IMDs and medication compliance

Just a quick update.....
      In regards to those wondering about medication compliance and placements in IMDs... IMD's usually prefer to see their patients medicated and compliant. Alpine intake paperwork specifically states that they do not tolerate noncompliance. When managing clients on LPS conservatorship, the letters and orders stipulate that the LPS conservator has the right to order involuntary psychiatric medication. However, in reality most IMDs in San Diego and LA do not engage in daily forced medication administration; rather, they use verbal encouragement to make the patient more compliant. Alpine Special Treatment Center has been known to be the IMD to use the least amount of restraint and involuntary medication administration. 

What more realistically plays out is that the hospital will hold the patient until they are stable and ready for transfer to an IMD. They want to see the patient who has some degree of insight and willingness to adhere to medication before discharge. Once discharged to the IMD the patient will do their activities and therapies in the IMD. If noncompliance becomes an issue, then the IMD will try verbal techniques to encourage med compliance. If verbal deescalation does not work and too many emergency IM injections are required then the IMD can transfer the conservatee back to the facility for stabilization and med compliance. The hospital may also transfer the conservatee back to a different facility if the previous facility is unable to take back the patient. 

The IMDs have changed in that they are less hands on and work to preserve the patient's rights. Because of this IMDs try and use less restrictive methods of encouraging med compliance. They can also work on having the patient transition to a long acting IM shot to encourage med compliance without daily struggle of oral medication. Invega sustenna/trinza and Abilify Maintena are two commonly used long acting IM injectables.


Now within the world of hypothetical legal scenarios...

Would IMD return the conservatee to acute inpatient hospital or would there be a hearing to modify placement to move conservatee to a higher level of care such as Metropolitan Adult Acute LPS Unit/ Atascadero? (San Diego county supposedly contracts only a limited number of beds in the state hospital system and most of those are for murphy conservatorships)
 
Given that the current legal authority mandates that a “long-term Lanterman–Petris–Short Act conservatee possesses the right to refuse antipsychotic medication absent a determination of incompetence” In re Welf. & Inst.Code § 5000 et seq/ in re Keyhea v. Rushen (1986) 178 Cal.App.3d 526, 542 there would need to be a showing that the conservatee does lack capacity at an evidentiary hearing.
 
Assuming that this required prior determination of incompetence would be satisfied upon the imposition of disabilities under §§ 5357-5358 where the conservator has the power to require the conservatee to receive mental health treatment related to remedying the grave disability would these disabilities suffice for Metropolitan hospital to forcibly give routine daily antipsychotic medication/monthly IM depot meds. 
 
Should state hospital not consider the § 5358 powers in the letters of LPS Conservatorship valid then would state hospital petition to ask a court to make a Qawi order, which authorizes state hospital to involuntarily administer daily nonemergency antipsychotic medication. In re Qawi, 32 Cal. 4th 1, 81 P.3d 224 (2004)? And although Qawi orders are for mental disordered offenders and the like, could there be a case where one is written for an LPS conservatee to enforce daily anti psychotics? 

I doubt it but still.... pure speculation