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Name: California Dept. of State Hospitals v. A.H.
Case #: B286187
District 2 DCA
Division: 6
Opinion Date: 09/21/2018

Qawi order authorizing state hospital to involuntarily administer antipsychotic medication to treat MDO’s severe mental disorder was supported by substantial evidence and did not violate his constitutional right to free exercise of religion. Appellant, an MDO, engaged in significant violent and threatening misconduct at Atascadero State Hospital. A trial court found that appellant lacked capacity to refuse medical treatment and issued a Qawi order authorizing the hospital to involuntarily administer antipsychotic medication. (In re Qawi (2004) 32 Cal.4th 1.) He appealed and argued that the evidence did not support the finding that he was incompetent to refuse treatment and that the order violated his constitutional rights to the free exercise of religion and due process. Held: Affirmed. The Court of Appeal concluded that substantial evidence supported the Qawi order. There was evidence that appellant suffers from schizoaffective disorder, bipolar type, PTSD, and cannabis use disorder, severe. His symptoms included entrenched mood disorder featuring grandiose, often hyper-religious ideation; delusions; suicidal ideation; and post-traumatic stress nightmares with military related PTSD. He believed a spirit (Zahara) contacted him and told him not to use antipsychotic medication. Appellant denied that he was mentally ill. A doctor testified that appellant’s condition required treatment with antipsychotic medication but he lacked the capacity to evaluate the risks and benefits of taking this medicine. Although appellant argued it was against his religious beliefs to use antipsychotic medication, there was no credible evidence that his refusal to take the medication was grounded in a sincerely held religious belief. He was already taking an antipsychotic medication for PTSD and had taken antipsychotic medication during three previous involuntary confinements. Substantial evidence supported a finding that the Qawi order furthers a compelling government interest (preventing an individual from harming himself or others) that outweighs any religious belief.

The order authorizing involuntary administration of antipsychotic medication comported with due process requirements. The hospital followed existing statutory, administrative, and case law in obtaining the Qawi order. It is settled that antipsychotic medication may be involuntarily administered to an MDO who lacks the capacity to refuse treatment or is dangerous to others within the meaning of Welfare and Institutions Code section 5300.

The full opinion is available on the court’s website here: