends there was insufficient evidence to support (a) the trial court’s findings she was presently gravely disabled, and (b) the trial court’s order denying her certain rights and privileges. We affirm.
I. BACKGROUND
K.M. is a 65-year-old woman who has been diagnosed with schizoaffective disorder bipolar type for over 15 years. She has been under a conservatorship for 33 years altogether. For the last five years, Deputy Public Guardian Ricardo Mejia has been her conservator. In May 2016, the Placer County Guardian filed a petition for reappointment of her conservator. (§ 5361.)
In August 2016, at the contested hearing, Mejia testified that he had spoken with K.M. about her plans to provide herself with food, clothing, and shelter if she were released from the conservatorship. She indicated she had a Golden 1 Credit Union (Golden 1) bank account and a house in Roseville. She reported she could live in that house and utilize the money in that account to live. Mejia found no current account or record of any assets for K.M. Her only source of income was a benefit from Social Security. From that income Mejia paid the skilled nursing facility, leaving $50 a month, some of which he sent to K.M. and some of which was used for other incidental expenses.
Dr. Olga Ignatowicz, Chief Psychiatrist for Placer County, testified as an expert witness at the contested hearing. Dr. Ignatowicz reviewed K.M.’s medical records, the facility notes, and the mental health functional assessment prepared by K.M.’s conservator. Dr. Ignatowicz also evaluated K.M. on the day of the hearing. Dr. Ignatowicz testified that she had known K.M., on and off, for at least 10 years. She agreed with the diagnosis “given to [K.M.] by various providers” of schizoaffective disorder bipolar type. This had been K.M.’s diagnosis for over 15 years. Over the years, her symptoms had progressed.
According to Dr. Ignatowicz, schizoaffective disorder manifested in K.M. as pervasive delusions involving possession of wealth, finances, and real estate ownership. She believed she owned a home on Sunflower Lane in Roseville, but no such address exists. She believed her treating psychiatrist was Dr. Sena, although there is no such psychiatrist at Placer County Mental Health. She also believed her parents were the Kennedys. K.M. was prone to verbal outbursts, responding to unseen stimuli, and experiencing auditory hallucinations. Over the course of five months, she experienced 559 episodes of auditory hallucinations and 355 instances of verbal outbursts.
K.M. lacked insight into her mental illness. In fact, she denied having any mental illness. K.M. received about four medications to treat her mental illness and an additional 19 medications for other physical conditions. She had 14 physical diagnoses, including a cardiac pacemaker and hypothyroidism. K.M. denied having a pacemaker, which requires certain maintenance, care, and precautions. K.M. denied having a thyroid condition and believed the facility was giving her a thyroid reducer. Because of her hypothyroidism, they actually were giving her a thyroid enhancer. K.M. took her medications “under duress of the facility routines [where she resides] and conservatorship leverage.” Because she did not believe she had mental illness, K.M. did not recognize the need to take antipsychotic medication. The facility staff also had trouble getting K.M. to consistently take medications for her physical ailments. K.M. indicated she would only take her medication on the advice of the nonexistent Dr. Sena. Dr. Ignatowicz did not believe K.M. would take her medications if released from the conservatorship. This lack of antipsychotic medication would be detrimental for K.M.’s ability to provide for food, clothing, and shelter because the severity of her delusions would increase, her thought processes and behaviors would also become extremely disorganized. In addition, K.M. suffered from diabetes for which she took oral medication and insulin injections. Even when on her psychotropic medication, K.M. struggled to comply with these medications. Without the antipsychotic medication, it was likely she would neglect her diabetes medications and other medical treatments.
Dr. Ignatowicz reported K.M.’s plan if she were released was to get a ride to her home on Sunflower Lane in Roseville. K.M. believed there was a caretaker for her, employed by Golden 1, and she would live at the house using the money she believed she had won gambling a couple of days earlier. K.M. did not specify her plans regarding her food, diet needs, shelter, or clothing. Dr. Ignatowicz opined K.M.’s plan was not viable, as it was based on her delusions.
K.M. testified she planned to live at the home she owned on Sunflower Court in Roseville. If she could not live there, she would get an apartment. She said she would cook for herself, grocery shop at either Bel Air or Safeway, and buy clothes at K-Mart. She testified she would not go off of medications without speaking to her psychiatrist, Dr. Sena. She could not estimate her income, or identify how she would pay for her food and clothing and her apartment, but testified she made a lot of money gambling. She denied receiving Social Security benefits. She denied being 65 years old, claiming instead she was between 47 and 50, but that she was born in 1961. She denied she had a mental illness and denied she had had over 500 delusional episodes in the past five months. She denied having been diagnosed with schizoaffective disorder, and denied taking medications for mental illness.
Dr. Ignatowicz also testified about special disabilities. She opined K.M. should not operate a car. She had not driven for about 27 years and side effects from both her psychiatric and diabetic medications affected her cognition. Her thinking was frequently disorganized, her attention was easily distracted, and she had difficulty prioritizing responses to incoming stressors. Accordingly, the doctor believed K.M. would not be a safe and reliable driver. Dr. Ignatowicz did not think K.M. should be allowed to enter into contracts because it would be extremely easy to take advantage of her. In addition, her delusions of being independently and immensely wealthy would affect her ability to budget and pay bills. Dr. Ignatowicz concluded K.M. was not able to consent to medical treatment, either routine treatment or that related to her mental illness. K.M. denied critical conditions, including having a cardiac pacemaker which requires maintenance, care, and precautions. She refused to take her thyroid hormone replacement therapy, denying she had hypothyroidism. K.M. was easily distracted and would become guarded and argumentative about taking her medications. Lastly, Dr. Ignatowicz did not believe K.M. should have the right to possess a firearm because of her angry outbursts and delusions. K.M. believed the people at the facility were “slicing her up” and she felt threatened. Those fears and delusions might lead her to feel the need to defend herself. In addition, the cognitive effects of her physical and mental illnesses made it unlikely K.M. would be able to safely maintain and operate a firearm.
The trial court found K.M. was gravely disabled, that she was suffering from fixed delusional thinking and irrational thinking that impacted her ability to provide food, clothing, and shelter for herself. Accordingly, the trial court reappointed the conservator. The trial court also imposed special disabilities, restricting K.M.’s right to have a driver’s license, contract, refuse or consent to medical treatment, both related and unrelated to her grave disability, and her right to possess a firearm.
II. DISCUSSION
A. Evidence That K.M. is Currently Gravely Disabled
K.M. contends there was insufficient evidence to support the finding she was presently gravely disabled. She acknowledges she has a diagnosed mental disorder, but argues there was not substantial evidence that she “was currently so incapacitated” that she could not provide for her own basic needs of food, clothing, or shelter.
To establish a conservatorship under the LPS Act, the public guardian must prove the proposed conservatee is gravely disabled beyond a reasonable doubt. (§ 5350; Conservatorship of Smith (1986) 187 Cal.App.3d 903, 909.) As relevant in this case, “to establish that a person is gravely disabled, the evidence must support an objective finding that the person, due to mental disorder, is incapacitated or rendered unable to carry out the transactions necessary for survival or otherwise provide for his or her basic needs of food, clothing, or shelter.” (Conservatorship of Carol K. (2010) 188 Cal.App.4th 123, 134; see § 5008, subd. (h)(1)(A).)
“In reviewing a conservatorship, we apply the substantial evidence standard to determine whether the record supports a finding of grave disability. The testimony of one witness may be sufficient to support such a finding. [Citation.] We review the record as a whole in the light most favorable to the trial court judgment to determine whether it discloses substantial evidence. Substantial evidence, which is evidence that is reasonable, credible, and of solid value, also includes circumstantial evidence. [Citation.]” (Conservatorship of Carol K., supra, 188 Cal.App.4th at p. 134.) “Substantial evidence includes circumstantial evidence and the reasonable inferences flowing therefrom. [Citation.]” (Conservatorship of Walker (1989) 206 Cal.App.3d 1572, 1577.)
Here, there was ample evidence to support the trial court’s finding that K.M. is gravely disabled. After examining K.M. and reviewing her medical records, Dr. Ignatowicz concluded K.M. was gravely disabled. K.M. has been conserved for 33 years. K.M.’s plans if she were released from the conservatorship were not viable, as they were based on delusions; delusions as to her income, available funds, and housing. She believed she had funds from recent lottery winnings, a Golden 1 account, and a home in Roseville. She does not. Her plans included the belief that she had a caretaker employed by Golden 1. She does not. She could not estimate her income or identify how she would pay for food, clothing, or housing. K.M. lacked insight into her mental illness, denied she had a mental illness, and denied taking antipsychotic medications. She was only taking her medications at the facility under duress. Dr. Ignatowicz concluded K.M. would not take her medications if she were released from the conservatorship. Not taking her medications would further impede K.M.’s ability to provide for food, clothing, and shelter because the severity of her delusions would increase, and her thought processes and behaviors would become extremely disorganized.
In addition, K.M. denied or misunderstood a number of her medical conditions. She has a pacemaker that requires certain maintenance, care, and precautions, but she denied having a pacemaker. She has hypothyroidism. She denied having the disease and believed the facility was giving her a thyroid reducer, rather than an enhancer. She also refused to take that medication. Additionally, K.M. suffers from diabetes and 13 other medical conditions. She struggled to be compliant with her medications for these conditions, even when taking her antipsychotic medications. Given her denial and misunderstanding of her conditions, without the antipsychotic medication, it was likely she would neglect her diabetes medications and other medical treatments. This was sufficient evidence to support the finding that due to her mental illness, K.M. is unable to carry out the transactions necessary for survival or otherwise provide for her basic needs of food, clothing, or shelter.
The question of grave disability cannot be considered in a vacuum but rather “in the context of suitable alternatives, upon a consideration of the willingness and capability of the proposed conservatee to voluntarily accept treatment and upon consideration of whether the nondangerous individual is capable of surviving safely in freedom by [herself] or with the help of willing and responsible family members, friends or other third parties. [Citation.]” (Conservatorship of Davis (1981) 124 Cal.App.3d 313, 325.) K.M.’s denial and misunderstanding of her psychiatric and medical conditions, her unwillingness to accept medications and treatment for those conditions, and her inability to plan to provide herself with food, clothing, or shelter because of her delusions about her finances and home ownership provide sufficient evidence to support the finding that K.M. is gravely disabled.
B. Evidence Supporting the Imposition of Special Disabilities
K.M. next contends there was insufficient evidence to support the trial court’s order imposing special disabilities, denying her certain rights and privileges. She contends there was no specific evidence supporting the denial of her right to contract, or to refuse or consent to medical treatment, both related and unrelated to her grave disability. Contrary to K.M.’s claim, Dr. Ignatowicz testified as to each of the special disabilities.
A finding of grave disability is not sufficient, by itself, to justify the imposition of the special disabilities enumerated in section 5357. (§ 5005; Riese v. St. Mary’s Hospital & Medical Center (1987) 209 Cal.App.3d 1303, 1312-1313 (Riese).) The conservatee retains the rights and privileges covered by the special disabilities unless the trial court, after making separate findings of incapacity to support the imposition of the special disabilities, imposes those disabilities and confers corresponding authority on the conservator. (Conservatorship of George H. (2008) 169 Cal.App.4th 157, 165 (George H.); Riese, supra, at p. 1313.) Because the special disabilities deprive the conservatee of substantial constitutional rights, due process must be afforded before the rights are compromised. (§§ 5357, 5358; Conservatorship of Christopher A. (2006) 139 Cal.App.4th 604, 612.) “ ‘The party seeking conservatorship has the burden of producing evidence to support the disabilities sought, the placement, and the powers of the conservator, and the conservatee may produce evidence in rebuttal.’ [Citation.]” (George H., supra, at p. 165.) In other words, there must be evidence in the record to support each of the specific disabilities imposed. (Id. at pp. 165-166.)
1. The Right to Possess a Firearm
To support a limitation on a conservatee’s ability to possess a firearm or deadly weapon, the trial court must find “that possession of a firearm or any other deadly weapon by the person would present a danger to the safety of the person or to others.” (§ 8103, subd. (e)(1).) K.M. suffered from delusions, angry outbursts, and cognitive effects of her physical and mental illnesses. She felt threatened, and believed facility staff were prejudiced against her and injuring her. This was substantial evidence from which the trial court could conclude K.M. could not safely possess a firearm.
2. The Privilege of Possessing a Driver’s License
The overriding concern in the issuance of a driver’s license is generally whether the person is able to operate a motor vehicle safely. (Veh. Code, §§ 12800, subd. (g), 12805, subd. (a)(4), 12806, subd. (c); People v. Superior Court (Wilson) (1993) 18 Cal.App.4th 31, 36-37.) Mental disorders may affect a person’s “ability to exercise reasonable and ordinary control in operating a motor vehicle” and may be the basis for refusing that person a driver’s license. (Veh. Code, § 12800, subd. (g); see Veh. Code, § 12806, subd. (c).) Here, K.M had not driven a car for over 27 years. Side effects from both her psychiatric and diabetes medications impacted her cognition. Her thinking was disorganized, she was easily distracted, and she had difficulty prioritizing responses to incoming stressors. Dr. Ignatowicz opined K.M. would not be a safe and reliable driver. This was substantial evidence from which the trial court could conclude K.M. could not safely operate a motor vehicle.
3. The Right to Contract
Under Civil Code section 1556, persons of “unsound mind” are not capable of entering into contracts. Such incapacity has been categorized as follows: (1) entirely without understanding (Civ. Code, § 38); (2) unsound but not entirely without understanding; and (3) susceptible to undue influence (Civ. Code, §§ 39, 1575). (Smalley v. Baker (1968) 262 Cal.App.2d 824, 834-835, disapproved on another point in Weiner v. Fleishman (1991) 54 Cal.3d 476, 485-486.)
Dr. Ignatowicz opined K.M. could be very easily taken advantage of. In addition, her delusions as to the sources and amount of her income, and her claims of lottery winnings, were evidence that she was without understanding about her financial situation and was susceptible to undue influence. This was substantial evidence supporting the denial of her right to contract.
4. The Right to Refuse or Consent to Treatment.
In Riese, supra, 209 Cal.App.3d 1303, the Court of Appeal for the First Appellate District, Division Two, identified the following factors to consider in determining whether a gravely disabled person is incapable of making treatment decisions: “(a) whether the patient is aware of his or her situation (e.g., if the court is satisfied of the existence of psychosis, does the individual acknowledge that condition); (b) whether the patient is able to understand the benefits and the risks of, as well as the alternatives to, the proposed intervention . . . ; and (c) whether the patient is able to understand and to knowingly and intelligently evaluate the information required to be given patients whose informed consent is sought (§ 5326.2) and otherwise participate in the treatment decision by means of rational thought processes.” (Id. at pp. 1322-1323.)
In light of those factors, the record supports a conclusion that K.M. was incompetent to refuse or consent to treatment regarding her grave disability, or to refuse or consent to routine medical treatment unrelated to her grave disability. K.M. had 14 physical diagnoses in addition to her mental illness. She received about four medications to treat her mental illness and an additional 19 medications for her other medical conditions. K.M. consistently denied she had any mental illness, denied she was taking psychotropic medication, denied having a pacemaker or hypothyroidism, misunderstood her thyroid medication, refused to take medication for her medical conditions, and only took the medication for her mental illness under duress. The evidence supports a conclusion that K.M. was incompetent to make medical decisions, in that it demonstrates a lack of awareness or acknowledgment of her various conditions, an inability to understand proposed interventions, and an inability to understand and evaluate the information given to her and participate in treatment decisions with a rational thought process.
III. DISPOSITION
The judgment is affirmed.


/S/

RENNER, J.



We concur:


/S/

HULL, Acting P. J.


/S/

BUTZ, J.