DISCUSSION

S.F. contends the involuntary medication order should be vacated because there was insufficient evidence that he is incapable of making decisions about his medical treatment. We disagree. A court may order an OMHD to be involuntarily treated with antipsychotic medication if it determines that the offender is “incompetent to refuse medical treatment.” (Qawi, supra, 32 Cal.4th at p. 27.) Determining whether an OMHD is incompetent

3 to refuse treatment requires consideration of three factors: (1) whether the offender is aware of and acknowledges their mental disorder; (2) whether the offender is “able to understand the benefits and the risks of, as well as the alternatives to, the proposed intervention”; and (3) whether the offender is “able to understand and . . . evaluate the information required to be given patients whose informed consent is sought . . . and otherwise participate in the treatment decision by means of rational thought processes.” (Riese v. St. Mary’s Hospital & Medical Center (1987) 209 Cal.App.3d 1303, 1322-1323 (Riese).) We review a determination that an offender is incompetent to refuse medical treatment for substantial evidence. (People v. Fisher (2009) 172 Cal.App.4th 1006, 1016.) Substantial evidence supports the determination that S.F. is incompetent to refuse medical treatment. Dr. Fennell testified that S.F. suffers from schizoaffective disorder, with symptoms including auditory hallucinations, paranoia, irritation and agitation, and the belief that others wish to harm him. He also said that S.F. refuses to acknowledge his mental disorder, and instead believes that he is telepathic and does not need medication. S.F. did not counter Dr. Fennell’s testimony at the Qawi hearing, but argued his awareness that he has the “gift” of being able to hear voices means that he has the capacity to refuse treatment. The first Riese factor weighs in favor of the trial court’s medication order. So do the second and third. Because he refuses to accept that he suffers from a mental disorder, S.F. does not understand the risks and benefits of his medications. He believes his medications “ha[ve] literally nothing to do with” any improvements in his condition, “denies strongly that there are

4 any benefits associated” with them, and instead believes they only cause him harm. S.F.’s refusal to acknowledge his disorder also hinders his ability to discuss alternatives to his medication regimen, including adjusting his current dosages to help mitigate some of the side effects. It thus prevents him from being able to rationally evaluate and participate in his treatment decisions. The second and third Riese factors weigh in favor of the trial court’s medication order. This case is unlike Conservatorship of Waltz (1986) 180 Cal.App.3d 722, on which S.F. relies. The conservatee in Waltz feared undergoing electroshock treatment during his psychotic episodes. (Id. at p. 732.) But he also feared undergoing the treatment during his nonpsychotic episodes. (Ibid.) He additionally acknowledged he had a mental disorder, understood that he was undergoing treatment, understood that his doctors believed the treatment was helping him, understood the potential risks of that treatment, and understood that he could refuse it. (Ibid.) These understandings undercut the trial court’s determination that the conservatee could not give informed consent. (Id. at p. 734.) In contrast to the Waltz conservatee, here, the evidence does not show that S.F. has nonpsychotic episodes during which he understands that he has a mental disorder and the treatments he is undergoing. To the contrary, S.F. consistently refuses to acknowledge his mental disorder. He does not understand the risks and benefits of his medications, and cannot participate in his treatment decisions. Substantial evidence thus supports the trial court’s determination that he lacks the capacity to refuse medical treatments.

5

DISPOSITION

The trial court’s order compelling S.F.’s involuntary treatment with antipsychotic medication, entered January 21, 2022, is affirmed.

NOT TO BE PUBLISHED.

GILBERT, P. J.

We concur:

YEGAN, J.

PERREN, J.

6 Michael L. Duffy, Judge

Superior Court County of San Luis Obispo

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Gerald J. Miller, under appointment by the Court of Appeal, for Defendant and Appellant. Rob Bonta, Attorney General, Cheryl L. Feiner, Assistant Attorney General, Gregory D. Brown and Jordan R. Beres, Deputy Attorneys General, for Plaintiff and Respondent.