Warning back from earlier years of LPS hearings. New case law may have changed some factors.
“I will listen to the doctor’s testimony, I will read reports in your case, I will listen to what you have to say and to any witnesses brought on your behalf. Then I will make a determination as to whether, by reason of mental disorder, you need a conservator to assist you with the daily function of life, that is, food, clothing, and shelter.”
If I determine that is the case, then I would appoint a conservator to assist you. The conservator could either be the public conservator or a private conservator — that is, a friend or family member who would assist you with these functions.
“Then I would decide least restrictive placement for your living — that is, the type of living arrangement, not the specific place where you live. That is determined between you and your conservator. That could be anywhere from independent living (that is, living out on your own) all the way up to a closed, locked treatment facility or a state hospital level.
“I then must determine what rights may have to be restricted in your case — that is, whether or not you should have the right to possess a firearm, to vote, to contract, to make medical decisions that are related or unrelated to your mental disorder.
“You have certain important rights with respect to this morning’s hearing. You have the right to contest conservatorship, to say, ‘I don’t think I need this,’ and tell the court why. You have the right to the assistance of an attorney. If you cannot afford an attorney, then the public defender, who is very skilled in this area, will assist you. If you can afford an attorney and wish to bring in your own private attorney, you may do that as well. You also have the right to a jury trial. After this hearing is over, you may request a jury trial in this matter.
“It’s important to know that if the conservatorship is established, it will last for only one year and that it must terminate after that one year, unless it is reestablished by another court hearing.”
Dr. is called to the stand to testify in behalf of the county.
Doctor, have you had an opportunity to examine
Yes, I did. I saw him here in the courthouse in the forensic evaluation unit....”
Have you formed a diagnosis as to his mental condition?”
“Yes, his current diagnosis consists of what is called schizophrenic disorder. In the past, he’s been diagnosed as suffering from schizophrenia and later with ‘bipolar’
what used to be called manic-depressive illness. His current treating physician feels that schizophrenic disorder is the most appropriate diagnosis, and I concurred with that assessment.
“As a result of this mental disorder, is it your opinion that he’s unable to provide for his own food or clothing or shelter without assistance?”
“Yes, it is.”
“What about conservatee's functioning led you to believe that he is unable to provide for his basic needs?”
“The essential situation with this patient is that he tends to decompensate and require acute hospitalizations. When given appropriate medications, he then responds well and stabilizes. There has been a repeated cycle of this occurring.
“The current problems really have to do with his needing more insight into his own needs for treatment.... He evidenced some symptomatology that was relatively passive — illogical and psychotic thinking, difficulty in sequencing thoughts, some relatively mild depression.”
"Conservatee is ambivalent about taking medications and hopeful he may not need them in the future.” Further, says Michel, “He indicated that sometime in 1990 he had gone off medication because he didn’t like his previous board-and-care. He didn’t see judgment problems inherent in that.”
Conservatee is 38 years old, that he was first diagnosed at 19 as having a mental illness, that he has lived in a series of board-and-care facilities, and that in the past four years he has been hospitalized several times in an acute-care facility. Conservatee's ceasing to take medication and subsequent decompensation was a pattern that, according to Dr, is not uncommon. “Patients stabilize and do relatively well and then begin thinking that they can do without medications. When they try to go off them, then you see the cycle continue.”
“Is he capable of operating a motor vehicle?” “Of entering into a contract?” “Making medical decisions unrelated to his mental disorder?” “Completing of a voter registration form?” “Might he be a danger to others in possession of a firearm?”
“In your opinion, at this time what is the least restrictive level of placement for him?”
“At present, my opinion is that a board-and-care facility is appropriate, because he still requires prompting to eat, to take medications, to go to treatment. I think, though, that the goal for him in the very near future should be independent living.”
“You noted that he ceased medications in 1990 in order to get out of the board-and-care in which he was living?”
“Well, he said his reasons for ceasing medications there were because he didn’t like the board-and-care.”
“He did specifically state that it was dirty and he didn’t like being there?”
“Have you been to that particular board-and-care?”
County counsel objects. Judge overrules the objection, directs Dr. to answer. “No,” Dr. states, “I haven’t.”
PD queries Dr. about conservatee's recent compliance with taking medication and attending day treatment. Dr notes that conservatee's has, with prompting, taken medication, attended treatment.
After more questions from PD to Dr., questions intended to permit conservatee's to establish his ability to live without conservator’s supervision, conservatee's is sworn. PD asks his client,
“You understand the doctor’s concern that off conservatorship you may cease to take your medications?”
“I would like to explain to the judge that this has occurred in the past, but my mind has stabilized to a point where I am more coherent within myself and in my surroundings. So I am willing to take medication at all costs.”
“What are the costs?”
“I don’t know the costs, but at all costs. I mean, it’s really destroying your life if you are not taking medication if needed.”
Judge asks, “What do the medications do for you?”
“I am not sure. I know my thinking is not as clear as it used to be, Your Honor. And it seems like maybe the doctor right now has doses a little bit high, but I will continue taking my medication, because life is very precious and, you know, I don’t have 35 years left on this earth. I want to get a job. I want to work. I have two years of college. There is a lot of free time when you are on disability and it’s no fun. I would rather be industrious and do what I have to do and contribute to life.”
“What happens,” the judge asks, “if you cease your medications?”
“Well, at present, I think it would be unfeasible. I think I have a good relationship with the doctor. I think he knows me better than myself at times. He’s a good doctor. I want to stick to him. But I don’t have enough time to talk to him. He’s a real fast-acting doctor. I tell him I want to tell him something, but everybody crowds around and starts talking and I can’t get through the right amount.” Conservatee goes on to say that he would like to request a new social worker “because this one doesn’t help me out, doesn’t even talk to me sometimes.”
PD asks Conservatee, “Why did you cease taking medications?”
“Because I was scared. It’s bad — the neighborhood isn’t as good as it was — and it’s like a dungeon where I slept. The lady is okay, but the environment is dark all the time, and it scared me, you know.”
County counsel questions Conservatee, “Do you have many friends at the board-and-care or in your day treatment?”
“That is the problem, how I couldn’t resolve the schizophrenia because I don’t want to fool around with those people. I mean, you know, it’s a bad influence. That is why I ran away from the other board-and-care, because it’s a bad influence. I am not comfortable. I run to the doctor. But they should have the board-and-care where I am now checked out because there is no hot water there, and I am scared, Your Honor.” County counsel has no further questions. The judge speaks, notes that based on Dr. testimony, observing Conservatee, and reading the report, she believes conservatorship should be re-established. She adds that she thinks Conservatee has “legitimate concerns about medication,” that “without any question, there needs to be more dialogue about medication between Conservatee and his treating physician.”
“I understand what you are saying. I understand that you are saying, ‘I don’t like the side effects of these medications.’ At the same time, the history says that when you are taking medications, you don’t engage in behaviors that end up getting you picked up by police and brought back to the hospital. I think you know that too, so it’s a matter of getting it worked out. You have to live with some unpleasant side effects in order to stop those bad behaviors.
And apparently Dr. thinks that you are very close to getting it worked out, and he thinks in a few more months of getting stabilized, you should be okay for independent living. So I think there is good hope for you.” Judge wishes Conservatee luck and turns then to county counsel, suggesting a note be made in Conservatee's file that he would like to have further talk with the social worker.
Juvenile Dependency and