Opinion
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
APPEAL from the Superior Court of Riverside County. Ct.No. RIF081231, Carl E. Davis, Judge. (Retired judge of the San Bernardino Super. Ct. assigned by the Chief Justice pursuant to art. VI, § 6 of the Cal. Const.)
Rudy Kraft, under appointment by the Court of Appeal, for Defendant and Appellant.
Edmund G. Brown, Jr., Attorney General, Dane R. Gillette, Chief Assistant Attorney General, Gary W. Schons, Senior Assistant Attorney General, Peter Quon, Jr., Supervising Deputy Attorney General, and Stephanie H. Chow, Deputy Attorney General, for Plaintiff and Respondent.
OPINION
McKinster Acting P.J.
The court ordered defendant’s commitment as a mentally disordered offender be continued. (Pen. Code, § 2970.) Defendant contends the trial court erred in ordering that her commitment be continued, because the court improperly relied on hearsay statements. We affirm the order.
All further references to code sections are to the Penal Code unless otherwise indicated.
FACTS
1.
BACKGROUND FACTS
On April 25, 2007, the court held a hearing, without a jury, on the issue of whether defendant should continue to be held for involuntary treatment as a mentally disordered offender. Defendant is housed at Patton State Hospital. At the hearing, two doctors testified: (1) Dr. Galarza, who is an attending psychiatrist for Patton State Hospital; and (2) Dr. Afghan, who is a staff psychiatrist at Patton State Hospital. Dr. Galarza was responsible for defendant’s care from approximately July 2005 until January 2006. Dr. Afghan had been treating defendant since February 2007. The doctors testified regarding defendant’s diagnosis, treatments, behavior, medical problems, and psychiatric and social histories. Near the start of both doctors’ testimony, the defense requested an ongoing objection on the basis of hearsay, which the court granted.
2.
ALLEGED HEARSAY STATEMENTS
For reference, we provide the seven statements of Dr. Galarza and Dr. Afghan, which defendant contends contained hearsay that the court relied on for the truth of the matters asserted when it acted as trier of fact. In order to assist the reader, we include the questions and comments which prompted the witnesses’ responses. The statements which defendant finds objectionable are underlined.
Defendant lists 10 more sections of the reporter’s transcript that “might” contain hearsay. We do not address these portions of defendant’s argument, because, as she concedes, the record is silent as to whether the statements constituted hearsay, because the record does not reflect if the doctors were speaking about events they witnessed or events they learned about from other sources. When the record is silent, we must make presumptions that support the lower court’s ruling. (Thueson v. U-Haul Internat., Inc. (2006) 144 Cal.App.4th 664, 669.) Accordingly, we do not discuss these 10 possible hearsay statements, because we must presume they do not constitute hearsay.
A. Dr. Galarza – Statement No. 1
“[Prosecutor:] Are you familiar with [defendant’s] committing offense?
“[Dr. Galarza:] Yes.
“[Prosecutor:] Do you know what she did?”
“[Dr. Galarza:] Yes.
“[Prosecutor:] Yes, you know what she did?
“[Dr. Galarza:] Yes.
“[Prosecutor:] Okay. What was that?
“[Dr. Galarza:] If I can read from my report.
“[Prosecutor:] If it would refresh your recollection to review your report. And then when you’re finished if you could let me know, and I’ll ask the question again.
“[Dr. Galarza:] [Defendant] approached an unknown woman to her [sic] at a gas station. She asked her for a cigarette. Apparently the woman refused to. [Defendant] then grabbed the gas nozzle, hit the victim and sprayed her with gasoline. Afterwards she began hitting the woman with a gas nozzle until the victim fell to the ground. Upon fleeing the scene, [defendant] was [de]tained by an off-duty law enforcement officer who witnessed the incident. She had recently been discharged from a mental health facility and was not taking medications.
“[Prosecutor:] Okay. Now, since that committing offense – do you recall what year that happened in?
“[Dr. Galarza:] That was June 21, 1998.”
B. Dr. Galarza – Statement No. 2
“[Prosecutor:] Was [defendant] willing to participate in her treatment plan?
“[Dr. Galarza:] [Defendant] was somewhat willing to participate in her treatment plan. She would take medications. She would most of the time sit with me for a period of time. She would frequently refuse to go to groups. Occasionally require coaxing to get out of bed, to take her medications, to take a shower, to take care of basic hygiene for herself. [¶] She also would violate unit rules. She had sex on the yard. She felt like she couldn’t get AIDS. She refused to wear condoms. She would frequently yell at staff and other peers. She had to be moved from her room several times because other patients found her so distressful because how she would scream and yell and provoke.
“[Prosecutor:] So this screaming and yelling
“The Court: Did you say that she did have sex on the unit?
“[Dr. Galarza:] In the – on the grounds of Patton.
“The Court: Did she say she did or she
“[Dr. Galarza:] She was caught having sex.
“The Court: And she’s the one that was fearful of AIDS? Did she say that?
“[Dr. Galarza:] Let me read to you what she said. I wrote it here. If you can give me a moment. On May 17th, 2006, in her medical chart, it’s written: ‘Individual escorted back to the unit from grounds after staff observed individual engaging in sexual intercourse with a male peer. When counseled about rules regarding sexual activity as well as her own health[,] safety and the possibility of contracting diseases such as AIDS, individual responded by saying, “I don’t believe in condoms. If you get AIDS, the way to get rid of it is to give it back.”’”
C. Dr. Galarza – Statement No. 3
“[Prosecutor:] Now, going back to the assaultive behavior on the part of [defendant]. You mentioned that she had been assaultive approximately five times; is that correct?
“[Dr. Galarza:] That’s right.
“[Prosecutor:] Okay. Can you talk to us a little bit about those?
“[Dr. Galarza:] Yeah. I can talk to you about two episodes. Five times have been prior to my arriving on the unit. I clearly remember the situation. But if I can read from my report.
“‘On February 19th, 2006, [defendant] hit another peer unprovoked in the face and stated, “She told me to shut up and my father died. That’s fucked up.” Father passing away was not confirmed. She was given a prn for auditory hallucinations and agitation.’
A “PRN” is an emergency dose of medication.
“‘On February 25, 2006, she stated that she was hearing voices, and they were making her mad. Approximately two weeks later on March 11th, 2006, during the smoke break, she approached a staff member and thrust a cigarette on the staff member’s lower lip – cheek. Staff member pushed patient’s hand away. When questioned, the individual stated that she had seen a bug on the staff member[’]s face, and she did that to drive the bug away. And she received a prn for agitation at that time of the incident and another several hours later.’
“‘And on March 13 during courtyard break’ – that’s on the outside of one – of our unit[s] – ‘she hit another peer unprovoked in the left cheek. She stated that the victim wouldn’t give her a cigarette and “that ain’t right.” A prn was offered.’
“[Prosecutor:] Okay. So am I correct then there was the February 19th, March 11th, and March 13th? Is that correct?
“[Dr. Galarza:] Yes. February 19th, March 11th, and March 13th.
“[Prosecutor:] Okay.
“[Dr. Galarza:] And another example is on April 26 – not of her actually striking someone – ‘She began cursing staff and peers, using profanities towards unseen persons. Patient repeatedly stated, “The bitch is there, and you know it. You want her to get me.” Patient approached staff three times but stopped approximately three feet each time. An alarm pen was pulled and staff – support staff arrived.’ [¶] When an alarm pen is pulled that means a staff member feels an eminent [sic] threat to their safety. It’s an absolute alarm that goes off throughout the whole building and staff rush in to help.
“[Prosecutor:] That was on April 25th of 2006; is that correct?
“[Dr. Galarza:] April 26th of 2006.
“[Prosecutor:] Okay. So in that situation a staff member – I guess felt more threatened than in a situation where they would just automatically give a prn. Is that correct?
“[Dr. Galarza:] That’s right.
“[Prosecutor:] Okay. Now these instances and behaviors that we just covered, are those consistent with what you observed in [defendant] throughout your treatment of her?
“[Dr. Galarza:] Yes.
“[Prosecutor:] Did she need to be placed in seclusion at any point during your treatment of her?
“[Dr. Galarza:] She did. I don’t remember exactly the dates and times or the numbers, but I remember she was.
“[Prosecutor:] Okay. And what about restraints? Was that ever necessary?
“[Dr. Galarza:] I believe so.”
D. Dr. Afghan – Statement No. 1
“[Prosecutor:] In the last two months that you’ve been treating [defendant], what sorts of signs and symptoms of schizophrenia has she been displaying?
“[Dr. Afghan:] [Defendant] has continued to hear voices, hallucinations, and at times visual hallucinations, and also delusions.
“[Prosecutor:] What do you mean [by] delusions?
“[Dr. Afghan:] Delusion means false beliefs that [defendant] has.
“[Prosecutor:] Can you give us some examples?
“[Dr. Afghan:] Yes. [O]n March 3rd or 2nd – I don’t remember the exact date – [defendant] was screaming and was very agitated and was telling the staff that ‘I’m an Angel, and you grabbed me from the Mormon church.’ This is a false belief that [defendant] has. [¶] Another example is that [defendant] believes – this is in the past. I haven’t heard this from her recently, but it’s according to the chart that she was believing that she has several children, blue children[]. And also one time she had mentioned that she was in a soap opera.
“[Defense Counsel:] Excuse me?
“[Prosecutor:] She was in a soap opera.
“[Defense Counsel:] That she was what in a soap opera?
“[Dr. Afghan:] She was working in a soap opera.”
E. Dr. Afghan – Statement No. 2
“[Prosecutor:] How has she been doing in her group therapies and her other treatment?
“[Dr. Afghan:] According to the group leaders, [defendant] is going to the groups, but her level of participation in the group is limited secondary to her auditory hallucinations and agitation.”
F. Dr. Afghan – Statement No. 3
“[Prosecutor:] Let’s talk about a couple of recent instances. Are you aware of anything that happened just this month? I believe it would have been April 5th and 6th.
“[Dr. Afghan:] Yes.
“[Prosecutor:] Can you please describe the circumstances of the April 5th incident for us.
“[Dr. Afghan:] On April 5th [defendant] had taken her clothes off and [was] lying on the floor and was talking to herself and was very agitated and screaming. She was given prn medication.
“[Prosecutor:] And what about April 6th?
“[Dr. Afghan:] April 6th, [defendant] was again shouting and saying that ‘I’m hearing voices, I need prn.’
“[Prosecutor:] And this is April 5th and 6th of 2007; correct?
“[Dr. Afghan:] Yes.
“[Prosecutor:] Let’s see. April 11th – I’m sorry – February 11th of 2007, are you aware of any circumstances regarding [defendant] on that date?
“[Dr. Afghan:] Yes. On February 11th [defendant] was agitated and pacing and saying that ‘I feel like fighting somebody’ and prn was given.”
G. Dr. Afghan – Statement No. 4
“[Prosecutor:] Now, based on your treatment of [defendant] in the charts and documents that you have reviewed, do you have an opinion about whether she poses a substantial danger of physical harm to others?
“[Dr. Afghan:] Yes.
“[Prosecutor:] What is that opinion?
“[Dr. Afghan:] I believe that [defendant] will be a danger to others at the present time.
“[Prosecutor:] Why do you feel that way?
“[Dr. Afghan:] Because [defendant] still has symptoms of her severe mental illness, and she continues being very agitated and angry and asking for prn medications. And she – in March of this year she told the staff that she feels like fighting, although she hasn’t been assaultive since March of 2006. The last time that she assaulted the patient was March of 2006, but she continues having those thoughts.”
3.
TRIAL COURT’S RULING
When the trial court ruled that defendant met the criteria of a mentally disordered offender and ordered that her commitment be extended, the court made the following comments: “Well, starting with the severe mental disorder, I’m not going to catalog all of her symptomology, but to find that fact you don’t even have to be a psychiatrist, I don’t think. Her conduct – and I don’t want to lay it all out on the record, but the record is clear that her conduct indicates that she is severely psychotic. She hears things that aren’t there, sees things that aren’t there, screams and yells things that are just unrealistic.
“And so far as her severe mental disorder, I think that it’s profoundly demonstrated. [¶] And fundamental to this disorder beginning to end is dangerous aggressive hostile conduct, assaultive conduct. I don’t poo-poo the notion that it’s only – she hasn’t slugged anybody in the last year, but you can’t separate her symptomology from dangerousness. That’s the fundamental symptom that she has. [¶] She burned a staff member in March.”
“She hit a peer in February of last year and even currently she was found lying on the floor screaming and yelling that she wanted to bite somebody. [¶] So I think her dangerousness is manifest and can’t be separated from her severe mental disorder.
“And so far as remission is concerned, whether that’s a legal term or a medical term, I happen to think that it’s a medical term, and almost the last thing that the doctor said was that she has altered her dosage, tried her on new things, and her situation is getting worse rather than better. So that indicates to me that there is a fact – her conduct as a fact shows that it’s not in remission.”
DISCUSSION
1.
DEFENDANT’S CONTENTION
Defendant concedes that the alleged hearsay statements of Dr. Galarza and Dr. Afghan could properly be admitted to explain the information Dr. Galarza and Dr. Afghan relied on in forming their expert opinions; (Evid. Code, §§ 801 and 802) however, defendant essentially argues that the trial court erred by exceeding the limited purpose for which the hearsay statements could be admitted by relying on them for the truth of the matters asserted when it acted as trier of fact. We agree with defendant’s contention as to Dr. Galarza’s testimony, but find the error to be harmless. We disagree with defendant’s contention concerning Dr. Afghan’s testimony.
In her opening brief, defendant makes three assertions. First, defendant argues that the “trial court should have excluded some or all of the hearsay testimony.” Second, defendant essentially concedes that the hearsay statements could be properly admitted to explain the information relied upon by the experts in forming their opinions. Third, defendant asserts that the trial court improperly “us[ed] the hearsay for its truth in order to evaluate the experts’ opinions.” Because defendant’s first two points are contradictory, we infer that defendant’s third contention is the argument she is advancing in this appeal.
2.
DELINEATING THE LIMITS OF OUR DISCUSSION
The court referenced three alleged hearsay statements when explaining its finding that defendant met the criteria for a mentally disordered offender. The court mentioned (1) defendant burning a hospital employee; (2) defendant striking another patient; and (3) defendant lying on the floor wanting to bite somebody. The first two incidents were testified to by Dr. Galarza, and are labeled ante as “Dr. Galarza – Statement No. 3.” The third incident was testified to by Dr. Afghan. For clarification, we note that we are unable to locate in the record a statement describing defendant lying on the floor wanting to bite somebody. Accordingly, we infer that the trial court was referring to Dr. Afghan’s testimony that on one occasion, defendant was lying on the floor and was agitated and screaming, and that on a separate occasion, defendant stated that she wanted to fight somebody. This testimony is quoted ante, and is labeled as “Dr. Afghan – Statement No. 3.”
The other five alleged hearsay statements that defendant contends the trial court improperly relied upon were not referenced during the trial court’s explanation of its findings. Consequently, the record is silent as to whether the court relied upon these statements in making its findings. When a record is silent “we apply the general rule ‘that a trial court is presumed to have been aware of and followed the applicable law. [Citations.]’ [Citations.]” (People v. Stowell (2003) 31 Cal.4th 1107, 1114.) Accordingly, as to the other five alleged hearsay statements, we do not examine whether the trial court may have improperly relied upon them for the truth of the matters asserted, because we must presume the court did not improperly rely on the statements. Consequently, our discussion of whether the court improperly relied on hearsay statements will be limited to “Dr. Galarza – Statement No. 3” and “Dr. Afghan – Statement No. 3.”
3.
APPLICABLE LAW
“A treating physician is a percipient expert . . . .” (Schreiber v. Estate of Kiser (1999) 22 Cal.4th 31, 35.) “‘[A] percipient expert acquires his information independently of the party that expects to be calling him, such [an] expert is more like a fact witness . . . .’ [Citation.]” (Ibid.) However, “that does not mean [a percipient expert’s] testimony is limited only to personal observations. Rather, like any other expert, he may provide both fact and opinion testimony.” (Ibid.)
“[E]xperts may rely upon and testify to the sources on which they base their opinions (Evid. Code, §§ 801, 802), including [inadmissible] hearsay [if it is] of a type reasonably relied upon by professionals in the field. [Citations.]” (People v. Cooper (2007) 148 Cal.App.4th 731, 746-747; see also People v. Gardeley (1996) 14 Cal.4th 605, 618.) “Although experts are thus given considerable leeway as to the material on which they may rely, the rules governing actual communication to the [trier of fact] of any hearsay matter reasonably relied on by an expert are more restrictive. Although experts may properly rely on hearsay in forming their opinions, they may not relate the out-of-court statements of another as independent proof of the fact.” (Korsack v. Atlas Hotels, Inc. (1992) 2 Cal.App.4th 1516, 1524-1525; see also People v. Gardeley, supra, 14 Cal.4th at p. 619.)
In some cases, however, the trier of fact must consider hearsay on which an expert’s opinion is based in order to properly evaluate the opinion. Our Supreme Court has explained that “[b]ecause an expert’s need to consider extrajudicial matters[] and a jury’s need for information sufficient to evaluate an expert opinion[] may conflict with an accused’s interest in avoiding substantive use of unreliable hearsay, disputes in this area must generally be left to the trial court’s sound judgment.” (People v. Montiel (1993) 5 Cal.4th 877, 919.)
If “inadmissible hearsay utilized by an expert to form an opinion does make its way to the [trier of fact’s] attention, an inquiry into the prejudicial effect of such [material] becomes necessary. The main consideration is the purpose for which the material was presented. Where the information is admitted for a purpose other than showing the truth of the matter asserted . . . prejudice is likely to be minimal . . . . [Citations.] However, where . . . the [trier of fact] is allowed to consider the hearsay evidence presented by the expert in connection with proof of the matter asserted . . . prejudice is [often] apparent.” (Korsak v. Atlas Hotels, Inc., supra, 2 Cal.App.4th at p. 1525; see also Whitfield v. Roth (1974) 10 Cal.3d 874, 895-896 [discussing prejudice].)
4.
HEARSAY
We begin our analysis by determining whether the doctors’ statements constituted hearsay, and if so, whether the trial court relied upon the statements for the truth of the matters asserted.
A. Dr. Afghan’s Testimony
During direct examination, Dr. Afghan was asked about incidents when defendant required an emergency dose of medication. Dr. Afghan testified that on April 5, 2007, defendant was lying on the floor, screaming, and required an emergency dose of medication. Dr. Afghan further testified that on February 11, 2007, defendant was agitated and stated that she felt like fighting, and defendant was again given an emergency dose of medication.
It is unclear from the record whether Dr. Afghan’s statements about these two prior incidents constituted hearsay. The record does not reflect how Dr. Afghan acquired her knowledge about these two incidents. Dr. Afghan testified that she met with defendant four times, but also stated that she learned about some incidents involving defendant solely by reading defendant’s medical chart. Under the circumstances, we cannot conclude Dr. Afghan’s testimony was hearsay, because the record is silent as to whether she witnessed the two incidents or read about them in defendant’s medical chart. (See Thueson v. U-Haul Internat., Inc., supra, 144 Cal.App.4th at p. 669 [when the record is silent the reviewing court must make presumptions that support the lower court’s judgment]; see also Pfingsten v. Westenhaver (1952) 39 Cal.2d 12, 19 [the trial court properly overruled a motion to strike testimony when the record did not indicate whether the witness’s statements were hearsay].) In sum, we cannot conclude the trial court erred by referencing the incident testified to by Dr. Afghan, because we must presume that Dr. Afghan’s testimony did not constitute hearsay.
B. Dr. Galarza’s Testimony
On direct examination, Dr. Galarza was asked to describe incidents when defendant became assaultive. Dr. Galarza testified that he remembered two incidents, and that he was able to recall one of the incidents “clearly.” Dr. Galarza then read from a report when describing the two incidents where defendant burned a hospital employee and struck a patient. It is unclear from the transcript what report Dr. Galarza read from. We note that at one point during his testimony, Dr. Galarza read from defendant’s medical chart, but later in Dr. Galarza’s testimony he stated that he did not have defendant’s medical “chart in front of [him].”
Dr. Galarza’s testimony regarding these two incidents constituted hearsay because his testimony consisted of statements from an unidentified report, rather than in-court statements from his recollection of the incidents. (Evid. Code, § 1200.) The report Dr. Galarza read from was not introduced into evidence. Additionally, no testimony was given that Dr. Galarza needed to refresh his recollection. (Evid. Code, § 771.) Accordingly, there was no basis for him to read the report to refresh his recollection. Furthermore, there was no proof of when the report was created. Consequently, there was no foundation to support a finding that the report was admissible as a past recollection recorded. (Evid. Code, § 1237.)
In sum, Dr. Galarza’s statements concerning the two prior incidents should not have been considered for the truth of the matter asserted, because they were hearsay and did not fall within an exception to the hearsay rule. (Evid. Code, § 1200.)
The People argue that Dr. Galarza’s statements were not hearsay because Dr. Galarza was present when defendant burned the hospital employee and hit a patient. We agree that the record reflects that Dr. Galarza stated that he was present when defendant burned the hospital employee; however, we are unable to locate any statements by Dr. Galarza stating that he was present when defendant hit another patient. Nonetheless, whether or not Dr. Galarza was present during those incidents is immaterial, because when Dr. Galarza testified about the incidents, he read from an unidentified report. Therefore, Dr. Galarza’s testimony constitutes hearsay whether or not Dr. Galarza was present during the incidents, because his testimony was merely quotes from the unidentified report.
When the trial court referred to Dr. Galarza’s hearsay testimony when explaining its findings, it stated that defendant’s conduct, illustrated by the two incidents, indicated that defendant is psychotic, dangerous, and that her mental disorder is not in remission. The trial court’s comments reflect that it used the testimony about the two incidents to corroborate the doctors’ opinions, which meant the court determined that the incidents occurred, based upon the doctor’s testimony. In other words, it appears from the court’s comments that it relied on the substance of Dr. Galarza’s hearsay statements for the truth of the matters asserted, rather than simply to evaluate Dr. Galarza’s opinion. We recognize that it is a fine line between using the hearsay statements to evaluate the doctors’ opinions, and using the statements to corroborate the doctors’ testimony. However, when explaining its findings, the court referred to the burning and hitting incidents as “facts,” which causes us to conclude that the trial court crossed that fine line by relying on the statements for the truth of the matters asserted. Accordingly, we conclude the trial court erred by relying on the hearsay statements for the truth of the matters asserted.
5.
HARMLESS ERROR
We review the court’s error to determine whether it is reasonably probable that a result more favorable to defendant would have been reached in the absence of the trial court’s reliance on Dr. Galarza’s two hearsay statements. (People v. Campos (1995) 32 Cal.App.4th 304, 308-309; People v. Watson (1956) 46 Cal.2d 818, 836.)
A defendant’s involuntary commitment may be continued if the prosecution proves (1) that the defendant has a severe mental disorder; (2) that the defendant’s mental disorder is not in remission or cannot be kept in remission if the defendant is not in treatment; and (3) that the defendant’s mental disorder “represents a substantial danger of physical harm to others.” (§ 2970.)
In the instant case, the record reflects that the trial court used the hearsay statements of Dr. Galarza to corroborate the doctors’ opinions as to all three factors listed ante. We conclude this error was harmless because ample nonhearsay testimony supports the court’s finding that defendant’s commitment should be continued.
First, as to whether defendant suffers from a mental disorder, Dr. Galarza testified that he diagnosed defendant “with schizophrenia paranoid type because she had paranoid delusions, bizarre delusions, hypersexual delusions, and she also [acted] bizarre, talking and looking towards unknown people.” Dr. Galarza further testified that defendant displayed extreme paranoia; that defendant had auditory hallucinations; and that defendant required multiple emergency doses of medication to help control her verbally and physically assaultive behavior. Dr. Galarza concluded that defendant “met the DSM criteria for schizophrenia paranoid type.”
Dr. Afghan testified that she also diagnosed defendant with schizophrenia paranoid type, because defendant is delusional and has auditory and visual hallucinations. Dr. Afghan further testified that defendant’s schizophrenia paranoid type is a severe mental disorder because it causes defendant to be “out of touch with reality” and affects her processing of emotions.
In sum, we find substantial nonhearsay evidence supports the court’s conclusion that defendant suffers from a severe mental disorder.
Second, in regard to whether defendant’s mental disorder is in remission or could be kept in remission if the defendant is not in treatment, Dr. Afghan testified that defendant had not been in remission during her treatment of defendant. Dr. Galarza also testified that defendant did not go into remission during his treatment of defendant. Dr. Afghan stated that defendant still suffers severe symptoms of her mental disorder and requires emergency doses of medication. Dr. Afghan opined that defendant would not be able to control her mental disorder if not in treatment, because Dr. Afghan did not believe defendant would continue taking her medications if released from the hospital. Dr. Galarza testified that if defendant stopped taking her medication then she “would most likely become more aggressive.” In sum, substantial nonhearsay evidence supports the trial court’s finding that defendant’s mental disorder was not in remission or could not be kept in remission if defendant were released from the hospital.
Finally, in regard to whether defendant’s mental disorder represents a substantial danger of physical harm to others, Dr. Galarza testified that several times defendant had to be moved to different rooms “because other patients found her so distressful because . . . she would scream and yell and provoke.” Dr. Galarza stated that when defendant was moved she would kick, scream, and require an emergency dose of medication. Dr. Galarza further testified that an emergency dose of medication is given when a patient poses an imminent threat of violent behavior. Dr. Galarza stated that defendant received approximately 10 to 15 emergency doses of medication per month, in addition to her regular medications that consisted of two antipsychotic drugs and a mood stabilizer. Dr. Galarza also testified that at times defendant had to be placed in restraints to prevent her from swinging, biting, or kicking at hospital employees. Dr. Galarza opined that it was defendant’s “severe mental disorder, which clouds her thinking and her ability to differentiate reality versus nonreality,” that causes defendant to act violently. Dr. Afghan testified that defendant continues to be agitated and angry and suffer from visual and auditory hallucinations.
In sum, there is substantial nonhearsay evidence that supports the trial court’s conclusion that defendant’s mental disorder causes defendant to be dangerous to others.
Accordingly, because substantial nonhearsay evidence supports the trial court’s findings, we conclude that it is not reasonably probable that a result more favorable to defendant would have been reached in the absence of the trial court’s reliance on Dr. Galarza’s two hearsay statements.
DISPOSITION
The order is affirmed.
We concur: King J., Miller J.