Building a case for DS/GD via refusal to treat medical conditions

The question is not whether the conservatee will incur some incidental benefit from involuntary treatment. Involuntary treatment will always confer some incidental benefit to patient as they are stabilized on medication during their hold (assuming they have been Riesed). The issue is one of substantive due process meaning to what extend can the government interfere with someone’s fundamental liberties. So currently people are holding issue with the definition of grave disability and whether it it is too “vague”. Current legal authority dictates that the statutory definition of GD is not unconstitutionally vague or overbroad. Conservatorship of Chambers (1977) 71 CA3d 277, 285; Doe v Gallinot (CD Cal 1979) 486 F Supp 983, 991, aff'd (9th Cir 1981) 657 F2d 1017.
 
For clarification on this issue of vagueness, “As a matter of due process, a law is void on its face if it is so vague that persons 'of common intelligence must necessarily guess at its meaning [27 Cal. App. 4th 575] and differ as to its application”. Such vagueness occurs when a legislature states its [intent] in terms so indefinite/vague that the line between [mentally ill]and [normal] conduct becomes a matter of guesswork”. (Tribe, American Constitutional Law (2d ed. 1988) § 12-31, p. some parts edited for clarity. Any party challenging the statute as vague must show that they are an "entrapped innocent” and to ensure justice the current law would need to be draft more precisely.
 
Now that that has been clarified, we turn to the issue where people are contending that food, clothing, or shelter is too vague. Yes we do have case law that answers the questions that lay beyond just food clothing or shelter, but because of CA’s horizontal stare decisis problem that you and I have discussed before, opinions from our intermediate appellate courts are not honored “evenly” leading to discrepancies in how the counties are treated GD patients. So, because “medical neglect” does not have controlling authority ie laws/caselaw that controls what all CA superior courts decide to do, we as lawyers must use our skills and paint a picture for the court to understand how psychosis and neglect of medical needs due to said psychosis are grounds for a finding of GD. 
 
A note: the way I would do this differs from my colleagues so I would suggest that you reach out to both of them and ask them how they would approach this question.
 
I deal mostly with the public guardian/treating hospital around the 14 day/30 day/ T-con hold periods so my write ups are more lengthy than just a note to a PERT officer out in the field. When dealing with PERT and emergency personal, a different style needs to be adopted to ensure that they read it because everyone here is on limited time.
 
So the way I may address this is:
 
PATIENT IS CURRENTLY A DANGER TO SELF AND GRAVELY DISABLED AS A RESULT OF BEING UNABLE TO CARE FOR THEIR MEDICAL NEEDS DUE TO ONGOING PSYCHOSIS
 
 
Patient is currently GD because they suffer from ___and ____and ____ symptomology and because of current, ongoing, and severe _____ symptomology, they are unable to attend to their basic medical needs of ______ and __________. The current legal authority provides for a finding of DS/GD based on inability to care for one’s medical needs.
 
In justifying extending a ____ hold, the treating clinician must be able to point to specific and articulable facts which, taken together with rational inferences from those facts, reasonably warrant his or her belief or suspicion.
Here is where I would give a paragraph of the patient’s specific psychiatric and medical history that has brought them to the hospital. I would include psych and medical history too if relevant.
 
Based on this evidence, the patient’s ongoing delusion that the govt is poisoning their food or that the medical doctor will steal and sell their organs has prevented the patient from choosing to treat their diabetes or undergo surgery for a hernia. If the patient does not receive treatment for ______ condition, then their physical health will deteriorate to the point where they need treatment in the ICU or they may fall into a coma, have a stroke, etc etc.
 
The patient’s choice to not undergo treatment for ­­­­­_____ condition is not a voluntary choice. The law provides that a person cannot be found GD if their actions are voluntary and stem from alternative lifestyle choices [citation needed]. This is not the case. From the facts listed above, the patient is operating under a false delusion that has stripped them of their rational decision making. In the absence of their ongoing psychosis, they would not be making _____ decision to refuse treatment for _____ medical condition. Additionally, this pattern of refusing medical treatment because of their psychosis is not a novel situation. On [date] and [date] patient has refused treatment for _____ citing their delusion _______ which tells them that _________. Welf & I C §5008.2. mandates that the "historical course" of the patient's mental disorder must be considered when applying the definition of mental disorder [and grave disability].
 
Additionally, if dangerousness to self cannot be assessed at this time through physical actions alone, we are asking for a reconsideration based on the following; “[t]he threat of harm to oneself may be through neglect or inability to care for oneself. In re Doremus v. Farrell (D.Neb. 1975) 407 F.Supp. 509, 515.
The threat of dangerousness to self is the same as one who may be burning themselves or cutting themselves as patient’s neglect of crucial medical conditions would lead them to the same place as someone who is harming themselves; the ICU or the ER. Patient has been neglecting/refusing to treat ____ medical condition and should this condition remain untreated, then severe medical consequences shall arise such as ________ all which would land the patient in the ER or ICU for life threatening complications.
 
 
Finally, when determining if a person should be taken into custody pursuant to subdivision (a), the individual making that determination shall apply the provisions of Section 5150.05, and shall not be limited to consideration of the danger of imminent harm.
The patient may be refusing treatment for their medical condition at this present moment, but based on ____ medical authority, if ____ condition is not treated with ____ time frame, then severe complications like ________ will occur and the patient will need immediate hospital transportation and there may not be a body present to ensure that they receive urgent ER/ambulance care. I am asking because of this reasoning that the treating clinician make a finding of current dangerousness to self and current grave disability based on all of the above.
 
Now there is some debate between me and my colleagues about how much is too much. Like I’ve discussed before, I’ve come from the dependency system, so we are always taught about statements not making it into the records and appeals being forfeited as a result. I don’t like to allow room for that so when I include a written report of the psych and medical symptomology and the legal authority that allows for involuntary treatment, I like to cover all controlling authority favourable and unfavourable because if the hospital/cert officer brings up something unfavourable to the outcome I want, there are “facts”, information, and legal reasoning as to why the bench officers or cert officer’s adverse legal authority does not apply in my case.
 
Again each case is extremely fact specific so without more facts its hard to build a complete case.